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Changes in Teaching Hospitals’ Community Benefit Spending After Implementation of the Affordable Care Act

Alberti, Philip M., PhD; Sutton, Karey M., PhD; Baker, Matthew, MS

doi: 10.1097/ACM.0000000000002293
Research Report: PDF Only

Purpose: U.S. teaching hospitals that qualify as 501(c)(3) organizations (a not-for-profit designation) are required to demonstrate community benefit annually. Increases in health insurance access driven by Affordable Care Act (ACA) implementation, along with new regulations, research opportunities, and educational expectations, may be changing hospitals’ allocations of community benefit dollars. This study aimed to describe changes in teaching hospitals’ community benefit spending between 2012 (pre-ACA implementation) and 2015 (post-ACA implementation), and to explore differences in spending changes between hospitals in Medicaid expansion and non-expansion states.

Method: In 2017, for each teaching hospital member of the Association of American Medical Colleges’ (AAMC’s) Council of Teaching Hospitals and Health Systems required to submit Form 990s to the Internal Revenue Service, the authors sought community benefit spending data for 2012 and 2015 as reported on Schedule H.

Results: The analysis included 169 pairs of Form 990s representing 184 AAMC member teaching hospitals (93% of 198 eligible hospitals). Compared with 2012, hospitals in 2015 spent $3.1 billion (20.14%) more on community benefit despite spending $804 million (16.17%) less on charity care. Hospitals in Medicaid expansion states increased spending on subsidized health services and Medicaid shortfalls at rates higher than hospitals in non-expansion states. The latter increased spending at higher rates on community health improvement and cash/in-kind contributions.

Conclusions: After ACA implementation, teaching hospitals increased their overall community benefit spending while their charity care spending declined. Changes in community benefit spending differed according to states’ Medicaid expansion status, demonstrating hospitals’ responsiveness to state and local realities.

P.M. Alberti is senior director, Health Equity Research and Policy, Association of American Medical Colleges, Washington, DC.

K.M. Sutton is a lead specialist, Health Equity Research and Policy, Association of American Medical Colleges, Washington, DC.

M. Baker is a senior research analyst, Health Care Affairs, Association of American Medical Colleges, Washington, DC.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Philip M. Alberti, Association of American Medical Colleges, 655 K Street NW, Suite 100, Washington, DC 20001; telephone: 202-828-0522; email: palberti@aamc.org.

© 2018 by the Association of American Medical Colleges