BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2551|
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THIRD READING
Bill No: AB 2551
Author: Hernandez (D), et al
Amended: 8/20/10 in Senate
Vote: 27 - Urgency
PRIOR SENATE COMMITTEE VOTES NOT RELEVANT
SENATE HEALTH COMMITTEE : 6-2, 8/11/10
AYES: Alquist, Cedillo, Leno, Negrete McLeod, Pavley,
Romero
NOES: Strickland, Aanestad
NO VOTE RECORDED: Vacancy
SENATE APPROPRIATIONS COMMITTEE : 7-4, 8/12/10
AYES: Kehoe, Alquist, Corbett, Leno, Price, Wolk, Yee
NOES: Ashburn, Emmerson, Walters, Wyland
ASSEMBLY FLOOR : Not relevant
SUBJECT : Health workforce planning
SOURCE : Author
DIGEST : This bill establishes the Health Workforce
Development Fund consisting of moneys received from federal
and private sources, as specified,
authorize the Fund to be used, upon appropriation by the
Legislature, for prescribed purposes relating to health
workforce development, and requires the California
Workforce Investment Board and the Office of Statewide
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Health Planning and Development to report specified
information to the Legislature annually from April 1, 2012,
to April 1, 2016, inclusive.
Senate Floor Amendments of 8/20/10 provide a mechanism for
possible funding of activities related to health workforce
development.
ANALYSIS :
Existing federal law:
1. 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.
2. 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.
3. 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.
4. Under the Workforce Investment Act of 1998 (WIA),
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.
5. Provides, under the WIA, for the establishment of state
and local Workforce Investment Boards.
Existing state law:
1. Establishes the California Workforce Investment Board
(CWIB), appointed by the Governor, to be responsible for
assisting the Governor in the development, oversight,
and continuous improvement of California's workforce
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investment system.
2. 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.
3. Requires the Office of Statewide Health Planning and
Development (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.
4. 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.
5. Establishes the California Healthcare Workforce Policy
Commission to identify specific areas of the state where
there are unmet priority needs for dentists, physicians,
and registered nurses.
6. 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.
This bill:
1. Establishes the Health Workforce Development Fund
consisting of moneys received from federal and private
sources, as specified, authorize the Fund to be used,
upon appropriation by the Legislature, for prescribed
purposes relating to health workforce development, and
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requires the CWIB and the OSHPD to report specified
information to the Legislature annually from April 1,
2012, to April 1, 2016, inclusive.
2. Provides that the Fund, upon appropriation by the
Legislature, shall be used to do all of the following:
A. Support the development of a health workforce
council.
B. Develop a strategic health workforce plan.
C. Assist in identifying and linking health care job
opportunities with health workforce development
training opportunities in local workforce investment
areas (LWIAs) and encourage regional collaboration
among LWIAs to meet regional economic demands.
D. Develop public, private, philanthropic, and
nongovernmental partnerships to build and expand the
state's health workforce development programs,
network, and infrastructure.
E. Provide policy guidance for job training programs
in the health care sector to assist and prepare
specific populations, including, but not limited to,
at-risk youth, displaced workers, veterans, formerly
incarcerated individuals, and others facing barriers
to employment.
F. Develop, collect, interpret, and distribute
statewide and regional labor market data on
California's health workforce needs, trends, and job
growth.
G. Foster regional collaboration in the health
sector.
Background
Health Workforce Shortages
Statewide shortages of health providers currently exist in
several major health professions, such as nursing, primary
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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 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 10 years.
Seventy-six percent of clinics report a staffing shortage
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
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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 the University of California, 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
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
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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 Centers for Disease Control
and Prevention 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
OSHPD staff $125 $250 $220
Special*
CWIB staff $75-$100 $150-$200
$150-$200 General
* California Health Data and Planning Fund
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SUPPORT : (Verified 8/20/10)
Association of California Healthcare Districts
California Medical Association
Latino Coalition for a Healthy California
Service Employees International Union
ARGUMENTS IN SUPPORT : The author's office 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's office
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.
CTW:mw 8/23/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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