Document Type

Journal Article

Publication Date



New England Journal of Medicine


Volume 364, Issue 6

Inclusive Pages



Health Services Accessibility; Insurance Coverage--trends; Medicaid--trends; Primary Health Care; Medicaid & SCHIP; Primary Care; Health Reform; Geiger Gibson/RHCN


In the coming years, the United States must address both an expansion of Medicaid coverage and an unexpected shortage of primary care physicians. Under the Patient Protection and Affordable Care Act (ACA), the Medicaid eligibility threshold for nonelderly adults will rise to 133% of the federal poverty level (about $30,000 for a family of four) in 2014. States with restrictive Medicaid eligibility requirements and high rates of uninsured residents will expand coverage substantially, while programs in states with higher current Medicaid eligibility thresholds and fewer uninsured residents will grow less. However, since many of the states with the largest anticipated Medicaid expansions are also the ones that have less primary care capacity, they could face surging demand from the newly insured without having sufficient primary care resources available. These gaps could affect access to care not only for newly eligible Medicaid beneficiaries but also for others who depend on a state’s existing supply of clinicians.

Peer Reviewed


Open Access


Included in

Health Policy Commons



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