Case study: Struggles at Atlanta safety-net hospital illustrate problems under reform

As health reform discussions wind their way through Congress, safety-net hospitals are wondering whether their already-struggling facilities might actually have it worse under currently proposed measures.

One example of the struggles facing such hospitals can be found at Atlanta's Grady Memorial Hospital, where the facility is the only option for many poor residents, including illegal immigrants. Now, undocumented immigrants with severe kidney problems fear they're facing a death sentence as the hospital's dialysis clinic closes this month. Hospital administrators say the decision to close the clinic is "gut wrenching" but needed to keep the hospital afloat financially.

Grady is facing off in state court with the dialysis patients right now, as attorneys for the sick are fighting to keep the clinic open until they can make other arrangements for care. For the moment, there's a restraining order in place keeping the clinic open.

However, such problems won't go away, and might get worse, under current health reform measures, public health leaders say. As health insurance coverage expands, current bills would reduce disproportionate-share coverage for safety-net hospitals. It's hard to say how many last-chance clinics like the Grady dialysis center would close, but service cutbacks seem likely if DSH funding gets cut, they suggest.

To learn more about this issue:
- read this piece in The New York Times

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