This report from the Center for Health System Change examines the health care markets in six regions in California -Fresno, Los Angeles, Riverside/San Bernardino, Sacramento, San Diego, and the San Francisco Bay Area — to highlight variations in health care affordability, access, and quality of care across the state. The report was funded by the California HealthCare Foundation.

One issue examined across all six regions is the status of community safety-net systems. Under the federal Patient Protection and Affordable Care Act (ACA), large numbers of Californians will become eligible for Medicaid in 2014. Even with federal resources to help safety-net providers prepare, however, communities with weaker safety-net systems are lagging in reform preparations.

As a result, low-income people in those communities may be left without health coverage and timely access to health care services. Even well-prepared regions will need time and assistance to help people gain health care coverage.

Key findings from this regional study of safety-net providers include:

  • Almost all safety-net providers in the study reported concerns about sufficient funding and workforce to care for newly insured people and for those who remain uninsured.
  • Safety-net providers are bracing for potential competition for insured patients from other providers and a consequent reduction in revenue.
  • As federal and state policymakers launch Medicaid (Medi-Cal) expansion and the health insurance marketplace (Covered California), they may wish to coordinate with community safety-net leaders to focus resources and assistance to those communities that are further behind in preparing for national reform.

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