The nation’s not-for-profit hospitals receive tax breaks in exchange for providing a community benefit, which has been a focus of public debate and legislation. Hospitals are not required to provide free or discounted care to low-income patients to meet their tax obligation, but patient advocates, states attorneys general and lawmakers have scrutinized financial aid policies as a measure of hospitals’ benefit to local communities. The introduction of new subsidies for health insurance and a mandate for coverage under the Patient Protection and Affordable Care Act raised the question: Would hospitals alter financial aid policies now that patients had a new source of federal aid? The answer could mean a significant shift in the role that private not-for-profits have played in the nation’s safety net. Interviews with hospital executives found a debate underway and some hospitals have changed their policies. I returned to the story again in December 2014 and found more examples of not-for-profit health systems that had altered financial aid policies to exclude those low-income patients who do not take advantage of ACA subsidies.
