(Bloomberg) — Holy Cross Hospital’s health center in Aspen Hill, Maryland, is bracing for more business.

The center treats the uninsured, and has been busy since it opened in 2012 with a waiting list of more than 400 people at its clinic. Now, as a result of the U.S. Affordable Care Act, it’s mulling adding staff and hours in anticipation of next year’s rush of newly-insured patients, many with chronic medical conditions that have gone untreated for years.

Poorly controlled diabetes can cause stroke, kidney failure and blindness. Undiagnosed cancer can translate into complex end-of-life care, and untreated high blood pressure can lead to heart attacks. In effect, the ACA’s biggest promise becomes its most formidable challenge: unprecedented access to care for a needy population when the nation is already grappling with overtaxed emergency rooms and a shortage of physicians.

“When you’re getting people that haven’t had insurance, they have significant health issues,” says Kevin Sexton, president and chief executive officer of Holy Cross Health. “A lot of people need these services.”

About 25 million Americans are expected to gain coverage under the health law, commonly known as ‘Obamacare.’ Starting Oct. 1, as many as 7 million uninsured Americans will begin shopping for private plans through government-run exchanges, with many people eligible to have their premiums subsidized by taxpayers. On Jan. 1, Medicaid programs for low-income people will be expanded in about half the U.S. states.

Strained system

The increase in newly insured patients arrives at a time when the nation has 15,230 fewer primary-care doctors than it needs, according to an Aug. 28 assessment by the U.S. Department of Health and Human Services. And emergency rooms report being strained with visits that have risen at twice the rate of population growth.

“It’s like we’re handing out bus tickets and the bus is already full,” says Perry Pugno, vice president for medical education at the American Academy of Family Physicians. “The shortfall of primary-care access is not an insignificant problem, and it’s going to get worse.”

Almost half of all uninsured, non-elderly adults had a chronic condition, based on a 2005 report by the Urban Institute and the University of Maryland. One in six with hypertension reported no visits to health professionals in a year.

Most who come to Holy Cross’s health center now lack insurance, and have lived for years with serious ailments, according to Elise Riley, the center’s medical director. “It’s frustrating to see diseases that could have been prevented,” she said in an interview in her office.

More demand may lead to months-long waits to see doctors, delays in finding specialists, and strains on hospitals and outpatient clinics, others said.

Patient access

Ensuring patient access is critical to the Affordable Care Act’s success: if the newly insured swamp the medical system, it could hand critics pushing to derail the law another argument to fray public support. Sara Rosenbaum, a health-law professor at George Washington University in Washington, says she doesn’t believe it’s going to happen.

“It’s going to be a slow ramp up,” Rosenbaum says. “It’s not like seven million people will get insurance at once. They’re not going to all come racing in the door.”

While that number of new patients can be debated, the status of those who do come in the door is not.

Patients who have had gaps in health insurance were more likely to have not gone to a doctor when sick or to have skipped getting prescriptions, according to an April 2013 report by the Commonwealth Fund, a New York-based foundation that works for health-care access. The uninsured were less likely to be up-to-date on recommended cholesterol, blood pressure, colon cancer screenings and mammograms.

Exciting challenge

At Grady Health System in Atlanta, more patients are expected, especially at its six outpatient centers. San Francisco General Hospital and Trauma Center in California has some expanded hours its 19 primary care centers. The centers are located in the hospital and out in the community.

“We anticipate an increase in primary care and specialty,” Chief Executive Officer Sue Currin says.

On a recent Friday morning at the Holy Cross clinic in Aspen Hill, Riley donned a white coat and prepared to see patients. While there may be more patients under reform, Riley said an increase in business will be welcome.

“I’ve very excited,” Riley said. “I’ve been dealing with uninsured patients for a long time. If they get coverage, we can prevent a lot of problems.”

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