The Lown Institute, an independent think tank that studies hospitals’ social responsibility, recently released it Fair Share Spending Reports for 2025. These reports, entitled “Making Hospital Tax Breaks Work for Communities,” represent both a national scale and a more zoomed in look at 20 select states. As not-for-profit hospitals are exempt from various taxes, the fair share spending report weighs those savings against how much each health system gives to its community to discover which hospitals have the biggest deficits and surpluses. The Lown Institute reports have been widely criticized by different advocacy groups. Despite opportunities to improve the methodology, the reports have garnered the attention of the media and legislators. 

Key Takeaways 

According to the report, more than half of the hospitals included in the analysis (54%) had a deficit, meaning they received more in tax benefits than they invested into the community; 46% of the hospitals had a fair share surplus. By Lown’s calculations, hospitals in the 20 states measured gave over $22 billion per year in community investment, which left an overall fair share deficit of $11.5 billion when compared to 2022 data from the IRS, CMS, and “local property assessment portals.” 

Lown also noted that 20% of the national deficit calculated comes from just twelve hospitals in the data set; each had fair share deficits of over $100 million.  

Methodology 

For determining the tax benefits for each hospital, Lown receives its data from the Internal Revenue Service (IRS) and combines income, property, state and other tax breaks to determine total exemption numbers and compare them with community contribution calculations. While the Lown Institute takes various forms of community benefit contributions into account when calculating these reports, it is not exhaustive. For example, Lown doesn’t account for Medicaid shortfall or health education and research in its methodology despite these being recognized as community benefit by the IRS. Instead, Lown focuses on five areas of community investment: financial assistance, subsidized health services, community health improvement services, cash and in-kind contributions and community building activities. 

The American Hospital Association has also argued that these numbers are misrepresented in multiple ways. Studies have shown that every dollar a hospital invests in its community creates $9 in benefits delivered back.  

Lown’s Policy Recommendations 

Lown recommended for Congress to improve the community benefit reporting requirements, standards for financial assistance, and spending targets based on each hospital. Other policies recommended include leveraging community investment as conditions for Certificate of Need expansions, payment in lieu of taxes programs, and requirements to include community groups in the CHNA process. According to Lown, longer-term solutions include “total cost of care” models, increased reimbursement for underfunded high-need services, and increased insurance coverage.  

Other Lown Reports 

In addition to the Fair Share Spending Report, Lown produces different reports such as the “Hospital Index,” which includes letter grades for each hospital ranking them on their overall Social Responsibility based on over 50 different metrics. This year’s hospital index has not yet been published.