Experts estimate the Patient Protection and Affordable Care Act of 2010 (ACA) will extend health coverage to more than 30 million Americans and alter care-delivery models to focus on remaining healthy and managing illness before it becomes acute. How will the healthcare workforce treat these new patients and implement this new paradigm?
Title V of the ACA includes more than 40 provisions to support, increase and encourage innovation in the healthcare workforce. From student loans, training grants, and employee retention programs, to expansion of health centers and innovative pilot programs for both training and care delivery, the law casts a wide net to accomplish its intent of increasing the healthcare workforce's capacity to care for more patients in more proactive ways.
"There is a lot in [the ACA] that would help us boost our workforce, particularly in allied health professions," said Mollye M. Demosthenidy, JD, clinical assistant professor in the department of global health systems and development at the Tulane University School of Public Health and Tropical Medicine in New Orleans. "It was a major step and very important that they included those incentives for workforce development and training. Do we have the capacity to train the number of people we need to train? The law takes a forward-thinking approach."
Scholarships and Loan Repayment
One of the ACA's primary mechanisms for increasing the number of providers, especially in areas where need is high, is through additional funds to the National Health Service Corps (NHSC). This 40-year-old program, administered by the Health Resources and Services Administration (HRSA), offers providers financial, professional, and educational resources in exchange for working in traditionally underserved areas of the country.
The ACA and the American Recovery and Reinvestment Act (ARRA) have increased funding to the NHSC loan repayment program, which provides health professionals with up to $60'000 in exchange for two years of service in an underserved community. The health reform law also changed the way HRSA administers the program to offer higher awards and more flexibility, including the opportunity for providers to complete their service by working half-time and to obtain credit for teaching. Providers in the fields of medicine, dentistry, psychiatry, social work, marriage and family therapy and counseling, as well as nurse practitioners, physician assistants, dental hygienists and psychiatric nurse specialists are eligible.1
Further, the ACA created the NHSC Students to Service Loan Repayment Program. Medical students (MDs and DOs) in their last year of school can receive loan repayment assistance of up to $120,000 in exchange for committing to three years of full-time service in communities with limited access to care. The program has been appropriated $9.1 million in funding, according to the U.S. Department of Health and Human Services (HHS).2
The ACA also has increased funding for the NHSC scholarship program. Awardees receive tuition, required fees, and other education costs for up to four years of schooling in exchange for providing two to four years of service at an NHSC-approved site in a high-need area.3
Thanks to the ACA and ARRA, in addition to annual appropriations, the NHSC has awarded $900 million in scholarships and loan repayment assistance. As of 2011, nearly three times the number of providers - more than 10,000, up from 3,600 in 2008 - are receiving assistance through the NHSC to provide care in underserved areas.3
Separate from the NHSC, the Health Professions Opportunities Grants provide tuition and supportive services for those seeking training in health professions. These grants, created under the reform law, have so far provided more than $67 million for low-income individuals to attend training programs to enter the healthcare workforce as home care aides, certified nursing assistants, registered nurses, health information technicians, and other professionals.4
Prevention and Public Health Fund
Public health budgets have taken a serious hit during the recession, said Denise Link, PhD, WHNP-BC, CNE, FAAN, clinical associate professor in the College of Nursing and Health Innovation at Arizona State University. These budget cuts have led to reduced workforces, while individual and family financial strains have pushed more people to seek care from public health entities.