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J Health Care Finance. 2005 Winter;32(2):36-71.

A review of state legislation and a state legislator survey related to not-for-profit hospital tax exemption and health care for the indigent.

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Williams School of Commerce, Economics and Politics, Washington and Lee University, Lexington, VA, USA.


This study examines recent states' legislation related to the not-for-profit (NFP) hospital tax exemption and care to the uninsured and underinsured, and compares these legislative provisions to a past survey of state legislators' opinions about appropriate criteria for the NFP hospital tax exemption. To be tax-exempt, hospitals need to provide services that benefit the community. The problem lies in the ambiguous nature of the community benefits standard and the type of information required for compliance with the standard. As a consequence, NFP hospital tax-exemption challenges have occurred across the nation, resulting most recently in a federal class action lawsuit against NFP hospitals across several states. Empirical research has examined whether the NFP hospital tax exemption is justified based on the amount of community benefits and charitable care provided, without examining the type of policy alternatives that might be proposed by legislators who are responsible to change and create tax-exemption regulations. This article surveys state legislators and examines state legislation. The survey reveals that legislators from states with tax-exempt challenge activity focus more narrowly on the provision of charitable care and that state legislators consider quantitative information to be as important as qualitative information for the tax-exemption decision. Essentially, the survey predicts that state legislation would focus primarily on charitable care policy and indigent care guidelines, which is confirmed by the review of recent state legislation; however, there is still much variation in tax-exemption legislation between states. More standardization is needed to address the needs of indigent patients equitably.

[Indexed for MEDLINE]

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