Safety net in the era of health reform: a new vision of care.

The collection of services and providers that making up the safety net system plays a crucial role in providing health care to the nearly 50 million uninsured adults and children nationwide (Kaiser Commission on Medicaid and the Uninsured 2011a). Passage of the Patient Protection and Affordable Care Act (ACA) presents both opportunities and significant challenges for this system. The health reform law will extend health insurance coverage to more than 30 million individuals by 2014. At the same time, it will invest significantly in building provider and clinic capacity, as well as in more coordinated and integrated care delivery systems (Summer 2011). This influx of patients will place increased demands on a system that is already experiencing capacity, financial, and workforce stressors. This issue brief focuses on some of the daily challenges facing the safety net, as well as new challenges and opportunities that will emerge as health reform unfolds. Philanthropy has long supported many aspects of the safety net, including developing the business and clinical structure and infrastructure, such as health information technology and strengthening the primary care and paraprofessional workforce. Philanthropy has also helped increase the capacity of community clinics and other safety net providers and expand the services associated with patient-centered care models to include translation, transportation, health literacy support, and community prevention. This paper highlights some of these efforts, and outlines areas of opportunity for funder investment in the safety net in this era of health reform.