Forum Session

Examining the Condition of the Health Care Safety Net: Time to Re-Cast?
May 18, 2012


Jessamy Taylor, MPP


Millions of people who would otherwise have little or no access to care rely on the safety net for health care services. This includes the uninsured, those who have low incomes and are underinsured, Medicaid beneficiaries, and other disadvantaged populations made vulnerable by poverty or poor health status. The safety net is difficult to define nationally because the providers and funding streams that constitute it vary from community to community. Safety net providers spend a lot of energy scraping together funds from multiple streams, including local, state, and federal governments and private sources, to pay for the care they provide. However, the financial complexity and status of safety net providers varies greatly. The varied types of funding, differing levels of payment, and range of local expertise and capacity to acquire funding mean that safety net capacity across the country is uneven, leaving significant gaps in access to care in many places.

This Forum session explored the current status of the health care safety net. A health policy researcher along with representatives from a federally qualified health center and an academic medical center discussed how safety net providers have fared through the economic downturn and shared strategies for strengthening financial performance while expanding access to care and improving patient outcomes. The session also considered their future plans, given the uncertain fate of the health reform law, and the many ways its reversal or upholding would affect them.


  • Peter Cunningham, PhD (bio)
    Senior Fellow
    Center for Studying Health Systems Change

  • Sheldon Retchin, MD, MSPH (bio)
    Chief Executive Officer 
    VCU Health System
    Vice President for Health Sciences
    Virginia Commonwealth University

  • Zara Marselian (bio)
    President and Chief Executive Officer
    La Maestra Community Health Centers 

Related Materials

See the Forum sessions "Focus on Reform: Health Care Safety Net-Related Provisions" (July 16, 2010) and "Health Care Safety Net Innovators: Forging Ahead, Though Challenges Persist" (January 11, 2008).

See also "Primary Care Safety Net: Strained, Transitioning, Critical" (Background Paper No. 79, September 28, 2010), "Fundamentals of Community Health Centers" (Background Paper, August 21, 2004), and "Medicaid's Disproportionate Share Hospital Program: Complex Structure, Critical Payments" (Background Paper, September 14, 2004).

In 2000, the Institute of Medicine released America‚Äôs Health Care Safety Net: Intact but Endangered (Marion Ein Lewin and Stuart Altman, Eds., National Academies Press).

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