Safety-net hospitals (SNHs) provide a disproportionate share of care to uninsured and Medicaid patients. Because they have few privately insured patients, SNHs cannot cover the costs of uncompensated care for the uninsured by charging higher fees to insured patients. As a result of the heavy burden of uncompensated care for the uninsured and inadequate Medicaid reimbursement rates, most SNHs have negative operating margins.1