The journal Health Affairs has put together a special issue in the wake of the Supreme Court upholding the Affordable Care Act, looking specifically at hospitals that service the impoverished and the uninsured. These hospitals have been doing surprisingly well for themselves.

With these hospitals poised to accept the bulk of the newly-insured under the act, their current performance has become a topic of debate, but it seems they might not have been doing as poorly as is commonly thought.


In key areas, such as treating Medicare patients with acute myocardial infarction, heart failure, or pneumonia, the safety-net hospitals stood equal with the more affluent ones. In fact, the rate difference between the two types was broadly less than 1%, proving that just because a hospital works with an underserved community, it doesn't have to offer subpar care.

Another study showed that prior to the current depression, many safety-net hospitals thrived and maintained profitability — especially those controlled directly by elected officials in competitive markets.

This seems to have been due to local government support for the institutions, such as such as property tax transfers or extra Medicaid payments. However, the recession has put a major dampener on these sources, and the banner of deficit reduction has caused support for safety-net hospitals to shrink. With the threat of significant higher patient load from the Affordable Care Act, these hospitals now need to significantly alter the business side of the equation to stay afloat.


The Affordable Care Act will mean that millions of more people will now be insured and have access to greater healthcare and a better quality of life. It remains to be seen how the medical field will adapt to so many new patients arriving at once.