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children, health insurance, safety net, uncompensated care



  1. Cousineau, Michael R. DrPH
  2. Farias, Albert J. MPH


The role of the safety net has been debated in various proposals for healthcare reform in the United States. Yet little is known about how health coverage expansion affects the use of safety net services. This study uses data from Los Angeles County to analyze how the expansion of health insurance for low-income uninsured children has affected their utilization of ambulatory care services in safety net hospitals and health centers. In the Los Angeles Healthy Kids program, 40 000 mostly immigrant children ineligible for State Children's Health Insurance Program or Medicaid, were enrolled in a new insurance program called Healthy Kids. Coverage expansion was associated with a decrease in the utilization of pediatric services in two county-funded programs for the uninsured: directly operated healthcare services and private contracted programs. Thus, coverage expansion may have saved more than $37 million in compensated care for children. For public hospitals and other safety net clinics, these data and previous studies suggest that insurance not only improves access but also reconfigures where people get care. It also helps reduce uncompensated care and provides new avenues to support and stabilize the healthcare safety net. These data suggest that a state or jointly funded insurance expansion will help offset the growing burden of uncompensated care among safety net providers while improving utilization and health status among children. Universal coverage programs are not only good for children but also help stabilize the fragile healthcare safety net by reducing the demand for uncompensated care at county facilities.