When the government set out to help 32 million more Americans gain health insurance, Congress and the Obama administration acknowledged that steering more people into coverage had a dark underside: If it works, it will aggravate a shortage of family doctors, internists and other kinds of primary care.
So Page 519 of the sprawling 2010 law to overhaul the health-care system creates an influential commission to guide the country in matching the supply of health-care workers with the need. But in the eight months since its members were named, the commission has been unable to start any work.
The group cannot convene, converse or hire staff because $3 million that it needs for its initial year has been blocked by two partisan wars on Capitol Hill — strife over the federal budget and Republicans’ disdain for the health-care changes that Democrats muscled into law 14 months ago.
“We’ve been sort of hamstrung,” said Fitzhugh Mullan, a professor of medicine and health policy at George Washington University who is one of the 15 commission members appointed by the Government Accountability Office. The panel’s only activity so far, Mullan said, was a single conference call during which members were told they could not lobby members of Congress for funds or accept money to operate from foundations or anywhere else.
The National Health Care Workforce Commission is intended as an ongoing brain trust to focus new energy on solving an old problem that will become increasingly severe. The law says the new commission will analyze primary-care shortages and propose innovations for the government — and medical schools — to help produce the doctors and other health workers the nation needs. The idea is to furnish expertise to counterbalance the intense lobbying of medical groups.
The commission is unlike many other aspects of the law, which have built-in money to carry them out. Despite the efforts of some Democratic senators, appropriations for the commission were not in the continuing budget resolution Congress belatedly adopted for the fiscal year that began last fall. President Obama has requested the $3 million in his budget proposal for next year, but Republicans who control the House oppose it.
Having voted four months ago to repeal the entire Patient Protection and Affordable Care Act, as the law is called, the House GOP has proposed a budget that “makes the case ... no new taxpayer dollars will be directed to fund the law,” said Conor Sweeney, spokesman for House Budget Committee Chairman Paul Ryan (R-Wis.)
But Sen. Jeff Bingaman (D-N.M.), who has long advocated greater attention to the health-care workforce, said, “If, in fact, you are going to provide access to health care for all of these uninsured people, what is that going to do to the ability of our clinics and hospitals and doctors’ offices to handle this?” Even if the commission eventually is given the means to do its work, Bingaman said in an interview, “the delay is a serious problem.”
Proponents of the workforce commission say they were surprised that Republicans have balked, because there has, in the past, been little ideological schism over the need to bolster the supply of primary care — doctors, nurses, physicians assistants and others.