No CHNA is ever perfect, but there are compelling reasons for nonprofit hospitals to seek community-based partnerships, not only because such partnerships comply with the law but, more importantly, because they hold great promise for linking the CHNA process and results to the health realities of local communities, ultimately bolstering community engagement while creating shared health priorities.

States’ varied decisions with respect to Medicaid expansion under the Affordable Care Act have drawn significant attention to questions about equity across states. Missing from the conversation is consideration of the varied impact that reform will have within states. This article considers how low-­income Pennsylvanians will fare under Medicaid expansion. Although Medicaid reform has already expanded access to insurance to significant numbers of low-­income residents in the state, improvements in access to health care are mediated by pre-­existing regional inequalities in social determinants of health and by Pennsylvania’s system of health governance. Drawing on lessons gleaned from the literature on regionalism, and examples of success in states that have adopted regional approaches to health delivery, we offer a theoretical approach for thinking regionally in Pennsylvania by building opportunities and capacities for cross-­jurisdictional approaches to health and health care access.

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