The Health Policy Process: Early in the Obama Administration Mary Wakefield, Administrator of the Health Resources and Services Administration (HRSA), visited Hawaii in order to get a first hand view of our unique health care needs, particularly on the neighbor islands. Captain Jacqueline Rychnovsky, Senator Inouye's Department of Defense (DoD) Nurse Fellow, and
"One of the results of the Affordable Care Act and its early investment in the primary care delivery system ($11 billion more for community health centers over five years and an emphasis on patient-centeredprimary care services) is the need to ensure the credibility of the federal designation process. This is the process that assesses the needs vs. the primary care resources of a defined community: * Any community that wants to compete for federal community health center funding or be designated a federally-qualified health center must be designated as a Medically Underserved Area or Population (MUA/P). * Any community that wants to take advantage of National Health Service Corps resources must be designated a Health Professional Shortage Area (HPSA). * Any clinician or medical group that wants to become a Rural Health Clinic and reap the benefits of enhanced Medicare and Medicaid payments must be in a designated Health Professional Shortage Area. And, * Besides the CHC and NHSC programs, there are dozens of other federal programs that have come to rely on federal designations for eligibility or prioritization of resources.
"The rules now in use for HPSAs and MUA/Ps date back to the 1970s. Proposed changes to the criteria for designations were introduced in 1998 and 2008, each time setting off an avalanche of questions, concerns, and opposition. This time, HRSA is employing a process to bring together a wide array of stakeholders to work together on a negotiated draft of the proposed rules. Participants in this process include representatives from Primary Care Associations (including the Hawai'i Primary Care Association), the National Association of Community Health Centers, Safety Net Clinics, state Primary Care Offices, the National Association of Rural Health Clinics, the Association of State and Territorial Health Officers, Rural Hospitals, Native American and Alaskan health organizations, and public health and health data experts, among others.
"To-date, the group has agreed that we need to maintain the distinction between areas where the provider to population ratio is too low (HPSA or MUA) and areas where there may appear to be an adequate number of providers but barriers to access exist for some of the area residents (MUP). We are also working with the principle that organizations like community health centers that continue to serve a significant underserved population will not be de-designated based on the results of new rules. Since there is so much to consider in this process, our committee has created subgroups. One is considering the availability and ramifications of data on populations, providers, and health status while another is working on the many issues around identifying special populations and barriers to care. We are scheduling 3-day meetings for each of the next three months so that we can make recommendations and allow for impact testing to help inform HRSA's ultimate decisions for the new designation rules."
A Personal Perspective: Lt. Col.
"It has been six amazing weeks since I began a year long military nurse fellowship in Senator Inouye's office and what an experience it has been! It started out with a bang as the first Session of the 112th Congress began two days after my arrival. In the six short weeks of my experience here in the Senate, there have been so many things that stand out that it is difficult to pick out the true highlights.
"One of the most memorable experiences occurred on opening day of the new Congress as I sat in the Senate gallery watching the events of the day unfold. I was awestruck as I watched the distinguished men and women of the Senate take the oath of office administered by the Vice President of the
"The next few weeks were filled with a flurry of activity as we worked feverously to make sure all the health related bills the Senator introduced in the 111th Congress were update and ready for reintroduction in the 112th Congress. During this time I learned that any bill introduced in the previous Congress that did not become law, needed to be reintroduced again in the hopes that this time around the bill would become law. Another highlight was helping prepare a speech for the Senator to give at a rural health conference. The day was spent learning how to research information for the speech. The amazing part was seeing how the Senator's vision for the contents of the speech was molded into a wonderful fifteen minute speech.
"The majority of the days are often filled with constituent, lobbyist and organization meetings. During these meetings various issues and concerns are raised. The common premise of these visits revolves around funding and legislation concerns in addition to ensuring their voices are heard. It is interesting to see the delivery of the groups that come through the office doors. One of the meetings actually resulted in the development of a brand new bill that the Senator introduced. It was interesting to learn how to write a bill and how to write a floor statement to accompany the bill's introduction, as well as learning how to drum up support for the bill so that it will gain momentum and ultimately result in the bill being passed into law. The most memorable meetings to date have been and continue to be those that I sit on with individuals meeting with Senator Inouye!
"Another interesting part of my time here has been learning about the budget process. More specifically, the impact of not passing the FY' 2011 budget or the Omnibus Appropriations bill during the "Lame Duck" session of Congress as Senator Inouye recommended and how this has affected the country as a whole. A key piece of my experience has been soaking in the wisdom of those around me including learning how the "ear-mark" process worked and seeing truly how many organizations and communities across the country will be adversely affected by the moratorium on this activity" [The views expressed are personal and do not necessarily reflect those of the USAF.]
Promises Kept -- Exciting Opportunities: Candidate Barack Obama: "I… believe that every American has the right to affordable health care." Earlier this year
