Another application of community benefit principles to colleges and universities, beyond the tax exemption context for nonprofits, is the issue of what expectations should be placed on governmentally sponsored institutions. These institutions receive the bulk of their revenues from state appropriations (U.S. Department of Education, 2002). Health professionals training schools based at these public institutions often receive significant appropriations from state governments. It would certainly seem to make sense to ask if these public institutions of higher education are meeting their “community benefit” expectations in advancing societal goals tied to healthcare workforce diversity. Such an expectation surely could be part of a state legislature’s quid pro quo for sending over significant taxpayer dollars to these public institutions.
From a public policy perspective, it is clear that health professionals training schools and hospital based training programs have made only limited progress in advancing workforce racial and ethnic diversity goals in the United States. Though community benefit principles offer an attractive framework for holding health professionals training programs and their institutional sponsors accountable for advancing goals tied to racial and ethnic diversity of their students and trainees, from a legal perspective, it is important that the principles be applied in the most effective venue. In that regard, while community benefit laws and associated public expectations have evolved out of a tax exemption context, it is reasonable to suggest that the most practical application of concepts for increased institutional accountability are outside of the tax exemption arena. Specifically, they are best applied in the accreditation world affecting health professionals training programs. Furthermore, for publicly sponsored colleges and universities, community benefit concepts might also be part of a scheme that in some way ties governmental subsidies for these public institutions of higher education to performance measures related to student and trainee diversity goals. These concepts apply for a number of reasons:
Legally, based on the relevant IRS Revenue Rulings, there is no current tax exempt status requirement that would necessitate either charitable teaching hospitals or private, nonprofit colleges and universities to make affirmative workforce diversity efforts in order to maintain taxexempt status. It would likely be too much of a stretch for the IRS (even if motivated to do so) to make such a regulatory change absent new Congressional legislation that modifies the language of 501(c)(3) of the IR Code. This is especially true with respect to colleges and universities, which, at present, have only the Bob Jones “public policy” test (as described above)