The Cicero Institute provides a must-read for health policy makers and students. This comprehensive state analysis offers an entirely new perspective of the problem that is tax treatment of nonprofit hospitals.

Spoiler alert: Michigan is listed among the worst performing states with no protections for community benefit, scoring 2 out of a possible 10 for transparency, accountability, and enforcement.

The 46-page report published 03/06/2025 and downloads at the link. I've copied the first few paragraphs as a sample here.

https://ciceroinstitute.org/research/restoring-the-social-contract-between-nonprofit-hospitals-and-taxpayers/

Strengthening Community Benefit:

Restoring the Social Contract Between Nonprofit Hospitals and Taxpayers

A 50-State Evaluation and Reform Blueprint

Authors: Christopher Jones, Tanner Jones, Ryan Quandt, Joshua Reynolds

Nonprofit hospitals receive billions in tax exemptions each year in exchange for “community benefit” provision. In theory, these tax breaks constitute one end of a social contract: hospitals enjoy tax relief, and communities enjoy community health programs and health education, preventative care initiatives, medical research, and reduced medical costs, including charity care. It is unclear, however, whether nonprofit hospitals meet their community benefit obligations, yet their communities lose an otherwise lucrative source of tax revenue. Absent clear reporting requirements and accountability measures, tax-exempt hospitals may spend only a token amount on charity care as they pour funds into other ventures unrelated to patient needs.

While nonprofit hospitals and health systems avoid taxes, they also consistently lobby both the federal and state governments for programs to address the rising cost of providing care to the uninsured, underinsured, and their bad debt obligations. Over the years, policy has attempted to address the providers’ concerns. These include facility-based payments, 340b, disproportionate share hospital payments, sole community hospital payments, and, most recently, state-directed payments—all payments to address the unpaid costs these providers incur. However, there is little to no transparency on these payments, so it is unclear the extent to which (and how well) nonprofit hospital and health system spending is being used to lessen their cost burden while addressing community needs.

Christopher Jones, formerly the Commissioner for ND Health and Human Services, led the integration of the state’s Departments of Human Services and Health under Governor Doug Burgum’s leadership. Based in Bismarck, ND, Chris is motivated to advocate for truthful policy implementation to improve individuals’ access to affordable healthcare. Christopher’s policy work includes transforming reimbursement models in long-term care, expanding behavioral health services, and improving access to quality early childhood experiences. A Minnesota native raised in Indiana and North Dakota, Christopher holds degrees from Concordia College and the University of St. Thomas. He’s an amateur professional cyclist and a father of three.

Ryan Quandt, PhD, brings his expertise as Chief Economist and Director of Research to various policy areas at Cicero. Based in Austin, TX, Ryan holds degrees in Philosophy and Economics and is passionate about empirical analysis and rigorous policy evaluation. He enjoys spending time with his wife, Devan, and their three children, engaging in games, books, and outdoor adventures.