If all states implement the Medicaid expansion outlined in the Affordable Care Act (ACA), an estimated additional 21.3 million people would enroll in Medicaid by 2022. That rapid increase in the number of insured Americans looks good on paper, but there is no guarantee that patients covered under Medicaid will have access to care. The physician shortage has put physicians in an interesting position. With no lack of patients seeking care, physicians can be selective in coverage plans they choose to accept. Unfortunately, Medicaid’s low reimbursement rates lead many physicians to refuse new patients. The Florida Medical Association (FMA) is concerned that the one million additional Floridians expected to be covered under the Medicaid expansion will not be able to find a primary care provider. In Florida, only 59% of the state’s physicians are taking new Medicaid patients, according to a Kaiser Health News study. And it’s not just Medicaid patients that may have a hard time finding physicians. Patients covered under state-subsidized programs acquired through insurance exchanges could also have trouble. Nick Rajacich, president of the Washington State Medical Association, wrote an op-ed piece in The Seattle Times where he warned that the estimated 344,000 patients who will obtain coverage through the state’s insurance exchange program may have a hard time finding a physician. “Physicians who participate in any network generally have a mix of the types of patients and insurance products they accept in order to maintain the viability of their practices. It’s not guaranteed physicians will participate in these new exchange products,” Rajacich wrote. One thing is clear. Expanding insurance coverage is not enough to achieve the ACA’s ultimate goal of improving access to care. The Obama administration has taken steps to make Medicaid more attractive for primary care physicians, including increasing reimbursement rates so they are on par with Medicare rates. Other states, such as California, are considering allowing nurse practitioners to practice independently, which would instantly increase the number of primary care providers in the state.