December 3, 2009

America's Safety Net and Health Care Reform - What Lies Ahead?

This brief was written by Irwin Redlener, M.D., Mailman School of Public Health, Columbia University, Children's Health Fund, and Roy Grant, M.A, Children's Health Fund. To say that the current U.S. health care system is a dysfunctional and costly patchwork of employer-based insurance, private markets, public programs, and special initiatives is an understatement. Fortunately, recognition of this reality has at last made major reform of the system not only inevitable, but imminent. Even without knowing the final details of the bill that will make its way to President Barack Obama's desk, one can assume that it will make affordable insurance coverage available and required for many, but not all, of the 45 million people who are currently uninsured. But what will happen to Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) - safety-net programs that serve some 100 million Americans? The idea behind safety-net programs is to ensure that, regardless of social or economic conditions, no citizen's access to essential services falls below a certain level. Today's health care safety net is a complex array of entitlements, specialty services, hospital-based programs, and emergency services that is designed to facilitate access to vital health care for many medically underserved, uninsured, or underinsured persons.