Kaiser, which operates nonprofit hospitals and provides health care for more than 12 million people, was already conducting such assessments under California regulations. Obamacare, passed nearly a decade ago, extended the obligation nationwide.

“It brought a discipline to the industry so that we all had to think about this,” says Bernard J. Tyson, Kaiser’s chief executive officer, during an interview at the company’s headquarters in Oakland. “It forced the industry to think outside its own box.”

The Democracy Collaborative convened the first participants in what would become the Healthcare Anchor Network in Washington in December 2016. In the years since, it has sought to coax medical companies to formalize and expand financial commitments that are now voluntary and vaguely defined — more like an accepted social compact than a firm obligation.

The logic is driven by large numbers: Hospitals and health care providers across the United States collectively spend more than $780 billion a year, control investment portfolios worth some $400 billion and employ more than 5.6 million people. Even a minor shift in how they manage their money, contract for services or hire workers will have an impact on the American economy.

“We encourage a pledge of 1 percent of assets as a starting point,” says David Zuckerman, the coordinator for the health care network. “This conversation is moving very fast and moving in a very powerful way. These institutions are just being exposed to this idea.”

Over the last two years, members have pledged more than $300 million toward local investments, with Kaiser alone promising two-thirds of those funds.

The company has taken its cue from volumes of literature attesting to the fact that poverty is lethal. People who experience homelessness have shorter life expectancies than the rest of the population. People without jobs do not eat as well as those who are fully employed. Financial stress can breed other ills, including substance abuse. Health care costs have risen so rapidly that many Americans fret about how to pay their bills.