The annual physical has been cast as both an essential benefit for preventive care and an unnecessary cost that overtaxes an already burdened system without making people healthier. Now that the routine checkup is covered under the federal Affordable Care Act as well as Medicare, that debate is likely to heat up. "The annual physical - the annual part - is where the current tension applies," said Dr. Edward Yu, a family practice doctor and the Palo Alto Medical Foundation's lead physician on quality measures. "Now with the ACA, more patients have access to insurance that allows them to see the doctor. From our end, there will be more patients coming into the health care system."