The Federal Panel that Has Never Met
One of the biggest threats to health care reform is the shortages of nurses, doctors, and other health care professionals. Despite this concern, a 15-member commission — the National Health Care Workforce Commission — created to investigate the problem has never met in two and a half years because it has received no money from Congress or the administration.
With an aging population and 30 million people expected to gain coverage under health care reform, the demand for medical care is expected to increase. Members of the independent nonpartisan panel have said they wanted to address such questions as: How many more doctors are needed? What is the right mix of primary care physicians and specialists? Who will care for the millions of people gaining Medicaid coverage next year? Should states rewrite their laws to allow nurse practitioners and physician assistants to do more of the work done by doctors? Could pharmacists play a larger role in coordinating care and managing the use of medications?
The commission was created by the 2010 health care law, the Patient Protection and Affordable Care Act. Mr. Obama has requested $3 million for the panel in each of the last two years. Some Democrats, like Senator Tom Harkin (D-IA), chairman of the Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, have supported the request. But Republicans have been reluctant to provide money for anything connected with the law, which they oppose.
The chairman of the commission, Peter I. Buerhaus, a professor of nursing at Vanderbilt University, recently said: "It's a disappointing situation. The nation's health care work force has many problems that are not being attended to. These problems were apparent before health care reform, and they will be even more pressing after health care reform."
Members of the panel, appointed in September 2010 by the comptroller general of the United States, have no staff, no budget, and no agenda. Kim J. Gillan, the director of the work force training program at Montana State University-Billings, said federal officials had made clear to her and other panel members that "we were not to function as a group or have contact with one another." Ms. Gillan said some people apparently feared that the commission might recommend the national licensing of health care professionals or other steps that could interfere with state prerogatives. Another panel member, Dr. Thomas C. Ricketts of the University of North Carolina at Chapel Hill, said the Government Accountability Office, an investigative arm of Congress, had advised the panel that "we were not to work or be seen to be working."
UPDATE: Title VIII Funding - FY 2013
The House passed a continuing resolution (CR) — H.R. 933 — by a vote of 267 to 151 on March 6, 2013. The CR includes legislative language for some spending bills, but funds Health and Human Services appropriations as a continuing resolution for the remainder of FY 2013. This legislation essentially keeps the existing funding levels for most accounts and sets the total discretionary spending at $984 billion after the sequestration cuts that began on March 1. The bill also includes a 5.1 percent cut from sequestration and a slight adjustment in the overall spending caps that translates to $219.4 million, or $11.7 million below FY 2012, for the Title VIII programs.
On March 11, the Senate Committee on Appropriations chair Barbara Mikulski (D-MD) and ranking member Richard Shelby (R-AL) proposed a bipartisan amendment as a substitute to the House continuing resolution. The Senate CR funds the HHS programs, including Title VIII, at FY 2012 levels with certain anomalies. The Senate is expected to vote on the measure before the March 22 recess and the March 27 expiration of the current continuing resolution.
Below is a chart of the Title VIII programs with the 5.1 percent sequestration cut.
|Program||FY 2012||FY 2013 Sequestration
|Advanced Education Nursing ||$63.925 million ||$60.665 million
|Nurse Education, Practice, and Retention ||$39.182 million ||$37.184 million
|Nursing Workforce Diversity ||$15.819 million ||$15.012 million
|Loan Repayment and Scholarship Program ||$83.135 million ||$78.895 million
|Comprehensive Geriatric Education||$4.485 million ||$4.256 million
|Nursing Faculty Loan Program ||$24.553 million ||$23.3 million
|Subtotal, Title VIII ||$231.099 million ||$219.312 million
FROM THE STATES . . .
Michigan Bill Revives Debate over Four-Year Nursing Degrees
In 2012, Michigan's community colleges pushed hard for the ability to offer bachelor's degrees in nursing. The state's public universities pushed back harder. On the last day of its lame duck session, the Michigan legislature allowed community colleges to offer bachelor degrees in a handful of fields. It only passed in the Senate because nursing had been stripped out of the bill.
California Bills Seek to Expand Scopes of Practice
The fields of study left in the bill were specialized, targeted toward individual schools. Nursing, by contrast, is offered by all 28 of the state's community colleges and all 15 of its public universities. It remains the plum prize and the bone of contention.
State Representative Mike Shirkey has taken up the fight again with the introduction of a new bill for the state's community colleges. The state's public universities oppose Shirkey's bill, as they have previous efforts to allow community colleges to offer bachelor's degrees. So does the Michigan Nurses Association, the state's largest nurses union.
Not every community college in the state is interested in offering four-year degrees in nursing or in other areas. But others say a turf war is preventing them from meeting the needs of their local community. For example, in Jackson, there will soon be a significant demand. Starting June 1, Allegiance Health, a regional hospital and health system headquartered there, will require that all of its nurses who don't already have a bachelor's degree enroll in a program to get one within five years of their date of hire. "Without the community colleges offering the (bachelor's of science in nursing)," said Deborah Strohaver, director of Allegiance's corporate learning division, "it's impossible to meet the demand that we need."
On March 13, 2013, California Senator Ed Hernandez (D-West Covina) introduced a package of bills to expand the services that nurse practitioners, optometrists, and pharmacists can offer patients. Hernandez cited a need for more medical professionals able to treat patients, who will soon have health insurance under the federal Patient Protection and Affordable Care Act. The "scope of practice" bills set the stage for a massive fight with the state's physicians, who will look to protect their role as gatekeepers to medical care.
In a news conference at a Sacramento health clinic, Hernandez, an optometrist, argued that because of a shortage of doctors in California, other medical professionals should be permitted to offer patients more care. "Here in the state of California we have a capacity issue. We have a workforce shortage," said Hernandez, adding that the problem is most severe in rural and inner-city areas. "How is it that we're going to be requiring somebody to purchase health insurance, but yet they won't have access to a doctor?" Hernandez asked. "This is what we need to address."
The California Medical Association (CMA) that lobbies for the state's doctors responded by saying California should focus on policies that will create more doctors — not allow medical workers with less training to expand their practice. "A huge concern of ours is this notion of patient safety," said Molly Weedn, CMA spokeswoman. "These allied health professionals definitely play a very important role in the health care delivery system . . . . But doctors are highly trained professionals who have been taught to diagnose and treat their patients." Weedn went on to say that people expect that the insurance they purchase will buy them a visit with a doctor and added that any care by other kinds of medical professionals should be overseen by a physician.