Assessing the Implementation of the Nonprofit Hospital Community Benefit Program: 15 Years Post–Affordable Care Act

The nonprofit hospital community benefit (CB) program has existed for more than six decades, dating back to 1956. The program has undergone several regulatory changes over the years to improve oversight, transparency, and accountability; the most recent changes were implemented through the Patient Protection and Affordable Care Act (ACA). As the 15-year anniversary of the ACA approaches, this article provides an in-depth review of the literature on how nonprofit hospitals have responded to ACA Section 9007 (“Additional Requirements for Charitable Hospitals”). This review summarizes the state of the evidence on CB activities specific to the ACA provisions as well as other related recent state policies, discusses CB spending, identifies gaps in the CB literature, and proposes a research agenda for the next 10 years to continue to build the evidence base on hospital CB activities. In addition to contributing to academic literature, this review provides a foundation for policymakers and practitioners as they consider additional reforms to the CB program to improve oversight, transparency, and accountability.