Obamacare seeks to extend health coverage to millions of previously uninsured Americans, but that doesn’t include the nation’s estimated 12 million undocumented immigrants. And as Kaiser Health News reports, that oversight — along with the historical difficulty that undocumented immigrants face when trying to obtain coverage — has led to the proliferation of underground, cash-only “bodega clinicas” in Los Angeles migrant communities.

The clinicas aim to serve Latino immigrants who do not have public or private health insurance. Strictly speaking, they are closer to private primary care doctors’ offices than public clinics that are subject to much tighter regulations. But while the community clinics provide immigrants with a much needed service, their off-the-grid nature has some health officials worried about the quality of care that they provide.

Still, care providers also see in the clinicas the potential to ease the burden of America’s primary care doctor shortage:

Health officials see in the clinicas the tantalizing opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians. By January 2014, up to 2 million currently uninsured Angelenos will need to enroll in Medicaid or buy insurance and find primary care. And the clinicas, public health officials note, are already well established in the county’s poorest neighborhoods where they are meeting the needs of Spanish-speaking residents. The clinicas also could continue to serve a market that the Affordable Care Act does not touch: undocumented immigrants who are prohibited from getting health insurance under the law.

Dr. Mark Ghaly, deputy director for Community Health at the Los Angeles County Department of Health Services, said bodega clinicas, a term he seems to have coined, that agree to some scrutiny could be a good way of addressing the physician shortage in these neighborhoods.

“Where are we going to find those providers?” he said. “One logical place to consider looking is these clinics.”

The clinicas are obviously not a perfect solution. While the clinicas could make for an effective source of cost-effective primary care, their cash-only model does pose some risks for the people who may need more specialized and expensive care — after all, paying $120 in cash for antibiotics is one thing, but $5,000 for a surgery is another story entirely. For more extensive care, these immigrants will require some sort of public or private insurance coverage.

But barring comprehensive immigration reform or additional measures to extend health benefits to America’s undocumented immigrants, Los Angeles’ clinicas are many people’s realities.

California’s state Medicaid program, Medi-Cal, has struggled to remain fully funded as its budget — and particularly the reimbursements that go toward the doctors who accept poorer patients under the program — perennially falls under the knife. And the low-income Americans who need specialist care are particularly susceptible to the shortcomings of the strained social safety net.

The Los Angeles Times reports that poor Americans seeking access to specialist services — such as complex surgeries and neurological treatment — are faced with a dearth of specialists willing to service Medi-Cal, mostly due to its historically low reimbursement rates. And on top of that, the United States continues to face a growing doctor shortage that is leading to long waiting periods for Americans:

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, a nearly tenfold increase from 2010, according to the Assn. of American Medical Colleges. Healthcare reform is expected to worsen the problem as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult.

“Specialists are paid so poorly that they don’t want to take Medi-Cal patients,” said Mark Dressner, a Long Beach clinic doctor and president-elect of the California Academy of Family Physicians. “We’re really disappointed and concerned what it’s going to do for patient access.”

This shortage disproportionately affects Americans on Medicaid because the program’s lackluster funding makes it difficult to attract specialists who — after expensive and time-consuming stints in medical school — are willing to take on poor patients for lower reimbursements. Unfortunately, saddled with long waiting periods for specialist treatment, some Americans resort to inefficient and expensive emergency room care, raising health care spending nationally.

Obamacare seeks to quell this problem by vastly expanding funding for states that open up their Medicaid pools to more Americans and providing medical schools incentives for producing more general practitioners and family doctors. But as the LA Times notes, the medical school incentives do not also extend to specialists, and all the extra Medicaid funding in the world will mean little if states do not offer doctors reimbursements high enough to attract their services.

Since the downward trend in Americans becoming doctors has long been in the pipeline, the health reform law is not the root cause of this shortage. But since Obamacare expands the Medicaid program to extend coverage to millions of previously uninsured Americans, it does highlight just how deep the existing shortage is.