The Patient Protection and Affordable Care Act (ACA) provides an opportunity to transform local health care safety nets into seamless systems of care. An assessment of safety net integration activities underway in five study counties—Contra Costa, Humboldt, San Diego, San Joaquin, and San Mateo—suggests much progress has been made to this end.

This report discusses the gaps in health coverage in California, how well the House and the Senate proposals would succeed in filling those gaps, and effects on California’s safety net system.