The Law of Tax-Exempt Healthcare Organizations, 3rd Edition

CHAPTER ONE

Rationale for Tax-Exempt Healthcare Organizations

• § 1.3 Categories of Tax-Exempt Healthcare Organizations
• § 1.8 Social Welfare Organizations

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As the debate in and outside Congress about the appropriateness, as a matter of tax policy, of tax exemption for nonprofit hospitals and similar entities has intensified,¹ greater attention has been given to the possibility of legislation on the topic. For example, legislation was introduced late in 2006 to deny exempt status and impose excise taxes on healthcare providers that fail to provide a minimum level of charitable medical care.² Not long thereafter, the Internal Revenue Service³ set the stage for the enactment of tax legislation concerning the exemption criteria for hospitals when it developed a wholly revamped annual information return (Form 990), including its Schedule H.⁴ This legislation emerged in 2010, as the legislative crown jewel of the Obama administration, in the form of the Patient Protection and Affordable Care Act,⁵ as amended by the Health Care and Education Reconciliation Act of 2010,⁶ bringing, among a dazzling array of new laws, additional criteria to be satisfied by exempt hospitals as a condition of retention of exempt status.⁷

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The absence of substantial federal healthcare legislation (until 2010) ...