Howard has participated in the formation of over 45 tax-exempt, bond-financed senior living facilities and has represented specialty, general and academic hospitals as general counsel, as well as municipalities and tax-exempt and taxable entities in disputes with the Internal Revenue Service. In 2010 he assisted two competing health systems in forming one of the first Accountable Care Organizations in the country. He has published articles on both ACOs and physician-owned hospital issues.

Howard's work has been recognized by The Best Lawyers in America©, Chambers USA and Great Plains Super Lawyers®. He has been listed in Best Lawyers®, Non-Profit/Charities Law, Tax Law, every year since 1995 and also is a Fellow of both the American Bar Foundation and the Nebraska State Bar Foundation.

He is a past member and chair of the City of Omaha Planning Board and the Omaha Airport Authority, and also a past president of the Legal Aid Society and the Merrymakers Association. Additionally, he has served on the boards of the Sienna Francis House, the Greater Omaha Chamber of Commerce and Landmarks, Inc.