A report by the Kaiser Family Foundation in coordination with the Center for State and Local Government Excellence shows several states already struggling with a shortage of necessary workers with experience in government healthcare administration as deadlines for healthcare reform approach.
The report examined five states – Connecticut, Michigan, Massachusetts, North Carolina and Washington – as they began to implement the first set of new rules laid out in the Patient Protection and Affordable Care Act (ACA). Those rules focused primarily on the expansion of Medicaid and development of state-controlled Health Insurance Exchanges. Leaders in all five states say they do not have sufficient levels of experienced staff to implement the new programs in a timely manner, and they point to a variety of factors responsible for the shortage and a variety of potential solutions.
Where the Shortage Originates
Leadership transitions and the uncertainty they create were chief among the causes of workforce deficiency, according to the report. In Connecticut and Michigan, new governors were elected in November of 2010, just as program implementation was scheduled to pick up steam. This meant the insurance regulators in those states, who serve at the appointment of the governor, were scheduled to be replaced when the new administrations took office in January. This prevented the rapid formation and staffing of necessary state agencies to administer the changes called for in the ACA. Washington and North Carolina face the same issue as gubernatorial elections in those states are scheduled for 2012. As such, the report observed that current administrations there are moving especially quickly to finalize healthcare decisions while their bureaucracies are still in place. Because of the rapid implementation, more government healthcare administrators are needed than are available.
The makeup of state workforces themselves and the intricacies of government hiring were also highlighted in the report as major factors of the worker shortage. In all states surveyed, the high percentage of qualified state workers at or near retirement age was an issue that hindered the state's ability to keep up with the pace of healthcare reform. In Washington, nearly one third of employees at the Department of Social and Health Services will become eligible for retirement in the next five years. In Michigan, 20% of workers in that state's Medical Service Administration are retirement eligible right now.
As states attempt to hire new workers to replace those retiring, the sometimes slow and antiquated government hiring processes were sited by several states and an impediment to the task. Also, the five states all reported some level of budget deficiency or other fiscal pressure which made rapid hiring difficult. In a companion survey to the Kaiser Family Foundation report, 90% of state workers polled reported their agencies had implemented hiring freezes in response to budget shortfalls due to the lingering economic downturn.
What Can Be Done
To address the workforce issues, all five of the states observed were turning to some kind of outside assistance to help manage their new healthcare responsibilities. Non-government consultants with expertise in government healthcare administration were hired in all five states, and leaders of each state also indicated a fear that a shortage of qualified consultants could develop as well, as all 50 states were expected to face the same worker shortages and seek out the help of the same pool of private consultants.
All these factors are combining to create a robust job market for professionals with education and experience in government healthcare administration, a market which should continue to remain strong as reform timetables laid out in the Affordable Care Act stretch into 2013 and beyond.
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Source: Kaiser Family Foundation report: "Staying on top of health reform: an early look at workforce challenges in five states." http://kff.org/health-reform/report/health-reform-and-state-workforce-challenges-an/
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