Most of us believe that there is a backstop out there – that some wonderful, saintly, infallible and unshakable organization, clinic, or do-gooder is in place to ultimately take care of people who are left out. More outspoken purveyors of this thinking such as Mississippi Governor Phil Bryant will even go as far as to assert that “there is no one who doesn’t have health care in America. No one.” While there is a small grain of truth to this statement, it is largely an oversimplified fantasy and poor substitute for reality. In fact, the job of providing delayed and expensive treatment for the vulnerable falls to a network of tenuously supported providers known collectively as the safety net, and things in that part of the system aren’t so healthy themselves.

Large holes have been blown through Arizona’s health care safety net – the network of health care facilities and providers primarily serving the uninsured, underinsured and Medicaid recipients either by legal mandate or by dint of their stated mission. They result from specific consequences driven by a simple truth that would sink any system or industry: demand for services is up considerably at exactly the same time that funding and capacity for providing them is down significantly. A tsunami-like wave of uncompensated care costs has battered providers overall, and safety net providers in particular. That wave isn’t far from overwhelming some facilities and providers entirely to the point of closing down – particularly in rural areas of the state.

SLHI’s forthcoming report titled Re-Knitting the Safety Net will tell the story in much more detail: where we started, how we got to this point, where the risks lie, and how we can begin the work of creating new possibilities. Suffice it to say that an important first step lies in adopting the Governor’s proposal for Medicaid expansion. Doing so promises to stem and even reverse the wave of uncompensated care from overwhelming Arizona safety net structures and leaving a significant human toll in its wake.