Health and Human Services Secretary Kathleen Sebelius drew criticism from key Democrats on Wednesday after the agency announced that $250 million from a public health fund established in the healthcare overhaul law would be used to increase the physician workforce.
While lawmakers and interest groups acknowledged that addressing a shortage of primary care physicians was important, they also said they were disappointed with the agency's use of half of the $500 million appropriated to the prevention fund in 2010 for purposes they say were not the intent of the law.
"We need to do prevention and we need to do workforce, but we had an agreement," said House Energy and Commerce Committee Chairman Rep. Henry Waxman, D-Calif., explaining that funds originally intended for the workforce title of the law got lost in the shuffle of bills between the House and Senate in the reconciliation process used to pass the legislation.
"I don't like the idea that there should be a scramble for funds when we had a pretty clear idea that we were going to use them for different purposes," said Waxman.
"Prevention and public health, as well as manpower, are things we need to support, not have them compete against the other the way it appears the way they're doing now," he added.
Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin, D-Iowa, agreed that the workforce programs were not an ideal implementation of the funds.
"Well, I don't like it, but I understand what they're doing. It's a one-time shot," said Harkin, who said he would make sure prevention funds would not be used for the physician workforce in the future.
Trust for America's Health Executive Director Jeff Levi said HHS' use of the money was not the intended purpose of the prevention funds.
"While increasing the primary care workforce is important, the goal of the prevention fund was to start early, so more people could enter the reformed system healthy," said Levi. "HHS' use of this money may be within the letter of the law, but it is not the intent of the law."
Levi also said HHS' use of half of this year's prevention funds would mean that prevention efforts would have to "do more with less."
"We were hoping to overcome that tradition in public health prevention efforts with this fund," said Levi.
HHS said the $250 million would be used to train 500 new primary care physicians and 600 new physician assistants by 2015, in addition to funding nursing education and grants for state health departments.
Sebelius said increasing the primary care workforce was a "personal priority" of President Obama, and putting the funds to this effort would be a "quick but critical investment" in improving the healthcare system.
Rep. Lois Capps, D-Calif., helped Sebelius introduce the workforce initiatives.
"This critical investment will help alleviate the current shortage of primary health care providers, including physicians, physician assistants and nurses," said Capps.
Robert Pestronk, executive director of the National Association of County and City Health Officials, said the public health workforce was also shrinking, losing 15 percent of the workforce in 2008 and 2009.
"The same funding could have been applied to creating workers in the public health workforce," said Pestronk, who noted that the purpose of public health work is to "prevent disease from happening in the first place," as opposed to treating already existing illness.
"Within the primary care workforce, patients tend to see physicians when they are ill, and a smaller portion of the time is spent on preventing disease," said Pestronk.
HHS officials couched the use of the prevention fund to build the primary care workforce as targeting money to workers on the "front line" of prevention efforts.
"We actually think the primary care workforce certainly aligns with prevention," said Health Resources and Services Administration Administrator Mary Wakefield.
Levi said his group had assurances this would be the only time the agency would use prevention funds for the primary care workforce, signaling that HHS is struggling to find money for the myriad programs authorized, but not appropriated any funds, in the healthcare law.
Sebelius told the House Labor-HHS Appropriations Subcommittee in April that the administration would not request additional funds in 2011 to implement the healthcare law. The Congressional Budget Office estimated the agency would need as much as $2 billion a year over the next 10 years to cover the cost of implementation.