The Obama administration said on Monday it would free up as much as $1 billion in grants to help groups, doctors, and communities hire and train health care workers as a way both to create jobs and improve health care. The goal is to experiment with ways to expand the health care work force while reducing the overall cost of services—and to get around Congress, which has stymied his suggestions for a jobs bill.
But critics and supporters alike suggested the impact of the Health Care Innovation Challenge would likely be limited.
“Today’s grants can be a catalyst for the kind of innovation we need,” Health and Human Services Secretary Kathleen Sebelius said at a news conference. She said the program would reduce health care costs while creating jobs and encouraging local innovation.
“When I visit communities across the country, I continually see innovative solutions at the very ground level—a large health system working with community partners to decrease the risk of diabetes with nutrition programs or a church group that sends volunteers to help homebound seniors so they can live at home,” Centers for Medicare and Medicaid Services Administrator Dr. Donald Berwick said in a statement.
“By bringing national attention to these projects, we can help them spread to other communities,” Sebelius said. The program, she said, will train “the health care workforce of the future.”
The program will provide up to $1 billion in grants for hiring health care workers, 10 percent of the total funding afforded to the Center for Medicare and Medicaid Innovation. It will target high-need populations enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program.
Billed as the latest component of the White House's “We Can’t Wait" initiative, the Health Care Innovation Challenge adds another federal program to President Obama’s job-creation agenda.
But it will require projects to be implemented within six months, and some critics noted the individual grants—between $1 million and $30 million over three years—would be relatively modest. Those parameters mean that workers at the lowest levels of the health care workforce will benefit the most, said Joseph Antos, who researches health care policy at the American Enterprise Institute.
Bobbi Ryder, CEO of the National Center for Farmworker Health, said the grant program will help organizations like hers boost prevention programs, increase community outreach, and train medical staff to use electronic records.
Ryder’s network of community health centers currently employs five "lay health promoters," community leaders who go door-to-door educating women about breast-cancer screening and prevention. “That’s something that we can hire and train on immediately,” Ryder said.
Employing lay health promoters is “not a new idea. In fact, it’s a very old and traditional idea,” Ryder said. She said her organization would “absolutely" consider applying for a grant. "We’ve experienced a 15 percent reduction in one of our grants and a total elimination of another," she said.
Prevention, coordination, and technical training are all vital links in the overall health care system. But the new grants will do nothing to address a larger problem: the shortage of physicians in American communities, and the need for more nurse practitioners, physician assistants, and other mid-level professionals, said James Sherk, senior policy analyst in labor economics at the right-leaning Heritage Foundation.
HHS officials downplayed the job-creation goals of the program. “This is not about a specific number” of new jobs, said Richard Gilfillan, acting director of the Center for Medicare and Medicaid Innovation. “This is about finding out, learning about what those jobs should be, how we can train people for them and how we can deploy them.”
Another conservative critic, AEI's Antos, noted that nurse practitioners take far more than six months to train, and that state-level regulations continue to limit what non-physicians can or can’t do.
“This looks like just a piece of PR, and not a very effective piece of PR,” Antos said. “Having Health and Human Services put out $1 billion isn’t going to have any impact on state regulations.”
Some health care experts also worry that a short-term federal grant program by definition won’t create long-term jobs.
“We have to be very careful that we don’t create a bunch of positions for which there won’t be adequate payment,” said Dr. Glen Stream, president of the American Academy of Family Physicians. Without assurance that these new positions will be supported over the long term, he said, he doubts many of the doctors his organization represents will apply for grants to bolster their practice. Physicians are generally unlikely to apply for federal grants anyway, he said.
“We also want to see, beyond short-term investments, a long term investment in the physician workforce,” Stream said.
The launch of another White House initiative met no applause from Congressional Republicans.
“Given the number of questions that have been raised about whether funding for the Innovation Center is being effectively spent, I have serious concerns with them being at the helm of this new program,” Sen. Orrin Hatch, R-Utah., said in a statement.