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  Cook County Hospital fills more outpatient prescriptions every day than are filled at 26 Walgreen's drug store combined.

Provena Case may open door for state, local effort to tax hospitals.

Thursday, March 18, 2010
Crain's Chicago Business
by Greg Hinz's Blog

Thursday's decision by the Illinois Supreme Court in the Provena case may open the door to widespread local and state efforts to force hospitals to either provide adequate free care to the poor or pay property taxes if they don't.

For starters, the decision could revive a stalled legislative campaign by Illinois Attorney General Lisa Madigan to force property-tax-exempt hospitals to spend a specific amount -- at least 8% of their operating budget -- on charity care.

Though Ms. Madigan did not immediately announce any General Assembly plans, a statement put out by her office could be read as an invitation to the hospital industry to come to the bargaining table.

Negotiating with Ms. Madigan could be a lot easier for the industry than having to deal with more than 100 county assessors throughout Illinois.

The court's decision "upheld over a century of Illinois law that requires tax-exempt hospitals to provide free heath care in exchange for the enormous tax breaks they choose to receive," Ms. Madigan said in a statement. "This decision is good news for the nearly 2 million uninsured Illinoisans."

Ms. Madigan's spokeswoman later added only that, "We certainly will need to take a look at where we are, going forward, after talking with all the stakleholders."

More direct was Cook County Commissioner Larry Suffredin, who said the decision "absolutely is going to provoke a discussion" about how the county can be reimbursed for free care that it provides but which tax-exempt hospitals should be offering.

"This is a seminal decision. We are going to have to respond," Mr. Suffredin said. "The decision opens up an opportunity here to ensure that charity care is available."

Those discussions could result in "looking at the tax status" of delinquent institutions, Mr. Suffredin said. Or it could evolve into a set system in which certain institutions provide certain types and amounts of care.

County Assessor Jim Houlihan declined to tip his hand yet, saying only in a statement that his office is "still reading and analyzing" the decision.

But Mr. Houlihan in recent years yanked the tax exemption from a high-end retirement complex, the Clare, on the Near North Side that is sponsored by a Roman Catholic group.

Perhaps more on point, in 2007 he released a study saying that the county's 50 or so tax-exempt hospitals would have to pay $238 million to $241 million a year in property taxes if they lost their exemption.

All of the above not withstanding, the Illinois Hospital Association is one of the biggest, best funded and most effective lobbying forces in Springfield. It was one of the top campaign contributors to former Gov. Rod Blagojevich and has repeated that stance with his successor, Pat Quinn.

But even IHA's clout will be limited, given what at this point appears to be a clear and decisive high court ruling.

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