A new report conducted on behalf of Hawaii’s nonprofit, acute-care hospitals lays out broad areas in need of investment to help improve the overall health of the community, including improving housing and financial security, increasing access to mental health services and ensuring access to healthy food.
Nonprofit hospitals are required to complete a Community Health Needs Assessment every three years as part of requirements of the 2010 Patient Protection and Affordable Care Act, often referred to as Obamacare. The needs assessment is intended to help ensure nonprofit hospitals receiving tax breaks are investing in the communities that they serve.
“The concern that some people had, and Congress had, was because the hospitals do have a preferential tax status, are they then appropriately giving back to their communities?” said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, a trade group for the state’s hospitals and nursing homes.
Raethel said that the health reform provision was intended to make sure that nonprofit hospitals understand the needs of the communities that they serve and that their investments will “essentially offset what they would pay if they were paying taxes.”
While the needs assessment doesn’t delve into the levels of investment that would be needed to meet this goal, it does provide hospitals with a guidepost of where investment could be particularly beneficial.
This year’s report focuses on the “social determinants” of health, while also describing some of the disproportionate harms that the COVID-19 pandemic has had on more vulnerable segments of population, including Compact of Free Association migrants.
The report found, for instance, that COFA migrants often had trouble accessing unemployment insurance during the pandemic and thus filled many of the essential worker jobs, putting themselves and their families at greater risk of being exposed to the coronavirus.
The report also found that there were long-lasting health effects as a result of the reduction in Medicaid benefits to COFA migrants, which were restored in December 2020. By that time, the “damage has already been done,” according to the report, which found that the reduced health benefits has helped keep COFA communities living in poverty and that rebuilding relationships with health care providers will take time.
The pandemic sent significant shockwaves throughout the community in spite of federal pandemic aid and boosts to unemployment insurance, the report found. Prior to the pandemic, 42% of households in Hawaii qualified as “ALICE” households, which stands for Asset Limited, Income Constrained, Employed. ALICE describes households that earn more than the federal poverty level, but not enough to cover basic living costs in their county. After the pandemic hit, 59% of households in Hawaii qualified as ALICE households.
This year’s report also zeroed in on the health impacts of being homeless or housing insecure, which has been linked to higher levels of chronic diseases, such as diabetes, high blood pressure, stroke and heart disease.
It found that during the pandemic, hospitals often had to keep homeless patients for longer than medically necessary because there was no place to safely discharge them to, contributing to overcrowding during COVID-19 surges. Service providers also reported that on Oahu alone, hundreds of individuals are considered “housing ready,” but they can’t even find rooms in a shared home or dorm-like dwelling.
Each of Hawaii’s 18 nonprofit hospitals will need to tailor the report to their specific community in order to comply with Internal Revenue Service requirements. But the report lays out a long list of strategies that could help hospitals meet some of the community needs, such as implementing high school and community training programs in low-income communities for entry-level health care jobs that provide career development, and designating a percentage of a hospital’s investment portfolio to provide capital for projects such as affordable housing.
“How we are going to help is you are going to see hospitals participating in collective work that foundations have typically been in, that banks have typically been in, that other large employers have been in,” said Michael Robinson, vice president of government relations and community affairs at Hawaii Pacific Health. “You now have another sector of the economy that is also going to be pitching in on those efforts.”
2021 CHNA Final Report by Honolulu Star-Advertiser
