In the absence of universal health insurance coverage, large numbers of low-income or disadvantaged Americans rely on safety net providers. The Robert Wood Johnson Foundation's safety net grantmaking has aimed at expanding access to health. This chapter sketches three types of initiatives: expanding ambulatory care, strengthening volunteerism and improving services for homeless people. The author argues that the Foundation has put forth an impressive array of initiatives in order to attack nagging problems of inadequate, poor quality, or inefficient health care for the nation's most vulnerable populations, but it has never consistently coordinated these programs under a grand strategy. Historically, the Foundation has had to adapt to the diminishing prospect of a national health insurance plan. At the same time it has had to face the dilemma that improving safety net care gives comfort to those who argue against universal health care coverage.