The new health reform law is expected to create 32 million more insured Americans, according to the Congressional Budget Office. The federal government plans to expand Medicaid to low-income adults and subsidize purchases on the health-insurance exchanges when it requires most Americans to carry insurance in 2014.
However, an insurance card will not mean much to patients without providers to care for them.
Iowa will have 125,000 more insured residents because of reform, according to an Urban Institute analysis.
A primary-care physician is the first contact for people with undiagnosed illnesses. They include family physicians, pediatricians and internal-medicine doctors. Primary-care physicians' share of the U.S. health-care dollar is only 7 cents. However, primary-care doctors control 80 cents of the health-care dollar by sending their patients to hospitals, referring them to specialists and handing out prescriptions.
The U.S. has the about the same number of physicians per capita as other industrialized nations. However, the U.S. has far fewer primary-care physicians than specialists. They make up about 50 percent of the physician workforce in most other developed nations, compared with 35 percent in the U.S.
The number of U.S. specialists per capita has risen dramatically since 1965, while the ratio of primary-care physicians has remained relatively constant, because they earn as much as three times more income. The outlook is for more of the same: greater scarcity of primary care and a growing supply of specialists.
Massachusetts reformed its state health-care system in 2006, giving the nation a glimpse of what is to come when access to health insurance is expanded without expanding the supply of primary care. The average wait for a non-urgent appointment with an internist rose from 17 days in 2005 to 48 days in 2011. Less than half of family physicians there are accepting new patients, compared with 70 percent four years ago.