H.R. 3200 – Full of Pork – Let’s Have a Barbecue!
Under the title of Public Health & Workforce Development are a number of grants, scholarships and other programs, providing training, services and a whole new array of studies relating to health care – a lot of money being spent to support the expansion of government, special interests, illegal immigrants and labor unions, but little to help solve the health care issues.
The first expansion is the establishment of the Public Health Investment Fund, which requires deposits from the revenues of the Treasury in the amount of $88,700,000,000 over 10 years. This money is authorized to be appropriated by the Committee on Appropriations of the House and Senate for carrying out the activities under the designated public health provisions. These areas include Community Health Centers, National Health Service Corps Program, National Health Service Corps Scholarship and Loan Repayment Programs, Primary Care Loan Funds, Primary Care Education Programs, Nursing Workforce Development, The National Center for Health Statistics and the Agency For Healthcare Research and Quality.
To make these programs even more appealing is the stipulation that “Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget solutions for fiscal years during which appropriations are made from the fund.” More spending without any concern for balancing the budget or controlling the country’s deficit. We don’t have it, but let’s spend it!
The first program – Community Health Centers – will obtain increased funding in the amount of $38,800,000,000.
The National Health Service Corps is being amended allowing the Secretary to issue waivers to individuals who enter into a contract for obligated service to pay for their education. It further raises the loan repayment amount from $35,000 to $50,000 and will be adjusted thereafter to reflect inflation. Additional appropriated funds for this program are $796,000,000 over the next 10 years. Additional funding is authorized in the amount of $3,171,000,000 over 10 years to cover the National Health Corps Scholarship and Loan Repayment Programs.
The Frontline Health Providers Loan Repayment Program will be established to address unmet health care needs in certain areas, populations, or facilities as designated by the Secretary. Individuals participating in this program must agree to serve for a period of 2 years in a health professional needs area specified in the program. This program has a clause that if there are an insufficient number of applicants for the program, then all excess funds from the program will be transferred to the National Health Service Corps to recruit more people to take advantage of this fund.
The Secretary shall establish a primary care training and capacity building program consisting of grants and contracts to plan, develop, operate or participate in accredited professional training in the field of family medicine, general internal medicine, general pediatrics or geriatrics. Funds for this program are from the Public Health Investment Fund in the amount of $3,023,000,000 for 10 years and will include the following:
- Capacity Building in Primary Care – grants to specialties of family medicine, general internal medicine, general pediatrics or geriatrics, with preference given to entities that train individuals who are from underrepresented minority groups or disadvantaged backgrounds.
- Training of Medical Residents in Community-Based Setting – a program established for the training of medical residents in community-based settings, with preferences given to entities that support teaching programs addressing the health care needs of vulnerable populations or are a Federally qualified health center or rural health clinic, as well as preference to those training individuals from underrepresented minority groups or disadvantaged background.
- Training for General, Pediatric or Public Health Dentists and Dental Hygienists – grants and contracts to plan, develop, operate or participate in an accredited professional training program or oral health professionals, with preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds.
Grants for Health Professionals Education – Advanced Education Nursing Grants is being amended, including increases in dollar amounts for the Nurse Faculty Loan Program. Funding for this program is $1, 450,000,000 over 10 years.
The Public Health Workforce Corps is being amended and expanded by the following: Creating the Public Health Workforce Scholarship Program, Public Health Workforce Loan Repayment Program, Enhancing the Public Health Workforce, and Preventive Medicine and Public Health Training Grant Program. Appropriations for these programs total $642,000,000 over 10 years. The Enhancing the Public Health Workforce even includes provisions for veterinary medicine! I’m not sure how veterinarians will provide quality health care to people or decrease health care costs, but it’s nice to see even our animals will be included in the grant programs.
Under the Subtitle “Adapting Workforce to Evolving Health System Needs” there are a number of grants and programs including:
- Health Professionals Training for Diversity, which includes scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistant in health professions regarding individuals from disadvantaged background.
- The Nursing Workforce Diversity Grants is being amended and adding the Coordination of Diversity and Cultural Competency Programs.
- The Secretary will establish a cultural and linguistic competency training program for health care professionals, including nurses, consisting of grants and contracts to develop and implement models of cultural and linguistic competency training. Preference will be given to entities that address cultural and linguistic needs of the population and health disparities, and placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations, including communities along the United States-Mexico border. Obviously this program will benefit all the illegal immigrants coming from Mexico to obtain free health care.
Appropriations for these programs total $1,138,000,000 over 10 years.
Grants and contracts are given to develop training programs to promote the delivery of health services through interdisciplinary and team-based models, with preferences given to entities that demonstrated training to the greatest number of health professionals who serve in underserved communities.
The Secretary will establish a permanent advisory committee to be known as the Advisory Committee on Health Workforce Evaluation and Assessment. This is a 15 member committee appointed by the Secretary, including health professionals within the health workforce, health care patients and consumers, employers, labor unions and third-party health payors who have experience working with populations in urban and federally designated rural and non-metropolitan areas and populations who are underrepresented in the health professions including underrepresented minority groups.
Appropriations for these programs total $1,149,000,000 over 10 years.
Grants and contacts will also be available to collect data on the health workforce with respect to the supply of health professionals, diversity of health professions (including race, ethnic background and gender) and geographic distribution of health professionals.
Under Prevention and Wellness the grants, committees and task forces funds are appropriated as follows:
- Prevention and Wellness Trust, with funding in the amount of $35,300,000,000.
- The Prevention Task Force with $35,000,000 each year for the next 10 years is funded for this program.
- Prevention and Wellness Research, with funding in the amount of $2,740,000,000.
- Delivery of Community Preventive and Wellness Services, with funding in the amount of $17,200,000,000.
- Core Public Health Infrastructure and Activities for State and Local Health Departments, with funding in the amount of $13,600,000,000.
- Core Public and Health Infrastructure and Activities for CDC is funded in the amount of $400,000,000 for each year for the next 10 years.
The Secretary shall submit to Congress a national strategy designed to improve the nation’s health through evidence based clinical and community prevention and wellness activities, including core public health infrastructure improvement activities.
The establishment of the Task Force on Clinical Prevention Services by the Secretary is a permanent task force responsible for identifying clinical preventive services for review. The task force is composed of 30 members appointed by the Secretary including members with expertise in Health promotion and disease prevention, Evaluation of research and systematic evidence reviews, Clinical primary care in child and adolescent health, adult health, geriatrics, Clinical counseling and behavior services for primary care patients. The Secretary shall ensure that all areas of expertise are represented and members collectively have significant experience treating racially and ethnically diverse populations.
This task force shall also convene a Clinical Prevention Stakeholders Board, composed of representatives from appropriate public and private entities with an interest in clinical preventive services. Membership includes representatives in Health care consumer and patient groups, Providers of clinical preventive services, Federal departments and agencies including appropriate health agencies and offices, and Private health care payors. The board shall recommend clinical preventive services to be reviewed by the task force.
The Secretary shall establish the permanent task force known as the Task Force on Community Preventive Services, responsible for identifying community preventive services for review. Membership will consist of 30 members appointed by the Secretary including expertise in Public Health, Evaluation of research and systematic evidence reviews, and Disciplines relevant to community preventive services, and shall ensure members include representatives of State health officers, Local health officers, Health care practitioners and Public health practitioners. Individuals shall be appointed who collectively have significant experience working with racially and ethnically diverse populations.
This task force will also convene the Community Prevention Stakeholders Board with representatives with an interest in community preventative services to advise the task force. Membership in the board shall include representatives from Health care consumer and patient groups, Providers of community preventive services, Federal departments and agencies and other Federal departments and agencies who programs have a significant impact on health, and Private health care payors. This board will recommend community preventive services for review by the task force.
The Secretary shall award grants to provide evidence-based, community preventive and wellness services to a state, local or tribal department of health, a public or private entity or a community partnership representing a Health Empowerment Zone. Not less than 50 percent of these funds are to be used for planning or implementing community preventive and wellness services whose primary purpose is to achieve a measurable reduction in one or more health disparities.
A Core Public Health Infrastructure will be established by the Secretary in the way of grants to each State health department, and may award grants on a competitive basis to State, local or tribal health departments. Not less than 50 percent of this money shall be grants to State health departments and not less than 30 percent grants to State, local or tribal health departments. The formula for determining State grants will be based on population size, burden of preventable disease and disability, and core public health infrastructure gaps. The Secretary shall also expand and improve the core public health infrastructure and activities of the Center’s for Disease Control and Prevention to address unmet and emerging public health needs.
There is a transition provision that transfers all functions, personnel, assets and liabilities, and administrative actions of the Preventive Service Task Force and the Task Force on Community Preventive Services to the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services.
The Center for Quality Improvement is established and headed by the Director. The Director shall prioritize areas of best practices for quality improvement activities in the delivery of health care services and may award grants or contracts to assist with the responsible tasks. Included in the prioritized areas are: Health care associated infections; Surgery – increase patient safety, including reducing surgical-site infections and surgical-errors; Emergency rooms – use of principles of efficiency of design and delivery to improve patient flow; and obstetrics – including the identification of interventions that are effective in reducing the risk of preterm and premature labor and the implementation of best practices for labor and delivery care. This area would be especially important since the government is taking people that potentially should not be in the medical field, training them, and then unleashing them on the public to provide “quality” service. In order to maintain some of the basic medical practices, this agency needs to be established to be sure these potentially unqualified individuals don’t do stupid things during their treatments, including surgery on an incorrect site, leaving surgical instruments in a patient or causing an increase in infections. To prepare for the increase in visits to the emergency rooms, the proper set up of an emergency room will be required to improve patient flow while the patient is waiting to obtain treatment. I especially like the obstetrics reference as over the years I’ve seen this area go from bad to worse, putting expectant mothers on a specific timeline for delivery and if they don’t stay within that timeline a cesarean delivery is scheduled. Best practices for the majority of labor and delivery mothers is the medical profession staying out of it and letting nature take its course.
The bill also established within the Department an Assistant Secretary for Health Information. The scope of this expands government so much that another permanent government job is created just to handle the health information aspects of the bill.
Quality and Surveillance appropriations will be made in the amount of $300,000,000 for years 2010-2014 and $330,000,000 for the years 2015-2019.
Entities receiving discounted drug prices is expanded to include a variety of hospitals and entities, many of which had been excluded from Medicare. It also prohibits the use of group purchasing arrangements to obtain covered out-patient drugs.
School based health clinics are also established by the Secretary, consisting of grants to support the operation of these clinics. The entity shall be a SBHC and will provide on-site access during the academic day when school is in session. Preferences in awarding grants is given to those who have demonstrated record service to a high percentage of medically underserved children and adolescents, communities or populations in which children and adolescents have difficulty accessing health and mental health services, and communities with high percentages of children and adolescents who are uninsured, underinsured or eligible for medical assistance under Federal or State health benefits programs. Matching funds of 20 percent are required by the SBHC. Appropriations of $50,000,000 for each fiscal year beginning 2010, and sums as may be necessary for years 2011-2014. I have two problems with this program. First, if under this act all legal persons are required to obtain insurance then there should not be any uninsured children or adolescents. Likewise, if the government is establishing the benefits for all insurance policies then there should be no underinsured children or adolescents unless the government is establishing substandard policies. So the only group these clinics will serve is a high number of illegal immigrants. My second problem is the statement on communities in which services are difficult to access. I live not far from a school that currently has a school-based clinic, 70% of the children are of Hispanic descent. However, within 1-3 miles of the area in just about any direction there is access to a hospital, doctor’s offices, testing labs, and just about any medical facility someone might need. Bus service is available in the area. There is no reason to have a school-based clinic in this area other than to serve the illegal population.
Under the Federal Food, Drug and Cosmetic Act, the National Medical Device Registry is established to facilitate analysis of post-market safety and outcomes data that is or has been used in or on a patient, is a class III device or class II device that is implantable, is life-supporting or life-sustaining. The devices will be identified by type, model, serial number or other unique identifier. To facilitate analysis, the Secretary shall develop methods to obtain access to disparate sources of patient safety and outcomes, including data from Federal health-related electronic data (Medicare or VA), private section health-related electronic data (pharmaceutical purchase data and health insurance claims data), and other data the Secretary deems necessary. Appropriated sums are authorized for fiscal years 2010 and 2011 to carry out the program, but an amount is not specified. I would think sharing this type of data would violate HIPAA laws, especially when this section is supposed to be covering medical devices and the government wants access to prescription medication data and health insurance claims.
Grants will be made available for programs to provide education to nurses and to create a pipeline to nursing. These grants will address the projected shortage of nurses and provides training programs only to organizations that are administered by the health care provider and labor unions. There is a collaboration requirement which states what funds will be used for. One of these areas is “preparing incumbent workers to return to the classroom through English-as-a-second language education. There is also a matching fund requirement, matching dollar for dollar contributions to the grant. Where do you start with what is wrong with this grant program. It screams of special interests and labor union involvement in the development of the bill. It further supports immigration problems by providing funds to teach non-English speaking individuals English, having nothing to do with nursing. There are no other funding limits, so basically it provides an open checkbook as long as participants provide matching funds.
The bill has a provision that indicates if states fail to adhere to the employment obligations then the state will not be eligible for Federal funds under the provisions of the Public Health Service Act.
There is a lot of money being spent for specials programs not directly related to providing health insurance to anyone. Some of the programs may increase the number of medical professional, including nurses available by providing grants or loan repayment programs. Most of the programs are aimed at individuals from specific racial or ethnic backgrounds (minorities) or disadvantaged backgrounds. So while the president and other groups are screaming “racist” when one questions or does not support their point of view, this program is loaded with racial bias. Everyone should receive an equal chance. Just because someone is of a certain background does not necessarily make him or her the best choice to go into the medical profession. These people will become the future of medicine, so I would hope criteria other than the preferential background is being used to determine eligibility. Medical professions take a lot of hard work, education and money, so I would certainly hope taxpayer money isn’t being wasted on sending individuals to medical training of any type without a reasonable expectation of success. To provide medical training to people that may possess limited English proficiency is asking for failure. Not that these people may not make good medical professionals, but what are the chances for success if they cannot even understand the class material!
Other programs support the accusations of providing illegal immigrants with health care, like the school-based programs and programs to provide services to populations with cultural and linguistic challenges, especially those along the US-Mexican border. Who are they kidding!
Labor unions have definitely had a hand in the development of this bill as they will only benefit from it being past. No wonder they are out a town hall meetings creating disruptions and beating up people who oppose the bill. There are grants only for entities supporting labor unions and a number of Task Forces and Committees specifically call for labor unions to make up part of the committee. They will only gain further strength in the government if this bill is passed.
There is also the allocation of money to create expanded government and support studies. None of these studies are directed at ways to lower the cost of medical care. So far I have read nothing to indicate any way of making medical care affordable. The only attempt is by expanding the Medicare billing rates to the expansion of a government option, and Medicare is one of the contributors to the ever increasing cost of medical care. One could continue to conclude that H.R. 3200 is for the purpose of a government takeover of health care and further support of special interests, including labor unions, but nothing to truly solve the health care issues facing us today. Over $88 billion dollars in spending has to be paid somehow, so the cost of “affordable” health insurance isn’t looking so affordable.
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