West Virginia's population of 1.8 million people is 1) widely dispersed, 2) increasingly elderly and 3) tragically poor. Serving the medical needs of this population is a challenge at best.
The federal-state Medicaid program for the poor now covers about 420,000 West Virginians, and the state is required under the optimistically named Affordable Care Act to extend coverage to 130,000 more people.
Will there be enough physicians to serve them all?
There is reason to worry.
The state has long talked a good game about the need for family physicians, and it supports three medical schools to educate them.
But the state has long undercut this effort by paying Medicaid providers less then it costs them to provide medical services.
In 2010, one hospital filed suit, saying Medicaid was covering only 67 percent of its cost of serving those insureds. And 72 percent of its patients were on some government health program.
Many physicians, particularly in sparsely populated rural areas, face similar realities.