Looking at Comprehensive Safety Nets in Seven Communities

Analyzing access to care and the cost of care and looking at the role of safety nets in health reform

Dates of Project: May 2009 through July 2012

Field of Work: Examining effective health care safety nets

Problem Synopsis: Many more Americans will gain access to insurance under the Patient Protection and Affordable Care Act (ACA), but millions will remain uninsured, and thus in need of a safety net. Yet studies of well-functioning safety nets are rare.

Synopsis of the Work: The researchers examined model health care safety nets that provided uninsured low-income residents with access to a range of medical services, with at least some coordination through a primary care medical home. The communities included Asheville, N.C.; Boston; Denver; Exeter and Portsmouth, N.H.; Flint, Mich.; south coastal Maine; and San Antonio.

Key Findings

  • In five communities with a coordinated safety net offering primary care, hospital care, prescription drugs, and most specialist services, participants had access to care comparable to that of insured residents. The communities were Ashville, Boston, Denver, Flint, and San Antonio.

  • In 2008, the average cost of care per member per month in four communities—Asheville, Flint, Denver and San Antonio—was 25 to 50 percent less than the average cost of providing similar services through Medicaid and private insurance.

  • The nation could achieve near-universal coverage by combining safety-net programs with expanded public and private insurance under the ACA. However, organizations that provide safety-net care will need to adapt to the needs of the remaining uninsured U.S. residents.

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