Health Care Safety Net in Iowa Post-Health Care Reform

Insurance expansion and other provisions of the Patient Protection and Affordable Care Act (ACA) has the potential to significantly alter the financing and patient populations of the health care safety net. This study is one of four projects funded by The Commonwealth Fund (i.e., Harvard, Rand and the National Academy for State Health Policy) assessing the impact of the ACA on the safety net. This project is using Iowa as a laboratory to evaluate the potential impacts of the ACA on states and identifying opportunities for integration and coordination of safety net providers and payers into the rest of the health care delivery system. The Wellmark Foundation has also contributed support for this project.

The primary objectives of this study are to:

  1. Inventory the current funding, expenditures, and infrastructure of the health care safety net at the state level, using Iowa as an example.
  2. Evaluate the potential implications of the ACA on funding, expenditures and capacity of the safety net.
  3. Develop and evaluate strategies for improving integration and coordination of safety net providers and organizations within the health care delivery system such as community care teams and Accountable Care Organizations (ACOs).

This project is emphasizing the impact of the ACA on the primary care safety net; for this study it is defined as:

  • Providers-primary care safety net:
    • Federally Qualified Health Centers (FQHCs), Rural Health Clinics, Title X funded Family Planning Clinics, Free Clinics, and Adult community-based mental health
  • Payers-primary care safety net:
    • Medicaid, Children's Health Insurance Program (CHIP), Medicare, Ryan White, IowaCare
  • Other services-primary care safety net
    • Oral health, public health and other block grants, uninsured

The project is being guided by state and national experts in the field including:

The four phases  incorporate background research, analysis of the ACA law and associated implementation, analysis of the gaps in knowledge, an assessment of the impact of the law on the safety net funding and delivery of services, and identification of opportunities for integration and coordination with the private sector.

These activities will help provide policymakers and providers in Iowa and other states with information concerning the impact of the ACA on the health care safety net and best practice models to integrate safety net services efficiently and effectively into the overall health care delivery system.

Additional support for this project has been provided by the Wellmark Foundation, NASHP and the Dentaquest Foundation.

Inventory reports on the safety net providers and payers in Iowa is posted on this web site (on top right area of this website).

If you have questions or comments about the project, please contact Peter Damiano: