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Pennsylvania’s Safety-Net Hospitals

Pennsylvania's Safety-Net Hospitals

What is the Safety-Net Association of Pennsylvania?

The Safety-Net Association of Pennsylvania (SNAP) is an advocate for private, acute-care hospitals that care for especially high proportions of low-income and medically vulnerable patients. Our mission is to educate policy-makers in Harrisburg about the role, needs, and future of safety-net hospitals in Pennsylvania; to advocate for the communities safety-net hospitals serve; to build consensus to ensure the continued viability of safety-net hospitals; and to advocate vigorously for state health care policies that meet the needs of safety-net hospitals.

What is a safety-net hospital?

A safety-net hospital treats an especially high proportion of Medical Assistance patients and provides the services those patients need most. In SNAP’s view, safety-net hospitals provide more care to Medical Assistance patients than the state-wide average, which is 19.5 percent of inpatient days, plus they also deliver babies and/or provide inpatient behavioral health services – the two most common reasons Medical Assistance recipients are admitted to hospitals. If a hospital does not provide at least one of these two services, it must do even more to be considered a safety-net hospital: at least 25 percent of its inpatient days must be in service to Medical Assistance patients.

Isn’t this just an issue for hospitals in Philadelphia?

You’d be surprised at the degree to which it isn’t. In fact, there are safety-net hospitals in 24 of Pennsylvania’s 67 counties. While they share the common characteristic of their unusually high level of service to low-income and medically vulnerable patients, they are diverse in many ways: they include community hospitals, teaching hospitals, children’s hospitals, and academic medical centers; they are large, small, and medium-sized hospitals; they are located in urban, suburban, and rural areas; and they can be found in the western, eastern, and central parts of the state.

Why do safety-net hospitals need special advocacy?

Because their situation is special – and very different from that of the typical Pennsylvania hospital. Today, the state pays hospitals less than the cost of the care they provide to their Medical Assistance patients. This means that the more Medical Assistance patients a hospital serves, the more money it loses. Pennsylvania’s safety-net hospitals provide far more care to Medical Assistance patients than other hospitals, and the state’s failure to cover the cost of that care puts many of these hospitals in great financial jeopardy. This situation grows worse as the number of Pennsylvanians enrolled in Medical Assistance grows – and that number has nearly doubled, from 1.5 million to 2.9 million, since SNAP’s founding in 2002. Because of where they are located, moreover, hospitals that care for especially large numbers of Medical Assistance patients also care for especially large numbers of uninsured patients – yet another financial challenge safety-net hospitals must overcome.

Is this any different from what safety-net hospitals face in other states?

Yes – very different. In many other states, the health care safety net consists primarily of public hospitals. Pennsylvania doesn’t have any public hospitals, so safety-net responsibilities have fallen entirely to the private sector. In fact, Pennsylvania is the largest state in the nation with no public hospitals. In those other states, public hospitals receive significant local, county, and state subsidies to support their safety-net activities, but Pennsylvania's private safety-net hospitals do not – and they suffer financially as a result.

What is SNAP doing to help safety-net hospitals?

SNAP is the only advocacy group in Pennsylvania that focuses solely on the interests and needs of safety-net hospitals. SNAP advances the agenda of safety-net hospitals through education, research, and advocacy.

  • SNAP works to ensure that public policy-makers understand the unique challenges that safety-net hospitals face and the importance of preserving these hospitals as the only way of ensuring access to care for all Pennsylvanians.
  • SNAP performs detailed analyses of hospitals and their financial performance that help document and define these special challenges.
  • SNAP offers creative, workable solutions to the problems we identify. Instead of simply asking for help, SNAP develops and advocates politically and financially feasible ways for the state to provide that help.
  • SNAP aggressively advocates the interests of safety-net hospitals and works to build consensus among stakeholders – including government – for policies that will preserve and protect Pennsylvania's health care safety net.