Safety-net providers and preparation for health reform: staff down, staff up, staff differently.

A LTHOUGH THE PATIENT PROTECTION AND Affordable Care Act (ACA) was passed in 2010, the major expansion of health insurance promulgated by the bill does not occur until 2014. At that time an estimated 23 million uninsured Americans with incomes below 133% of the federal poverty level will gain Medicaid. An additional 17 million persons will be eligible for subsidized coverage under a health insurance exchange, some of whom currently have private coverage. An estimated 24 million persons will remain uninsured, including undocumented persons. Of the various health care providers, safety-net providers will be the most affected by the health coverage expansion because they are the major providers of care for the uninsured. Safety-net providers are those that serve a disproportionate number of uninsured and publicly insured Medicaid patients. In most communities the major safety-net providers are public hospitals and clinics, private nonprofit community health centers, and hospitals in low-income neighborhoods.