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The ACA will impose additional strains on the health care workforce. Seniors currently account for 12 percent of the population but will account for 21 percent by 2050.

This growing, aging population will ensure more chronic disease and additional stress on the health care workforce.[6] Distribution Shortfall. In much of the nation, health professionals are highly concentrated in urban locations.[7] The federal government established Health Professional Shortage Areas (HPSAs) in 1976, pursuant to congressional enactment of the Health Professions Educational Assistance Act, to increase the number of health care workers in rural and underserved areas.

The danger is that these shortages will result in increased morbidity and mortality for rural Americans.

Solving the problem will likely require a paradigm shift in educational admission practices, recruitment of more personnel with rural experiences, payment reform in the public and private sectors, and a much friendlier regulatory environment for medical practice, including tort reform. Another personnel supply problem is the disproportionate ratio of primary care physicians to specialists.

These are intended to reduce the rural shortages, but these programs have historically achieved only limited success.

The higher the acuity, the more care a patient requires.

In fact, the “transformational” changes touted by the law’s champions will likely complicate and negatively affect health care workers and their ability to provide care.

These changes will increase regulatory burdens, increase already heavy workloads, reduce payments, impose new penalties, and disregard personal preferences and values.

Research suggests that the ideal ratio of specialists to primary care physicians is 40 percent to 50 percent in the healthiest nations.[12]A large gap in this ratio currently exists, with only one-third of physicians working in primary care.

In states with higher ratios of specialists to primary care physicians, research indicates increased costs and decreased quality of care.[13] The ACA relies heavily on the concept of the Patient Centered Medical Home (PCMH) model and free preventive care.

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