Study examines primary care capacity challenges that states will face when Medicaid eligibility expands

A new article released online January 26 in the New England Journal of Medicine, authored by researchers at the George Washington University School of Public Health and Health Services and supported by the Geiger Gibson/ RCHN Community Health Foundation Research Collaborative, examines primary care capacity challenges that states will face when Medicaid eligibility expands in 2014, under the Patient Protection and Affordable Care Act (ACA).

The health reform law expands Medicaid's income eligibility level for non-elderly adults up to 133% of the federal poverty line (about $30,000 for a family of four) across the nation in 2014. The authors explain that coverage will expand substantially in those states with restrictive Medicaid eligibility requirements and high uninsurance rates. However, since many of those states have limited primary care capacity, this will create a gap between the demand for medical care by those who are newly insured and the current supply of physicians, nurse practitioners and physician assistants in each state.

Using estimates of the size of planned Medicaid expansions and current primary care capacity, the researchers computed rankings across the 50 states and the District of Columbia. The authors find that many of the states that will experience the largest Medicaid expansions under the ACA unfortunately also have the weakest primary care capacity.

"For many years, we've been aware that there is a maldistribution of primary care practitioners across the nation; national health reform really moves this issue to the forefront," commented Dr. Lynn Goldman, dean of the School of Public Health and Health Services.

"Federal and state officials will need to collaborate with physicians and other clinicians to bolster primary care capacity when the insurance expansions begin just three years from now," said Dr. Leighton Ku, Professor of Health Policy at GW and lead author of the paper. "The challenges are greater in southern and Midwestern states, because insurance coverage will grow more in those states, but they have fewer practitioners ready to provide care."

Eight states - Oklahoma, Georgia, Texas, Louisiana, Arkansas, Nevada, North Carolina, and Kentucky — were found to have especially weak primary care infrastructure in the face of large Medicaid expansions and seventeen other states could also face substantial challenges. The interstate differences underscore the importance of state-specific and local plans to address the capacity and access issues.

"Community health centers play a key role in addressing the nation's primary care needs," said Julio Bellber, president and CEO of the RCHN Community Health Foundation, which helped sponsor this study, "It is fortunate that health reform makes a major new investment in health centers, which are poised to expand substantially to improve access in underserved communities."

SOURCE George Washington University Medical Center