Dwight Tillery. Photo provided

By The Honorable Dwight Tillery

Former Cincinnati Mayor

For the past three weeks, we’ve heard about nothing but the vote on the Children’s Hospital expansion, as though it were of as much importance as Hurricane Harvey. The difference between the two is that one is bogus (the expansion was never in jeopardy), and the other is of dire consequence to people caught in the tropical storm.

The public is being fed misleading and false information by Jason Williams, a reporter for the Cincinnati Enquirer. He has suggested that Simpson is guilty of not performing her duties by missing a committee meeting and offering an amendment to the expansion of Children’s, while characterizing her actions as an attempted extortion, shake down, etc. is not only legally wrong – it’s designed to make her look hostile towards Children’s Hospital.

Judge Mark Painter wrote an op-ed for the Enquirer explaining the dynamics of the decision-making process and how it is experienced by neighborhoods impacted by gentrification or big institutional expansions. The failure to recognize the racial and economic implications of the people living in Avondale simply ignores the historical experiences where Black neighborhoods have often been sacrificed for the so-called “greater good.” No predominantly White neighborhoods in this city have undergone a loss of the soul of their community like Black neighborhoods. Councilmember P.G. Sittenfeld stated at the special session of Council that the African American community had not gotten a fair shake from local government. Obviously, this meant very little, given the hostility of Cranley, Smitherman, and Flynn.

I served as mayor of Cincinnati and was a councilmember over the span of eight years. It was common practice for business leaders to tell the city manager that if they didn’t get money or tax breaks, they would relocate to the suburbs. And nobody on Council accused these businesses of doing “shake downs” when they gave these ultimatums. No member of Council suggested those companies acted unlawfully like Cranley, Flynn, Smitherman and Williams continue to implicate Simpson and others for. Why shouldn’t the mayor and Council look out for neighborhoods while helping big business? There is a precedent that institutions wanting to expand in neighborhoods and the City work together so that the residents impacted feel respected and treated fairly. The history and the law are on Simpson’s side.

In fact, all hospitals have a legal obligation to invest in the surrounding communities under the IRS code titled “Community Benefits.’’ This has nothing to do with how altruistic Children’s might be to a neighborhood, but rather, it is a matter of law. Congress imposes this requirement particularly on hospitals because they are nonprofit organizations, and many have been found not to be living up to the standard of “charitable obligations.’’

Robert Woods Johnson, writing in Health Affairs, states, “The act’s requirements appear to reflect concerns that have arisen in recent years about whether non-profit hospitals are providing adequate public benefits to justify their tax-exempt status. Non-profit hospitals are eligible for federal tax-exempt status as charitable organizations described in § 501(c)(3) of the Internal Revenue Code (IRC). Under the ‘community benefit’ standard developed by the IRS, charitable hospitals are judged on whether they provide sufficient health benefits to the community. The IRS has recently developed a new annual reporting requirement (Schedule H of the Form 990) for hospitals to report information regarding their activities.”

Johnson continues, “Schedule H categories of community benefit activities include the net, unreimbursed costs of charity care (providing free or discounted services to patients who qualify under the hospital’s financial assistance policy); participation in means-tested government programs, such as Medicaid; health professions education; health services research; subsidized health services; community health improvement activities; and cash or in-kind contributions to other community groups (such as donating funds to a community health screening event or hosting a blood drive). Hospitals can also claim what the IRS terms community building activities, such as investments in housing or environmental improvements, if they separately submit evidence documenting the relationship between such investments and health improvement. Schedule H also requires the reporting of bad debt (amounts uncollected from patients who did not qualify for charity care) and shortfalls associated with Medicare payments, but the IRS does not count these amounts as community benefits.”

Say what you want, but this is not about an attempt to “shake down” Children’s Hospital—which is one of the wealthiest hospitals in the nation. Healthcare is big business and all corporations have a social responsibility. The Avondale community has every right to make requests for its residents under the Affordable Care Act. The way Winburn, Simpson and Young were mischaracterized by Cranley, Flynn, Smitherman and Williams is just plain wrong and unethical. The mayor and Council have an obligation to the people of Cincinnati to see that their residents are being treated fairly. Simpson was simply doing her part to uphold these standards.

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