N Engl J Med. 2013 Sep 18. [Epub ahead of print]
State Politics and the Fate of the Safety Net.
Source
From the Department of Family Medicine, University of California, Los Angeles, Los Angeles (K.N.); the Spivey/Harris Health Policy Group, Washington, DC (M.S.); and Public Health Systems and Preparedness, RAND, Arlington, VA (A.L.K.).
Abstract
Only 2% of acute care hospitals nationwide are safety-net facilities, but they provide 20% of uncompensated care to the uninsured. Because most are in low-income communities, they typically generate scant revenue from privately insured patients. The Medicaid Disproportionate Share Hospital (DSH) program was established to help defray their costs for uncompensated care.1 Currently, Medicaid DSH disburses $11.5 billion annually to the states, which have considerable latitude in allocating these funds. Some states carefully target their DSH payments to hospitals providing large volumes of uncompensated care, but others, such as Ohio and Georgia, spread their payments broadly, transforming the program into . . .
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