2023 Advocacy Agenda

Why Join ASH

  • ASH has represented the federal policy interests of community safety-net hospitals since 1993.
  • ASH advocates on behalf of the needs of these hospitals before Congress and the administration.
  • ASH focuses exclusively on the interests of community safety-net hospitals.
  • ASH is the only organization for which the interests of community safety-net hospitals is its one and only priority.

ASH’s Accomplishments

  • ASH has helped define community safety-net hospitals as a distinct group of hospitals among federal policy-makers.
  • ASH has overcome the conventional wisdom that only public hospitals serve meaningful numbers of low-income patients and deserve special consideration in federal reimbursement policies for that reason.
  • ASH has preserved Medicare and Medicaid reimbursement to community safety-net hospitals and helped prevent billions in cuts in such payments.
  • ASH hospitals have long been leaders in health equity efforts and continue to advocate workable public policy changes that will meet the needs of people and communities whose lives and health have been affected by various social determinants of health.

How Ash Operates

  • ASH has excellent relationships with key officials in both political parties.
  • ASH focuses on the public policy aspects of the positions it advocates.
  • ASH’s policy priorities and positions are strictly member-driven.
  • ASH supports its positions with extensive data that over the years has given the group great credibility among public officials.


Some of the challenges facing community safety-net hospitals have been constant over the years while others have changed based on changing policy and political climates.  ASH envisions the following matters demanding most of its attention in the next few years:

  • The need to cultivate public policies that promote health equity and equitable access to care in  the distinct communities private safety-net hospitals serve.  Because of the social determinants of health that confront many of their patients, community safety-net hospitals face challenges most hospitals cannot imagine.  Often, their patients come to them with more complex medical problems and fewer financial and community supports with which to tackle them.  ASH will continue to work to shape public policies that address these social determinants of health; to advocate health equity and equitable access to care; and to convey to public officials how federal policies can better support community safety-net hospitals in the work they do.
  • Threats to entitlement programs.  Some policy-makers and advocates seek to reduce the federal commitment to Medicare and Medicaid.  ASH will work to ensure that any fundamental changes in entitlement programs preserve the ability of community safety-net hospitals to continue meeting the needs of the low-income residents of their communities.
  • Changes in beneficial health care policies.  Recent years have seen a number of policy changes that have greatly benefited communities challenged by disproportionate numbers of low-income, medically vulnerable, and disadvantaged residents, including extending access to health insurance to many more people.  ASH will work to ensure that future policy endeavors do not take these communities backwards and reverse the progress they have experienced in recent years.