April 19, 2010; Florida Times Union | How do those running nonprofit hospitals in the Jacksonville, Florida metropolitan area feel about the new health insurance reform? On one hand, Northeast Florida hospitals foresee more patients with insurance coverage leading to reductions in how much “charity care” they will have to provide in the form of writing off unpaid bills.

So what’s bugging them? Post-healthcare reform, it’s a question about what makes a nonprofit hospital a nonprofit. And it’s a question we’ve raised before too. According to the article, “Most of the region’s [nonprofit] hospitals . . . earn their tax-exempt status, in no small part, by charging the poor and uninsured little or nothing for care.” With 32 million previously uninsured people now slated for coverage, the nonprofit hospitals are uncertain about how much free or discounted care they will have to provide in order to keep their nonprofit status.

While many critics from the Senate Finance Committee on down have broadly hinted that some nonprofit hospitals were a little deficient in their “nonprofitness,” the hospitals escaped mandatory charity care standards in the recent health reform legislation. There’s limited mention of nonprofit hospitals in language concerning the formalization of required community needs assessments, the hospitals’ plans to meet those needs, and the requirement that hospitals publicize their financial assistance policies and back down on thuggish bill collecting tactics toward non-payers.

According to the CEO of the nonprofit Baptist Health hospital chain, “There’s been no indication that reform itself will challenge the existence of not-for-profit hospitals.” The Orange Park Medical Center, one of the two nonprofit hospitals in metro Jacksonville, is already working on a community health assessment in conjunction with the Clay County Health Department.

In reality, even after 2014 when most of the law goes into effect, there will be people who won’t have insurance (for example, undocumented and perhaps some documented immigrants) and others who can’t pay their deductibles and co-pays. How the nonprofit hospitals deal with the inevitable gaps and shortcomings of national health insurance reform will be a telling indication of the depth of their nonprofit values.—Rick Cohen