I once worked for a company in Georgia that owned hospitals across the United States. Executives provided employees a gift certificate for a free Thanksgiving turkey at the grocery store Piggly Wiggly. A nice gesture, but employees in California and Colorado had never heard of the chain since no branches were within their states. So, while hundreds of employees had a free turkey, they had no access to Piggly Wiggly. Something akin to this could happen in Texas.

Many residents do not have a primary care provider to assist in coordinating their health care. They seek treatment in emergency departments, which is the wrong setting for such care. In many cases, their delay in seeking treatment until the last possible moment worsens their condition.

As we work towards expanding Medicaid coverage and establishing insurance exchanges, the uninsured will have a form of coverage not available before. Initially, they will not have a primary care provider, lacking access to the best medical setting. Once again, despairing patients will be forced to utilize hospital emergency departments. This identical dilemma recently hit Massachusetts, with the public hospitals experiencing a tremendous financial strain.

As we increase coverage, we must strengthen our primary care network so patients have access to health care in the right setting. Only 35 percent of physicians participate in Medicaid. If you think about it, this is a frightening statistic. Many medical school graduates leave Texas never to return due to a lack of residency program slots. A growing number of physicians continue to move towards specialty care rather than primary care. According to a report from the Texas Higher Education Coordinating Board, Texas will need 220 more residency positions by 2014 to have one for every Texas medical school graduate. The state’s investment for four years of medical education is $168,000 per student. This is money spent with no return on investment, with Texas essentially training physicians for other states.

Stakeholders should develop collaborative strategies for more Medicaid providers, increased residency slots and rewards for physicians entering primary care. Otherwise even with a gift certificate, residents could be searching for a Piggly Wiggly.