2018 MIDTERM ELECTION

Time: D H M S

Guest Post: "But there aren't enough doctors!"

Most ACA critics now grudgingly admit that people are getting insured after all, but they say there's a catch. "Where are we going to get all the doctors?" a social worker asked me recently. "We're overwhelmed as it is." A letter in the local paper said, "People aren't really covered unless someone accepts their 'insurance', and if nobody is accepting it, then why should people pay for it?"

I briefly answered the letter writer online, saying that the solution was in the provisions of the Affordable Care Act to increase the primary care workforce, not only with more primary care doctors but also more nurses, nurse-practitioners and physician assistants. I was then curious to find out more about what the ACA has been doing to upgrade primary care in the U.S. and found that it has already made major improvements.

To train more primary care physicians and other personnel, the ACA has provided scholarships and loans. For example, in 2011 the White House reported: "The Affordable Care Act’s Prevention and Public Health Fund is supporting the training of 600 new nurse practitioners and nurse midwives by 2015" and "the investment in Nurse Managed Clinics is projected to help train more than 900 nurses by 2013 and serve 94,000 patients." The ACA has also enabled community health centers to increase their staffs, with 3,000 nursing positions added since 2009.

To encourage more doctors to accept Medicare and Medicaid patients, the law included $3.5 billion for a 10% increase in primary care reimbursement rates for Medicare providers 2011-2016, and $8.3 billion for primary care Medicaid providers for the years 2013-2014. Sarah Kliff, who writes about the ACA for the Washington Post, explained in "Obamacare is about to give Medicaid docs a 73 percent raise" that the increased pay is temporary, but if it brings more doctors to the program, higher Medicaid rates may be maintained in the future.

To further strengthen primary care, the ACA has allocated $1.5 billion over five years to the National Health Service Corps, founded in 1972. In 2011, up to $28 million was available for scholarships for physicians, dentists, nurse practitioners, nurse-midwives, and physician assistants. Graduates agree to work for several years in areas where there is a shortage of health care professionals.  The ACA also provides $11 billion for Federally Qualified Health Centers, 2011-2015, serving 15-20 million more patients by 2015.

The primary care physician shortage could be reduced by 50% or more by 2025, according to a Forbes article: "Doctor Shortage Could Ease As Obamacare Boosts Nurses, Physician Assistants." The article cautions, however, that achieving the goal may require "changes in policy, such as laws to expand the scope of practice for nurse practitioners and physician assistants, and changes in acceptance, on the part of providers and patients, of new models of care."