Monday, March 11, 2019

Dean Zerbe Says Time Is Now to Fix Nonprofit Health Care for the Poor.


There is an interesting article in the March 9 issue of Modern Healthcare. The article describes the history of Grassley's nonprofit health care efforts, the IRS's revamping of Form 990's Schedule H, and the continuing efforts to ensure health care for the poor.  The excerpt below picks up at the event triggering Senator Grassley's long held interest:

Dean Zerbe, former senior counsel to the Senate Finance Committee, recalled the pivotal moment nearly 15 years ago for panel Chairman Chuck Grassley’s scrutiny of not-for-profit hospitals.  It was when Mark Everson, then commissioner at the Internal Revenue Service, wrote in a March 2005 letter to the committee that “some tax-exempt health care providers may not differ markedly from for-profit providers in their operations, their attention to the benefit of the community, or their levels of charity care.”  “That was a pretty blatant moment,” Zerbe said.  What happened next still reverberates today. As the powerful committee conducted its investigation, the IRS ran its own parallel, three-year study into not-for-profit hospitals.  The IRS ultimately redesigned its Form 990 tax document for not-for-profit organizations with a special Schedule H section—H for hospitals—and released the final version in 2008. It required tax-exempt providers to answer a slate of questions about how they give back to their communities. Significantly, hospitals had to start tallying the hard cash they spend treating poor patients and disclose how their community benefit stacks up as a percentage of spending.  The Iowa Republican didn’t let up on his oversight on the issue. When the Affordable Care Act came around, Grassley secured a provision expanding Schedule H to gain even more insight into hospital operations.  Fast-forward to 2019. Grassley is back chairing the Finance Committee following a stint at the helm of the Judiciary Committee. His concern over tax-exempt status hasn’t waned and coincides with the increased focus in Washington on transparency.  Due to Senate Republican rules, Grassley has two more years chairing the committee, leaving little time to make sure one of his signature oversight accomplishments is doing what he intended: make sure not-for-profit hospitals are providing the right level of care to poor patients and that they’re not playing pricing games or threatening debt collection.  “This is the time for activists who care about the poor; this is very meaningful,” Zerbe said. “When we have had hospitals change, it made a big difference. I know people get excited about this election or that election, but if people want to see something tangible for the poor, now’s the time.”

 To see a copy of the letter Senator Grassley recently sent to the IRS, responses to which are due April 1, click here.  

Darryll K. Jones

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