How Underfunding Threatens Primary Care Access

Primary care serves as the foundation of an effective healthcare system, yet recent data reveal a concerning trend of underinvestment that threatens its stability and accessibility.

According to the 2025 Primary Care Scorecard, primary care accounted for less than 5% of total U.S. health spending in 2022. Specifically, Medicare allocated just 3.4% and Medicaid 4.3% of their expenditures to primary care services. This fiscal shortfall correlates with declining access, as over 30% of U.S. adults reported lacking a usual source of care in 2022—the highest level in a decade.

The workforce that supports primary care is also contracting. The number of primary care clinicians, including physicians, nurse practitioners (NPs), and physician assistants (PAs), declined from 105.7 per 100,000 people in 2021 to 103.8 in 2022. Meanwhile, the share of NPs and PAs practicing in primary care dropped to 30% and 24.3%, respectively—continuing a multi-year downward trend (Milbank Memorial Fund, 2025 Scorecard).

In a targeted attempt to reverse these trends, California’s Office of Health Care Affordability has proposed a statewide benchmark requiring insurers to allocate 15% of healthcare spending to primary care by 2034. This initiative is part of broader affordability goals aimed at improving equity, preventive care access, and long-term cost control (California HCAI Benchmark Proposal).

Restoring balance to healthcare investments will require more than isolated policy initiatives. It demands federal-state collaboration, redesign of payment models to reward longitudinal care, and stronger workforce development strategies. The alternative—continued erosion of primary care—risks undermining every downstream part of the health system, from emergency care to chronic disease management.