ABC for Health, a public interest law firm, argues that a Dane County health assessment should have addressed the problem of medical debt. (Getty Images)

ABC for Health, the public interest law firm, has filed a complaint with the IRS, charging a team of hospitals led by UW Health of falling short of federal standards when they filed a Community Health Needs Assessment required of health nonprofits under federal law.

Late last year, the hospitals  released their report on the health needs of Dane County.

Federal law requires nonprofit health care providers to file such a  document every three years. The December report covered reproductive care, chronic illness, mental health and substance abuse, along with special sections about health concerns for children and youth as well as the elderly.

But in 63 pages, the report included no discussion of how the cost of care and medical debt have burdened people without money and hampered their access to the health care system.

For Bobby Peterson, that was a glaring omission — and on Thursday, Peterson and ABC for Health, the firm he founded and directs, filed a complaint with the IRS, charging the report doesn’t live up to the federal law’s requirement for a Community Health Heeds Assessment (CHNA).

ABC for Health focuses on health care access along with helping people overcome or avoid medical debt.

The organization’s complaint argues that failing to address that issue in the Dane County health needs document violates the collective responsibility of UW Health and the other three nonprofit hospital systems that produced it.

“Their insistence to exclude medical debt from consideration during the CHNA betrays many principles and requirements of non-profit hospitals,” the complaint states. “We maintain that UW Health’s intentional indifference towards the medical debt epidemic stems from a value for their own revenue at the expense of their community. That value is at odds with UW Health’s duty towards its community.”

Sara Benzel, media relations manager for UW Health, defended the report Thursday as well as the hospital system’s handling of medical debt.

“UW Health stands behind the priorities identified in the community health needs assessment process,” Benzel told the Wisconsin Examiner in an email message.

“Regarding the UW Health Financial Assistance Policy, we are proud of the work we do every day to make this support accessible, and the work we have done to simplify the process and lower barriers to accessing financial support.”

She said the hospital system’s financial assistance program is posted online in English and Spanish.

“The application has been simplified over the years using an equity lens, requires minimal supporting documents, and goes up to 600% of the federal poverty level, well above others in the state,” Benzel said.

Medical debt critic

ABC for Health has been a longstanding critic of hospitals’ handling of medical debt and has published several reports finding fault with how hospital systems address the problem of patients unable to pay their health care bills.

While hospitals have programs for financial help when a patient has no insurance and can’t afford to pay out of pocket, ABC has argued those programs are too often needlessly complex. The organization also contends that hospitals’ financial counselors don’t take actions that could circumvent a problem — such as helping patients enroll in Medicaid if they qualify.

The requirement for a Community Health Heeds Assessment is a little-noticed provision in the 2010 Affordable Care Act — the legislation nicknamed Obamacare that has helped drive down the numbers of uninsured Americans since its passage 15 years ago. Nonprofit health care systems must  produce a CHNA report for their communities every three years.

“The IRS is regulating this because they are looking at their tax-exempt status,” Peterson said Thursday. “And to be a tax-exempt organization, to be able to step away from all the property tax requirements that many of us face, they have a responsibility then to give back.”

He sees a hospital’s approach to medical debt as a direct measure of how they give back.

“They have a community benefit that they need to provide, and part of that benefit is making sure that they’re providing enough charity care and services to the vulnerable in a community,” Peterson said.

The 2025-2027 CHNA report, like several previous editions, was the work of Healthy Dane Collaborative, a coalition of the county’s four hospital systems: Unity Point-Meriter, SSM Health-St. Mary’s Hospital, Stoughton Health and UW Health. The report’s drafters conducted a survey, collected and analyzed data, met with a variety of community organizations and held focus groups

The final report included discussions of health care disparities by race, income and gender. It called attention to the health care needs of the LGBTQ and immigrant communities, including undocumented migrants.

Early on, the text of the report emphasized concern for health equity — “ensuring fair distribution of health resources, outcomes, and opportunities across different communities.”

Seeking a voice

At an ABC for Health symposium Thursday on Medicaid and health care access, Peterson said the report’s priorities were “good things” and were all important.

“But what we wanted to see was access to health care coverage,” Peterson said, along with a discussion about improving financial assistance policies and better coordination among providers. “It wasn’t there. That’s not part of what they wanted to give out to the community.”

Peterson said ABC started reaching out more than a year and a half ago to offer input for the CHNA report.

“We wanted to make sure that the people that are in the planning process understand what the access to health care coverage needs are, what the barriers in the financial assistance process are, and how can we make it better. What can we do to improve that process?” Peterson said.

“We thought this is a real opportunity for us to make sure that all these issues that we see every day can be put up in this Community Health Needs Assessment process,” he added. “We wanted our voice and the voice of our clients to be heard.”

The IRS complaint includes email messages ABC Health sent various people about the assessment process starting in mid-2023.

In a message Aug. 13, 2024, Peterson told Adrian Jones, UW Health Director of Community Health Improvement, “ABC remains eager to engage in Dane County’s 2024 CHNA process.”

The message asked for updates on the CHNA “process and timeline” and mentioned that ABC for Health was “preparing a report with recommendations to provide input, from the perspective of our clients, to inform Dane County’s CHNA process.”

In her Aug. 14 reply, Jones invited Peterson to “share your report with us.” She wrote that “we have also held our own community input sessions and survey and have analyzed a lot of quantitative and qualitative data.”

Peterson followed up with an email Aug. 16 that included a half-dozen questions about the data being collected, when and where community meetings had been conducted, whether more community meetings were planned and the timeline for completing the assessment document.

“ABC for Health is eager to continue engagement with the Dane County CHNA process,” Peterson wrote. “Please keep us posted about future community input sessions and meetings.”

Correspondence ends

There was no further response, and “the Dane County hospitals quietly released the CHNA report in late 2024, without ABC’s input that we maintain failed to take into account the perspective of the many communities we represent,” the complaint to the IRS states.

“Unsurprisingly, this report ignored access to health care coverage issues. The report lacks any recommendations to improve financial assistance policies, practices, and processes to equitably serve populations negatively affected by health disparities. It fails to address the impact of medical debt on Dane County patients,” the complaint states.

“It lacks broad community input and instead reflects a hospital-driven marketing piece that ignores and sidesteps Affordable Care Act requirements. ABC was largely shunned despite our multiple efforts over the past 2 years to provide client-based input.”

ABC for Health released its report shortly after Peterson learned that the CNHA report was published. Its critique was unsparing.

“Dane County hospitals must do more to justify extensive tax breaks and better serve patients impacted by health disparities,” the report states. “In 2023, Dane County hospitals spent an average of only 0.7% of their gross patient revenues on charity care. The national average is 2.3%.”

ABC for Health bases its calculations for Dane County charity care on Wisconsin Hospital Association data, and the national average on a 2022 Wall Street Journal report.

Peterson sent a letter reiterating ABC for Health’s concerns and the organization’s complaint about its lack of input in the CNHA report to UW Health’s CEO, Alan Kaplan, in January. He said there was no response.

ABC for Health also invited Kaplan and other hospital leaders to the ABC for Health event Thursday. The invitations were ignored or declined, Peterson said.

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