Strategies in 4 Safety-Net Hospitals to Adapt to the ACA

Conclusion

This study has reviewed the major opportunities and challenges four safety-net hospitals were facing in adapting to changes under the ACA, as well as strategies to be better positioned to meet these challenges. Reflecting the diversity of safety-net hospitals’ situations across the country, study hospitals varied in both the intensity of effort and their availability of resources to adapt for health reform. SCVMC has taken a robust approach to its ACA preparations, which have included employing financial strategies, undertaking significant organizational changes, forging new relationships with community-based providers, and moving ahead with infrastructure improvements. Leading up to ACA implementation, SCVMC, Cook County HHS, and Harris Health all benefit from Section 1115 waivers that are supporting system transformation. Constrained financial resources and a highly competitive market in Las Vegas that is resistant to collaborative efforts, have strained UMC’s health reform preparations. However, the challenges are greater for Harris Health, given that Texas is not moving forward with the Medicaid expansion.

Even after full implementation of the ACA, the study hospitals, as well as other safety-net hospitals across the country, are expected to continue to serve a critical role in their communities in caring for uninsured and underinsured populations including undocumented immigrants who are not eligible for Medicaid and other coverage options in the ACA. Safety-net hospitals are also important as providers of core services for the entire community that are not available elsewhere (e.g., trauma and burn care services). So while these and other safety-net hospitals must adopt new strategies to thrive under reform, policy makers at the federal, state and local levels of government will need to monitor and evaluate how safety-net hospitals are faring as the ACA is implemented to ensure that the safety-net is sustainable for vulnerable populations and for broader community needs. We will also continue to track safety-net hospitals across the country as health reform is fully implemented to identify successful strategies hospitals are using to adapt to the changing health coverage environment and to better understand how they and the populations they serve are faring in the post-reform world.