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.