The Institute of Medicine defines the health care safety net as: “Those providers that organize
and deliver a significant level of health care and other related services to uninsured, Medicaid,
and other vulnerable populations” (IOM, America’s Health Care Safety Net: Intact but
Endangered, 2000).
The Institute of Medicine further defines “core safety net providers” as having: 1. “legal mandate
or explicitly adopted mission, they maintain and ‘open door’ [policy], offering patients access
to services regardless of their ability to pay;” and 2. a “substantial share of their patient mix [that]
is uninsured, Medicaid, and [members of] other vulnerable populations.” (IOM)
The National Association of Public Hospitals and Health Systems (NAPH) adds that “they
(the health care safety net) are distinguished by their commitment to provide access to care for
people with limited or no access to health care due to their financial circumstances, insurance status,
or health condition” (NAPH, What is a Safety Net Hospital?).
Why do we need the Health Care Safety Net? Millions of Americans remain uninsured following
the implementation of the Affordable Care Act. Some are exempt from the individual mandate and
others find health insurance unaffordable and choose to pay a penalty. Kaiser Family Foundation
reports low-income working families make up over 40% of the remaining uninsured.
Even under the Affordable Care Act (ACA), many uninsured people cite the high cost of insurance as the main reason they lack coverage. In 2016,
45% of uninsured adults said that they remained uninsured because the cost of coverage was too high. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage. Some people who are eligible for financial assistance under the ACA may not know they can get help, and undocumented immigrants are ineligible for Medicaid or Marketplace coverage. (www.kff.org)
Despite the passage of the federal health reform legislation, an estimated 20 million people will likely remain uninsured and reliant on
safety net care, making the efficacy of the nation’s health care safety net a vital issue for policy-makers and health care advocates. (www.rwj.org)
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