Health Care Safety-Net Toolkit for Legislators


Toolkit CoverHealth Care Safety-Net Toolkit for Legislators publication provides information on issues such as payment reform, primary care workforce, Medicaid and safety net, oral health, community health centers.

Payment Reform

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Two of the most important and challenging health care issues for state policymakers are improving patient care and, at the same time, controlling escalating costs. According to the Centers for Medicare and Medicaid Services (CMS), health care spending grew 3.9 percent from 2010 to 2011. Yet Americans are not healthier—the incidence of chronic disease continues to grow.

These statistics lead policymakers to ask, “What are we paying for?” Unfortunately, the answer often is, “Not the health system we want.” How health care is paid for affects how it is delivered. This brief explores how states can leverage their market power as a purchaser of health care services to create payment methods that may simultaneously contain costs and improve care.

Primary Care Workforce

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The primary care workforce delivers essential primary and preventive health care to a population that is increasingly demanding these services. Access to appropriate primary care services is important to maintaining and improving health. Those who obtain regular primary care receive more preventive services, are more likely to comply with their prescribed treatments, and have lower rates of illness and premature death, according to research. Effective primary care is comprehensive, coordinated, timely, and patient-centered and can result in better health for the patient, fewer avoidable hospitalizations and emergency room visits and lower costs.

Mom and son at the doctors office photoMedicaid and the Safety Net

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The health care safety net refers to the providers and payers that ensure people who do not have access to traditional coverage options—such as employer-sponsored insurance or an insurance product sold on the individual market—are able to access the health care they need. Medicaid plays multiple roles in the health care safety net, including as an important source of financing for safety-net  providers, a coverage option for vulnerable populations, and as a mechanism for policymakers to develop new payment and delivery system models. Medicaid currently covers approximately 20 percent of Americans.

Doctor and nurse photoChronic Disease Prevention and Management

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Chronic diseases are among the most prevalent and costly health conditions in the United States. Nearly half of Americans suffer from at least one chronic condition, and the number is growing. Chronic diseases—such as cancer, diabetes, hypertension, stroke, heart disease, respiratory diseases, arthritis, obesity, and oral diseases—can lead to hospitalization, long-term disability, reduced quality of life and, often, death. In fact, such persistent conditions are the nation’s leading causes of death and disability.

Girl at the dentist office photoOral Health

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Good oral health is key to good overall health, yet millions of Americans lack access to basic, affordable oral health care. Largely preventable, poor oral health can negatively impact quality of life by affecting speech, nutrition, growth and social development. Growing evidence links oral diseases to health conditions such as diabetes, heart and lung disease, and potential pregnancy complications.

Nurse and kid photoCommunity Health Centers

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Federally Qualified Health Centers (FQHCs), also known as “health centers,” are community-based, nonprofit or public organizations that provide services to people who lack access to health care, including those without insurance, residents of rural and underserved areas, and Medicaid patients. These services are available to all people, regardless of their ability to pay. Health centers include community health centers, migrant health centers, health care for the homeless health centers and public housing primary care centers.

For more information please contact the Health Program.