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Evolving Picture of Nine Safety-Net Hospitals: Implications of the ACA and Other Strategies

Safety-net hospitals are an integral part of the U.S. health care landscape, providing care to some of the nation’s most medically vulnerable populations, including Medicaid enrollees and the uninsured. With the implementation of the Affordable Care Act (ACA), the U.S. health care system is rapidly changing, and safety-net hospitals need to make major adjustments to survive in the post-reform environment. This brief draws on interviews with executives at nine safety-net hospital systems and examines how their hospitals have fared since major coverage provisions of the ACA came into effect in January 2014. The brief also examines new and ongoing strategies that the hospitals are adopting in the face of a quickly changing health care environment. While acknowledging the importance of the ACA, executives at each system in the study noted that other non-ACA related factors have also shaped how their hospitals fared over the last year. The hospitals in the study were: Cook County Health and Hospital System (CCHHS); Denver Health (Denver Health); Harris Health System (Harris Health); New York City Health and Hospitals Corporation (HHC); Parkland Health and Hospital System (Parkland); Santa Clara Valley Health and Hospital System (SCVHHS); San Francisco General Hospital (SFGH); University Medical Center of Southern Nevada (UMC), and Virginia Commonwealth University Health System (VCU). These hospitals participated in two earlier related studies that examined how the systems were preparing for health care reform.

How Are Hospitals Faring Under the Affordable Care Act? Early Experiences from Ascension Health

Expanded health insurance coverage through the Affordable Care Act (ACA) is having a major impact on many of the nation’s hospitals through increases in the demand for care, increased patient revenues, and lower uncompensated care costs for the uninsured. This report examines the early experiences with the ACA by Ascension Health, the delivery subsidiary of the nation’s largest not-for-profit health system, Ascension. It finds that, overall, Ascension hospitals in Medicaid expansion states saw increased Medicaid discharges, increased Medicaid revenue, and decreased cost of care for the poor, while hospitals in non-expansion states saw a very small increase in Medicaid discharges, a decline in Medicaid revenue, and growth in cost of care to the poor.

Medicaid Expansion, Health Coverage, and Spending: An Update for the 21 States That Have Not Expanded Eligibility

Ever since the Supreme Court ruled in June 2012 that states could effectively choose whether or not to accept the Affordable Care Act’s expansion of Medicaid eligibility, that choice has been one of the most prominent and often one of the most contentious issues for states. In this report, we provide new projections of the impact of Medicaid expansion on health coverage, Medicaid enrollment, and costs in states that have not expanded Medicaid.

JAMA Forum: Those Pesky Lines Around States

In this post for The JAMA Forum, the Kaiser Family Foundation’s Larry Levitt discusses the concept of allowing insurers to sell health plans across state lines and how such a proposal could affect people with pre-existing conditions.

Americans’ Health Priorities Diverge From Washington’s Focus on Obamacare

In his latest column for The Wall Street Journal’s Think Tank, Drew Altman finds the public’s health-care priorities have more to do with drug costs and other real-world issues people deal with using the health-care system than the ongoing partisan wrangling over the Affordable Care Act. All previous columns by Drew Altman are available…

Briefing on the ACA in CA: Year One & Beyond

Continuing an effort to explore Affordable Care Act (ACA) implementation in the states, the Kaiser Family Foundation and the Blue Shield of California Foundation examined ACA implementation in California (CA) at a Sacramento, Calif. briefing and panel discussion on May 28. A state official, experts and advocates discussed issues and challenges related to implementation of the law, and the practical impact of providing coverage to roughly 4.5 million Californians who have coverage via the state marketplace or the Medi-Cal expansion.

Minimum Contraceptive Coverage Requirements Clarified by HHS Guidance

New HHS clarification on ACA contraceptive coverage requirement specifies that insurance plans must cover at no cost to women all of the 18 contraceptive methods approved by the FDA.  If a provider recommends a specific option or product, plans must cover it at no cost as well. Minimum Contraceptive Coverage…

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.