What’s In the ACA Anyway? (Part 8)

Welcome back! As always, you can follow along at congress.gov, which offers a (very dry) summary and a (even drier) full text version.

Title V: Health Care Workforce

This title was written in the context of a pending nursing shortage projected to be something like a million openings by 2022. You can see at that second link that there’s also likely to be a shortage of physical therapists, dental hygienists, pharmacists, dietitians… basically anything that isn’t as glamorous and well-paid as a doctor but still requires specialized scientific knowledge.

Subtitle A: Purpose and Definitions

This section starts out by laying out the purpose of the title: to improve access to and the delivery of health care services for all individuals, particularly low income, underserved, uninsured, minority, health disparity, and rural populations. It plans to do this by improving both the quality and the quantity of medical professionals available, particularly in low-income areas.

Subtitle B: Innovations in the Health Care Workforce

This section lays out the National Health Care Workforce Commission, which apparently has never met since it was formed. This is apparently Congress’ fault: “Although members of the Workforce Commission were appointed September 30, 2010, Congress has been unable to appropriate the $3 million requested by the administration to fund the commission.” (source). Despite being well liked, this title’s funding never got approved due to the Republican congress You can read more about it at the New York Times.

This commission was meant to, among other things, hand out grants for states to do the following:

  • Analyze State labor market information in order to create health care career pathways for students and adults
  • Identify what jobs need such pathways
  • Improve the education system to produce more people who are qualified to go into health care training programs
  • Break down existing barriers preventing people from going into these fields

Each state getting a grant has to put forth matching funds: 25% of the total they’re asking for.

This section also lays out a provision for its own assessment of the health care workforce, to devise a plan to put together a response. You can find the research findings of this center online as well. A study was also conducted specifically for Alaska, the findings of which can be found in PDF format.

Subtitle C: Increasing the Supply of the Health Care Workforce

This is where the fixing the problem part begins.

First off, there are special student loans only available to people in med school; to qualify for one, previously you had to pledge to practice medicine until the entire loan was paid off, but this amends it to require 10 years of practice instead. The penalty for noncompliance was previously a 12% interest rate, but is amended to being 2% higher than compliance, due to changing interest rates across the student loan industry. This section also specifies that you don’t need a FAFSA to get one of these loans, as parent financial information is not relevant

The next section increases the amount of federal loans available for nursing students by just straight increasing all the caps in the previous legislation.

The next section establishes student loan payments by the Federal government for anyone who is willing to work as a pediatrician in an underserved area for 3 years. Which is pretty swell. The next section establishes a similar repayment program for people who are willing to work in federal, state, or tribal agencies that are underserved, regardless of speciality. The section after that extends student loan forgiveness to people in “allied health” situations, such as emergency rooms or outpatient clinics. All of this is eligible for the grants provided in subtitle B.

The next section offers grants for mid-career training, which is where health care professionals take classes after college in order to keep current on the best practices. We’re always learning new things about health care, so most providers end up needing to do these from time to time.

The next section offers grants for nurse-run clinics. These clinics see 2 million patients per year, and often act as primary care for people who are uninsured or on Medicaid.

Did you know we have a Public Health Service Commission Corps? Apparently their job is to provide medical care to indigenous folks, prevent the spread of major diseases, improve the nation’s mental health, ensure that drugs are safe and effective, ensure that cosmetics are harmless, and support biomedical, behavioral, and health services research. The ACA removes the cap on the number of officers that can be enlisted, and adds a Ready Reserve to this force for burst capability.

Subtitle D: Enhancing Health Care Workforce Education and Training 

This subtitle allows the Secretary to pay for any of the following:

  • planning, running, or participating in professional training, such as a residency or internship, in family medicine, general medicine, or pediatric care
  • med students, interns, residents, or physicians in the above fields who cannot afford tuition
  • training people to teach the above fields
  • training physicians in community-based settings
  • training physician-assistants
  • creating professional development training
  • creating joint degree programs
  • creating more medical degree programs
  • training dentists and dental professionals
  • awarding schools and medical facilities who are doing well at training medical professionals in specific areas, such as chronic illness or underprivileged populations
  • creating training programs, awards, and fellowships in geriatric care, including geriatric dentistry
  • recruiting students for mental health, behavioral health, and social work
  • doing research and demonstration projects around prevention, cultural competency, disabilities, and reducing health disparities
  • creating nurse retention programs to prevent nurses from leaving the field

One section establishes grants for schools who are in programs to provide training and residency situations for people interested in long-term care facilities such as nursing homes (again, remember that the baby boomers are getting old enough to start needing that kind of care).

A demonstration program is put together in this subtitle to show the usefulness of non-dentist dental professionals in serving rural or underserved areas. Generally, oral hygiene is very important in a population, because poor oral health can escalate into poor overall health, but people tend to look at it as “just teeth” and not worry as much about it.

Another portion of this subtitle creates a loan repayment program for nurses the same way there are some for medical students. This includes nurse-midwives, but only if they are accredited programs, much the same as medical schools must be.

Another portion straight out establishes advanced degree programs at various schools in the fields of public health, epidemiology, and emergency preparedness and response. Furthermore, a one-year program is established to train nurse practitioners to be primary care providers, since they already are.

Subtitle E: Supporting the Existing Health Care Workforce

The first section here increases federal funds for medical schools to improve the number of minorities going into health care; we also here get some scholarships being created. The second section makes physician assistant education programs eligible for loan repayments. I’m not really sure at this point how or why they’re organizing all this; I’d have put all the loan repayment stuff together, but what do I know.

There are new grants established for med schools to not only improve diversity of skin color and background, but also diversity of specialty: promoting interdisciplinary training that includes midwifery, psychology, dentistry, and other training.

A special grant is set up for people working in underserved communities who want further education, including telelearning, conferences, and distance learning opportunities.

Grants that existed to help with retention are expanded to include bridge programs and degree completion programs, for people who were almost done with their degree but had to drop out.

A program is set up to educate primary care providers. Primary care providers are, by definition, the first line of detection in just about any field; this program educates them in chronic disease management, mental health, substance abuse, and preventative medicine. Chronic pain is often treated only with opiates, leading to substance abuse problems, and mental health problems are suspected to be widely underdiagnosed.

Subtitle F: Strengthening Primary Care and Other Workforce Improvements

This opens with Medicare payments to primary care practitioners and general surgeons in underprivileged areas. It then goes on to redistribute how many residents each hospital can have subsidized by the government, and allows for residents in non-provider settings to count those hours toward their residency requirements.

The next section allows the Secretary to pay grants for demonstration programs that will provide low-income individuals with training in fields that are likely to see shortages in the near future. This both improves employment and reduces shortages, so it’s basically a win-win here.

More money is allocated for teaching health centers to create residencies. Time that people in the National Health Service Corps spend teaching counts toward their service requirements, to provide more teachers for these centers. Furthermore, money is set aside for clinical training for nurses at hospitals as well.

Subtitle G: Improving Access to Health Care Services

More money is set aside for health centers in underserved populations. In addition, the Secretary is asked to come up with a comprehensive criteria for what an underserved population is, and the same for a health shortage area.

The Wakefield Act is extended, which provides more funding for the Emergency Medical Services for Children, whose purpose is improving pediatric emergency care.

A grant is outlined for centers where people with co-morbid chronic illness and mental illness can be treated holistically.

A commission is put together to review key national metrics in health and make suggestions as to further improvements.

Finally, a grant is put together for health centers that treat a large number of underserved people.

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