BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 2551
A
AUTHOR: Hernandez
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AMENDED: August 2, 2010
HEARING DATE: August 11, 2010
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CONSULTANT:
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Orr/cjt
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SUBJECT
Health workforce planning
SUMMARY
Requires the Office of Statewide Health Planning and
Development (OSHPD) and the California Workforce Investment
Board (CWIB) to jointly convene a committee to address
specified health care workforce needs.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes, under the Patient Protection and Affordable
Care Act (PPACA), a competitive health care workforce
development grant program, under which the Health Resources
and Services Administration is required to award planning
grants to eligible partnerships. Defines an eligible
partnership to be a state workforce investment board, if it
includes or modifies its membership to include specified
representatives of health care employer, labor, education,
and philanthropic organizations, as specified.
Establishes numerous programs to support delivery of health
care services in medically underserved areas, including the
National Health Services Corps program, and to provide
funding for community health centers.
Continued---
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Under the Workforce Investment Act of 1998, establishes a
national workforce preparation and employment system
designed to meet both the needs of the nation's businesses
and the needs of job seekers and those who want to further
their careers. Provides, under the Act, for the
establishment of state and local Workforce Investment
Boards.
Existing state law:
Establishes the California Workforce Investment Board,
appointed by the Governor, to be responsible for assisting
the Governor in the development, oversight, and continuous
improvement of California's workforce investment system.
Requires the CWIB to consist of the Governor, two members
of each house of the Legislature, and representatives of
businesses (which comprise a majority of its board
members), labor organizations, educational organizations,
youth organizations, elected bodies of cities and counties,
and state employment agencies, as specified.
Requires OSHPD to administer several health care workforce
training programs including scholarship and loan repayment
programs designed to encourage health professionals to
practice in medically underserved areas.
Establishes within OSHPD the California Healthcare
Workforce Clearinghouse Program, to serve as the central
source of health care workforce and educational data in the
state. The Clearinghouse is responsible for the collection,
analysis, and distribution of information on the
educational and employment trends for health care
occupations in the state.
Establishes the California Healthcare Workforce Policy
Commission (CHWPC) to identify specific areas of the state
where there are unmet priority needs for dentists,
physicians, and registered nurses.
Establishes various health professions development
programs, including, but not limited to, the Song-Brown
Health Care Workforce Training Act, the Health Professions
Education Foundation Programs, and the Steven M. Thompson
Physician Corps Loan Repayment Program.
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This bill:
Establishes the California Health Workforce Development Act
of 2010. Requires CWIB and OSHPD to jointly establish a
committee known as the Health Workforce Development
Council, comprised of specified representatives, and
authorizes CWIB and OSHPD to allow others to serve as
consultants to the council as appropriate.
Requires the Council to:
Identify and develop the framework, funding,
strategies, programs, policies, partnerships, and
opportunities necessary to meet the needs of
California's health care infrastructure.
Identify and link health care job opportunities with
health workforce development training opportunities.
Develop partnerships as described, and foster regional
collaboration in the health sector.
Provide policy guidance for job training programs for
specified populations.
Develop, collect, interpret, and distribute statewide
and regional labor market data.
Identify funding sources.
Additionally, requires the Council to report to the
Legislature on the status of the Council's activities and
its development of a health care workforce strategic
initiative by April 1, 2012, and annually thereafter until
April 1, 2016.
Contains an urgency clause in order to resolve problems
related to health care workforce shortages as soon as
possible.
Makes findings and declarations regarding the passage of
federal health reform and the need to develop California's
health care workforce.
FISCAL IMPACT
This version of the bill has not been analyzed by a fiscal
committee.
BACKGROUND AND DISCUSSION
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The author believes that developing California's health
care workforce to better represent and serve its consumer
population will help to mitigate increasing health care
costs. The author claims California's efforts to develop
its health professions workforce has been piece-meal,
focusing on data collection, loan repayment programs, and
funding for specific professions within health care,
without evaluation or strategy. California is missing an
overarching vision, action plan, and infrastructure to
coordinate efforts to maximize efficiency and impact.
Health workforce shortages
Statewide shortages of health providers currently exist in
several major health professions, such as nursing, primary
care providers, and allied health (allied health
professions are clinical health care professions distinct
from medicine, dentistry, and nursing). Health care
workforce needs are projected to increase dramatically due
to the aging of the population and the state's increasing
diversity. In February of 2009, the Senate Health
Committee held a hearing on California's health care
workforce. The background paper, prepared by the Senate
Office of Research (SOR), stated that the health care
worker shortage is defined in many ways, citing as examples
the following:
The state will face a shortage of up to 17,000 physicians
by 2015.
The Center for California Health Workforce Studies
researchers indicate that the current registered nurse
shortage is between 7,000 and 21,000. This shortage is
expected to grow due to both the aging of the general
population and the nursing workforce.
California presently ranks 48th in the nation in the
number of pharmacists per capita. It is projected that
California will need a 26.1 percent growth in the number
of pharmacists from 2006 to 2016.
Fifty percent of the public health workforce and seventy
percent of community clinic administrators will retire in
the next five to ten years.
Seventy-six percent of clinics report a staffing shortage
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of allied health workers.
In addition to the shortages of certain health
professionals, SOR stated that California's health
professions workforce does not reflect the state's
demographic racial and ethnic composition and language
proficiency.
Diversity of health professionals and impacts on quality of
care
According to SOR, lack of diversity can lead to impacts on
the quality of health care. A report by the Institute of
Medicine links poorer health outcomes for minorities to the
shortage of minority health care providers. One reason for
this is that persons of color are less likely than whites
to receive needed services, including clinically necessary
procedures, due to cultural or linguistic barriers between
the health care provider and the patient.
Furthermore, the Sullivan Commission finds the lack of a
diverse workforce has been found to result in a "loss of
productivity, higher absenteeism, and greater employee
health care costs?resulting in millions of dollars lost to
companies as the result of chronic conditions left
untreated."
According to research conducted by the Public Health
Institute and UC Berkeley's
School of Public Health, California's emerging populations
are under represented in all
health professions and in the health professions pipeline.
In general, as the level of
education increases and as admission spots become more
competitive, racial and ethnic
diversity diminishes.
Health care workforce provisions contained in PPACA
On March 23, 2010, President Obama signed the PPACA, a
comprehensive measure designed to expand the number of
persons with health insurance coverage, regulate health
insurance offering, rating, and coverage practices, test
changes in health care delivery designed to promote health
care costs and quality reforms, advance public and
community health goals, and expand and diversify the health
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care workforce.
Title V requires the Health Resources and Services
Administration to award health workforce planning and
implementation grants to eligible partnerships, which are
defined as state workforce investment boards that include
as members, or modify their membership to include, at least
one representative from a health care employer, labor,
state labor federation, educational council, higher
education, public secondary education, and philanthropic
organizations. California would need to add
representatives of health care employers, public four-year
higher education, and philanthropic organizations, that
provide support for recruitment, education, and training of
individuals for the health care and related fields, to its
workforce investment board in order to qualify as an
eligible partnership.
Also, as part of its Enhancing Health Care Workforce
Education and Training provisions, Title V of the PPACA
requires the Director of the CDC to award grants to
eligible entities to promote positive health behaviors and
outcomes for populations in medically underserved
communities through the use of community health workers.
Entities eligible for grants would include public or
nonprofit private entities, including a state or public
subdivision of a state, public health department, free
health clinic, hospital, or federally qualified health
center, or a consortium of any such entities. The entities
would have to use community health workers to qualify for
grants, defined as individuals who promote health or
nutrition within the community in which they reside and
provide services in a medically underserved community,
which is defined as a community identified by a state that
has a substantial number of individuals who are members of
a medically underserved population, and has a significant
portion of its areas designated as a health professional
shortage area.
Related bills
AB 657 (Hernandez) would have required the Office of
Statewide Health Planning and Development (OSHPD) to
establish the Health Professions Workforce Task Force (task
force) to assist in the development of a health professions
workforce master plan for the state. AB 657 was vetoed by
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the governor, who claimed he recognizes the importance of
developing California's health professions workforce, but
believes this bill is unnecessary and duplicative of
efforts already under way.
Prior legislation
AB 2375 (Hernandez) of 2007 was substantially similar to AB
657. It would have required OSHPD, in collaboration with
the California Workforce Investment Board, to establish the
Health Professions Workforce Task Force, comprised of
specified members, to assist in the development of a health
professions workforce master plan for the state. AB 2375
would also have required the task force to submit to OSHPD
its recommendations for a statewide health professions
workforce master plan. Finally, AB 2375 would have
required OSHPD to determine gaps in the health professions
workforce data collection, and to request the appropriate
state entities to prepare and collect the data required.
AB 2375 was held on the Senate Appropriations suspense file
and then subsequently referred to the Senate Rules
Committee, where it died at the end of session.
AB 2439 (De La Torre), Chapter 640, Statutes of 2008,
requires the Medical Board of California (MBC) to assess an
additional $25 fee for the initial license and license
renewal of a physician to support the Steven M. Thompson
Physician Corps Loan Repayment Program. Fifteen percent of
the funds collected from the additional $25 fee are
dedicated to loan assistance for physicians who agree to
practice in geriatric care settings or settings that
primarily serve adults over the age of 65 or adults with
disabilities.
AB 638 (Bass), Chapter 628, Statutes of 2008, establishes,
until January 1, 2014, the California Physician Assistant
Loan Assumption Program, to assume the qualifying
educational loans of physician assistants (PAs) who agree
to practice in designated medically underserved areas
(MUAs) to the extent funding is provided in the annual
Budget Act.
AB 2543 (Berg) of 2008 would have enacted the Geriatric and
Gerontology Workforce Expansion Act to provide grants for
loan repayment assistance, on or after January 1, 2010, to
licensed and associate clinical social workers, marriage
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and family therapists, and registered marriage and family
therapy interns who provide geriatric services, as defined.
AB 2543 was vetoed by the Governor, who stated "?the
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. I would encourage the
stakeholders to consider the loan repayment funds they
currently receive though licensure assessments and discuss
how those funds can be redirected to address their policy
goals."
SB 764 (Migden) of 2007 would have required the Medical
Board of California (MBC) and the Osteopathic Medical Board
(OMB) to provide physician information to OSHPD, and would
have required OSHPD to prepare a report with projections
concerning primary care physicians for the Legislature and
the Department of Health Care Services, as specified. SB
764 was vetoed by the Governor, who stated "?[the bill's]
goal can be more effectively accomplished administratively.
In fact, my Administration already has efforts under way,
in the context of my comprehensive health care reform
proposal to discuss and develop strategies to improve the
diversity and capacity of this state's health care
workforce."
SB 139 (Scott), Chapter 522, Statutes of 2007, among other
provisions, establishes the Health Care Workforce
Clearinghouse under OSHPD.
AB 2283 (Oropeza), Chapter 612, Statutes of 2006, requires
the MBC to annually aggregate existing data reported to it
by physicians on their cultural background and foreign
language proficiency, as specified, and report that
information on their website.
AB 938 (Yee), Chapter 437, Statutes of 2004, establishes
the Licensed Mental Health Provider Education Program and
the Mental Health Practitioner Education Fund to increase
the number of mental health professionals.
Arguments in support
The Association of California Healthcare Districts believes
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this bill will play an important role in addressing health
workforce needs in California. They claim that, to date,
California's efforts to develop its health workforce have
been focusing mainly on data collection, loan repayment
programs, and funding for specific health professions with
limited evaluation and strategy. They believe California is
therefore missing an overarching vision, action plan, and
infrastructure to coordinate efforts in order to maximize
efficiency and impact.
The Latino Coalition for a Healthy California claims that
the population is aging, growing, and becoming more
diverse, and cites that demographic shifts are causing gaps
between health workforce supply and demand. They claim that
California's health professionals have not reflected these
changes and are ill-equipped to respond to new pressures on
the health care system. With the passage of federal health
reform, the need for a coordinated health workforce
development plan is essential to the overall success of
health reform in California. Provisions in the federal
package call for states to establish coordinating councils
as well as to establish available funding grants for these
sorts of state activities. They support this bill because
they believe it will provide the mechanism necessary to
create a coordinated workforce development plan.
PRIOR ACTIONS
Prior actions are not relevant to this version of the bill.
POSITIONS
Support: Association of California Healthcare Districts
Latino Coalition for a Healthy California
Service Employees International Union
Oppose: None received
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