Newly published research reveals a mixed picture regarding the quality of care that low-income patients can expect as health system reform moves ahead after the Supreme Court’s June decision on the Affordable Care Act.

The flood of newly insured patients — about 30 million during the next decade, according to a July Congressional Budget Office estimate — probably will strain a health system that the Assn. of American Medical Colleges says will see a shortage of 160,000 physicians by 2025. The CBO estimates that 11 million of the newly insured will be covered by Medicaid, though that number could be substantially higher if more states decide to accept the federal government’s plan to expand eligibility for the program.

Beyond the work force issue, there is the broader question of where these patients — and the 30 million the CBO expects to remain uncovered by the law — will seek care and what caliber of care they will get. Some experts argue that federal pay-for-performance efforts could exacerbate the financial squeeze felt by the health care organizations that traditionally have delivered care to the poor.

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