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(Jefferson City) (AP) – Missouri is facing a shortage of the primary care doctors to whom patients turn for antibiotics to cure strep throat and for answers to make health decisions. The strain could grow as more Missourians soon gain health insurance under the federal health care law.

“A lot of folks say that politics is the biggest threat to Obamacare or the Affordable Care Act. I think the second biggest threat is the lack of primary care providers to serve the folks who are going to gain access to coverage,” said Joe Pierle, CEO of the Missouri Primary Care Association that represents community health centers. “We can give everybody health insurance, but if they can’t get in to a doctor, especially in rural Missouri, then we’re really not making much progress.”

Nationwide, the shortage of family doctors stems from a populace that is getting older and more chronically ill and a desire by doctors to seek out specialties with better pay and hours. A shortfall of primary care doctors can mean more difficulty scheduling appointments and longer waits while reduced preventive care can push patients’ health problems into chronic conditions. Clinics more frequently are using search firms to find practitioners.

Missouri had a little less than 74 active patient care primary care doctors per 100,000 residents in 2010 according to figures from the Association of American Medical Colleges. That ranked 35th and put it behind the national per capita average of more than 79 active primary care doctors. Among its neighbors, Missouri had fewer doctors per 100,000 residents than Illinois, Iowa, Kansas, Nebraska and Tennessee.

Access to a primary care doctor seems a particular issue in Missouri’s rural areas. The medical school at the University of Missouri-Columbia has a pipeline program aimed at increasing supply and retention of rural doctors that includes but is not limited to family medicine.

Some also are suggesting consideration of changes to types of care health professionals are authorized to offer.

The challenge of access to primary care doctors could grow as the federal health care law is fully implemented Jan. 1. The law will require most Americans to obtain health insurance. People with lower incomes will be eligible for subsidies and can obtain coverage through online marketplaces called health insurance exchanges. Insurers also will be barred from denying coverage because of a pre-existing condition.

The Missouri Foundation for Health estimated there currently are 877,000 people in Missouri without health insurance. The foundation said about 300,000 people will be eligible for the subsidies. Another roughly 50,000 people likely have been priced out of the insurance market because of significant pre-existing conditions but could pay for affordable insurance coverage. That means about 350,000 more people could gain insurance, and they are expected to seek health care. However, it’s unclear how many doctors Missouri will need to meet the demand.

Ryan Barker, vice president of health policy for the Missouri Foundation of Health, said better data could track where doctors practice and how frequently. Furthermore, some of the people who will gain health insurance already could be seeing a primary care doctor.

“We do not have a good sense of how many of the individuals who are going to gain insurance currently do not have a primary care doc and are going to put this additional pressure,” Barker said. “Honestly, we just don’t have a good sense of how much pressure is this adding to the system.”

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