After Health Reform, Safety Net Providers Still Play Crucial Health System Role, Experts Say

Survey Finds Nearly Seven of 10 Health Care Opinion Leaders Believe Affordable Care Act Will Improve Access and Financial Protection for Vulnerable Populations

NEW YORK, August 8, 2011—Nearly all leaders in health and health care policy recently surveyed (98%) believe traditional safety-net providers—including public hospitals, community health centers, and faith-based and mission-driven organizations—will continue to play crucial roles in the U.S. health system after the Affordable Care Act is implemented. Even in the post-reform environment, experts say, these providers will fulfill a critical need by serving individuals who remain uninsured and by being best equipped to meet the special needs of vulnerable populations—for example, providing culturally competent care or translation services. These findings and others are from the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, which asked respondents about the ways in which health care reform can improve care for vulnerable populations—including low-income people, the uninsured, and disadvantaged racial and ethnic minorities.

By broadly expanding Medicaid eligibility and providing subsidies for private insurance, the Affordable Care Act will dramatically reduce the number of Americans without insurance coverage. In addition, the law will establish a standard benefits package that limits costs to patients. When asked about how the law will affect vulnerable populations specifically, nearly seven of 10 health care opinion leaders said it would improve access (68%) and financial protection (67%) for those groups.

In addition to enhancing access and affordability, the new law is designed to improve the quality of care—both within the safety net and across the entire health system. Opinion leaders expressed strong support for strategies designed to improve the quality of care vulnerable populations receive from safety-net providers including ensuring access to services like transportation and translation (86%), facilitating the adoption and spread of patient-centered medical homes (83%), moving toward integrated models of care delivery (82%), and using performance-based payments to make providers more accountable for the care they provide to their communities (74%). There was less support for the adoption and spread of accountable care organizations (47%).

Under the new health care reform law, undocumented immigrants are ineligible for financial assistance and expanded Medicaid coverage. Seventy percent of health care opinion leaders support or strongly support policies that would guarantee access to preventive, primary, and acute care for undocumented immigrants. Only 17 percent of respondents oppose such policies.

“The Affordable Care Act is a major step forward toward our goal of reducing disparities in health and health care for vulnerable populations,” said Commonwealth Fund president Karen Davis. “But, even after the new law is fully implemented, there will be an ongoing need for safety-net providers. Health care leaders recognize that safety-net institutions are a vital part of our health care system and essential to the continued good health and good health care of vulnerable populations.”

Other findings from the survey include:

  • Ninety percent of respondents think the health system is currently unsuccessful in achieving equity overall. About 80 percent think it is unsuccessful in achieving equity in the specific domains of access to care, quality of care, and health outcomes. 
  •  More than eight of 10 leaders support policies that would expand opportunities for scholarships and loan forgiveness for providers who practice in areas with shortages of health professionals and policies that would provide positive incentives—like enhanced payment rates—for providers to serve vulnerable populations.

The survey is the 26th in a series from The Commonwealth Fund, and the 18th conducted in partnership with the publication Modern Healthcare. Commentaries by Patricia Gabow, M.D., the CEO of Denver Health and a member of the Commonwealth Fund Commission on a High Performance Health System, and David N. Sundwall, M.D., a primary care physician and former executive director of the Utah Department of Health, appear in the August 8th issue of Modern Healthcare. The commentaries are also posted on The Commonwealth Fund’s Web site, along with a Commission data brief discussing the survey findings.

Methodology: The Commonwealth Fund/Modern HealthCare Health Care Opinion Leaders Survey was conducted online within the United States by Harris Interactive on behalf of The Commonwealth Fund between June 14, 2011, and July 20, 2011, among 1,246 opinion leaders in health policy and innovators in health care delivery and finance. The final sample included 186 respondents from four sectors: academic/research institutions, health care delivery, business/insurance/other health care industry, and government/labor/consumer advocacy, for a response rate of 14.3 percent. The complete methodology is available on The Commonwealth Fund Web site.

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