Assuring Access to Care Under Health Reform

The central aim of the Patient Protection and Affordable Care Act of 2010 (ACA) is to increase health insurance coverage in order to make care more affordable for U.S. citizens. Fears have arisen, however, that the new coverage will not translate into improved access to needed services, especially primary care. Shortages of providers were projected nationwide even before the reform debate began, and an aging population and increases in chronic conditions will further pressure the supply of care.

To succeed, the ACA’s coverage and financing reforms need improvements in service delivery that promote ready access to appropriate care. Access needs to be maintained for the currently insured and developed for the newly covered—both without undue effects on overall affordability or quality. The sharp rise in coverage seems inevitably to necessitate some changes in how care is accessed, delivered, and paid for. Such change calls for supportive workforce policies, many of which are begun by ACA provisions. Perhaps even more important, caregivers and patients need to appreciate that business as usual may not best meet their needs.

The ACA lays the groundwork to support such change but much remains to be done to identify and expand on promising experiments in improving delivery. This brief discusses four possible avenues for change that can help meet expected demand under the ACA and the workforce policies that could contribute to their success.

  1. Improve access by increasing the supply of primary care physicians;
  2. Improve access by increasing the efficiency of care provision;
  3. Improve access through enhanced roles for other primary care clinicians;
  4. Improve access through system transformation.

Educating more doctors and nurses is a logical response to feared shortage of access—but a slow one. More promising for the near term is reorganizing practices to make more productive use of nurses and other more rapidly trainable staff.