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In exchange for large tax breaks, not-for-profit hospitals are required to provide programs, services, or other resources to address community health needs through “community benefit” activities. These include grants to community-based organizations, charity care (free or reduced- cost services for low-income individuals) and the un- or under-reimbursed costs of care for patients on Medicaid (called Medi-Cal in California) and other government programs. When a hospital receives not-for-profit status, it enters a pact with the public that it will provide community benefits in exchange for its tax exemption, but this exchange is not equal. Studies of community benefit programs show that the financial benefit hospitals get by not paying taxes greatly exceeds the amount of funds they invest in community benefit activities. In California, not-for-profit hospitals received $3.27 billion in total government subsidies and benefits, while only providing $1.43 billion in community benefit in 2010 alone. Questions have also been raised regarding how not-for-profit hospitals account for their community benefit investments and how these activities relate to the most pressing community health needs.
Charrettes are collaborative meetings where all project stakeholders come together for a period of focused planning activity in order to resolve conflicts and map solutions. Charrettes are highly effective tools for planning and public engagement, but may be too expensive to fit into a project’s budget especially when the goal of a project is to make “small possible”. Lean Charrette reduce necessary time and resources by breaking the process into manageable increments with less top-down intervention, creating more opportunities for action and input. Lean charrettes maintain the inclusionary approach to creating shared narratives and transparent decision making of the standard process, while introducing benefits of efficiency and continuity associated with the compressed time frame.
On June 24, 2009, President Barack Obama signed into law the Consumer Assistance to Recycle and Save Act of 2009 which gave up to $4,500 to owners of vehicles with poor fuel economy who trade them in for more efficient new vehicles. This \"cash-for-clunkers\" program was touted as meeting three objectives: increasing vehicle sales, at a time when the U.S. auto industry is struggling; reducing fuel use; and reducing greenhouse gas emissions. This column examines the workings of the program as well as describes what kinds of vehicles can be turned in and purchased under it. The column then assesses how well the program meets its stated objectives. In conclusion, the authors found that the program will chiefly benefit the vehicle manufacturers as there is such a narrow differential in mileage between traded-in and new vehicles eligible for credit that the resulting reductions in fuel usage and GHG emissions will be modest. In addition to this, they found that the energy cost of building new vehicles must be factored into the equation as the carbon dioxide payback time for manufacturing vehicles can take several years. Lastly, the column points out that the program greatly affects income distribution as it encourages old cars to be crushed and shredded, thus reducing the supply of old cars and presumably raising the price of those that remain, in turn hurting lower income people.
Currently 83 percent of the energy consumed in the United States is from fossil fuels. This in turn creates 81 percent of the United States\' emissions of greenhouse gases, is the principle source of air pollution, and leads to major environmental problems where the fuel is extracted from the ground. Increasing the share of non-fossil energy involves a switch from the fuels that took tens of millions of years to form under the ground, to sources that are constantly renewed. This column is devoted to the legal aspects involved in increasing the share of the energy that we use that comes from renewable sources. The author points to six legal techniques that have been developed to increase the use of renewable energy: 1) Portfolio Standards 2)Mandatory Utility Purchases 3)Renewable Fuel Standards 4)Carbon Price 5) Tax Incentives and 6)Research and Development. In addition to this, the author points to six impediments to the growth of renewables: 1)Intermittency 2)Fossil Subsidies 3)Capital Availability 4)Turnover Rate of Capital Plant 5)Scale and Timing and 6)Siting and Environmental Impacts.
In recent years the frequency and severity of heavy precipitation and floods in parts of the United States have been increasing to a statistically significant degree, and this trend is expected to worsen. This article summarizes some of the liability issues that result from floods, and efforts to control them. Under governmental liability, the author highlights multiple participating factors including sovereign immunity, structural measures, nonstructural measures, flood-related regulations, and land use regulations. Under private liability, the column points to issues regarding neighboring property owners, dams and other obstructions, overflow, insurance, utilities, and design professionals. Lastly, the author draws upon the Hurricane Katrina Case where the U.S. Court of Appeals heard oral arguments in an important case on flood liability.
Increasing energy efficiency is the most important action that can be taken to combat climate change. There are currently an abundance of legal techniques available at the federal, state and municipal levels that cumulatively could accomplish a great deal in cutting energy use, lowering U.S. reliance on foreign oil, and reducing GHG emissions and the other adverse environmental impacts on energy production. The author points to nine legal techniques by which we can increase energy efficiency: 1)Technology Standards 2)Retrofitting 3)Information 4)System Benefit Charges 5)Urban Density 6)Portfolio Standards 7)Carbon Price 8)Tax and Non-Tax Incentives and 9)Government Procurement. In addition to this, the author lays out six impediments to achieving efficiency: 1)Split Incentives 2)Low Energy Prices 3)Capital Budgeting 4)Capital Stock Turnover 5)Utility Rate Systems and 6)Invisibility of Waste.
Numerous federal and state judicial decisions have established that environmental impact statements under the National Environmental Policy Act and its state equivalents should examine the impact of proposed projects on emissions of greenhouse gases. Administrative agencies and court settlements are now establishing the guidelines for the conduct of these examinations. This column surveys the emergence of these new guidelines, which is occurring against a backdrop of accelerated activity in both Congress and the U.S. Environmental Protection Agency, leading towards federal regulation of GHGs. The column looks at these guidelines on the federal level as well as within New York, California, Massachusetts, Washington, and Hawaii.
This annual survey describes new environmental laws that were signed into law in 2010 in New York, as well as two executive orders issued by Governor David A. Paterson and important new regulations from the New York State Department of Environmental Conservation concerning endangered and threatened species. The new laws discussed in this survey include the following topics: Air Quality, Brownfields, Endangered Species, Energy, Emissions/Climate Change, Green Jobs, Hazardous Substances, Land Use, Pesticides, Public Health, Recycling, State Environmental Quality Review Act, Solid Waste, Transportation, Wetlands, and Wildlife.
The central purpose of the National Environmental Policy Act (NEPA) is to improve governmental decision making by making relevant information available to officials and by ensuring that everyone affected by the decisions is given a voice. In this article, Michael Gerrard focuses on the effect of NEPA on decisions. First, Gerrard discusses the effect that NEPA has had on internal decision making. Then, he delves into the accuracy of predictions in environmental impact statements. Lastly, Gerrard analyzes what happens to environmental impact statements after the record of decision is issued.
In this piece, Michael B. Gerrard comments on an article by Thomas D. Peterson, Robert B. McKinstry Jr., and John C. Dernbach which held two central insights: (1) Any serious national effort to control emissions of greenhouse gases must continue to leave important roles to the states; and (2) It would be a mistake to put too many eggs in the cap-and-trade basket. Although Gerrard agrees with these insights, he has reservations about the authors\' proposal to use the mechanism of national ambient air quality standards and state implementation plans as a way to give states the vital roles they deserve. In discussing alternative methods to this, Gerrard delves into the topics of state action, the national ambient air quality standards, state implementation plans, and lastly, alternative approaches to state roles.