The History of NAPH

Our association's first organizational meeting was hosted on Capitol Hill in July 1980, by New York Representative Charles Rangel (who then served as Chairman of the House Ways and Means Health Subcommittee). The CEOs of several large urban public hospitals from around the country attended this meeting, to consider whether or not there was a need for closer coordination among safety net hospitals nationally. Their answer to that question was unequivocally "yes".

Many of those present recalled the predictions 15 years earlier that public hospitals would no longer be needed because of the enactment of Medicare and Medicaid. Those Great Society programs had raised the hope that all elderly and low-income Americans might one day have adequate coverage and access to care.

By 1980, however, it had become clear that these had been false hopes for many Americans. Medicaid never fully covered even its initial target population - the poorest of the poor. By 1980, the proportion of the lowest income Americans enrolled in Medicaid had already been declining for several years, after peaking in the mid-70s. While Medicare covered a broader proportion of the elderly population, huge gaps remained in what the program would pay for, which most dramatically affected the lives and health status of the low-income elderly. Clearly, the enactment of Medicare and Medicaid had not eliminated the need for an institutional health safety net.

In the late 1970s, health reform proposals to fill some of the gaps had been widely debated, but all had failed to win Congressional approval. At the same time, national health costs continued to grow at an alarming rate -- over twice the rate of general inflation. The combination of a large and growing population of uninsured and rising health costs was a double-edged sword hanging over America's safety net hospitals. Closer cooperation among such hospitals and the development of a strong advocacy agenda were seen as essential to such providers and to the many millions of vulnerable patients they served.

NAPH was formally incorporated in November 1980, and opened for business in early 1981. From its initial handful of members, NAPH has grown today to represent over 100 of the nation's most important safety net hospitals and health systems. Our legislative victories include authorship of numerous amendments to the Medicare and Medicaid statutes recognizing the needs of hospitals that serve a significantly disproportionate number of low-income patients. Indeed, NAPH actually helped to "invent" the concept of Medicaid and Medicare DSH in 1981 and 1982 (respectively). We estimate that over $20 billion in additional payments have flowed directly to NAPH member hospitals as a result of NAPH's efforts in the last 20 years.  

Additionally, NAPH has worked closely for the last two decades with the Congress, various federal regulatory agencies and many state and local governments on behalf of our members. NAPH's advocacy agenda is coordinated and implemented today by its staff and the health practice group of the law firm of Ropes & Gray LLP. In recent years, we have achieved many of our legislative goals with the support of a wide range of other organizations. We work closely with important specialized organizations such as those representing community health centers, teaching hospitals, children's hospitals and vulnerable patient populations, as well as with "umbrella" organizations like the AHA, AARP, state hospital associations, and other provider groups.  

In addition to our advocacy efforts, in 1985 NAPH developed a research arm, the National Public Health and Hospital Institute (NPHHI). NPHHI has sponsored projects that range from a definitive study of the characteristics and costs of treating AIDS patients in major public and teaching hospitals, to developing important foundation-supported in-service training programs for senior administrative staff and medical directors of safety net hospitals. NPHHI has also studied the impact of managed care on the safety net and conducted numerous other surveys. The Institute's research agenda is primarily driven by the needs and concerns of the NAPH membership. Finally, in 1997, NAPH established a formal alliance with the University HealthSystem Consortium (UHC), and over 40% of NAPH members also belong to UHC today.