The Alliance of Safety-Net Hospitals has operated in various forms since 1993, when it was launched as the National Association of Urban Critical Access Hospitals by hospital executives who recognized that non-profit urban community safety-net hospitals have distinct needs and face unique challenges that deserved their own strong, united voice in the policy deliberations that affect such providers in Washington, D.C.

Years of experience in public policy advocacy demonstrated to them that community safety-net hospitals face common challenges regardless of where they are located, so over the past 30 years the organization evolved and changed names amid growing recognition that compounding these challenges were issues such as health equity, a growing emphasis on social determinants of health, and the need to respond to entirely new medical and policy challenges raised by a pandemic of unprecedented proportions.

Amid this evolution, ASH’s mission remains steadfast:  to advocate adequate support and financing, primarily through Medicare and Medicaid, for the community safety-net hospitals that serve America’s neediest communities.

The U.S. today has a vast, multi-part health care safety net of which community safety-net hospitals are a vital part as the primary providers of care for many uninsured, under-insured, low-income, and Medicare- and Medicaid-dependent residents of the communities in which they are located. Without them, millions of Americans would have limited access to quality, accessible, equitable care.

Community safety-net hospitals benefit the entire nation. Many have teaching programs through which they train our next generation of physicians; some are deeply involved in medical research; others serve as laboratories for exploring new and better ways of caring equitably for people who have fallen through the health care safety net’s web – often doing so at their own expense for no reason other than that such efforts are desperately needed.

Community safety-net hospitals often operate in areas that the health care market has otherwise abandoned, providing equitable access to care to the low-income residents of those communities. These hospitals routinely provide money-losing services – maternity and neonatal intensive care, behavioral health and substance use services, care for AIDS patients, burn and trauma services, and more – for the simple reason that their communities need these services and no one else is willing to provide them.

While caring for disproportionate numbers of low-income and disadvantaged patients, community safety-net hospitals routinely provide services that no payment system recognizes and for which no payment system will compensate them. Their patients benefit greatly from help with transportation and social work services; instruction in nutrition and visits and telephone calls to the homes of pregnant women and post-surgical patients from nurses and other health care professionals; classes on raising children and special programs for low-income seniors; and much more.

Community safety-net hospitals are almost always the economic engines that drive their communities. Often, they are the largest employer in their communities – communities that other businesses have long abandoned for more lucrative markets.

Finally, community safety-net hospitals provide equitable access to care in places where they are one of the only such sources, if not the only one, serving neighbors whose lives and whose health have been shaped by social determinants of health.