Managed care cost pressures threaten access for the uninsured.

People without health insurance have historically received medical care from the safety net, which among many kinds of providers includes physicians who voluntarily provide uncompensated care. With 43 million Americans uninsured today--a group that has grown by 1 million a year for the last decade--the health care safety net is increasingly critical as a way for the medically indigent to get services. However, there are signs that the safety net is weakening because of certain changes in the health care system. This Issue Brief discusses Center for Studying Health System Change (HSC) findings from its Community Tracking Study indicating that higher managed care penetration is associated with both physicians providing less charity care and less access to care for the uninsured.