Forum Session

Safety Net Hospitals Post ACA Implementation: Improving or At Risk?
April 17, 2015


Sally Coberly, PhD


Safety net hospitals serve a greater proportion of uninsured patients than other hospitals, providing a significant share of hospital-delivered uncompensated care. Medicare and Medicaid disproportionate share hospital (DSH) payments and other subsidies are intended to offset a portion of these costs. With the expectation that uncompensated care would decrease because more individuals would be insured due to Medicaid expansions and the coverage purchased on the insurance marketplaces, the Patient Protection and Affordable Care Act of 2010 (ACA) imposed reductions in both Medicare and Medicaid DSH. Medicare cuts have gone into effect, and Medicaid reductions are scheduled to begin in fiscal year 2017. Early research suggests that hospitals in states that expanded Medicaid have seen reductions in uncompensated care and an increase in Medicaid as a source of payment. Significant numbers of uninsured remain, however, with many likely to turn to safety net hospitals for care. This Forum session provided an overview of the key provisions of the ACA that affect safety net hospitals and, from the perspective of two institutions, identified some of the challenges and opportunities these hospitals face as they operate in a post-ACA environment.


Teresa A. Coughlin, MPH (bio)
Senior Fellow, Urban Institute

George V. Masi, CHE, FACHE (bio)
President and Chief Executive Officer, Harris Health System (Houston, Texas)

René G. Santiago, MCP, MPH (bio)
Deputy County Executive, Santa Clara County
Director, Santa Clara Valley Health and Hospital System

Related Materials

Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, "Insurance Expansion, Hospital Uncompensated Care, and The Affordable Care Act," March 23, 2015.

Dennis Andrulis et al., "Safety-Net Hospital Systems Transformation in the Era of Health Care Reform," Texas Health Institute, February 2015.

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