Strategic Planning & Timelines

Safety-net hospitals have long played an important role in the U.S. health care system in serving vulnerable populations, providing high cost services, and training medical and nursing students.  However, under the ACA, safety-net hospitals now face challenges competing for newly insured patients and continuing to serve the remaining uninsured (including adults in states not expanding Medicaid and undocumented immigrants who remain ineligible for Medicaid or new ACA coverage). They also face reductions in financing for uncompensated care. This brief examines four safety-net hospitals to learn how they were preparing for the full implementation of health reform, in order to gain additional insight into the strategies being used and challenges being faced among safety-net hospitals across the country.
 

This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. For each city, the researchers estimated changes in health coverage under the ACA, particularly the resulting decline in the uninsured. The report also includes an estimate of the additional federal spending on health care that would flow into these cities. For cities in states that have not expanded Medicaid eligibility, the report provides estimates both with and without expansion.
 

Churning in health insurance enrollment has long been a problem for many people, as changes in their life circumstances create a cycle of losing and regaining eligibility for coverage. For millions of Americans, the ACA means an end to the worst form of churning—the loss of insurance coverage entirely. However, the law also introduces a new risk: individuals and families with changes in income may move back and forth between Medicaid and subsidized marketplace coverage. This issue brief examines a variety of strategies that states can employ to ease coverage transitions and help keep people insured at all times.
 

This survey is the first in a series of Kaiser Family Foundation surveys taking a closer look at the entire non-group market. This first survey was conducted from early April to early May 2014, after the close of the first ACA open enrollment period. It reports the views and experience of all non-group enrollees, including those with coverage obtained both inside and outside the Exchanges, and those who were uninsured prior to the ACA as well as those who had a previous source of coverage (non-group or otherwise). The survey found that nearly six in ten Exchange enrollees were previously uninsured, and the majority of non-group enrollees give positive ratings to their new insurance plans and the value of those plans.
 

Safety net hospitals rely on disproportionate-share hospital (DSH) payments to help cover uncompensated care costs and underpayments by Medicaid. The ACA anticipates that insurance expansion will increase safety net hospitals’ revenues and will reduce DSH payments accordingly. This study examines the impact of the ACA’s Medicaid DSH reductions on California public hospitals’ financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions. The researchers found that decreases in uncompensated care costs resulting from the ACA insurance expansion may not match the DSH reductions because of the high number of people who will remain uninsured, low Medicaid reimbursement rates, and medical cost inflation.