Examining the Impacts of the Affordable Care Act on Safety Net Hospitals

Prepared for
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Doctor and nurse with patient on a stretcher by an ambulance

The Affordable Care Act (ACA) will have profound effects on the health care system in the United States, including the nation’s safety net hospitals that provide health services to many low-income uninsured people, Medicaid enrollees, and other vulnerable populations. It is essential to understand how the ACA will affect the ability of safety net hospitals to continue serving their communities.

Mathematica is conducting on-the-ground assessment—primarily through case studies—to help ASPE understand the extent and nature of early changes in safety net hospital utilization, services, and financial viability as a result of the ACA and other changes in the health care system. In 2014, our researchers are conducting case studies of six safety net hospitals.

We are also constructing a quantitative database on all safety net hospitals in the United States, combining data from various sources, such as the American Hospital Association annual survey, Healthcare Cost and Utilization Project, Medicare cost reports, and Hospital Compare data. This information can be used to estimate the effect of ACA coverage expansions and other policy changes on safety net hospitals’ utilization and financial performance, and as a resource for tracking changes in safety net hospitals in the future.