[Congressional Record Volume 149, Number 115 (Wednesday, July 30, 2003)]
[Senate]
[Pages S10275-S10277]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Cochran, Ms. Landrieu, and Mr. 
        Kerry):
  S. 1498. A bill to provide for the establishment of a Health 
Workforce Advisory Commission to review Federal health workforce 
policies and make recommendations on improving those policies; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. BINGAMAN. Mr. President, the legislation I am introducing today 
with Senators Cochran, Landrieu, and Kerry entitled ``The Health 
Workforce Advisory Commission Act of 2003'' is designed to create a 
Health Workforce Advisory Commission to review Federal health workforce 
policies and make recommendations on improving those policies.
  In my own State of New Mexico, over 9 percent of our total workforce 
is employed in the health sector. The New Mexico work force is not 
dissimilar to the rest of the Nation, where the total health workforce 
comprises 10.5 percent of the total U.S. labor force.
  By 2020, the total population of New Mexico is projected to grow 32 
percent and the population over 65 is projected to grow 80 percent, 
compared to national growth projections of 18 percent and 53 percent, 
respectively. But who will care for these burgeoning populations? New 
Mexico ranks 33rd among States in physicians per capita, and we 
graduate fewer new physicians per 1,000,000 population than the entire 
United States.
  The problem is not simply one of too few physicians however. New 
Mexico ranks 7th lowest among the States in per capita employment of 
Licensed Practical/Vocational Nurses and we have 7 nurse anesthetists 
per 100,000 population, while the national average is close to 9 per 
100,000 population. New Mexico ranks 49th in the Nation in then number 
of dentists per capita. In fact, while the State's population grew in 
the 1990s by 12 percent, the number of dentists in New Mexico declined 
7 percent in the same time period. Among the 50 States, New Mexico 
ranks 42nd in the number of pharmacists per 100,000 population.
  We are reflection of a crisis occurring in States across the Nation: 
a critical shortage in multiple areas of the health workforce in the 
face of a changing population whose health care needs are only going to 
grow and increase in complexity.
  It is estimated that by 2050 the U.S. will need to more than triple 
its number of long-term care workers; enrollment in nursing education 
programs has been declining of the last 8 years; vacancy rates for 
pharmacists in Federal facilities is up to 18 percent and 11 percent in 
public hospitals. At the same time, the number of practitioners other 
than physician grew rapidly in the 1990s. How does this growth interact 
with the simultaneous shortages in other areas? How should the 
workforce of the future best be structured to meet the rise in baby 
boomers and how should we prepare for this?
  These are the issues that health workforce policies attempt to 
address. There has been, and continues to be, a significant investment 
on the part of Federal and State governments in measuring, monitoring, 
and analyzing the numbers and types of health professionals who are 
trained and practice in the U.S. but despite such efforts, there remain 
significant problems in determining the appropriate number, type, and 
distribution of such personnel needed to provide access to appropriate 
care for Americans. The underlying problem is that health workforce 
policies developed by various State and

[[Page S10276]]

Federal entities tend to be profession or position specific. What is 
lacking is a perspective on health workforce policies that is both 
interactive and global in nature. As health care becomes increasingly 
complex, and as the health needs of the Nation changes, it is 
imperative to have a means with which the dynamics of a changing health 
care market and health care workforce can be assessed and addressed.

  We are all aware of the critical nursing shortages so many areas face 
now, the increasing difficulty in recruiting and retaining rural based 
physicians, the shortages of pharmacists and pharmacy techs, and of 
skilled laboratory technicians. And there are organizations focused on 
each of these specific issues; but these issues overlap in the 
marketplace and impact each other in ways we cannot currently define. 
It is as if there were a giant health care workforce machine with 500 
interacting mechanisms and while there is a specific mechanic for each 
of these components, there is no mechanic looking at the machine as a 
whole. The health workforce is more than the sum of its individual 
parts, and in order to enact effective Federal workforce policies, this 
must be reflected in the analysis and creation of such policies. HWAC 
is designed to do that.
  For these reasons, we have introduced legislation that will create a 
new health workforce commission, or HWAC for short. This legislation 
requires the creation of a national advisory commission to review and 
make recommendations pertaining to Federal health workforce policies. 
Specifically, it will: Review federal health workforce policy under the 
following Acts and their titles: Social Security Act, titles 18 & 19; 
Public Health Service Act Titles 7 & 8, NIH, DOD, and VA and other 
pertinent Acts and titles; Analyze and make recommendations to improve 
the methods used to measure and monitor the U.S. health workforce and 
the relationship between numbers and mix of such personnel and access 
to appropriate health care; Review health workforce policies and other 
factors and their impact on the ability of the health care system to 
provide optimal medical and health care services; Analyze and make 
recommendations pertaining to federal incentives, financial, 
regulatory, and otherwise, and federal programs currently in place to 
promote the education of an appropriate number and mix of health 
professionals to provide access to appropriate health care for U.S. 
citizens; Analyze and make recommendations about the appropriate supply 
and distribution of physicians, nurses, and other health professionals 
and personnel to achieve a health care system that is safe, effective, 
patient centered, timely, equitable, and efficient; Analysis of the 
role(s) and global implications of internationally trained physicians, 
nurses, and other health professionals and personnel in the U.S. 
workforce; Analyze and make recommendations about achieving the 
appropriate diversity of the U.S. health workforce.
  The Commission will be represented by national experts in health 
workforce issues, the commissioned corps of the Public Health Service, 
a wide spectrum of health professionals and personnel, and be 
geographically balanced in its representation. The Commission will work 
closely with other state and Federal advisory panels that deal with 
professional or work specific issues of health workforce policy. 
Membership in the Commission will be chosen by the Comptroller General, 
with representation from a diverse group of fields in health care, 
including members who are recognized for their policy expertise in 
health workforce measurement, monitoring, and analysis, health 
services, economic and other workforce related research and technology 
assessments. At least 25 percent of the members are to be health care 
providers from rural areas, in order to ensure a geographic balance in 
representation. Through the creation of HWAC, a nodal focus of 
information gathering, sharing, analysis, and implementation of the 
knowledge created about the dynamics of the U.S. health workforce will 
be put into place.
  This legislation was created with significant input and assistance 
from a variety of national organizations representing a cross section 
of the spectrum of the U.S. health workforce. Organizations that have 
expressed support for this bill include: American College of 
Physicians--American Society of Internal Medicine, the American 
Clinical Laboratory Association, the National Organization of Nurse 
Practitioner Faculties, the American Society of Health-System 
Pharmacists, the American Chiropractic Association, the National Rural 
Health Association, the Commissioned Officers Association of the USPHS, 
and the Therapeutic Communities of America.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1498

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Health Workforce Advisory 
     Commission Act of 2003''.

     SEC. 2. HEALTH WORKFORCE ADVISORY COMMISSION.

       (a) Establishment.--The Comptroller General shall establish 
     a commission to be known as the Health Workforce Advisory 
     Commission (referred to in this Act as the ``Commission'').
       (b) Membership.--
       (1) In general.--The Commission shall be composed of 18 
     members to be appointed by the Comptroller General not later 
     than 90 days after the date of enactment of this Act.
       (2) Qualifications.--In appointing members to the 
     Commission under paragraph (1), the Comptroller General shall 
     ensure that--
       (A) the Commission includes individuals with national 
     recognition for their expertise in health care workforce 
     issues, including workforce forecasting, undergraduate and 
     graduate training, economics, health care and health care 
     systems financing, public health policy, and other fields;
       (B) the members are geographically representative of the 
     United States and maintain a balance between urban and rural 
     representatives;
       (C) the members includes a representative from the 
     commissioned corps of the Public Health Service;
       (D) the members represent the spectrum of professions in 
     the current and future healthcare workforce, including 
     physicians, nurses, and other health professionals and 
     personnel, and are skilled in the conduct and interpretation 
     of health workforce measurement, monitoring and analysis, 
     health services, economic, and other workforce related 
     research and technology assessment;
       (E) at least 25 percent of the members who are health care 
     providers are from rural areas; and
       (F) a majority of the members are individuals who are not 
     currently primarily involved in the provision or management 
     of health professions education and training programs.
       (3) Terms and vacancies.--
       (A) Terms.--The term of service of the members of the 
     Commission shall be for 3 years except that the Comptroller 
     General shall designate staggered terms for members initially 
     appointed under paragraph (1).
       (B) Vacancies.--Any member who is appointed to fill a 
     vacancy on the Commission that occurs before the expiration 
     of the term for which the member's predecessor was appointed 
     shall be appointed only for the remainder of that term.
       (4) Chairperson.--
       (A) Designation.--The Comptroller General shall designate a 
     member of the Commission, at the time of the appointment of 
     such member--
       (i) to serve as the Chairperson of the Commission; and
       (ii) to serve as the Vice Chairperson of the Commission.
       (B) Term.--A member shall serve as the Chairperson or Vice 
     Chairperson of the Commission under subparagraph (A) for the 
     term of such member.
       (C) Vacancy.--In the case of a vacancy in the 
     Chairpersonship or Vice Chairpersonship, the Comptroller 
     General shall designate another member to serve for the 
     remainder of the vacant member's term.
       (c) Duties.--The Commission shall--
       (1) review the health workforce policies implemented--
       (A) under titles XVIII and XIX of the Social Security Act 
     (42 U.S.C. 1395, 1396 et seq.);
       (B) under titles VII and VIII of the Public Health Service 
     Act (42 U.S.C. 292, 296 et seq.);
       (C) by the National Institutes of Health;
       (D) by the Department of Health and Human Services;
       (E) by the Department of Veterans Affairs; and
       (F) by other departments and agencies as appropriate;
       (2) analyze and make recommendations to improve the methods 
     used to measure and monitor the health workforce and the 
     relationship between the number and make up of such personnel 
     and the access of individuals to appropriate health care;
       (3) review the impact of health workforce policies and 
     other factors on the ability of the health care system to 
     provide optimal medical and health care services;
       (4) analyze and make recommendations pertaining to Federal 
     incentives (financial, regulatory, and otherwise) and Federal 
     programs that are in place to promote the education of an 
     appropriate number and mix of

[[Page S10277]]

     health professionals to provide access to appropriate health 
     care in the United States;
       (5) analyze and make recommendations about the appropriate 
     supply and distribution of physicians, nurses, and other 
     health professionals and personnel to achieve a health care 
     system that is safe, effective, patient centered, timely 
     equitable, and efficient;
       (6) analyze the role and global implications of 
     internationally trained physicians, nurses, and other health 
     professionals and personnel in the United States health 
     workforce;
       (7) analyze and make recommendations about achieving 
     appropriate diversity in the United States health workforce;
       (8) conduct public meetings to discuss health workforce 
     policy issues and help formulate recommendations for Congress 
     and the Secretary of Health and Human Services;
       (9) in the course of meetings conducted under paragraph 
     (8), consider the results of staff research, presentations by 
     policy experts, and comments from interested parties;
       (10) make recommendations to Congress concerning health 
     workforce policy issues;
       (11) not later than April 15, 2004, and each April 15 
     thereafter, submit a report to Congress containing the 
     results of the reviews conducted under this subsection and 
     the recommendations developed under this subsection;
       (12) periodically, as determined appropriate by the 
     Commission, submit reports to Congress concerning specific 
     issues that the Commission determines are of high importance; 
     and
       (13) carry out any other activities determined appropriate 
     by the Secretary of Health and Human Services.
       (d) Ongoing Duties Concerning Reports and Reviews.--
       (1) Commenting on reports.--
       (A) Submission to commission.--The Secretary of Health and 
     Human Services shall transmit to the Commission a copy of 
     each report that is submitted by the Secretary to Congress if 
     such report is required by law and relates to health 
     workforce policy.
       (B) Review.--The Commission shall review a report 
     transmitted under subparagraph (A) and, not later than 6 
     months after the date on which the report is transmitted, 
     submit to the appropriate committees of Congress written 
     comments concerning such report. Such comments may include 
     such recommendations as the Commission determines 
     appropriate.
       (2) Agenda and additional reviews.--
       (A) In general.--The Commission shall consult periodically 
     with the chairman and ranking members of the appropriate 
     committees of Congress concerning the agenda and progress of 
     the Commission.
       (B) Additional reviews.--The Commission may from time to 
     time conduct additional reviews and submit additional reports 
     to the appropriate committees of Congress on topics relating 
     to Federal health workforce-related programs and as may be 
     requested by the chairman and ranking members of such 
     committees.
       (3) Availability of reports.--The Commission shall transmit 
     to the Secretary of Health and Human Services a copy of each 
     report submitted by the Commission under this section and 
     shall make such reports available to the public.
       (e) Powers of the Commission.--
       (1) General powers.--Subject to such review as the 
     Comptroller General determines to be necessary to ensure the 
     efficient administration of the Commission, the Commission 
     may--
       (A) employ and fix the compensation of the Executive 
     Director and such other personnel as may be necessary to 
     carry out its duties;
       (B) seek such assistance and support as may be required in 
     the performance of its duties from appropriate Federal 
     departments and agencies;
       (C) enter into contracts or make other arrangements as may 
     be necessary for the conduct of the work of the Commission.
       (D) make advance, progress, and other payments that relate 
     to the work of the Commission;
       (E) provide transportation and subsistence for personnel 
     who are serving without compensation; and
       (F) prescribe such rules and regulations at the Commission 
     determined necessary with respect to the internal 
     organization and operation of the Commission.
       (2) Information.--To carry out its duties under this 
     section, the Commission--
       (A) shall have unrestricted access to all deliberations, 
     records, and nonproprietary data maintained by the General 
     Accounting Office;
       (B) may secure directly from any department or agency of 
     the United States information necessary to enable the 
     Commission to carry out its duties under this section, on a 
     schedule that is agreed upon between the Chairperson and the 
     head of the department or agency involved;
       (C) shall utilize existing information (published and 
     unpublished) collected and assessed either by the staff of 
     the Commission or under other arrangements;
       (D) may conduct, or award grants or contracts for the 
     conduct of, original research and experimentation where 
     information available under subparagraphs (A) and (B) is 
     inadequate;
       (E) may adopt procedures to permit any interested party to 
     submit information to be used by the Commission in making 
     reports and recommendations under this section; and
       (F) may carry out other activities determined appropriate 
     by the Commission.
       (f) Administrative Provisions.--
       (1) Compensation.--While serving on the business of the 
     Commission a member of the Commission shall be entitled to 
     compensation at the per diem equivalent of the rate provided 
     for under level IV of the Executive Schedule under title 5, 
     United States Code.
       (2) Meetings.--The Commission shall meet at the call of the 
     Chairperson.
       (3) Executive director and staff.--The Comptroller General 
     shall appoint an individual to serve as the interim Executive 
     Director of the Commission until the members of the 
     Commission are able to select a permanent Executive Director 
     under subsection (e)(1)(A).
       (4) Ethical disclosure.--The Comptroller General shall 
     establish a system for public disclosure by members of the 
     Commission of financial and other potential conflicts of 
     interest relating to such members.
       (5) Audits.--The Commission shall be subject to periodic 
     audit by the Comptroller General.
       (g) Funding.--
       (1) Requests.--The Commission shall submit requests for 
     appropriations in the same manner as the Comptroller General 
     submits such requests. Amounts appropriated for the 
     Commission shall be separate from amounts appropriated for 
     the Comptroller General.
       (2) Authorization of appropriations.--There are authorized 
     to be appropriated to carry out this section, $6,000,000 for 
     fiscal year 2004, and such sums as may be necessary for each 
     subsequent fiscal year, of which--
       (A) 80 percent of such appropriated amount shall be made 
     available from the Federal Hospital Insurance Trust Fund 
     under section 1817 of the Social Security Act (42 U.S.C. 
     1395i); and
       (B) 20 percent of such appropriation shall be made 
     available for amounts appropriated to carry out title XIX of 
     such Act (42 U.S.C. 1396 et seq.).
       (h) Definition.--In this Act, the term ``appropriate 
     committees of Congress'' means the Committee on Finance of 
     the Senate and the Committee on Ways and Means of the House 
     of Representatives.
                                 ______