Chicago's safety net hospitals are essential institutions, particularly for under-insured, un-insured and Medicaid patients. They provide crucial emergency and inpatient care, employ thousands of community members, and serve as a critical economic anchor for neighborhoods. The threat facing these hospitals is real; a combination of compounding debt, inadequate reimbursement, and aging infrastructure has placed many safety net institutions on an unsustainable trajectory. Recent analysis projects that nine of Chicago's safety net hospitals will lose $2.46 billion between 2025 and 2030, and those losses are likely to grow substantially in the wake of federal Medicaid changes.
The Safety Net Moonshot Initiative, a two-year, multi-stakeholder project designed to identify pathways toward a more integrated and financially resilient healthcare safety net, was created in response to this crisis. This effort, which has now come to a close, was grounded in a deep belief that, without action, hospitals will be forced to shutter their doors and communities that already have fragmented access to care will face even deeper disparities in health outcomes. Since its inception, this work has been deeply rooted in and informed by the perspectives and experiences of people who've dedicated their lives to enhancing access to high-quality care, and it was squarely focused on identifying opportunities to enhance investment in a system that has been historically underinvested.
During this two-year ideation period, a diverse group of leaders from safety net hospitals, Federally Qualified Health Centers (FQHCs), Academic Medical Centers, managed care organizations, community mental health centers, and philanthropy worked together to develop a framework for addressing the structural challenges facing the safety net. That framework is built around a core premise: piecemeal interventions have been unable to deliver system-wide stability, and meaningful progress requires coordinated investment in community-based care access, workforce stability, and infrastructure modernization.
The framework that emerged from this effort is by no means a finished plan. It identifies areas of focus and organizing principles that could guide how diverse stakeholders—public, private, and philanthropic—come together to strengthen Chicago's safety net. A recent effort to discredit this work mischaracterizes both the content of the framework and the process that produced it. Put simply, the Safety Net Moonshot Initiative does not propose closing hospitals. In fact, it recommends significant investment in enhancing access to modernized acute care, expanding community-based access points, investing in FQHC capacity to expand primary and preventive care, improving access to specialty care, and re-aligning financing structures to ensure that communities have reliable access to care rather than facing the continued risk of sudden closures.
Why was the Safety Net Moonshot Initiative created?
The Safety Net Moonshot Initiative was built upon the belief that safety net hospitals are critical community resources, particularly for Chicago's Black and Brown communities. These hospitals provide essential emergency and inpatient care, support local employment, and contribute to the economic stability of neighborhoods across the City's South and West Sides. The Safety Net Moonshot Initiative exists precisely because these institutions have been at risk for decades, and the pace of painful and abrupt hospital closures continues to increase. Without coordinated action and significant investment, more hospitals will be forced to close as a result of financial insolvency, which will be further exacerbated as the funding cuts of the current Federal administration's “One Big Beautiful Bill Act” take effect. The Safety Net Moonshot Initiative proposes an initial framework for strengthening Chicago's safety net hospitals and outlines a path toward sustainability so that safety net hospitals can continue serving their communities rather than facing the painful cycle of crisis and closure that Chicagoans have already experienced.
What does the Safety Net Moonshot Initiative actually propose?
The Safety Net Moonshot Initiative proposes significant investment in modern acute care capacity, expanded ambulatory access points throughout neighborhoods, additional investment in FQHCs, and improved access to specialty care.
The Safety Net Moonshot Initiative recognizes that some existing facilities are operating with aging infrastructure and unsustainable cost structures. Rather than waiting for these facilities to fail—which would result in abrupt closures, disrupted care and a displaced workforce—the initial framework proposes significant investment in modern infrastructure that can serve communities reliably for generations.
Of equal or greater importance is a fundamental reimagining of the care model. The framework proposes a community care hub construct that puts primary care at the epicenter of coordinating health resources throughout the city.
The alternative to planned investment and modernization is what communities throughout the South and West Sides of Chicago have already experienced: sudden facility closures that leave communities without access and community members without jobs.
How does the initiative invest in and expand access to care?
The Safety Net Moonshot Initiative proposes significant investment in community-based care — not the elimination of services.
Chicagoans have already witnessed multiple safety net sites close over the past several years. These closures have devastated communities and exacerbated gaps in health care access across the South and West Sides of Chicago. The Safety Net Moonshot Initiative believes that investing in safety net clinical capacity and expanding access to care is more crucial than ever. The Safety Net Moonshot Initiative recommends significant investment in modernizing acute care facilities and expanding community-based ambulatory care sites. This type of investment from public and private stakeholders will enhance access to urgent care, diagnostic services, mental and behavioral health, and specialty care pathways.
How does the initiative address emergency department overcrowding?
In Chicago, many uninsured, underinsured and Medicaid patients are unable to access high-quality preventive care. This access will be further strained as federal changes to the Medicaid program are implemented in the months ahead. This leads to an overreliance on emergency departments, which are not designed to serve patients with chronic or preventive care needs. The Safety Net Moonshot Initiative recognizes the urgent need to shift away from chronic overreliance on hospitals and specifically proposes increased investment in ambulatory care capacity and specialty care services in order to address these drivers of emergency department overcrowding.
Defending the current system configuration does not address emergency department crowding; in fact, it perpetuates the conditions that cause it. The Safety Net Moonshot Initiative's initial framework proposes building additional “front doors” for care so that emergency departments remain available for true emergencies, rather than serving as the only accessible entry point for patients who need timely care.
How does the initiative protect health care workers and jobs?
The Safety Net Moonshot Initiative's initial framework explicitly includes workforce continuity as a guiding principle. This means transparent workforce retention planning, training and redeployment pathways, and protection of institutional knowledge. This is a critical part of a long-term strategy, because financial insolvency and sudden hospital closures are what actually eliminate jobs overnight without any plan for workers.
The greatest threat to the safety net workforce is the current operating model. The Safety Net Moonshot Initiative framework proposes a thoughtful approach to increasing investment in the safety net system, which protects workers rather than leaving the workforce vulnerable to a system that cannot be sustained by its current funding streams.
What investments does the initiative propose and how will those investments impact local communities?
For any community, economic stability is threatened by disorderly hospital closures and repeated crisis cycles. This framework proposes significant capital investment in modern health care infrastructure, including acute care facilities, ambulatory care sites, FQHC modernization, technology, and operational reserves. These investments are critical to ensuring the long-term viability of community-based care.
How does the initiative address health disparities on the South and West Sides of Chicago?
The Safety Net Moonshot Initiative was a response to the devastating health disparities that plague communities on Chicago's South and West Sides. This work acknowledges that communities already lack equitable access to high-quality care, and it proposes significant investment in community-based access points that would bring services closer to where patients live. This work is rooted in the belief that all patients deserve equitable access to care within their home community.
Who has informed the work of the Safety Net Moonshot Initiative?
Over two years, a diverse group of leaders from safety net hospitals, Federally Qualified Health Centers (FQHCs), Academic Medical Centers, managed care, community mental health centers, and philanthropy worked together to develop a framework for addressing the structural challenges facing the safety net.
Since its inception, this work has been deeply rooted in and informed by the perspectives and experiences of people who've dedicated their lives to enhancing access to high-quality care, and it is squarely focused on increasing investment in a system that has been historically underinvested.
Why are both public and private resources needed to save Chicago's safety net hospitals?
The Safety Net Moonshot Initiative recognizes that public dollars alone cannot transform Chicago's safety net. For that reason, the effort is focused on identifying opportunities to engage a diverse set of stakeholders with a shared economic interest in a long term, viable safety net for Chicago. To be clear, the framework does not envision investment capital of any kind, nor is there any construct under which profits, assets, or resources would flow to outside parties. The Safety Net Moonshot Initiative advances the same non-profit, community-focused, patient-centric architecture that aligns incentives with community need.
At the end of the day, hope is not a strategy. In fact, the enduring hope that these fragile institutions will somehow stabilize on their own has been the reason Chicago has witnessed the closures of multiple safety net hospitals in recent years.
Now is not the time to walk away from these crucial community anchors; instead, the Safety Net Moonshot Initiative encourages significant investment to ensure the long-term viability of Chicago's safety net providers.