For decades, it has been almost an article of faith that not-for-profit hospitals, clinics, nursing homes and other institutions dedicated to serving the health care needs of the sick and elderly would be exempt from paying almost any type of taxation in recognition of their charitable purposes. The simple logic behind these exemptions was that these institutions should be able to devote 100% of their resources to fulfilling their charitable mission of serving their communities without the burden of paying levies to federal, state or local governments.

Over the years, some of these exemptions have been rescinded as a purely business matter. For example, many localities ended hospitals’ historic exemptions from water and sewer taxes when the localities discovered that the hospitals could be reimbursed for these taxes as part of their Medicare or Medicaid payment rates.

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