Nonprofit organizations are expected to use their tax breaks to give back to their communities.
But a new national study found that many Florida hospitals aren’t doing as much as they should.
The Lown Institute, a national health care think tank, examined 1,800 hospitals across 20 states to see how they were using the money they saved on taxes from 2020 to 2022.
Out of the 88 Florida hospitals studied, the results were split almost down the middle.
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Forty-three had a “fair share deficit,” which meant they received more in tax breaks than they spent on public assistance and investment.
Combined, the gap amounted to $485 million a year, which Lown said is enough to feed 623,000 people facing food insecurity or wipe out medical debt for 700,000 people.
The other 45 nonprofit hospitals with a "far share surplus" spent a total of $602 million a year more on community reinvestment than they saved.
“There’s a difference between meeting your bottom line to stay in business and maximizing your profits,” said Vikas Saini, president of the Lown Institute. “We haven’t really created the right environment in health care, it’s not the same as a regular nonprofit.”
Combined, the 88 hospitals receive $1.7 billion in tax benefits annually.
Saini said there isn’t a clear pattern between which hospitals choose to give back and which don’t. In fact, they often coexist.
“In any given city, you can often find two hospitals — one of which is in a surplus and one of which is in a deficit,” he clarified. “So it really seems that we have a tale of two hospitals in our health care.”
According to the study, this was definitely the case for Tampa. St. Joseph’s Hospital had a $48 million fair share deficit, while Tampa General Hospital and AdventHealth were each above a $15 million surplus.
Lakeland Regional Medical Center had the largest surplus in Florida.
It invested $78 million more than it would have paid in taxes, in things like discounted health care and addressing food insecurity.
Some hospitals dispute Lown's findings. On April 16, the American Health Association released a statement questioning the authenticity of the report. For example, representatives of BayCare Health System say St. Joseph's tax benefit in 2022 was $71 million, while its community benefit was $163 million.
However, that was a single year, while the study looked at averages from 2020 to 2022.
Additionally, Judith Garber, senior policy analyst at Lown, told WUSF that their report focuses on what they consider the most meaningful categories of community spending. This includes subsidized health services, cash and in-kind contributions for community benefit and community building activities, according to Lown's methodology.
The excluded categories are research, training, and Medicaid shortfall, because they are "susceptible to double- or triple-dipping, meaning hospitals may choose to claim those expenses in multiple circumstance," the Lown website reads.
Saini said the Lown team made another discovery during their research: there’s almost a complete lack of accountability for nonprofits.
“The regulations require hospitals to simply file a form; there’s no requirement that there would be a certain amount of spending,” he said, adding that there have been efforts across the country to create baseline amounts that hospitals must spend on community investment.
One example is Oregon Health Authority, a state agency that has set a minimum since 2019 and currently has a proposed floor of over $300 million for fiscal year 2026.
Another factor is that Florida is one of 10 states that has not expanded Medicaid availability under the Affordable Care Act. A citizens groups is working to get a constitutional amendment on the 2026 ballot to change that.
Hospitals in those states are under extra pressure to provide strong medical services and benefits to their communities, according to Saini.
Hence, even more so in the non-expansion states, Saini said nonprofit hospitals should be committed to providing free and subsidized health care, spearheading community health care programs and addressing core issues like food insecurity behind common medical problems.
