Because the reforms under the Affordable Care Act of 2010 will leave an estimated 20 million or more people still uninsured, some Americans will continue to seek care at low or no cost through existing safety-net systems.
To identify appropriate care models, this comparative case study assessed the costs of care provided by four large, well structured, comprehensive safety-net programs for the uninsured in Colorado, Michigan, North Carolina and Texas. The average monthly resource cost, including the value of referred, donated and in-kind services in these model programs was $141 to $209 per adult in 2008. This was 25 to 50 percent less than the estimated cost of care for comparison groups covered by local Medicaid programs or by private insurance that provided similar services.
Although these programs’ services are somewhat less comprehensive than those of generous insurance plans, the findings suggest that these model safety-net programs could be adapted to provide an alternative type of coverage for the uninsured, including both low-income and middle-class people.