Bill to Cut Spending Would 'Gut' Healthcare Workforce, House Dems Argue

House Democrats slammed their Republican colleagues' plans to pass spending cuts that they argued would slash funding for healthcare programs and threaten an already depleted workforce during a hearing of a House Appropriations Labor, Health & Human Services, and Education subcommittee on Wednesday.

House Republicans planned to vote as early as Wednesday on a bill to raise the debt limit and cut spending by roughly $4.8 trillion over the next decade, according to The Washington Post.

Even before COVID-19 hit, the American Academy of Medical Colleges projected a shortage of 122,000 physicians by 2032, while the Bureau of Labor Statistics predicted that 275,000 additional nurses will be needed before 2030, said Rosa DeLauro (D-Conn.), ranking member of the subcommittee.

To that end, the Appropriations Committee has made significant investments in the Health Resources and Services Administration's (HRSA) workforce programs in both the 2022 and 2023 appropriations bills, and President Biden's budget request builds on those investments, DeLauro explained.

While Congress should be doing everything it can to continue to support and grow the healthcare workforce, she noted, "these spending cuts would gut nursing programs, exacerbate our shortage of skilled nurses. There would be fewer mental health providers and substance abuse specialists as the country continues to combat an opioid and a fentanyl crisis."

"And it would mean fewer doctors and other healthcare professionals choosing to serve in rural and underserved communities, because we removed incentives to serve there," DeLauro added.

On questioning, Carole Johnson, HRSA administrator and the hearing's sole witness, provided a more detailed account of the impact that the projected 22% spending cuts would have on the workforce.

An estimated 2 million people served by community health centers could lose access to care, including more than 600,000 people living in rural communities, she said.

The Nurse Corps Scholarship Program would be forced to scale back its scholarships by "about a quarter," and offer 1,400 fewer loan repayments to nurses in the field. In addition, the agency's Behavioral Health Workforce Education and Training Program for Professionals would lose about 1,700 slots.

Johnson noted that nurse staffing challenges aren't due to a lack of interested candidates. "We're seeing many people raising their hands wanting to be nurses. We don't have the infrastructure to support it."

A shortage of clinical faculty to oversee, mentor, and train new nurses is hurting the nurse workforce pipeline, and is leading to more turnover among new nurses, she said.

Maternal Care

When Rep. Lois Frankel (D-Fla.) asked the administrator to explain how budget cuts would hamper access to maternal care, Johnson said the closure of labor and delivery services is an issue "that keeps me up at night."

The problem began in rural areas but now affects exurban and suburban communities, she said, and "the distance to get to a labor and delivery site is continuing to grow."

While HRSA has worked to bring together stakeholders -- payers, hospitals, and emergency services -- to identify solutions, they're only "patchwork solutions," Johnson said. The agency expects to announce awards for healthcare workers providing prenatal care in June, but "all of those things are contingent on budget availability," she added.

Frankel noted that another concern for maternal health are the growing number of anti-abortion laws in red states like Florida, which only worsen access issues because "doctors are leaving like crazy."

Florida Gov. Ron DeSantis (R) signed a law banning abortions after 6 weeks in mid-April.

"Between the budget cuts and the abortion restrictions, those of us who live in red states are going to have a hard time finding gynecologists who deliver babies and who take care of women," Frankel said.

Federal Deficit Spending

Steering the conversation away from workforce programs, Rep. Andy Harris, MD, (R-Md.) said that medical inflation is "one of the greatest impediments" to physicians his age remaining in practice, adding that the $31 trillion debt creates inflation and instability in primary markets, which further drives experienced healthcare providers from the profession.

Such spending needs to be "reined in," he argued. "My state has billions of dollars in their rainy day fund. They could actually do some of the things that HRSA does, and ... they should be doing it."

Harris also called for the private sector to take more responsibility for graduate medical education training, noting that during the pandemic, one large practice facing a shortage of emergency department physicians decided to train its own.

Johnson agreed that the private sector is "part of the solution." While facilities in rural areas may be able to run residency programs, they often can't stand them up, she said. "So, we invest in helping them do that."

At the end of the hearing, Rep. Steny Hoyer (D-Md.) pointed out to Robert Aderholt (R-Ala.), subcommittee chairman, that many of his Republican colleagues had asked about the kinds of investments needed to shore up the healthcare workforce in their districts.

"So cutting in a broad stroke can sound very appealing until you come down to what the ramifications of those cuts mean," he said.

House Republicans passed the Limit, Save, Grow Act late Wednesday in a vote of 217-215.

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