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Ensuring Health Care Access, Not Just Coverage

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Since Massachusetts passed legislation that resulted in near-universal coverage, the state's health care system has continued to struggle to provide universal access to timely primary care. With federal health reform, we will see similar challenges in New York.

Although the supply of primary care physicians throughout New York State has grown modestly since 2004, demand for primary care services will increase sharply as more New Yorkers have access to health insurance coverage. Increased demand could be a particular challenge in the western and central parts of the State, where supply is lowest.

Compounding the problem, fewer medical students are seeking careers in primary care. Data compiled by the American Academy of Family Physicians show that the number of medical students seeking careers as general practitioners after graduation has dropped by more than 50 percent since 1997.

However, the opportunity to revitalize our primary care system exists, and it starts with the same catalyst that will create the new demand--federal health reform.

In addition to extending coverage to millions of Americans, health care reform also creates new incentives and payment increases for primary care providers, as well as new opportunities for federal funding for states that foster the growth of this sector. There are three pieces that are particularly promising for New York:

First, federal reform jump-starts payment increases to primary care physicians who take care of Medicare and Medicaid patients. In New York, low-income and rural communities with high Medicare and Medicaid populations are generally most underserved when it comes to primary care, so the funding boosts should make it easier and more attractive for providers to serve in these areas.

Second, the law established $11 billion in funding for community health centers and the National Health Service Corps. Community health centers play a key role in serving New York's Medicaid patients, and this new funding offers the State an opportunity to further expand these resources. Community health centers are affordable and provide high-quality care; New York must prioritize strengthening and expanding them.

Finally, health care reform sets aside funding to support the development of training programs that focus on a range of primary care models--including medical homes, team management for chronic conditions, and integration of physical and mental health services--that rely not only on physicians, but also on nurses, nurse practitioners, and community health workers as part of a health care team. New York already has several of these programs in the works, and the federal funding could help bolster those ongoing efforts to ensure that patients have access to primary care services in the setting that is right for them.

Provisions in the federal law will play a significant role in helping New York develop a more robust and sustainable primary care system, but as a State we must continue to invest in primary care. The opportunity to develop our primary care system exists. It's time to take it.