Creating Jobs and Increasing the Number of Primary Care Providers
For too long, our nation has suffered from a shortage of primary care health professionals. The Association of American Medical Colleges estimated that the nation would have a shortage of approximately 21,000 primary care physicians in 2015. Without action, experts project a continued primary care shortfall due to the needs of an aging population, and a decline in the number of medical students choosing primary care.
The Obama Administration believes that strengthening and growing our primary care workforce is critical to reforming the nation’s health care system. Increasing access to primary care physicians and nurses can help prevent disease and illness and ensure all Americans – regardless of where they live – have access to high quality care. It can also reduce costs by increasing access to preventive care care The Affordable Care Act includes a comprehensive strategy to achieve these goals by investing in a new generation of primary caregivers through increased resources for training, new incentives to physicians for providing primary care to patients, and support for caregivers who choose to enter primary care in underserved areas.
On June 16, 2010, the Administration is announced a key step in that strategy – the availability of $250 million in new funding provided by the Affordable Care Act to expand the primary workforce. The new funding – part of the Prevention and Public Health Fund – will help prepare the health system to meet the demand for health care workers with a new initiative that will train and support thousands of new doctors, nurses, nurse practitioners, and physician’s assistants.
Combined with the earlier investments made by the American Recovery and Reinvestment Act, the provisions of the Affordable Care Act will support the training, development, and placement of more than 16,000 new primary care providers over the next five years.
Some of the steps the Administration is taking to train new doctors, nurses, public health workers and other health providers and strengthen the primary care workforce include:
The Prevention and Public Health Fund
Primary care is the backbone of preventive health care, and a strong primary care workforce is essential to health of our country. The Affordable Care Act creates a new Prevention and Public Health Fund designed to help create the necessary infrastructure to prevent disease, detect it early, and manage conditions before they become severe. This new initiative will increase the national investment in prevention and public health, improve health, and enhance health care quality.
On June 16, 2010, the Obama Administration announced the first allocation of $500 million for the new Prevention and Public Health fund for fiscal year 2010. Half of this fund – $250 million – will be used to boost the supply of primary care providers in this country by providing new resources for:
•Creating additional primary care residency slots: $168 million for training more than 500 new primary care physicians by 2015;
•Supporting physician assistant training in primary care: $32 million for supporting the development of more than 600 new physician assistants, who practice medicine as members of a team with their supervising physician, and can be trained in a shorter period of time compared to physicians;
•Increasing the number of nurse practitioners trained: $30 million will train an additional 600 nurse practitioners, including providing incentives for part-time students to become full-time and complete their education sooner. Nurse practitioners provide comprehensive primary care;
•Establishing new nurse practitioner-led clinics: $15 million for the operation of 10 nurse-managed health clinics which assist in the training of nurse practitioners. These clinics are staffed by nurse practitioners, which provide comprehensive primary health care services to populations living in medically underserved communities.
•Encouraging States to plan for and address health professional workforce needs: $5 million for States to plan and implement innovative strategies to expand their primary care workforce by 10 to 25 percent over ten years to meet increased demand for primary care services.
A New Focus on Education and Worker Training
This effort is just one part of a comprehensive, multi-faceted strategy to encourage and educate more physicians, nurse practitioners, and physician assistants to practice in primary care, including:
•Increasing access to providers in underserved areas: The Affordable Care Act builds on the important work of the National Health Service Corps (NHSC) to address the nation’s workforce demands. The NHSC repays educational loans and provides scholarships to primary care health care providers who practice in areas of the country that have too few health care professionals to serve people who live there. Eligible providers include primary care physicians, physician assistants, and nurse practitioners. The Affordable Care Act provides $1.5 billion over five years to expand the National Health Service Corps. This builds on a $300 million investment in the NHSC in the American Recovery and Reinvestment Act. The combined nearly $2 billion investment is expected to result in an increase of more than 12,000 additional primary care physicians, nurse practitioners, and physician assistants by 2016.
•Focusing on career training: The Department of Labor is providing job training across the health care sector with a focus on low-skill and low-wage workers. In FY 2010 and 2011, the Department is making grants available to community colleges, consortia of community colleges, two-year Hispanic-Serving Institutions or Historically Black Colleges, Workforce Investment Boards, and other training institutions for the development or expansion of career pathway programs that prepare workers for careers in the health care sector. These programs build on efforts already underway. In fact, also on June 16, 2010, the Department of Labor announced the release of $14.7 million in new grants made possible by the American Recovery and Reinvestment Act. These funds will support projects designed to provide health care training and virtual service-delivery models to promote career opportunities in the health care sector.
•Expanding tax benefits to health professionals working in underserved areas: In addition to the incentives provided by the Departments of Labor and Education to pursue primary care as a profession, the Department of Treasury is responsible for providing tax benefits to students. The Affordable Care Act includes a provision that excludes from taxes the value of student loans that were repaid or forgiven because the individual worked in certain health professions, including primary care. This provision is retroactive to 2009. Also on June 16, 2010, the Internal Revenue Service took steps to ensure health professionals are aware of this benefit. For 2009, approximately $10 million in tax refunds will be made available to health care professionals who practice medicine in areas that need it most.
•Building primary care capacity through Medicare and Medicaid: Currently, there are unused Medicare-funded resident training slots. The Affordable Care Act reallocates Medicare resources to primary care residencies in underserved areas of the country. Teaching hospitals benefiting from the additional slots must ensure that the number of primary care residents is not reduced and at least 75 percent of the slots received must be in primary care or general surgery for at least five years. Medicare will provide a 10 percent bonus payment for primary care provided by qualified physicians from 2011-2015. In addition, Medicaid payment rates to primary care physicians will be increased in 2013 and 2014 to at least 100 percent of associated Medicare rates. Emphasizing the critical importance of primary care by providing financial incentives will build capacity in underserved areas.
•Providing financial assistance for students: The Department of Education currently makes more than $150 billion in aid available to students to help pay for undergraduate and graduate education, through a combination of grants, loans, work study, and tax credits. The Affordable Care Act increases the Federal government’s investment in Pell Grants by $40 billion, to ensure that all eligible students receive an award and that these awards are increased in future years to help keep pace with the rising costs of a college education.
•Making health care education more accessible: Many individuals in health professions are eligible for generous student loan forgiveness programs under current Department of Education programs. This includes Public Sector Loan Forgiveness, which allows individuals in eligible jobs to have their loans forgiven after 10 years. Qualifying jobs for Public Sector Loan Forgiveness include positions in Federal, State, local, or Tribal governments as well as nearly any non-profit organization, including many hospitals and clinics. In addition, certain nurses and medical technicians are also eligible to have their Perkins loans cancelled. The Affordable Care Act expands the existing income-based student loan repayment programs for new borrowers after July 1, 2014, by capping payments at 10 percent of their discretionary income (down from 15 percent) and forgiving loans after 20 years (down from 25 years). Public sector employees will still have their loans forgiven after 10 years.