Abstract

The Patient Protection and Affordable Care Act (ACA) expanded health insurance to millions of Americans and has provided U.S. health care safety-net institutions, including public hospitals and clinics that provide health care to a disproportionate share of low-income people, with crucial funds. The ACA is a crucial source of financial support for America’s urban health care safety net, but it is politically controversial. Efforts by the Trump administration and Congressional Republicans’ efforts to repeal the ACA and cap the federal government’s commitment to the Medicaid program threatened to reduce the capacity of local safety-net institutions to provide needed health care to poor and vulnerable populations living in urban areas, including undocumented patients.