Strategies in Four Safety-Net Hospitals to Adapt to the ACA

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.