A blockbuster healthcare bill to boost the workforce and training pipeline? Looks that way
A handful of states are addressing staff shortages with limited success. Now, a huge U.S. Senate bill – that could alter the hiring and training landscape – is headed for a September debut.
In the July 20 edition of this newsletter, I referenced the boat-load of data showing that the “Great Resignation” of the pandemic has been especially true among healthcare professionals — and how the trend is not slowing.
About half of nurses surveyed earlier this year said they plan to leave the profession soon; as many as 85% of nurses working in hospitals said they will no longer be working in hospitals in a year.
Hospitals’ nursing departments are already impossibly short-staffed.
Meanwhile, healthcare organizations — struggling to stay on top of costs as inflation rises faster than insurer reimbursement rates — are not quickly filling their open nursing jobs. (Whether that’s by design, i.e. to trim budgets, or due to a job market that's more competitive than ever in history, depends on whom you ask.)
Throwing Spaghetti At the Walls in Congress?
The problem of too few nurses to meet inpatient needs is undeniably a nationwide one, and over the past year, nurses’ groups have demanded the attention of state lawmakers, union leaders, and the U.S. Congress.
Listed in the July 20 Healthcare Workforce Report were a few federal bills proposed this spring; each calls for some type of Band-Aid program to fix what nursing organizations and some patient advocacy groups say is a system that puts too many patients — and impossibly high expectations — on the nurses who haven’t yet left their jobs.
(Not that there’s anything wrong with that! Band-Aids do, after all, serve their purpose.)
Those bills, though, look a lot more like Congress members throwing noodles against the wall to see which ones will stick.
The healthcare workforce-related bills we’ve seen introduced in D.C. thus far in 2023 have very little chance of actually becoming law.
However, it appears a serious contender is set to debut soon after Congress’ August recess, with a bipartisan group of Senators working on a deeply detailed “healthcare workforce overhaul” bill. More on that below.
States Eyeing Band-Aids of Their Own
First, though, let’s look at the handful of state legislative efforts to enact mandates for “safe staffing,” aka minimum nurse-to-patient ratios:
(By the way: California was the first state to require “specific numerical nurse-to-patient ratios for acute care, acute psychiatric, and specialty hospitals” — in 1999. Color me unsurprised that Cali was 24 years ahead of the curve on this issue.)
Pennsylvania’s House Bill 106, dubbed the Patient Safety Act, was approved (by a healthy margin and with bipartisan support, by the way) and sent to the state Senate on June 28. It would limit the number of patients a hospital can assign to any individual nurse. (An intensive care unit, for instance, could assign a single nurse no more than two patients.) The Pennsylvania Senate has not taken any action nor scheduled any committee hearings on the bill, labeled SB 247 in that chamber.
“We don’t have a nurse shortage, we have a nurse retention problem. We are not keeping nurses in the hospitals. The turnover is nearly 30% and we need to change that environment.”
— Pennsylvania State Rep. Thomas Mehaffie, R-Dauphin
In New York, where a “Safe Staffing Act” was passed in 2021, the new nurse-to-patient ratios are now being implemented but only in critical care units, according to a recent New York Post report. Similar to the Pennsylvania proposal, New York’s new rules require at least one nurse assigned to every two patients in critical care units in all hospitals in the state.
Oregon, Maine, Minnesota, Connecticut, Washington, and Massachusetts are among the list of states with new laws or proposed legislation mandating nurse-to-patient ratios; find more about those efforts at Forbes.com and BeckersHospitalReview.com. The Forbes article delves into why this push is happening — and why a piecemeal approach via state laws is nowhere near enough to solve the problem.
As writer Rita Numerof explains, the healthcare workforce crisis — and the manner in which staff shortages and market forces are negatively impacting patient care, in some cases — requires federal action. Big action.
She is one of many people shouting this from the rooftops.
A Bipartisan Primary Care and Health Workforce Expansion Act? Say What?
Namely, U.S. Sen. Bernie Sanders is shouting it, too — and unless you’ve been hiding under a rock for 15 years, you’ve heard him hollerin’ about his so-called “Medicare For All” plan.
Now, Sanders apparently has shifted his focus from that idea to instead calling for the government to invest — to do a lot more investing — in the primary care workforce and boosting the workforce pipeline for our existing healthcare system, explains the Times and Democrat in a July 31 report.
The headline of the Times and Democrat report on Sanders’ giant healthcare bill explains why everyone should care about healthcare workforce shortages: “Sen. Sanders says millions of people can’t find a doctor. He’s mostly right.”
Sanders recently gave a sneak peek at the new massive package of legislation; it includes dozens of moving parts addressing every area of the healthcare sector that is currently considered broken, inaccessible, and/or dangerously short-staffed. Yes, that is a list of vague descriptors open to wide interpretation; that is the point.
At 285 pages, it covers a heckuva lot. (And no, it does not sneak in any Medicare For All business.)
Sanders’ bill, named The Primary Care and Health Workforce Expansion Act, hasn’t yet been officially introduced on the Senate floor. It’s HUGE. It would actually impact every American and their access to healthcare, if passed into law.
Unlike some of the federal legislation filed earlier this year and referenced above, this bill appears to be undergoing a thoughtful, bipartisan negotiation and revision process before its official introduction and number assignment in the Senate.
A “markup session” — where Senators on the committee covering the focus of any bill sit down to review the language, negotiate, and clarify as needed — was scheduled for last week in the Senate Health, Education, Labor, and Pensions Committee, but it was postponed until after the August recess while members from both sides of the aisle work on the details privately, according to Sanders’ website.
The Primary Care and Health Workforce Expansion Act calls for the U.S. to invest $20 billion a year for five years to “expand community health centers and provide the resources necessary to recruit, train, and retain tens of thousands of primary care doctors, mental health providers, nurses, dentists, and home health workers.”
The bill summary can be viewed at Sanders’ Senate website. I’ve read the whole thing. It has the potential to become a big deal, and it could markedly improve many shortfalls of our healthcare system — if Congress can meet in the middle long enough to work together on it. That said, it’s still a loooong way from even being debated, let alone approved.
I’ll be watching how this progresses and will keep you updated here; make sure you subscribe to Healthcare Workforce Report to get the latest updates.
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