Failure to Expand Medicaid Eligibility Costs States Chance to Build Their Primary Care Workforce, Economic Development

FOR IMMEDIATE RELEASE: Friday, January 2, 2015

Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224 

WASHINGTON, DC — States that fail to expand Medicaid coverage to low-income adults 
will probably also stunt growth in their primary care physician workforce, according to “Primary Care Workforce Opportunity Costs of Not Expanding Medicaid,” a one-page research summary in today’s American Family Physician.

Using data from several sources, researcher Mark Lin, MD, and his colleagues at the Robert Graham Center for Studies in Family Medicine and Primary Care estimated the increased demand for primary care physicians due to Medicaid expansion. They then compared the higher demand in each state with the number of primary care physicians that state produces. 

According to Lin, states that did not expand Medicaid coverage may have less demand for Medicaid-serving primary care physicians, which in turn may encourage some physicians trained in those states to move to states with expanded Medicaid.

“Had the 23 states currently electing not to expand Medicaid chosen to expand per Affordable Care Act parameters, we estimate the need for 1,525 additional primary care physicians by 2030,” Lin and his colleagues write. “By our estimates, the 28 states expanding Medicaid can expect to increase their primary care workforce by 1,312 physicians. The [attached] figure reveals the estimated workforce opportunity cost for each non-expansion state, in proportion to the annual production of primary care physicians.”

“This will further exacerbate primary care physician shortages in states that did not increase eligibility for Medicaid,” he said. “States that didn’t expand Medicaid not only affected their residents’ ability to get coverage, they also worsened their primary care physician shortfall.”

Lin cited Texas as an example. The state produces 474 primary care physicians each year. However, by failing to expand Medicaid eligibility under the ACA, Texas forfeited the chance to retain 316 of those newly graduated primary care physicians.

“With evidence of increased hiring of PCPs in Medicaid expansion states, non-expansion may mean more than a lost opportunity to strengthen a primary care workforce that is already strained by the challenges of caring for an aging and expanding population,” he and his coauthors write. “Increased primary care demand in neighboring states that expand Medicaid may exacerbate the problem by attracting more PCPs away from non-expanding states.”

That trend, in turn, would have economic consequences. Research indicates that each primary care physician generates up to $1.5 million in annual revenues and supports 23 new jobs.


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.