Do small businesses in your area know about tax credit for offering coverage?
There’s been a fair amount of coverage about the lower-than-expected enrollment in high-risk pools created by the federal health reform law. Another available benefit – a tax cut for certain small businesses that offer coverage to workers – is also eliciting less of a response so far than the White House had anticipated.
What questions do you have about health reform and how to cover it?
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
The tax credit hasn’t gotten a whole lot of attention, but an uptake update was tucked away in that annual Kaiser Family Foundation report on employer health benefits. The overall report got a lot of front-page press, but it’s worth taking a look at the small business tax credit too (and h/t to my colleague Jason Millman at Politico).
The Affordable Care Act provides a temporary tax credit for small employers – defined as having 25 full-time workers or the equivalent – with average wages less than $50,000. But not many know about it, or that they may be eligible, according to the survey. The White House has estimated that up to 4 million small businesses may be eligible for credits, which are meant to defray part of the insurance costs
The survey found that 29 percent of firms with fewer than 50 employees that offer health coverage tried to find out if they were eligible, and 65 percent did not. Of small businesses that did not offer insurance, half said they were aware of the tax credit and 48 percent said they did not know about it. Of those that were aware, only 13 percent said the availability of a credit had not led them to consider whether to start offering insurance to their workers
The tax credit can cover up to 35 percent of premiums. It rises in 2014 for two years for businesses buying coverage for workers through the insurance exchanges. To qualify, the business has to pay at least half the worker’s premium. Remember these smaller, lower-paying firms do NOT have to cover their workers, although the tax credit and some exchange features aim to encourage them to cover workers. Only larger employers have to contribute or pay a fee.
This is a pretty easy story to localize. How are businesses in your areas learning about the credit – or why aren’t they hearing about it? Perhaps more interesting – are they hearing misinformation? If so what’s the source of that?
The IRS says it’s working on improving outreach via the tax software industry, insurance brokers, agents and carriers, accountants and the small-business community. Do you see any signs of such outreach in your community? How much confusion do you find – do small businesses think they will have the same obligations as large employers? Do they understand the role of exchanges in helping the small-business market?
Related:
Fla. system forces ventilator patients to stay in hospitals, incur multimillion-dollar bills
Richard Martin of the St. Petersburg Times reports that, because Florida has few nursing homes that can care for patients on ventilators, some patients are forced to stay in hospitals and rack up enormous bills.
Photo by quinn.anya via Flickr
The patients in question have been stabilized to the point where they no longer need hospital care, though they rely on ventilators, but the hospitals can’t discharge them without finding a facility that can take patients on a ventilator.
Martin reports that fewer than two dozen nursing homes, of about 700 in Florida, care for ventilator patients. Other states pay nursing homes more to care for ventilator patients.
So, in a state where uninsured people go without even basic care, millions of dollars go to ventilator care for people who don’t need to be in hospitals — and who might not even want to be there.
Martin says no one knows how many patients need long-term ventilator care, but one hospital administrator estimates his hospital has three or four patients who fall in this category. According to the Florida Hospital Association, there are about 300 hospitals in the state. The article cites cases in which ventilator patients racked up bills of $9.2 million and $1.7 million.
Hospitals often have no way to collect such bills, and have to write them off as charity care, Martin reports.
Health reform comes with new rules for nonprofit hospitals
Filed under: Government, Health care reform, Hospitals
When I first started covering health care, I thought that a nonprofit hospital was one that didn’t make any money. It took longer than I should probably admit to come to understand that nonprofit/nonprofit status isn’t about making money. It’s mostly about paying taxes.
As this excellent recent story by M.B. Pell in The Atlanta Journal- Constitution shows, nonprofits may or may not have a healthy bottom line. They may or may not pay their top executives a lot of money. They may or may not provide really good care.
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
What they don’t do is pay taxes. Nonprofits are supposed to be mission-driven. In exchange for serving their community, they get the tax exemption.
One little-known element of the health care reform law – which I highlighted in my first tip sheet on the anniversary of the law’s passage – sets new rules for nonprofits. They are required to assess community needs, and inform patients of charity policies. Some lawmakers, notably Sen. Chuck Grassley, an Iowa Republican, want tougher rules and oversight. The goal is to make sure they are providing enough service to the community to justify the tax break.
States, which make their own determination on who is exempt, may follow suit; in fact, Illinois just denied property tax exemptions to three hospitals.
As a report from the Hastings Center said, “A 2007 Internal Revenue Service report stated that about half of nonprofit hospitals spent 3 percent or less of revenues on charity care. Nowadays, hospitals are bringing in large amounts of money, paying their CEOs record amounts of compensation, and engaging in aggressive debt recovery actions.” Many of the hospitals use “sticker” prices to value their charity care, even though that’s not what the hospital gets from most patients.
In Georgia, the hospitals get millions in tax breaks. Nationally, the latest number I saw was $13 billion for federal taxes, and that doesn’t count state and local tax breaks. Pell explains:
Residents pay more in taxes because these hospitals are exempt. In exchange, taxpayer-subsidized hospitals are expected to provide charitable services - “a community benefit.”
But Georgia, like 35 other states, has no specific requirements hospitals must meet to justify these tax breaks.
And an Atlanta Journal-Constitution analysis of hospital data reveals that some not-for-profit hospitals provide less in community benefits - specifically, charity health care for the poor - than the tax-paying, for-profit hospitals they compete with.
It’s not all black and white; the article notes complexities such as a hospital that doesn’t provide much free care - but does heavily subsidize some local community clinics. And Georgia has instituted a “bed” tax on nonprofits and for profits alike to help generate some more money for Medicaid, which has been strapped during the nation’s economic crisis. Overall, it’s a good read and a roadmap for enterprise reporting in other communities. Pell wrote an article about how he did his reporting for AHCJ that spells out a number of tips for reporters.
That tip sheet has further resources, including advice on deciphering hospital financial records from this presentation from The Philadelphia Inquirer’s Karl Stark. If you are interested in the topic and are still daunted by the data, see if you can find a reliable local advocacy group who can help you sort them out, or a health care finance professor in your state who may be able to help you out.
If you Google, you will find stories about highly paid executives at nonprofit hospitals – that’s a good part of the story, and one that readers/listeners/viewers can grasp, but it’s not the whole story. Nancy Kane, a professor at Harvard School of Public Health, (who explained a lot of this to me some years ago) wrote on this topic a lot for a while, but when I did a quick check, most of the work I found was several years old. Here are some current resources to help reporters check into the nonprofit hospitals in their areas:
Related
- Follow the numbers to report on hospital executives’ compensation packages, M.B. Pell
- Hospital CEO pay has some ill at ease: $1 million-plus salaries drawing new scrutiny, The Atlanta Journal-Constitution
- Are hospital CEOs making too much money?, The Atlanta Journal-Constitution
AHCJ tip sheets
- Digging into hospital finances: Recent trends and five key documents
- Reporting on the business of health care
- How to understand a 990
- Changes to 990 forms make hospital finance investigations necessary
- Tools for covering hospitals: Financial documents
- Tools for covering hospitals: Hospital stories to do
- Understanding hospital issues
Related stories
- Charity Care: How Much is Enough?, Wisconsin State Journal
- In Their Debt, The (Baltimore) Sun
Md. hospitals sue patients despite state subsidies: Investigation finds policies for offering charity care to low-income patients vary widely - St. Vincent’s Is the Lehman Brothers of Hospitals, New York Magazine
- Hospitals, Inc.: Rising Costs, Growing Clout, Kaiser Health News
Medtronic hires Yale researchers to review Infuse data
Medtronic, the manufacturer of spine fusion product Infuse, has hired Yale University researchers to review patient data and adverse event reports for the product.
Photo by planetc1 via Flickr
The review follows months of reporting by John Fauber for the Milwaukee Journal Sentinel and Medpage Today that have raised questions about the independence of doctors involved in clinical trials for the product.
The Wall Street Journal’s John Carreyou and Tom McGinty also used their paper’s Medicare data stockpile to look at the conflicts of interest and royalty money that drive the popularity of spine fusion treatments whose effectiveness has been disputed.
Serious complications involving Infuse have gone unreported in medical journal articles that were written by doctors who have financial ties to Medtronic.
The June issue of The Spine Journal was devoted to unreported complications related to Infuse, revealing that “complication rates … were 10 to 50 times greater than the estimated complication rates revealed” papers co-authored by doctors with financial ties to the company.
In a statement about the review by Yale researchers, Eugene J. Carragee, M.D., editor in chief of The Spine Journal, says “this appears to be a big first step in the right direction” but points out three challenges that lay ahead for the reviewers.
EPA changes would improve public access to data
Filed under: Government, Health data, Health policy, Hot Health Headline
A recent OMB Watch story covers the EPA’s latest attempt to leverage the Toxic Substances Control Act to make it easier for the public to access chemical data and harder for manufacturers to hide health and safety related information behind the “trade secrets” label.
Fire and emergency response personnel practice techniques for hazardous materials containment and removal. (CDC photo)
The key is the expansion of the Inventory Update Reporting rule, which requires companies to report toxic substances over a certain weight threshold. According to OMB Watch, the Bush administration bumped this threshold from 10,000 to 25,000 pounds, and decreased reporting frequency from every four years to every five years.
The proposed rule lowers or eliminates thresholds for reporting and increases reporting frequency, moves that should provide the public with more information on more chemicals. The amount of a chemical manufactured at a facility in any given year fluctuates widely. … EPA’s proposed rule would require a manufacturer to submit information on a chemical if the volume exceeds the 25,000-pound threshold for any year since the previous submission. The agency is also proposing to return the reporting frequency to every four years rather than every five. Additionally, EPA is proposing requiring all reporters to submit data on the processing and use of the chemicals. The current program requires such reporting only for chemicals manufactured or imported over 300,000 pounds.
The manufacturers would use EPA-provided software to report their chemical inventory – currently, most manufacturers submit paper reports. The paper reports take years to process and the data-entry process introduces extra error into the system.
Another proposed change would require reporting of a number of valuable pieces of information, such as yearly production volumes, more specific chemical names and numbers to ensure the correct chemical substances are identified, and the approximate number of workers exposed to the chemicals.
Furthermore, manufacturers currently can label just about anything as “confidential business information,” the new rules would place annual limits on the practice and require manufacturers to justify any such designations.
The Society of Environmental Journalists wrote about the issue back in March and included a link to a report [PDF] from the EPA’s Inspector General, as well as other coverage.
Documentary tonight examines health care system
Filed under: Government, Health care reform, Health policy
The documentary “Money-Driven Medicine,” based on a 2006 book of the same name by Maggie Mahar, will air tonight on PBS’ Bill Moyers Journal.
The film looks at effective care vs. more expensive care and “how our 2.6 trillion dollar a year healthcare system went so terribly wrong and what it will take to fix it.” It discusses access to health care, failures in treating chronic disease, the shortage of primary-care physicians, the undermining of the doctor-patient relationship and more. It includes a number of experts and comments from Barack Obama and George W. Bush.
Check the PBS schedule to find out when Moyer’s show airs in your area.
(Hat tip to Gary Schwitzer)
Holiday reading: Hospitals sue patients; team helps people die with dignity
Filed under: Government, Health data, Health journalism, Hot Health Headline
Hopefully, readers of Covering Health will have some time off over the holidays. Here are two fairly extensive projects that we recommend for reading if you have some spare time.
Nonprofit hospitals sue patients
In an eight-month investigation, reporters Fred Schulte and James Drew of The (Baltimore) Sun found that over the past five years some of Maryland’s 46 nonprofit hospitals have received millions of surplus dollars from the state’s unique payment system “even as they sued tens of thousands of patients over unpaid bills. Many of these suits have been filed against patients in the poorest areas of the state.”
The reporters found that hospitals have won at least $100 million in the past five years in debt collection suits, have added interest rates at twice the rate allowed for other debts and have placed 8,000 liens on patients’ homes. They also found that Maryland doesn’t closely monitor hospitals’ debt collection practices and doesn’t have standards to determine who qualifies for free or reduced-price care.
The investigation has prompted statements from the University of Maryland’s Medical System and Johns Hopkins.
End-of-life care
Lee Hancock of The Dallas Morning News explores palliative care, which combines “traditional medicine with pain relief, spiritual counseling, and practical advice” for patients near the end of their lives and their families.
The Baylor University Medical Center’s palliative care team has cared for 2,000 patients since its creation in 2003. “Hancock and photographer Sonya N. Hebert spent almost a year at Baylor, documenting some of the most difficult and meaningful moments in the life of any nurse, doctor, patient or family member.”
The online presentation includes engaging and emotional video of patients and family members, as well as a nurse and doctor on the palliative team who discuss what they do and the limits of medicine and technology.
Other elements of the package include a timeline illustrating how technology has extended life, questions to help people plan their medical wishes, first-person pieces from Hancock and Hebert and many resources.
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Join us in Atlanta
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Fellowship applications
due Feb. 27
New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
