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The Affordable Care Act

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The Affordable Care Act completely changed the patient landscape of health care safety nets with its implementation in 2010. In particular, its expansion of Medicaid significantly shifted uninsured patient healthcare provider utilization, from emergency departments and free clinics, towards community health centers and federally qualified health centers. Yet major gaps in healthcare coverage persist due to states choosing not to expand Medicaid, exclusion of undocumented immigrants, and misunderstandings of the ACA. Health care safety net providers must understand their changing demographics and the needs of vulnerable uninsured patient populations. In doing so, healthcare safety net providers will be better informed in regards to necessary changes needed to thrive in the post-ACA era. The enactment of the Affordable Care Act (ACA) has significantly reduced the rate of the uninsured, yet those who do not fit within the parameters of the ACA still face many obstacles in obtaining necessary healthcare. Those without insurance must rely on “locally organized [systems] of health care delivery intended to fill gaps in access to health care services for uninsured… and other vulnerable populations in medically underserved communities” (Liebert and Ameringer 2013)—understood as health care safety nets. Healthcare providers within these systems include emergency rooms, community health centers (CHC), federally qualified health centers (FQHC), and free clinics. (Liebert and Ameringer

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