In 2016, Health & Medicine initiated a research project to explore the impacts, unintended consequences, and unfinished work of health reform—broadly defined—from the perspective of representatives of Cook County’s health care safety net through interviews and focus groups with people working in the sector. In late 2018, we began the process of re-interviewing participants in our original research project as well as adding the perspective of stakeholders from additional sectors. Initial findings from this qualitative research served as the basis for an October forum entitled The Chicago Forum for Justice in Health Policy: Health Reform Impacts, Challenges, and the Future. Forum participants responded to our research findings as well as adding their own feedback and experiences. This report summarizes our learnings based on both our research and the forum proceedings.

This study extends previous research examining the impact of the Affordable Care Act and state Medicaid expansion on the safety net. The paper analyzes how the current political context is impacting the safety net sector while also examining overall adaptations to health reform, understanding its consequences, and identifying safety net stakeholders’ policy and philanthropy recommendations for future reform. This research focused specifically on the safety net in western Cook County and eastern DuPage County, Illinois (the western suburbs of Chicago).

This policy and practice review of national work examines how the safety net can use this time of health reform opportunity to shift toward addressing social determinants of health, structural determinants of health inequities, and ultimately health equity.

In late 2016, Health & Medicine completed new research on the Cook County Safety Net in partnership with Loyola and others to capture how state and federal health reform efforts have impacted Federally Qualified Health Centers (FQHCs), free and charitable clinics (FCCs), and hospitals in Cook County. This study was unique from others that examine the safety net in that it intentionally asked participants to discuss both the anticipated effects and the unintended consequences of health reform implementation.