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Safety-Net Emergency Departments: A Look at Current Experiences and Challenges

Safety-net hospital emergency departments (EDs) are an important part of our health care system, especially, but not only, for the uninsured and others with low income. With multiple major changes unfolding in our system today, including the development of new models of health care delivery, payment reforms, expanded insurance coverage, and increasing demand for primary care access, safety-net EDs are a sort of crucible in which these shifts and transitions can be seen playing out. To understand more about their current experiences and challenges as the Affordable Care Act (ACA) begins to takes hold, we conducted interviews with ED directors in a convenience sample of 15 safety-net hospitals around the country in June and July 2014.

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The Wisconsin Health Care Landscape

Wisconsin has long been a leader among states in expanding coverage to its low-income residents since even before the major coverage provisions of the Affordable Care Act (ACA) took effect on January 1, 2014. While Governor Scott Walker decided not to adopt the Medicaid expansion, thousands of previously uninsured Wisconsinites…

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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.

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Health Reform Hits Main Street

This short cartoon explains the problems with the current health care system, the health reform changes that are happening now, and the big changes coming in 2014 as part of the Affordable Care Act (ACA). You can view the video on our site and it is also available on YouTube.

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Medicaid and Community Health Centers: The Relationship Between Coverage for Adults and Primary Care Capacity in Medically Underserved Communities

Community health centers play an important role in providing care to uninsured and low-income individuals living in medically underserved communities. They rely on many different revenue sources and, over time, Medicaid has become a central source of funding for most health centers. To better understand how Medicaid influences health center…

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Keeping Coverage Continuous: Smoothing the Path between Medicaid and the Exchange

A key challenge for those implementing the reform law is how to manage churning, when people cycle in and out of public programs as their income varies. What approaches are states and the federal government taking to minimize the disruption from churning? Will people be able to keep their provider…

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Testimony: An Overview of the Medicare Program and Medicare Beneficiaries’ Costs and Service Use

Juliette Cubanski, Associate Director of the Foundation’s Program on Medicare Policy, testified on Feb. 27, 2013 before the Senate Special Committee on Aging to provide an overview of the Medicare program and Medicare beneficiaries’ costs and service utilization.  Testimony (.pdf)

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Today’s Topics In Health Disparities: Is the Health Care System Ready for Health Reform?

On Wednesday, November 4, at 1 p.m. ET, this Today’s Topics In Health Disparities live webcast examined how ready the health care system is for the influx of newly covered individuals that health reform aims to deliver. In the health care proposals being considered by Congress, changes to Medicaid alone…

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The Veterans Health Administration’s Role During the COVID-19 Response

A new issue brief examines the role of the Veterans Health Administration (VHA) during the coronavirus pandemic, and public health emergencies more broadly. The analysis finds that the VHA has provided assistance to 46 states and D.C., including treating over 270 non-veteran patients with coronavirus.

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COVID-19 and Massive Job Losses Will Test the US Health Insurance Safety Net

In this May 2020 post for The JAMA Health Forum, Larry Levitt explores how the massive and rapid job losses of the past few months will test the ACA’s coverage safety net – and how different policies could strengthen or weaken it.

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