Federal Funding Has Not Improved Access to Health Care

Supply of primary care physicians remained same or worsened from 2010 to 2019, despite billions in federal funding

Photograph with soft filter; a stethoscope on a desk with a reflection on the desktop, no doctor there
Image: Martin Prescott/iStock/Getty Images


When the comprehensive health care reform law known as the Affordable Care Act was enacted in 2010, it sought to eliminate the barriers preventing many Americans from accessing health care — primarily by making health insurance available to more people. But a lack of physicians, particularly primary care physicians (PCPs), remains a major barrier to health care in many communities with high poverty levels. As such, in 2011, the federal government invested more than $11 billion aimed at expanding the PCP workforce in medically underserved communities.

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In a paper published in JAMA, researchers at Harvard Medical School and Beth Israel Deaconess Medical Center used national data to study how the supply of primary care physicians has changed over the past decade across the United States by key county-level characteristics, including concentration of racial and ethnic minorities, poverty, rurality, and geography. The team found that despite recent federal investments, the supply of PCPs has not meaningfully changed in counties with high poverty levels and those with the highest concentration of racial and ethnic minorities.

“In fact, the number of primary care physicians per 100,000 residents has fallen in rural and southern counties,” said senior author Rishi Wadhera, HMS assistant professor of medicine at Beth Israel Deaconess. “These findings are very concerning because PCP supply is associated with population-level health and mortality. PCP shortages could in turn contribute to inequities in health care access and outcomes across the United States.”