Referred to the House Committee on Ways and Means.
This bill amends Internal Revenue Code section 501(r) to add a new community benefit standard for tax-exempt hospital organizations. Hospitals must have community-drawn boards, accept Medicare/Medicaid patients without site-based limits, and spend at least an amount equal to the value of their federal, state, and local tax exemptions on training/research, facility/equipment improvements (limited), and financial assistance.
Progressives emphasize accountability and increased charity care
Relative to its intended legislative type, this bill is a substantive statutory amendment that defines new obligations for tax-exempt hospital organizations and pairs those obligations with periodic oversight reviews.
This bill amends Internal Revenue Code section 501(r) to add a new community benefit standard for tax-exempt hospital organizations.
Hospitals must have community-drawn boards, accept Medicare/Medicaid patients without site-based limits, and spend at least an amount equal to the value of their federal, state, and local tax exemptions on training/research, facility/equipment improvements (limited), and financial assistance.
The bill bars counting acquisitions as facility improvements, requires Medicare-rate language in financial assistance policy text (text is ambiguous), sets a 2026 taxable-year effective date, and mandates TIGTA and GAO reviews and recurring reports on financial assistance policies and IRS enforcement.
Substantive tax-code reforms affecting powerful stakeholders, significant compliance burdens, and unclear cost/accounting raise opposition and implementation challenges.
Relative to its intended legislative type, this bill is a substantive statutory amendment that defines new obligations for tax-exempt hospital organizations and pairs those obligations with periodic oversight reviews. The bill contains several concrete, enforceable-seeming provisions (spending categories, a numerical threshold, caps on how spending may be counted, and board composition) and integrates by amending IRC section 501(r).
Progressives emphasize accountability and increased charity care
These are examples from the analysis, not a ranked list of the most-affected groups.
Progressives emphasize accountability and increased charity care
Likely supportive because the bill forces nonprofit hospitals to convert tax exemptions into measurable community benefits.
It emphasizes charity care, access for Medicare/Medicaid patients, and local governance, aligning with accountability priorities.
Cautiously optimistic: supports accountability but worries about measurement, administrative burden, and unintended impacts on hospital operations.
Would seek clearer definitions and safeguards for financially vulnerable hospitals.
Likely opposed: views rule as heavy federal intrusion, increasing regulation and costs.
Concerns include threats to investments, local control, and burdensome enforcement tied to tax-exempt status.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Substantive tax-code reforms affecting powerful stakeholders, significant compliance burdens, and unclear cost/accounting raise opposition and implementation challenges.
The bill has not accumulated any surfaced votes yet.
Progressives emphasize accountability and increased charity care
Substantive tax-code reforms affecting powerful stakeholders, significant compliance burdens, and unclear cost/accounting raise opposition…
Relative to its intended legislative type, this bill is a substantive statutory amendment that defines new obligations for tax-exempt hospital organizations and pairs those obligations with periodic oversight reviews. T…
Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.