J Leg Med. 2020 Apr-Jun;40(2):135-170. doi: 10.1080/01947648.2020.1822243.
The federal Medicaid statute provides states an incentive to tax hospitals (even otherwise tax-exempt ones) as a means of raising revenue and then leverage federal matching funds by returning at least some of the tax back to the hospitals in the form of Medicaid supplemental payments. The potential for supplemental payments is attractive to hospitals, especially those struggling to recoup the costs of treating Medicaid and uninsured patients, and has resulted in political support from hospitals for states to create hospital "taxes" in name only-hospitals and states both end up with more money than they did when they started because of the federal match. When state officials begin to perceive, however, that nonprofit hospitals may be serving private rather than public interests, they are able to use these hospital taxes as a way to incrementally chip away at the historic governmental support provided through tax exemption by redirecting the revenue raised from the hospital tax to general fund purposes rather than Medicaid supplemental payments. This article looks at how states have been using hospital taxes and supplemental payments to balance state budgets and whether this practice is consistent with the Medicaid program objectives that make the taxes politically feasible.
联邦医疗补助法规为各州提供了一项激励措施，即对医院征税（即使是免税的医院），以此作为筹集资金的一种手段，然后通过以医疗补助补充支付的形式将部分税款返还给医院，从而利用联邦配套资金。补充支付的可能性对医院很有吸引力，尤其是那些努力收回治疗医疗补助和无保险患者费用的医院，这导致医院从政治上支持各州名义上征收医院“税”——由于联邦配套资金，医院和州最终都比开始时拥有更多的资金。然而，当州官员开始意识到非营利性医院可能在为私人利益而非公共利益服务时，他们能够通过将从医院税中筹集的资金重新用于一般基金用途，而不是医疗补助补充支付，以此逐渐削弱通过免税提供的历史性政府支持，从而利用这些医院税。本文探讨了各州如何利用医院税和补充支付来平衡州预算，以及这种做法是否符合使税收具有政治可行性的医疗补助计划目标。
