Posts Tagged ‘House health reform bill’

November 24, 2009

The Health Workforce and Health Reform: Progress Report

In the recently released Senate Bill on Health Reform, the establishment of a National Health Care Workforce Commission that “develops and commissions evaluations of education and training activities to determine whether the demand for health workers is being met” is proposed on page 1278.  (As an aside, I am concerned with the use of the word “demand” in the sentence, as the word “need” would more accurately reflect the spirit of true health reform).

Earlier this month, House Speaker Nancy Pelosi released the House’s proposal for reform, calling, on page 1275,  for the establishment of a “permanent advisory committee…[that would] develop and implement an integrated, coordinated, and strategic national health workforce policy relective of current and evolving health workforce needs.”

The Association of Academic Health Centers is pleased to see both recommendations, which in part reflect our advocacy efforts on Capitol Hill to make the health workforce a priority issue in health reform.

These Bills reflect some of the recommendations in our 2008 report Out of Order, Out of Time: The State of the Nation’s Health Workforce.  The report presented a comprehensive overview of health workforce policy (or, perhaps more aptly said, the lack of health workforce policy) and concluded that health reform cannot ultimately be successful without health workforce reform.  The report was widely circulated and followed up with testimony before the Senate Finance Committee, multiple meetings with offices in the White House, DHHS, and a variety of letters, news releases and so forth.

While neither the House or Senate Bill captures many of the critical recommendations in the AAHC Report, both attempt to address critical workforce issues and raise the significance of health workforce policy.   At this point, the fate of these Bills and the outcome of health reform is not known.  However, we are taking this opportunity before floor debate in the Senate to stress with the Congress the need for broad and comprehensive approaches to workforce policy, and the compelling need to connect the health reform with the health workforce.

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November 11, 2009

Who’s Watching the Store? Congress Emboldens Insurers

The voluminous healthcare bill  passed by the House of Representatives last week overlooks several of the most egregious problems in our dysfunctional system.  Among them:

 Lack of meaningful oversight of the hugely expansive and expensive private insurance industry bureaucracy, resulting in rate increases that do not go to patient care. The most recent memorandum from the board of the group health insurance plan associated with my workplace shows double digit increases in the rate history of the medical plans provided by this group.  These are increases above inflation and cost of living and above the rate of any raises received by the average American. 

 Interestingly, some of the largest increases came in 2009, as health insurance reform started to move forward (from 12.4 to 28%, depending on the plan). Insurers are not stupid. They know how to make a fast killing as reform creeps forward and there is nothing to mandate that such actions do not continue into any reform era.      

 Tiered prescription and prescription precertification. Insurers are making medical decisions.  Insurance companies are mandating increasing numbers of medications must be pre-certified.  Insurance companies, not physicians, will tell you whether you are allowed to take the drug prescribed by your physician.  This is happening now and nothing in the legislation will prevent more of this in the future.

 Who will investigate the subversive practices that are emerging, such as demanding precertification for an ever-expanding list  of procedures and then denying payment (a practice that is growing at a startling speed)?  

 Will Congress now make a change and ensure strong oversight of this industry?  Who will monitor the rate increases?  What will be the penalities?  Who will enforce the law? Too many in the Congress have conflicts of interest when it comes to the industry–whether through contributions or spouses sitting on boards or lobbying for the industry. 

 The insurance companies have been emboldened by the ineffectiveness of Congress on health reform.  Until Congress can push back and ask the hard questions of the companies that over the last decade increased rates well beyond any cost of living or national standard, we will have no real reform.

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October 30, 2009

House Health Reform Takes AAHC Health Workforce Recommendation: More Needed

Yesterday, House Speaker Nancy Pelosi (D-Cal.) unveiled proposed health reform legislation from the House.  Put together from the work of three House Committees the bill  includes a public option. 

Also significant, the legislation also now includes language identical to the recommendation made by the Association of Academic Health Centers (AAHC) that a permanent health workforce advisory committee develop and implement “an integrated, coordinated, strategic national health workforce policy.”  The AAHC has advocated for a national workforce planning entity because it believes that the nation’s workforce policy must be changed; the nation’s customary piecemeal approach to the workforce is no longer viable or appropriate for the 21st century.

A  comparable Senate bill is still being negotiated. The Senate should not only include such language in any final bill but also move to ensure the creation of a permanent planning entity that operates continuously, makes ongoing findings and recommendations, and is available at any time to provide consultative support to federal, state, and private health workforce stakeholders. The planning entity must serve as an active policymaking partner, not a passive advisor.

The AAHC has been urging the congressional committees and congressional leadership to broaden the scope of activity of the proposed advisory committee/national commission to fully support a strategic national policy approach.

Specifically, the AAHC recommends the following modifications be incorporated into any health reform legislation considered by the full House and Senate:

  1. Make development and implementation of an integrated, coordinated, strategic national health workforce policy the primary objective of any advisory committee or national commission.
  2.  Constitute the advisory committee or national commission as a continuously available policy research and consultative resource, not simply as a body of external experts that convenes from time to time to make periodic recommendations.
  3. Amend the enumerated issues to be addressed by the advisory committee or national commission to include the harmonization of conflicting national and state-based regulatory and private self-regulatory standards (e.g., licensure, scope of practice, accreditation).

4.    As an interim step, create a national health workforce coordinator to assess current federal capabilities and prepare agencies for their interactions with the advisory committee or national commission once it is fully functional.

 This is the way to ensure that the nation  has the health workforce it needs for the short and long-term.

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