[5] The presence of philanthropic medical institutions during the 19th century pre-date the modern American safety net hospital.
[11] Additionally, there tends to be a lack of socioeconomic development and a lack of health care providers (both general and specialized) in the geographical regions where safety net hospitals tend to be located; this observation is made by Waitzkin and he refers to these facts as part of the social and structural "contradictions" that safety net hospitals face further negatively impact there financial stability and care performance.
[3] Besides, many of the level I trauma centers are within safety net hospitals and their financial stability is highly affected by policy changes.
These payments are intended to improve access for Medicaid recipients and uninsured patients, as well as to shore up the financial stability of safety-net hospitals.
[14] This was built into the law under the assumption that the amount of uncompensated care would decline substantially under the ACA due to expanded coverage.
[14] An additional issue with Obamacare and safety net hospitals arises from the coverage gap for those who have too high of an income to qualify for Medicaid but have too low of an income to afford a private plan; it is projected that even with the implementation of the health care law in 2016, roughly 30 million people are still expected to be without insurance coverage[15][16] and find service in safety net hospitals.
Another issue revolves around the fact that hospitals are required to provide care for patients in the emergency department, even if the person cannot pay or is an illegal immigrant.
[9] The American Health Care Act of 2017 (AHCA), if passed, would have repealed part of the Patient Protection and Affordable Care Act in such that it would have cut Medicaid coverage for lower-income Americans and effectively stopped ACA's Medicaid expansion, which was projected to result in loss of coverage for 24 million people by 2026.
[17][18] In addition, it would have placed a limit on federal funding that states could receive to cover health insurance to millions of low-income patients.
[19][21] This was expected to directly impact safety net hospitals because of increases in the number of patients without insurance and decreased financial support from the federal government.
[21][22] The aforementioned proposed act was criticized for its potential to increase financial burdens and operational constraints on both patients and safety net hospitals.
They must also adjust service fees to patient capacity to pay, have an ongoing qualify assurance program, and have a governing board of directors.
[26] Community Health Centers are clinics with a mission to provide care to low-income populations regardless of their ability to pay.
[30][10] In response to these critiques, some safety net hospitals have begun to offer customer service trainings, conduct employee evaluations and advocate for policy changes that could improve the patient experience.