The uncompensated care pool: saving the safety net.

affiliated with the Schneider Institute for Health Policy at Brandeis University, is a national initiative that works to strengthen community action, promote social change, and improve health, especially for those who are most vulnerable. The Commonwealth of Massachusetts has made a social commitment to the proposition that all residents of the state, regardless of their financial circumstances, should have some access to health care when they need it. For those who do not qualify for a public program, the Uncompensated Care Pool supports those who have no other way to pay for health care by paying hospitals and community health centers for services they provide to low-income persons. The Pool operationalizes the Common-wealth's commitment through its statutory purpose: " to provide access to health care for low income uninsured and underinsured residents of the Commonwealth. " The Pool, created in 1985 and modified significantly in 1988, 1991 and 1997, is at the core of a health care safety net that distinguishes Massachusetts from most other states. Since its last reform in 1997, however, it again has lapsed into a state of disrepair. As the most recently appointed Uncompensated Care Pool Commission meets and deliberates the next round of reform, this Issue Brief examines the Uncompensated Care Pool through the lens of access to care. It presents the basics of the history of the Pool, how it works and how it is funded; considers how well the Pool promotes access to care; and examines whether Pool financing is adequate to fulfill its central purpose. Finally, the brief identifies areas of reform for policy makers to consider concerning financing, how and where care is provided, and the monitoring of Pool operations. Approximately 418,000 people in Massachusetts have no health insurance and thus lack a key instrument of access to health care. The Uncom-pensated Care Pool is a critical component of the health care safety net for these people. Only a handful of other states finance uncompensated care using a redistributive mechanism that resembles the Pool. The Pool has achieved considerable success in providing for the most vulnerable, and it must be preserved and strengthened. Since 1990, allowable uncompensated care costs have exceeded the available funds in all but two years. This shortfall of funds is cause for concern, given the Commonwealth's goal of expanded access. Indeed, while Pool payouts declined in the first three years of MassHealth expansion, demand is increase-ing, for …