There is more to it than simply not enough primary care physicians. Prior to the ACA there was more primary care capacity. The obamacare role out enabled and even encouraged shady ACA carrier activity targeting provider networks with unnegotiated, unannounced rate cuts.

Primary care docs were left in a precarious situation d/t falling reimbursement rates. Falling rates were coupled with overhead practice pressure including ObamaAdmin EMR forcing.

Under the ACA, facilities did much better. Facilities and healthcare systems had long angled to buy up as many primary care practices as possible. Control of PCPs enables direction of referrals to facility assets. As an aside, control of PCPs obviously entails system self-referral, healthcare system monopolies, and higher costs.

The combination of pressured PCP practices with healthcare systems' desire to acquire them, led to a wave of PCPs fleeing risk of private practice ownership, to the shelter of facility employment, and guaranteed salary.

With that change went incentive to see as many patients as possible. In private practice, increased patient volume would have resulted in significant expansion of work weeks, clinic efficiencies, and relative income. The same incentives don't apply to salaried employee MDs. In the employed setting, work weeks not only did not expand, efficiencies waned. Fewer patients were seen. Capacity declined.

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However make no mistake, the main reason for a rise in ED visits is medicaid expansion. There is little medicaid incentive to seek care IAW cost. It shows. Another problem is obamacare policyholders often exhibit behavior identical to the uninsured. Unfortunately obamacare's high deductibles leave folks de facto uninsured. Their behavior matches.