This report examines the effects of Medicaid managed care and the related issue of welfare reform on the viability and future integrity of safety net providers in primary care settings.

The report recommends a new government initiative, in the form of competitive grants, to bolster this diverse set of health care institutions that provides care to tens of thousands of the nation's poor and uninsured. The report also calls for the creation of a new governent oversight body to monitor and assess the condition of safety net providers and thoroughly review the impact of federal and state policies on the system.

The September/October 2007 issue of Health Affairs featured a summary of a 2006 IOM symposium. The symposium revisited the IOM's 2000 report, America's Health Care Safety Net. Indact but Endangered, and was held on November 1, 2006.