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

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

• Threats to entitlement programs. Some policy-makers and advocates are interested in reducing the federal commitment to Medicare and Medicaid.  NASH will work to ensure that any fundamental changes in entitlement programs preserve the ability of private safety-net hospitals to continue meeting the needs of the low-income residents of their communities.
• Changes in beneficial health care reforms. Recent years have seen a number of health policy changes and practices that have greatly benefited private safety-net hospitals and their communities, including extending access to health insurance to many more people.  NASH will work to ensure that future public policy endeavors do not take these communities backwards and reverse the progress they have experienced in recent years.
• The opportunity to participate in new reform programs. In recent years Washington has become a laboratory for testing new health care delivery and payment systems through mechanisms such as accountable care organizations, alternative payment models, value-based purchasing initiatives, and others.  Often, private safety-net hospitals have found themselves excluded from these new undertakings.  NASH will work to ensure that policy-makers understand the needs of the communities private safety-net hospitals serve and understand the value and importance of giving such hospitals a fair opportunity to participate in these new ventures.
• Threatened loss of Medicare DSH funding. For years NASH has worked to ensure an equitable distribution of Medicare DSH money that fairly reflects the special role private safety-net hospitals play as providers of last resort in their communities.  This challenge remains, and NASH will continue to work  with policy-makers to ensure that their methodology for distributing Medicare DSH funds meets this essential objective.
• Threatened loss of Medicaid DSH funding. NASH has been at the forefront of successful efforts to delay the implementation of a congressional requirement to reduce Medicaid DSH funding to states.  That reduction is now scheduled to take effect in 2020, and NASH will work vigorously to ensure that the federal government continues to provide appropriate support for hospitals that serve communities with especially large numbers of low-income patients.
• The need to cultivate public policies that better reflect the distinct communities private safety-net hospitals serve. Because of the socio-economic obstacles many of their patients encounter, private 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.  NASH will continue to work to shape public policies that address these social determinants of health; to advocate the use of risk adjustment of quality and value-based government service delivery and reimbursement programs to reflect these special challenges; and to convey to public officials how government health care policies can better support private safety-net hospitals in the work they do serving their communities.