An ‘open door’ for the vulnerable
Even after reform is in place, need for safety net providers will be great
Afrequently asked question in health reform discussions is, “Will there still be a need for the healthcare safety net?” This is an interesting question for several reasons. First, it reflects the belief that healthcare safety net providers’ prime role is to care for uninsured patients who cannot access care elsewhere. This belief conforms to the Institute of Medicine’s definition of the core safety net: “Those institutions who by legal mandate or explicitly adopted mission maintain an ‘open door’ offering access to services to patients regardless of their ability to pay.”
Public hospitals and community health centers fit this definition as the patients they serve are often uninsured. About 18% of public hospital admissions are uninsured patients, reaching more than 50% in some hospitals. And uninsured patients constitute 31% of outpatient visits, climbing to more than 60% of visits in some hospitals. With the recession, Denver Health’s uninsured care increased from $275 million in 2007 to $389 million in 2010. The National Association of Public ity and providing premium subsidies would eliminate or markedly decrease the number of uninsured and the need for these institutions. However, even the most optimistic estimates predict that 23 million people will remain uninsured, including many of the most vulnerable, such as the chronically mentally ill, substance abusers and the homeless—who are unlikely ever to enroll in a plan—as well as an estimated 11 million undocumented immigrants. The uninsured population may be larger if there is no individual mandate or if the penalties for failure to enroll are small compared with the cost of subsidized premiums.
The second interesting aspect about questioning the future of the safety net is the assumption that other providers want to or can effectively care for the poor and socially disenfranchised even if they are insured. Medicaid provider data may