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Sen. Tim Kaine shares his approach to the health care workforce crisis

Roughly 1 in 4 Virginia hospitals are critically short-staffed, according to federal data.

During last week’s Senate Health, Education, Labor and Pensions Committee hearing, Sen. Tim Kaine highlighted two health care workforce bills he’s sponsoring. They're intended to ease labor shortages in the sector.

The legislation comes at a time when about 1 in 4 Virginia hospitals are in a critical staffing shortage, according to late-April data from the U.S. Department of Health and Human Services. A little over 40% of HHS-recognized Virginia hospitals responded to the survey.

Driving the shortage is that the number of U.S. health care workers who are quitting their jobs is still higher than it was before the pandemic, Federal Reserve of St. Louis data shows. In both Virginia and the U.S. at large, people aren’t stepping in to fill their shoes fast enough to keep pace with growing demand.

The resulting workforce crisis is especially severe in rural areas. More than 3 in 4 Virginia counties and cities — home to 29% of the commonwealth’s population — meet the federal criteria to be designated as Health Professional Shortage Areas for primary care, according to a November 2023 analysis by the Virginia Mercury.

Kaine recently has made health a legislative priority. The Democrat incumbent is also currently running for a third term in the U.S. Senate. He recently spoke with VPM News' Henry Brannan about two of his bills, the Welcome Back to the Health Care Workforce Act and the Expanding Medical Education Act.

Editor's note: This interview has been lightly edited for style and clarity.

Henry Brannan: Hi, Senator, thank you for taking the time to talk.

Sen. Tim Kaine: Absolutely, Henry. Glad to.

Can you tell me about the Welcome Back to the Health Care Workforce Act?

Yes, Henry, one of the issues in the HELP Committee — and it’s “Health, Education, Labor and Pension,” big jurisdiction — but an issue that's very bipartisan we're all seeing in our states is shortages in the health care workforce. These were noticeable before COVID; COVID made it much worse.

The shortages are acute in rural America, the shortages are acute in center cities, the shortages are acute in some specialties, like behavioral health. And so we need to do some really important things to build up our health care workforce.

I have a bill called the Welcome Back Act. And it takes advantage of a unique opportunity: There are about 270,000 people lawfully in the United States born in another country. So they're either green card holders or U.S. citizens, born in other countries and trained in other countries in health care professions.

But because of licensure transfer issues, they're not working in the health care field in the United States.

We need more people in the health care field. And this is a group of 250,000-plus who we should be working with to find a quicker way for them to transition into the health care professions that they're trained for.

This would be a bill [giving] grants to states that want to do something interesting to get this group of people into health care. And the idea would be: First, let's make everybody aware what a big source of health care workers we have on the sidelines now, and then accelerate efforts to get them into the health care workforce where they want to be.

I recently visited an adult education program in Charlottesville connected with Piedmont [Virginia] Community College. And these are adults who come from other countries, and they're taking classes to become language-fluent. But I talked to a physician, I talked to a number of people who had been nurses or allied health professionals in other countries; they don't want to just become language-fluent and then work in a retail establishment.

They have a passion for helping patients, and particularly in communities where there's a lot of new Americans, you know. They could help patients who might not have English-language fluency, but that they could interact with in a more effective way than some of the health care professionals now working in the community.

I'm very excited about this bill. And we've gotten some real nice pickup on it since we introduced it earlier in April.

And then for the second bill, can you talk a little bit about the Expanding Medical Education Act?

Our physician core doesn't look like our population. I mean, just African Americans: 14% of the nation's population, 5% or 6% of the physicians. And so what we are doing in this bill is to incentivize historically Black colleges, universities and other minority-serving institutions to start medical schools.

Many of our HBCUs train a tremendous number of undergrads who then go on to other medical schools, but not a lot of the HBCUs have medical schools. Xavier University in New Orleans has been famous for training people who go on to other medical schools, they're going to start a medical school in tandem with a local health system.

Hampton University — we're really excited about this — in Virginia is exploring starting a medical school in tandem with the [United States Department of Veterans Affairs]. That's already right there, essentially on the Hampton campus.

And a lot of this actually is building on a model that we helped create in Virginia when the Virginia Tech medical school started in tandem with the Carilion health system in Roanoke. That was kind of a new model. Wow, you start up in tandem with the health care system. And that seems to be a model that's really catching fire, and we think a number of our HBCUs, including Hampton, could do this.

Can you talk a little bit about what these two bills have in common in terms of issues they address? And then I'm also curious how you see these issues play out here in the Commonwealth.

What they have in common is creative ideas to get more health care professionals. Because if we just do it the old-fashioned way? Well, look, we're falling behind, we're losing people to retirements and not bringing enough people in. Whether it's these 270,000 people on the sidelines who are already trained, or whether it's HBCUs — we need to explore some new ideas to fill out the health care workforce.

I'm a supporter of other bills to put more funding into rural health. We've done a big community health center reform bill; an awful lot of health in rural Virginia and rural America is provided through the primary care venue of a federally qualified community health center. And we're going to do a lot more on the funding there, which will enable them to have better salaries and hire more health care workers.

So I think they all tie together around increasing the health care workforce, but particularly in areas where there are shortages.

To zoom out a little bit: Both these issues — a shortage of health care workers, and a particularly severe shortage of workers reflecting the communities they're serving — these are present in Virginia and around the country.

Can you talk a little bit about your view on the role of national-level legislation in addressing some of these local health challenges that we see all around Virginia?

Henry, you're right, these are these are local issues. But when you — when senators get together, and my local issue is the same one that Lisa Murkowski [R] in Alaska or Bill Cassidy [R] in Louisiana or Tammy Baldwin [D] in Wisconsin, we're seeing the same things, we think that there is some ground for national solutions.

As an example, at the hearing this morning, a couple of the physicians were talking about the value of Public Service Loan Forgiveness. If you have a shortage of behavioral health [workers], well, can you do incentives to get more people into that field?

We're having a shortage of nurses for a really peculiar reason: As soon as you can make more money being a nurse than being a nurse instructor, you leave the classroom and you go be a nurse. You might have a lot of people who want to be nurses and a lot of hospitals want to hire nurses, but if you have shortages on the nurse instructor side — that's a chokepoint that means you're not training the workforce.

If you do salary enhancements for nursing educators, suddenly you get more of them and you can train more people. Virginia has done this over the years. We had a cycle of it when I was governor and others have done the same thing; when we have a shortage of nurse instructors, and that's the chokepoint, we often do a special salary bump for nurse instructors at our public institutions. And then that tends to, within a couple of years, reduce or even eliminate the shortages.

I do think there's some things at the national level we can do. Again, Public Service Loan Forgiveness, inspire HBCUs to start med schools, take advantage of the quarter-million foreign-born trained health workers who are lawfully here. There's a lot we can do to solve these problems at a national level. It'll benefit Virginia, it'll benefit other states, too.

Lately, there's been a lot of concern about how functional Congress is. For these bills specifically, there's the issue that Republicans control the House. So I'm wondering, what are the prospects for these bills to make it to [President Joe Biden's] desk?

This is a tough one. And I'd say, particularly in an election year, things sort of slow down. We're doing a big [Federal Aviation Administration] reauthorization bill. We will do the defense bill, I'm on the Armed Services Committee, that will get to the president's desk. But it's a fair question.

I'll tell you this: I think between — and this is commonly the case — between an election day in November and the end of the year, we often get a whole lot of stuff done. People aren't thinking about the election, they're thinking about "What can we do?" And we do have a number –- we have a big bill on the health care workforce that's already out of our committee on the floor of the Senate, kind of waiting for its moment.

I would not give big odds that you're going to see some of the bills we're talking about passing before November. But I think there are good odds that you can see some significant legislation on the health care workforce passing in November, December.

And that would be really important. And that's why you file legislation like my Welcome Back Act; I know I'm not going to file it and it's going to pass in two months. You file it, and then you're waiting for a larger health bill to move, and then you attach it to it.

I think the chances that we're going to do a health care workforce bill before year-end are high. And so I want to see if I might be able to get both of the bills we've discussed connected to that.

With the caveat that anything can happen and polls are absolutely not a crystal ball, many polls are putting Donald Trump as the next president.

If you win in November, what's your plan for getting legislation like these bills that we're talking about today signed into law if Trump is reelected?

Well, I'm not really thinking about that so much. I mean, obviously, we gotta get it to the president's desk, and the president then gets to make his own decision — his or her own decision — about whether to sign a bill or not.

I think about it just from the congressional side. This is a nonpartisan issue: I know that every last colleague of mine, House member or senator, are hearing the same things I'm hearing about health care workforce shortages.

Look, if you're talking about choice, if you're talking about immigration reform, OK, there's partisan divides that are significant. But on the need for a health care workforce to take care of people? This is nonpartisan.

I view this issue as one where the parties don't really matter, and people are seeing in every region of the United States. Health care workforce issues are one of the handful that I feel like, regardless of the party lineup in either house, we should have a good ability to get something like this on a president's desk.

Then the president gets to decide whether to sign or veto. We worry about that later. But this is an issue where we can find common cause in Congress.