Government budgeting reveals our priorities

Merrill Goozner’s editorial “Healthcare’s role in the police reform debate” (June 15, p. 24) emphasizes the need to rethink the nation’s budgetary priorities in addressing the social and economic conditions that disproportionately affect low-income and minority communities.

As the editorial notes, budgets reveal our priorities, and many pressing social issues have been exacerbated by continued shortfalls in funding for behavioral health, fair housing and economic development. But the regulations government agencies adopt also speak to our values. Simple changes to the rules governing notfor-profit hospitals could motivate these providers to play a greater role in addressing the social and economic issues their communities face. For example, the IRS defines “community benefit” in a way that discourages notfor-profit hospitals from engaging in activities to address historic economic and social inequalities that produce poorer health outcomes.

Community benefit remains the cornerstone upon which the charitable status for not-for-profit hospitals rests. Members of Congress, state attorneys general and the media scrutinize the level of community benefit hospitals report annually on their IRS Form 990, often asking whether these hospitals do enough in exchange for their tax breaks. The IRS, however, has defined community benefit in a way that disregards many activities that lowincome and minority communities need for better health.

Not-for-profit hospitals clearly aren’t the only—or even primary—resource to address these social and economic issues. Government at all levels must invest more in health and human services to resolve the core problems that Mr. Goozner identifies. Changing the definition of community benefit to include community-building activities, however, would encourage not-for-profit hospitals to invest more in protecting or improving the health and safety of their communities.

Travis Jackson Partner King & Spalding Los Angeles