The Primary Care Shortage in the Rocky Mountain Region

As of September 2020, an estimated 81 million Americans lived in more than 7,200 areas or settings designated by the Health Resources and Services Administration (HRSA) as a primary care Health Professional Shortage Area (HPSA). A primary care HPSA is a geographic area, population group, or facility that has poor access to basic health services because it lacks a sufficient number of primary care providers. 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. With respect to primary care, HRSA designation criteria is based upon the population within the HPSA relative to the number of primary care providers that service the area. 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 stipulated by federal regulations. Areas designated as a primary care HPSA can participate in federal programs aimed at attracting more primary care providers to work with medically underserved populations. The HRSA estimates that, as of September 2020, all primary care HPSAs in the U.S. would need almost 15,000 more providers to eliminate all shortage designations.

HPSAs in the five-state Rocky Mountain region account for just over 3.6% of the U.S. population who live in primary care shortage areas.  To eliminate the shortage, the HRSA estimates that Rocky Mountain region HPSAs would need over 500 more primary care providers.  Here is a summary look at the primary care shortage in the Rocky Mountain region:

The Primary Care Shortage in the Rocky Mountain Region

State	(1) HPSAs	(2) Population	(3) Shortage
CO	119	1,112.1	255
ID	98	482.9	70
MT	138	410.4	88
UT	64	777.7	103
WY	47	187.9	24
Region	466	2,971.0	540
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)

CHIP and Medicaid Child Enrollment in the Southwest

Government funded programs are a critical source of health insurance coverage for children in the United States. The National Health Interview Survey (2019) estimated that just over 41% of children under the age of 18 in the U.S. have publicly funded health insurance coverage. Health benefit programs for local, state and federal government employees, including military personnel, are a source of some of the child enrollment in health insurance plans subsidized by taxpayer dollars.  However, it is the Children's Health Insurance Program (CHIP) and Medicaid that are the two key drivers of public health insurance coverage for children in the United States. Medicaid is the joint state-federal health insurance program for eligible individuals with limited income and resources.  Similarly, CHIP is a joint state-federal effort to make available health insurance for children from families with low incomes, but incomes not low enough to qualify for Medicaid coverage.  As of September 2020, federal reports indicate that there were about 37.4 million individuals who were either enrolled in CHIP or who were children enrolled in the Medicaid program.

That same September 2020 data reveals that the four-state Southwest region accounted for almost 13% of the U.S. children who were enrolled in CHIP and, excluding Arizona,  about 12% of U.S. children enrolled in the Medicaid program.  Here is a summary look at CHIP and Medicaid Child enrollment in the Southwest region of the United States:

CHIP and Medicaid Child Enrollment in the Southwest

State	(1) CHIP	(2) Medicaid Child	Total
AZ	111.8	-111.8	0.0
NM	39.7	303.0	342.7
OK	129.3	440.5	569.8
TX	591.5	3,026.7	3,618.2
Region	872.3	3,658.4	4,530.7
U.S.	6,719.1	30,641.9	37,361.0

(1) CHIP enrollment, in thousands

(2) Children enrolled in Medicaid plans, in thousands (derived by deducting State reported CHIP enrollment from State Reported Total Medicaid Child and CHIP enrollment)

Source: Medicaid.gov Enrollment Reports as of September, 2020