The 'Massachusetts Lesson': Bolster Primary Care Before You Mandate Coverage

Massachusetts led the nation in April 2006, when it passed a law requiring all state residents to have health insurance. But now, the state is playing catch-up on an issue that should have gotten more attention before insurance coverage was mandated: having enough primary care physicians to care for the more than 300,000 residents added to the insurance rolls in the first year (with many more still to be added) as a result of the mandate.

The mandate's impact was apparent in the Massachusetts Medical Society's 2007 Physician Workforce Study, (40-page PDF; About PDFs) which revealed an 11 percentage point drop from 2006 to 2007 in the number of patients who were able to see a primary care physician within a week of contacting the physician. In 2006, 53 percent of patients got in within a week; in 2007, only 42 percent could. In addition, anecdotal reports have indicated that waiting times to see a primary care physician sometimes have stretched to weeks and even months, with the director of one community health center noting that new patients had to make appointments two to three months in advance.

The impending primary care shortage was on the radar screen of Massachusetts officials as they crafted the 2006 reform law. To address the shortage, they included physician pay increases in the reform. But lawmakers finally realized that more needed to be done.

To rectify the situation, Massachusetts recently passed S.B. 2863 (55-page PDF; About PDFs); Gov. Deval Patrick signed the legislation on Aug. 10. Among its actions, the new law will create a loan forgiveness program for physicians and nurses who practice primary care in medically underserved areas, and it will increase tuition incentives for University of Massachusetts medical students who agree to practice primary care in the state for four years. The law also provides the authority to establish a medical home demonstration project, and it creates a health care workforce center within the state government. In addition, the law requires a seat for the Massachusetts AFP on the center's advisory committee.

The situation in Massachusetts should serve as a lesson for other states. Before mandating insurance coverage, take steps first to produce and retain enough primary care physicians to provide the care. After all, what good is an insurance card if you can't get in to see a doctor when you need one?

Several recent studies underscore the urgent need to boost primary care across the nation.

Clearly, daunting challenges face primary care. The AAFP will continue its battle at the national level to meet these challenges head on and will devote a substantial portion of its 2008 State Legislative Conference to this vital issue. For your part, if your state is considering a health insurance mandate, work with your Academy chapter to encourage such action after -- not before -- any necessary steps are taken to boost primary care.