BILL ANALYSIS
AB 657
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Date of Hearing: April 22, 2009
ASSEMBLY COMMITTEE ON LABOR AND EMPLOYMENT
William W. Monning, Chair
AB 657 (Hernandez) - As Proposed to be Amended: April 22, 2009
SUBJECT : Health professions workforce: master plan.
SUMMARY : Requires the Office of Statewide Health Planning and
Development (OSHPD), in collaboration with the California
Workforce Investment Board (Board), to establish a task force to
assist OSHPD in developing a health care workforce master plan
for the state. Specifically, this bill :
1)Makes legislative findings and declarations.
2)Requires OSHPD, in collaboration with the Board and based on
information provided by the Health Care Workforce
Clearinghouse (Clearinghouse), to establish and lead in
coordinating the Health Professions Workforce Task Force (Task
Force) to assist in the development of a health professions
workforce master plan for the state.
3)Specifies task force membership is voluntary and without
compensation and composed of not more than 21 members from
both rural and urban areas.
4)Requires the task force assist the OSHPD in the development of
a health professions workforce master plan by meeting on or
before October 31, 2010.
5)States the task force shall meet no less than three times per
year and submit to OSHPD and the Legislature, no later than
October 31, 2013, a completed statewide health professions
workforce master plan.
6)Requires OSHPD to seek and accept funds from the federal
government and private entities to support the activities of
the task force.
EXISTING LAW
1)Establishes the California Workforce Investment Board to
assist the Governor in the development, oversight, and
continuous improvement of California's workforce investment
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system, including a State Workforce Investment Plan.
2)Establishes OSHPD to administer several programs as part of
its health manpower objectives, including the federal National
Health Service Corps Scholarship Program, the federal National
Health Services Corps Loan Repayment Program, and the
California Medical and Dental Student Loan Repayment Program
of 2002.
3)Establishes the Healthcare Workforce Policy Commission, which
identifies unmet needs for specified health care professionals
and establishes standards for training programs for family
practice physicians, registered nurses (RNs),
physician assistants (PAs), and nurse practitioners (NPs),
including requirements for training professionals to work in
underserved communities.
4)Creates the California Health Professions Education
Foundation, a nonprofit public benefit corporation established
by OSHPD, for the purposes of raising public and private
donations, assisting in the implementation of various health
professions scholarship and loan programs, and making
recommendations as to the expenditure of funds in the Health
Professions Education Fund.
5)Establishes, within the Healthcare Workforce and Community
Development Division of OSHPD (Workforce Division), the
Song-Brown Health Care Workforce Training Act that provides
grants to health professional training institutions for the
training and education of health professionals, for practice
in medically underserved, low income, and rural communities.
6)Establishes, within the Workforce Division of OSHPD, the
National Health Services Corps/ State Loan Repayment Program
(SLRP). The SLRP assists with the repayment of educational
loans for select primary healthcare providers who make a
commitment to practice in Health Professional Shortage Areas
(HPSAs), as determined by OSHPD, for a minimum of two years.
7)Establishes within OSHPD the Steven M. Thompson Physician
Corps Loan Repayment Program, which provides physicians up to
$105,000 in educational loan repayments if they serve in a
designated underserved area for a minimum of three years.
FISCAL EFFECT : Unknown
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COMMENTS :
According to OSHPD, the Administration, with the assistance of a
grant from the California Wellness Foundation, convened the
Healthcare Workforce Diversity Advisory Council (Council) in
2007. The Council is comprised of health policy advocates,
health professions pipeline programs, workforce
investment, health student and professional associations,
research, labor and industry, and was charged with developing
recommendations to address California's health professional
shortages, especially among underrepresented groups. In May
2008, the Council released recommendations based on
two key issues that impact the delivery of health services to
Californians. First, the Council found that California's health
professions workforce does not reflect the state's demographics
with respect to racial and ethnic composition and language
proficiency. Specifically, the Council noted the following:
a) Latinos comprise over a third of the state's population,
but they make up 5.7 percent of nurses, 5.2 percent of
physicians, and 7.6 percent of psychologists in California.
b) African-Americans comprise approximately six percent of
the state's population but make up 4.5 percent of nurses
and 3.2 percent of physicians.
c) Current estimates indicate that roughly 9 out of every
10 physicians, dentists, and pharmacists in California is
either White or Asian.
The report also indicated that California is facing looming
health professional shortages:
a) By 2014, the projected demand will exceed supply for
pharmacy technicians by 119 percent, for dental hygienists
by 122 percent, for physical therapist assistants by 178
percent, and for clinical laboratory scientists by 559
percent.
b) There will be an estimated need for 47,600 additional
nurses by 2010 and 5,000 to 17,000 physicians by 2015.
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The Council made overarching recommendations, as follows:
a) Develop a comprehensive, multi-year strategy and
implementation plan to advance health workforce and
diversity in California.
b) Conduct a gap analysis to identify immediate
opportunities to enhance workforce diversity.
c) Facilitate the effective implementation of the
Healthcare Workforce Clearinghouse Program by building the
capacity of departments, institutions, and agencies
involved in the collection and reporting of health care
workforce and education data, and,
d) Institutionalize the Healthcare Workforce Diversity
Advisory Council.
ASSEMBLY HEALTH COMMITTEE HEARING
In May 2007, the Assembly Health Committee held an informational
hearing entitled, Developing the California Health Care
Workforce of Tomorrow: Addressing Shortages and Diversity." At
this hearing, many speakers spoke of the need for new programs
to increase the diversity of California's health
care workforce. A speaker representing TCWF pointed out that
increasing diversity in the health professions is not only an
avenue for improving quality of care and access to care, but
also an important workforce development strategy. TCWF noted
that jobs in the healthcare sector, particularly among the
allied health professions, are now among the fastest growing in
the economy, and data indicate that in the next 15 years the
health care and social services sector in California will grow
by more than 50%, requiring tens of thousands of nurses and
other allied health professionals to meet demand for healthcare.
SENATE HEALTH COMMITTEE HEARING
In March 2009, the Senate Health Committee held an
informational hearing entitled "California's Healthcare
Workforce - Toward a Comprehensive Solution." Witnesses at this
hearing highlighted California's health workforce shortages and
lack of diversity and described state efforts to
address the health workforce, innovative programs within the
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state, and next steps, including the recommendation that the
state develop a comprehensive health workforce master
plan.
ARGUMENTS IN SUPPORT : The California Academy of Family
Physicians (CAFP), sponsor of this bill, writes the lack of
an adequate primary care workforce base has pushed the health
care system to the edge of crisis. CAFP also notes California
has a substantial number of medically underserved
areas with primary care and other provider shortages and that
some 7 million Californians live in (HPSAs with less than one
primary care physician per 3,500 residents. HPSA
residents suffer higher rates of preventable diseases, poorly
treated chronic conditions, and preventable complications such
as end-stage renal disease. CAFP writes this bill will provide
support for programs that increase financial support for primary
care providers and providers serving in underserved areas. The
Latino Coalition for a Healthy California, cosponsor of this
bill, echoes CAFP's comments.
The California Dental Association writes in support that a
workforce master plan could produce findings for use by dental
and other health professions to develop policies on recruitment,
retention, training and educational programs to improve access
to care in the state.
The California Pan-Ethnic Health Network writes in support that
California's efforts to develop its health workforce have been
piece-meal, with limited evaluation and strategy, and California
is missing an overarching vision, action plan, and
infrastructure to coordinate efforts.
The San Bernardino County Board of Supervisors (San Bernardino
County) writes in support that an adequate supply of
well-prepared public health professionals is essential to an
effective public health system, and cites concerns over
bioterrorism and infectious disease outbreaks. San Bernardino
County further writes that, like many counties, its Department
of Public Health has had continuing difficulties in
hiring qualified public health professionals, leading to chronic
understaffing, difficult working conditions, the loss of
population-based services and direct patient services, and
delaying the start-up of new programs.
The American Federation of State, County, and Municipal
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Employees, AFL-CIO writes the state needs to have a skilled
health professions workforce in order to remain healthy,
prosperous, and globally competitive.
The United Nurses Association of California/Union of Health Care
Professionals writes it would support his bill if
amended to include one of its members on the task force.
PRIOR AND RELATED LEGISLATION :
AB 160 (Hayashi), currently pending in the Assembly, would
expand the Registered Nurse Education Program, which offers loan
repayment and scholarships, to include registered nursing
students who agree to serve in a school, as specified.
SB 606 (Ducheny) of 2009, pending in the Senate, would make
osteopathic physicians and surgeons eligible for a physician
loan repayment program and would require the Osteopathic Medical
Board of California to assess an additional fee for that
purpose.
AB 2375 (Hernandez) of 2008 was nearly identical to this bill
except that it also included provisions related to data
collection, and earlier versions also required OSHPD to
implement the master plan. AB 2375 was held under submission on
the Senate Appropriations Suspense File.
AB 2543 (Berg) of 2008 would have established the Geriatric and
Gerontology Workforce Expansion Act, which would have provided
loan repayment assistance to specified health care professionals
who work in a geriatric care setting by raising professional
licensing and renewal fees. The Governor vetoed AB 2543,
stating, in part: "[T]he provisions of this bill place an
additional licensing fee on an entire profession to provide
specialized loan assistance grants beyond the $10 surcharge they
already pay for the Mental Health Service Provider Education
Program. Unfortunately, this bill is double-assessing the same
profession for similar programs."
AB 638 (Bass), Chapter 628, Statutes of 2008, establishes a PA
scholarship and loan repayment program, to be administered by
the Student Aid Commission, to provide scholarships to pay for
the educational expenses of students enrolled in PA schools and
to repay qualifying educational loans of PAs who agree to
practice in designated medically underserved areas, as defined.
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SB 764 (Migden) of 2007 would have required the Medical Board of
California (MBC) and Osteopathic Medical Board to provide
physician information to OSHPD and OSHPD to prepare
a report with projections concerning the primary care
physician workforce. SB 764 was vetoed by Governor
Schwarzenegger, who stated the bill's goals could be better
accomplished administratively, and efforts were already underway
in the context of the comprehensive health care reform proposal.
AB 2283 (Oropeza), Chapter 612, Statutes of 2006, requires MBC
to annually aggregate existing data reported to it by physicians
on their cultural background and foreign language proficiency,
by the ZIP code of the primary practice location and on a
statewide basis, and report such information on the MBC's Web
site.
AB 938 (Yee), Chapter 437, Statutes of 2004, establishes the
Licensed Mental Health Provider Education Program (LMHPEP) and
the Mental Health Practitioner Education Fund to increase the
number of mental health professionals, which includes a
provision requiring LMHPEP participants to serve in a publicly
funded facility or a health manpower shortage area that is
multicultural and linguistically diverse for at least one year
in return for educational loan forgiveness.
Note: Please see the Assembly Health Committee's policy
analysis for more detailed background and comments.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County, and Municipal Employees,
AFL-CIO
Asian & Pacific Islander American Health Forum
California Academy of Family Physicians (Sponsor)
California Dental Association
California Pan-Ethnic Health Network
California Primary Care Association
California Society for Clinical Social Work
California State Association of Counties
Congress of California Seniors
Having Our Say
Latino Coalition for a Healthy California (CoSponsor)
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San Bernardino County Board of Supervisors
Service Employees International Union
United Nurses Association of Ca/Union of Health Care
Professionals
Opposition
None on file.
Analysis Prepared by : Lorie Erickson / L. & E. / (916)
319-2091