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[730] The Commission noted that the limited resources of many safety-net hospitals may make it difficult for them to compete with other hospitals for labor and technology, and observed that [t]his disadvantage, in turn, could lead to difficulty maintaining quality of care and even to hospital closure. [731] During the earlier phases of the COVID-19 pandemic, for example, studies showed higher rates of mortality among patients who received treatment at certain safety-net hospitals, with researchers citing understaffing and lack of access to advanced therapies as some of the factors that may have contributed to negative health outcomes