The Primary Care Shortage in the Great Plains Region

As of September 30, 2020, more than 81 million Americans lived in areas or settings designated by the Health Resources and Services Administration (HRSA) as a primary care Health Professional Shortage Area (HPSA). An HPSA with a primary care shortage is a geographic area, population group, or facility that has poor access to basic healthcare services because it lacks a sufficient number of primary care providers. In the primary care realm, HRSA designation criteria is based upon the population within the HPSA relative to the number of primary care providers that service the area. For HRSA purposes, primary care providers include Doctors of Medicine (MD) or Doctors of Osteopathy (DO) who provide services as general or family practitioners, general internal medicine physicians, pediatricians, obstetricians or gynecologists. Although the population-to-provider ratio needed to qualify for designation varies by HPSA type (geographic, population or facility), all HPSAs with a primary care shortage designation have a population-to-provider ratio that meets or exceeds certain limits established by federal regulations. HPSA's designated as having a primary care shortage are eligible to participate in federal programs aimed at attracting more primary care services to these medically underserved communities. The HRSA estimates that, as of September 30, 2020, all primary care HPSAs in the U.S. would need nearly 15,000 more primary care providers to eliminate all shortage designations.

HPSAs in the seven-state Great Plains region account for 5.1% of the U.S. population who live in primary care shortage areas.  To eliminate these shortages, the HRSA estimates that Great Plains region HPSAs would need more than 900 additional primary care providers.  Here is a summary look at the primary care shortage in  the Great Plains region:

The Primary Care Shortage in the Great Plains Region

State	(1) HPSAs	(2) Population	(3) Shortage
IA	132	666.1	92
KS	188	778.8	124
MN	158	556.8	90
MO	324	1,696.1	509
NE	76	19.1	3
ND	88	189.8	39
SD	97	253.2	51
Region	1,063	4,159.9	908
U.S.	7,203	81,516.3	14,945

(1) Designated Geographic, Population Group and Facility HPSAs with a primary care shortage

(2) Population of designated HPSAs, in thousands

(3) Primary Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 9/30/20 (HRSA)

Covid-19 and Medicaid Enrollment in the Great Lakes Region

In a prior commentary, we examined the impact of the Covid-19 outbreak on enrollment in Medicaid, the national health insurance program for eligible individuals with limited income and resources. Historically, Medicaid enrollment increases during economic downturns. Soft economic conditions create more unemployment, more people without workplace health insurance, more people with reduced household incomes, and more people eligible for health insurance coverage through the Medicaid program. This is in contrast to periods of robust economic activity, when enrollment tends to drop off and even decline.

Like previous economic downturns, the Covid-19 induced contraction of economic activity has sparked a jump in Medicaid enrollment.  Agencies that manage the Medicaid program in each state anticipate still more growth in enrollment in coming months.  After recent years of stagnant enrollment numbers, every region of the U.S. has realized gains in Medicaid enrollment since the Covid-19 outbreak began. In the five-state Great Lakes region, the impact of the Covid-19 outbreak has been more severe than in other sections of the country, as Medicaid enrollment in the region grew 7.9% during the first half of 2020, much more than the 6.5% enrollment growth nationally during the same period. Here's a summary look at Medicaid enrollment growth at the state and regional level in the Great Lakes region as Covid-19 spread during the first half of 2020:

Covid-19 and Medicaid Enrollment in the Great Lakes Region

	Medicaid Enrollment (in 000s)
State	July 1, 2020	Jan 1, 2020		Growth
IL	2,725.2	2,553.4		6.7%
IN	1,516.2	1,376.6		10.1%
MI	2,410.5	2,258.1		6.7%
OH	2,626.1	2,414.0		8.8%
WI	1,062.5	977.6		8.7%
GL Only	10,340.5	9,579.7		7.9%
National	68,826.6	64,621.4		6.5%

Source: Medicaid.gov Enrollment Reports.