The Affordable Care Act: Implications for Community Development

Even if you have not tuned out of the long-running debate about the future of health care in the United States, you can be forgiven if you’ve never heard of a “community health needs assessment” – which is also often referred to by the even more wonky initials CHNA.

Unlike putative “death panels” and insurance mandates, which consumed countless hours of media time, section 9007 of the Affordable Care Act, buried on pages 737–739 of the 906-page law and given the boring, bureaucratic title of “additional requirements for charitable hospitals,” was pretty much ignored.

But boring does not mean unimportant!

As an Ohio-based law firm explains, “In order to continue as a 501©(3) organization, each hospital must conduct a community health needs assessment every three years and adopt an implementation strategy to meet the community health needs identified through the assessment. The assessment must take into account input from persons who represent the broad interests of the community served by the hospital, including those with special knowledge of or expertise in public health, and such assessment is made widely available to the public. The statute mandates that the Secretary of the Treasury review at least once every 3 years the community benefit activities of each hospital.”

So let’s break this down. Nonprofit hospitals nationally have revenues of more than $650 billion and assets of $875 billion (as of August 2012). For decades, nonprofit hospitals have been required to provide “community benefit,” which typically has meant providing charity care to the uninsured. But they have not been responsible for health care “outside the hospital walls.”

Now they are.

Slowly, but surely, the field is taking notice. For example, Dayna Cunningham of CoLab at MIT notes that the CHNA creates an opening to engage hospitals in community economic development. Rick Cohen of the Nonprofit Quarterly writes that the CHNA requirement “changes the game for nonprofit hospitals in a fundamental way.” [Ed. Sister Lillian Murphy referred to the idea in her Shelterforce interview last year as well.]

Here at The Democracy Collaborative, we have long highlighted the economic impact of anchor institutions. Last month, we co-published a study (with CoLab at MIT) examining Cleveland-based University Hospitals’ strategy for increasing its procurement from local, minority and women-owned businesses.

Today we released a more detailed study titled Hospitals Building Healthy Communities: Embracing an Anchor Mission, which examines six institutions and provides an industry-wide perspective on possible ways for hospitals and community groups to partner to achieve better health and community development outcomes. A preview of a few of the upcoming report’s findings can be found in this Baltimore Sun article.

Of course, while the potential is enormous, the challenge will be in the implementation. Rick Cohen warns, “There is certainly the possibility that CHNAs could devolve into yet another governmental requirement that accomplishes little more than the creation and maintenance of an industry of consultants ready and willing to churn out reports for their clients.”

For both community wealth building and public health advocates, the stakes are too high to let this happen. For community groups, foundations, and intermediaries, incorporating hospitals into our community development strategies and thinking just became a whole lot more important.

Steve Dubb is senior editor of Nonprofit Quarterly. Formerly, he was director of special projects at The Democracy Collaborative.


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