By Tara Mancini

See CCF’s latest fact sheet on Medicaid Access

Earlier this week, my colleague, Joan Alker, blogged about how Medicaid provides access to needed care. As she mentioned, the decision to extend Medicaid coverage to millions of the uninsured has often been met with skepticism over whether the health care system has the capacity to handle the influx.  A new study released by Health Affairs speaks to this concern by forecasting the increased need for primary care providers in 2014, necessitated by the Affordable Care Act’s expansion of coverage through Medicaid and the exchanges.

Nationwide, the rise in the number of insured people will require a 2.5% (7,200) increase in the supply of primary care providers (PCPs) from the 2010 baseline. However, the researchers, Huang and Finegold, find that the need for PCPs will vary around the country. Again, the estimates are based on the expansion of coverage through the exchanges and Medicaid, and assume that all states expand eligibility for the latter.

In states, demand will range from a low of .7 percent (D.C.) to a high of 5 percent (Texas) of the baseline supply.  After Texas, the states of Mississippi, Nevada, Idaho, and Oklahoma are estimated to have the greatest need for more primary care providers.

Using primary care service areas (a designation for measuring the use of primary care resources), Huang and Finegold estimate that 44 million people live in an area where demand will be 5% of baseline supply.  Close to 7 million people live in an area where demand will be 10% of the baseline supply, ranging from PCSAs in New Ipswich, New Hampshire to Shady Cove, Oregon.  There are commonalities among the areas where the need rises above 5%; they are more likely to have smaller populations, fewer providers per 100,000 population, lower median income, and higher proportions of Black and Hispanic populations.

On average, the researchers do not expect the growth in demand for PCPs to be disruptive to the delivery system. However, they do stress that policies to promote proper distribution of PCPs will be just as important as policies that aim to maximize the total number of providers, especially in areas with larger estimated demand.

How does the Affordable Care Act address Medicaid access?

Several provisions of the ACA aim to address these disparities, such as the requirement that the Health Resources and Services Administration re-examine criteria for determining Health Professional Shortage Areas and Medically Underserved Populations.

The ACA also supplies funding to augment the number of National Health Service Corp providers working in underserved communities, expand the capacity of community health centers, and provide a temporary bump to Medicaid payment rates for primary care physicians.

State and local governments also have a role to play, and the information on PCSAs can be useful when determining how to allocate resources and adapt their workforce.  While some areas of the country will encounter more of a challenge than others in expanding the capacity of the primary care workforce, this research can be a helpful resource in attending to the task.