Primary care is your first line of defense. They're the people who do your regular check-ups, and they're typically the first call when you think something's not quite right. While our entire medical system is important, it's access to primary care that makes the biggest difference in community and individual health.

From an insurance standpoint, primary care is pretty well covered. And we continue to make improvements to that, including just this year.

But insurance coverage doesn't mean much if you can't get in to see a doctor — and that's a really common problem.

To a large extent, our issues with access to primary care are part of a national shortage of primary care providers. And to fully address that, it’s going to take action at the national level. For example, the GME system, which allocates funding for residents in different medical specialties, operates at a national level, and its outdated allocation contributes to not having enough primary care providers.

But this shortage hits rural communities harder. And there are several tools the state has to help address this problem, which we can — and should — use on our own.

During the COVID pandemic, we saw a huge increase in the use of telehealth — virtual visits by phone or video. Now, these are not suitable for all your needs, but for a lot of things, they're great.

When we can encourage their use — in cases where they are medically sufficient — we can improve access by reducing the time it takes to see a doctor and reduce the burden on patients to get to the office. That's especially important for elderly and disabled folks, and especially true in rural areas.

Unfortunately, these are not typically reimbursed the same way as in-office visits. For Medicare and Medicaid patents, a temporary authorization during the pandemic is set to expire; for private insurance, the situation is more complicated. That means our medical institutions don't have the right incentives to improve access in this way — access which does take new investment and new training.

But the state can influence reimbursement rates, the same way we have for other kinds of care. We need to look at this and make sure we're encouraging the kinds of investment which will address our access issues.

Doctors get out of medical school with a lot of student debt — on average, about $200,000. And primary care simply doesn't pay as well as many other specialties. This leads to almost a third of new medical students starting off pursuing primary care, but switching to another specialty.

On the state level, we have various methods to provide incentives for folks to go into primary care, and to practice in rural settings. One effective existing tool is debt forgiveness programs. These programs help today, offering loan repayment when a medical provider serves in a rural setting, but the qualification criteria are too narrow. Communities almost everyone would agree are rural — and are certainly underserved — are not included. We need to make these programs cover more of our rural areas, and make them more appealing for medical professionals starting their careers.