Health Reform Holds Both Risks And Rewards For Safety-Net Providers And Racially And Ethnically Diverse Patients

Abstract

The Affordable Care Act of 2010 creates both opportunities and risks for safety-net providers in caring for low-income, diverse patients. New funding for health centers; support for coordinated, patient-centered care; and expansion of the primary care workforce are some of the opportunities that potentially strengthen the safety net. However, declining payments to safety-net hospitals, existing financial hardships, and shifts in the health care marketplace may intensify competition, thwart the ability to innovate, and endanger the financial viability of safety-net providers. Support of state and local governments, as well as philanthropies, will be crucial to helping safety-net providers transition to the new health care environment and to preventing the unintended erosion of the safety net for racially and ethnically diverse populations.

Improving access to health care for undocumented immigrants in the United States

“…12 The ACA has also added substantial new resources to the CHC network which will expand their capacity. 13 California has a larger share of immigrants than any other state, with an estimated 10 million residents who were born abroad. Over 4 million California residents are Mexican immigrants; an estimated 2.7 million of them are undocumented.…”

Neighborhood Socioeconomic Status and Primary Health Care: Usual Points of Access and Temporal Trends in a Major US Urban Area

“…16,74,75 Notwithstanding the $11 billion the ACA committed for CHC expansion over 2010-2015, 34 the continuing financial challenges faced by safety-net providers may compromise access in low-income communities and undermine the quality of care by thwarting these institutions' ability to innovate in service delivery, improve quality, and participate in accountable care organizations. 35,36,76 Bolstering the financial viability of safety-net providers via such key mechanisms as ensuring adequate federal funding for CHCs as well as reforming Medicaid payments, which together make nearly 80 % of these facilities' revenue, 16 will be critical for securing more equitable health care for disadvantaged communities. 77,78 More broadly, several relevant empirical questions remain key to understanding the mechanisms linking neighborhood socioeconomic conditions and access to health care.…”

“…Several ACA provisions seek to improve primary care access and delivery, such as by increasing the primary care workforce, expanding community health centers, encouraging the formation of accountable care organizations, and promoting changes in provider payments and incentives. 34 The effectiveness of these provisions will likely vary across areas of different SES, given baseline variations in provider supply and capacity 35,36 and in community demographic characteristics and social organization. 37 In this study, we used time-series cross-sectional data from the Philadelphia region to (1) estimate the associations of neighborhood SES with self-reported access to usual sources of care, after adjusting for individual and area-level factors known to be associated with access; and (2) assess whether these associations varied over the decade of 2002-2012.…”

Clinic Workload, the Quality of Staff Relationships and Diabetes Management in Community Health Centers Catering to Latino and Chinese Patients

“…Some of the most innovative healthcare delivery transformations of the ACA will be implemented in CHCs [18]. New programs under the ACA aim to support coordinated, patient-centered care and expansion of the primary care workforce for CHC patients [2]. Future research should assess whether specific workplace climate factors, such as QSR and MCW predict CHC resilience to major ACA transitions.…”