Saving Safety-Net Hospitals

Emily K. Abel

Hospitals heavily dependent on Medicaid are expected to experience some of the most devastating effects of the $1 trillion cut the July budget bill inflicted on that program. The bill included a $50 billion fund for rural hospitals to compensate for the losses they were expected to sustain. That amount clearly is inadequate. On November 25, 2025 the Boston University School of Public Health reported that 700 rural hospitals are in danger of closing. Nevertheless, the fund highlighted the focus of Republican concern. There was no fund to support the urban safety-net hospitals that serve poor people and members of racially marginalized groups and that are less likely to be in districts represented by Republicans.

According to a study published on November 17, 2025 by researchers at Harvard’s T. H. Chen School of Public Health, those hospitals are most at risk of reducing services and eventually closing. Nearly one fourth already are financially distressed, and most rely on Medicaid for a substantial share of their revenues. Because eighty percent of the population lives in large cities, the closure of urban safety-net hospitals will have a far greater impact than that of rural ones.

Los Angeles’s major safety-net hospital emerged in the wake of the 1965 Watts Rebellion in South LA. Most of the city’s African-American population lived in that area which had poor schools, few health or welfare services, little or not public transportation, and a long history of complaints about police brutality. Ignited by the arrest of an African-American driver by a white policeman, the rebellion lasted six days and resulted in 11,032 people injured, nearly 3,500 arrests, and 34 deaths, more than the combined total of the seven rebellions that had occurred in the East the previous year. Police officers and members of the National Guard were responsible for 23 (68 percent) of the deaths.

Soon after the rebellion ended, Governor Edmund G. “Pat” Brown asked the former CIA director John McCone to lead a study of the cause of the rebellion. The “McCone Report” stated that the infant mortality rate in South L.A. was “one and one-half times greater than the city-wide average.” Life expectancies “were considerably shorter.” And health services were “insufficient.” The “number of doctors [was] grossly inadequate.” The few accessible hospitals were “also grossly inadequate in quality and numbers of beds.” The report concluded that “immediate and favorable consideration should be given to a new, comprehensively-equipped hospital in this area.” Alice Harris, a community organizer, hairdresser, and mother of nine, later recalled, “If a child got ran over in the street, he was going to die because it would be three hours before the rescue would come.”

Nevertheless, the Board of Supervisors initially decided that it could not afford to build the facility the report recommended. Antipoverty and civil rights activists along with Kenneth Hahn, the one Supervisor in favor of the project, convinced the rest of the board that they must do so. The Supervisors broke ground in April 1968. Because the assassination of Martin Luther King, Jr. had occurred the previous month, officials named the new facility the Martin Luther King, Jr. Hospital. It opened in 1971. The following year the hospital joined the Charles Drew University of Medicine and Science and became the Martin Luther King, Jr./Drew Medical Center. (Charles Drew was a renowned African-American physician and researcher in the field of blood transfusion.)

For many years, the hospital was a source of pride to South LA. The institution not only honored two African-American icons but also won the respect of the medical community and provided employment to African-American physicians, other professionals, and blue collar workers, many of whom could not find local jobs. In 1999, the facility had 450 beds and served 150,000 patients a year.

But soon reports of inadequate care surfaced. Dubbed “Killer King,” the hospital lost accreditation in 2005 and closed in 2007 after failing an inspection by the Centers for Medicare and Medicaid. Now South LA residents were forced to travel an hour to the nearest hospital. They experienced longer delays in care and had more difficulty gaining access to specialists; those with gun-shot wounds were at greater risk of dying.

In 2009, the Board of Supervisors and University of California regents approved a plan to build a new hospital. Martin Luther, Jr. Community Hospital (MLKCH) opened its doors in 2017. Although located on the same site as the old facility, this new hospital is very different. Once again the Board of Superiors funded the construction, but the University of California, Los Angeles, is responsible for physician staffing and a new profit foundation oversees the operation. The hospital also serves a different group of patients. As growing numbers African Americans have left South LA, Latinos have moved in, and they now represent more than half of the population in the area; many do not speak English.

And the new hospital is much smaller than the old one. With just 131 beds, it was designed to provide more outpatient services and serve as the center of a network of neighborhood clinics. It also provides behavioral health programs, a weekly farmer’s market, and nutrition education, as well as health screenings and maternity class in such sites as barbershops, shopping malls, and schools. “Hospitals are actually a very small part of the solution for most communities,” explained Mitch Katz, an internist who previously directed the Los County Department of Health Services. “Because hospitals are these large buildings, people tend to equate health with hospitals when, in fact, you go to a hospital when you’re not healthy.”

But now this hospital, like the old one before it, faces a grim future. Elaine Batchlor, MLKCH’s chief executive officer, anticipates that the facility soon will lose between fifteen and twenty percent of its revenue. “There aren’t enough things for us to cut to make up for that loss,” she told a Los Angeles Times reporter.

“Of all the forms of inequality,” Martin Luther King, Jr. stated in 1966, “injustice in health care is the most shocking and inhumane.” Sixty years later our government seems determined to magnify that injustice. Seeking to save safety-net hospitals is an essential way we can fight back.

Sources:

Zachary Levinson and Tricia Neuman, “A Closer Look at the $50 Billion Rural Health Fund in the New Reconciliation Review,” August 4, 2025, www.kff.org.

Violence in the City—An End or a Beginning? A Report by the Governor’s Commission of the Los Angeles Riots, December 2, 1965.

Jocelyn Apodaca Schlossberg, “Two Hospitals, a Partnership and the Resilience of South Los Angeles: Martin Luther King, Jr. Community Hospital and UCLA Health Have Vowed to Fulfill a Promise Made in the Wake of the Watts Rebellion,” www.uclahealth.org.

Emily Badger, Alicia Parlapiano, and Margot Sanger-Katz, “When the GOP Medicaid Cuts Arrive, These Hospitals Will Be Hit the Hardest,” Los Angeles Times, November 18, 2025.

James Queally, “Watts Riots: Traffic Stop Was the Spark that Ignited Days of Destruction in LA,” Los Angeles Times, July 29, 2015.

Victoria Colliver, “How ‘Killer King’ Became the Hospital of the Future,” Politico, August 11, 2017.

Healthcare Quality and Outcomes Lab, Harvard T. H. Chen School of Public Health, “Medicaid Cuts Likely to Affect Urban Safety-Net Hospitals,” November 17, 2025,

https://hsph.harvard.edu

Robert Bauman, “Martin Luther Jr. Medical Center/Charles R. Drew University of Medicine and Science (1971-), March 18, 2010,

https://blackpast.org

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Jennifer Steinhauer, “A Hospital, Pulse of a Neighborhood, Is Mourned,” New York Times, August 21, 2007.

Jillian McKoy, “The Loss of a Rural Hospital Is Devastating for a Local Community,” November 25, 2025, https://www.bu.edu/sph/news/articles/2025/

Nic John Ramos, Death as Prosperity: Racial Capitalism and Sexual Liberalism in Los Angeles (University of California Press, 2026).

Emily K. Abel is Professor Emerita at the UCLA Fielding School of Public Health.