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Missing Inaction: The National Health Care Workforce Commission

Posted by John McDonough  February 25, 2013 10:38 PM

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Way before the fight over creating the Affordable Care Act, broad agreement existed on one vital national health reform issue: the nation's health care workforce shortages. Even without the ACA, America faced serious problems with deficits of physicians, dentists, pharmacists, mental health professionals, and many more. With passage of the ACA, these issues assumed more urgency because of the pending expansion of health insurance to 30+ million formerly uninsured Americans.

The ACA sought to address these needs. Title V of the law is devoted entirely to measures to address America's health care workforce needs. No other title of the law received such broad support and so little controversy as did Title V.  During the legislative debate on the ACA, I heard condemnation of nearly every part -- except for Title V.  Here's the description of the Title from

"The Act funds scholarships and loan repayment programs to increase the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists in the areas of the country that need them most. With a comprehensive approach focusing on retention and enhanced educational opportunities, the Act combats the critical nursing shortage. And through new incentives and recruitment, the Act increases the supply of public health professionals so that the United States is prepared for health emergencies.

"The Act provides state and local governments flexibility and resources to develop health workforce recruitment strategies. And it helps to expand critical and timely access to care by funding the expansion, construction, and operation of community health centers throughout the United States."

The marquee provision of Title V is the establishment of a National Health Care Workforce Commission to be composed of 15 non-governmental health workforce experts and professionals to do data collection, analysis, and recommendations to help the nation to meet its ever-growing and changing workforce needs. The Commission was the brainchild of former Senator Jeff Bingaman (D-NM).  The ACA directs the U.S. comptroller general to appoint the 15 members and he did so in the fall of 2010, six months after the ACA was signed. And it is an impressive group -- here's the list:

  • Peter Buerhaus, PhD, RN, Professor of Nursing and Director, Center for Interdisciplinary Health Workforce Studies, Institute for Medicine and Public Health, Vanderbilt University Medical Center. Dr. Buerhaus will serve as Chair of the Commission.
  • Sheldon Retchin, MD, MSPH, Vice President for Health Sciences, Virginia Commonwealth University and Chief Executive Officer, VCU Health System. Dr. Retchin will serve as Vice Chair of the Commission.
  • Brian J. Isetts, PhD, Professor, Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy.
  • Harold M. Maurer, MD, Chancellor, University of Nebraska Medical Center.
  • Thomas Ricketts, PhD, Professor, Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, and Deputy Director for Policy Analysis, Cecil G. Sheps Center for Health Services Research.
  • Mary Mincer Hansen, RN, PhD, Director, Masters in Public Health Program, College of Health Sciences, Des Moines University.
  • John E. Maupin, Jr., DDS, President, Morehouse School of Medicine.
  • Neil M. Meltzer, MPH, President and Chief Operating Officer, Sinai Hospital, Baltimore, MD.
  • Fitzhugh Mullan, MD, Professor of Public Health and Pediatrics, George Washington University.
  • Steven Zatkin, JD, consultant to health plans.
  • Katherine A. Flores, MD, Director of the University of California (UCSF) Fresno Latino Center for Medical Education and Research.
  • Kim Gillan, Workforce Development and Training Coordinator, Montana State University's
    Billings (MSUB) College of Professional Studies and Lifelong Learning.
  • Lisa Renee Holderby, Director of Health Equity, Community Catalyst.
  • Deborah King, Executive Director, 1199SEIU Training and Employment Funds.
  • Richard Krugman, MD, Vice Chancellor for Health Affairs, University of Colorado Denver and Dean, University of Colorado School of Medicine.

Not too shabby, ready, willing and able to get to work.

Today, nearly 30 months after their appointment, the Committee has been unable to hold its first meeting. As Robert Pear reports in today's New York Times, the Commission is legally prohibited from convening -- and members are legally prohibited from communicating with each other -- because the Republican-controlled House of Representatives refuses to release the $2 million or so necessary to fund the commission's operations.

Why? Because the Commission was established in the ACA, (aka: ObamaCare) and Republicans in Congress are unwilling to support anything that is part of ObamaCare, even if everyone of them agrees that workforce shortages represent an urgent national, state, county and local need.

If the political temperature on the ACA can moderate so much that at least 7 Republican governors can embrace a huge expansion of Medicaid, is it too much to hope that Congressional Republicans can allow the National Health Care Workforce Commission to get to work?

(Correction -- original text modified to delete reference to workforce shortage of nurses. Out of date reference, my error.)

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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