December 18, 2013
Pursuant to Elections Code Section 9005, we have reviewed the
proposed initiative (A.G. File No. 13‑0042) that would cap total annual
compensation for executives at nonprofit hospitals at the level of
compensation received by the President of the United States (currently
set at $450,000).
Background
Two Broad Categories of Hospitals: Public and Private.
Hospitals generally fall into one of two broad categories: public or
private. A public hospital is operated by the state of California, a
county, a city, the University of California, a local health district or
authority, or any other political subdivision of the state. A private
hospital is typically operated by a corporation (either for-profit or
nonprofit). In California, about 80 percent of hospitals are private
hospitals and about 20 percent of hospitals are public hospitals.
Relative to private hospitals, public hospitals tend to deliver a
disproportionately large percentage of medical care to uninsured and
low-income persons in California. Public hospitals are mainly funded
with federal, state, and/or local government funds.
Two Broad Categories of Private Hospitals: For-Profit and
Nonprofit. For taxation purposes, there are two broad
categories of private hospitals: for-profit and nonprofit. Of the
private hospitals in California, about 30 percent are for-profit and
about 70 percent are nonprofit. The for-profit hospitals pay corporate
income taxes to the state. Nonprofit hospitals are exempt from state
corporate income taxes and local sales and property taxes. The tax
exemptions for nonprofit hospitals are intended to allow them to use the
funds that would have been paid in taxes to provide patient care, invest
in their facilities and equipment, and implement other measures that
would be beneficial to their delivery of health care services, such as
providing charity care. Charity care is generally considered to be care
provided for which payment is not expected and patients are not billed.
Executive Compensation at Nonprofit Hospitals.
A recent study published in the Journal of the American
Medical Association Internal Medicine found that nonprofit hospital
Chief Executive Officers (CEOs) nationwide earned almost $600,000 on
average in 2009; although, earnings ranged from less than $50,000 to
over $3 million. The CEOs managing nonprofit teaching hospitals and
managing nonprofit hospitals in urban areas were paid more than other
CEOs. As of 2011, it is estimated, based on tax filings, that there were
a few hundred nonprofit hospital executives in California earning annual
compensation above $450,000.
Proposal
This measure would impose a cap on compensation for executives at
nonprofit hospitals, impose new data reporting requirements on nonprofit
hospitals, impose new administrative responsibilities on the Attorney
General (AG), and give the AG authority to oversee and enforce the
provisions of this measure. This measure would go into effect on January
1, 2015.
Caps Executive Compensation at Nonprofit Hospitals
Executive Compensation May Not Exceed President of the
United States’ Compensation. This measure imposes a cap on
total annual compensation paid to nonprofit hospital executives at the
level of compensation received by the President of the United States.
Currently, this level of compensation is $450,000 per year. “Executives”
are defined under this measure to include individuals whose primary
responsibilities are executive, managerial, or administrative, such as
CEOs or chief financial officers, for example. “Total annual
compensation” capped by this measure includes, but is not limited to,
wages, salary, paid time off, bonuses, incentive payments, lump-sum cash
payments, loan forgiveness, housing payments, travel, meals,
reimbursement for entertainment or social club memberships, the cash
value of housing or automobiles, scholarships or fellowships, the cash
value of stock options or awards, and payments or contributions to
severance. Total annual compensation does not include the cost of health
insurance or disability insurance, or contributions to health
reimbursement accounts.
New Data Reporting Requirements for Nonprofit Hospitals
Nonprofit Hospitals Must Report Levels of Executive
Compensation. This measure requires nonprofit hospitals to
file an annual report to the AG that includes the names, positions, and
total annual compensation of the ten executives who received the
greatest level of compensation and the five former executives who
received the greatest level of severance compensation in the given year.
This report must include a breakdown of the wage and nonwage
compensation provided, identify all entities that contributed to the
compensation, and identify the amounts of the contributions. This
information must also be made publically available on a website and on
request from any member of the public.
New Oversight Responsibilities for the AG
Establish Requirements for Data Reporting.
This measure makes the AG responsible for determining the format that
nonprofit hospitals must follow when reporting data on executive
compensation.
Enforce Executive Compensation Cap. This
measure allows the AG (or any state taxpayer) to bring a civil action
against a nonprofit hospital for violating this measure. Civil actions
may be brought to assess a civil penalty, revoke a hospital’s corporate
status as a nonprofit corporation, and/or revoke a hospital’s tax-exempt
status under state tax law. This measure allows the AG to assess civil
penalties of up to $200,000 for each intentional violation. For
violations that are determined to be non-intentional, civil penalties of
up to $100,000 for a first offense and up to $200,000 for all subsequent
offenses may be assessed.
Supervise Noncompliant Hospitals. This
measure allows the AG to supervise nonprofit hospitals that fail to
comply with the executive compensation cap. The AG may appoint any
person to serve as its representative on the board of directors of any
nonprofit corporation that owns, operates, or controls a noncompliant,
nonprofit hospital. Nonprofit religious corporations and nonprofit
corporations incorporated outside of California are excluded from this
provision.
The AG May Assess Fees to Cover the Costs of
Implementation and Enforcement. This measure gives the AG
the authority to assess reasonable fees on nonprofit hospitals to cover
its administrative costs to implement and enforce the measure. These
fees will be assessed annually and must be submitted with the annual
report from each nonprofit hospital.
Fiscal Effects
Administrative Costs for AG, With Authority to Recover Costs Through
Fees Assessed on Nonprofit Hospitals
This measure creates additional workload for the AG to implement and
enforce the measure. The increased workload would result in annual costs
for the AG in the low millions of dollars. Under the measure, the AG is
given the authority to recover costs from fees assessed on nonprofit
hospitals.
Other Potential, but Likely Minor, Net Fiscal Effects on State and
Local Governments
The cap on executive compensation could have fiscal effects on state
and local governments in several different ways. These effects are
likely to be relatively minor on net. To the extent the cap on executive
compensation reduces the amount of income earned by certain employees of
private nonprofit hospitals, state personal income tax revenue collected
from these employees would decrease. However, hospitals could respond to
the cap on executive compensation in a way that generates additional tax
revenue, potentially offsetting the just-mentioned revenue decrease. For
example, hospitals could reallocate funds that were previously used to
provide compensation above the cap to hire new employees or to increase
the salaries of current employees who are under the cap—thereby
increasing state personal income tax revenue from these employees. A
hospital could also reallocate the funds to increase the amount of
charity care provided to uninsured individuals. To the extent this
reduces the amount of charity care necessary at public hospitals, this
would reduce costs for state and local governments, again potentially
offsetting any revenue decrease resulting from the measure.
The impacts of this measure on the amount of charity care provided by
private nonprofit hospitals and the salaries provided to employees who
are not subject to the cap on compensation are uncertain. While these
potential fiscal effects on state and local governments are uncertain,
on net, they are likely to be minor.
Summary of Fiscal Effects
This measure would have the following significant fiscal effect:
- State administrative costs in the low millions of dollars
annually to enforce the measure, with authority to recover costs
through fees assessed on nonprofit hospitals.
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