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Senate primary care plan approved by committee


Legislation has bipartisan support, but critic says it’s throwing money at a problem with no guarantee it will help.

congress capitol house: © Gary Blakeley - stock.adobe.com

© Gary Blakeley - stock.adobe.com

A Senate committee has advanced a bipartisan plan to improve primary care as one way to repair a “broken” American health care system.

The U.S. Senate Committee on Health, Education, Labor & Pensions (HELP) advanced the Bipartisan Primary Care and Health Workforce Act. The legislation, approved 14-7, would add to the primary care workforce and improve patient outcomes by investing in health and addressing illness instead of paying more to cure it later.

“Everyone in America understands that our health care system is broken and getting worse,” bill cosponsor Sen. Bernie Sanders (I-Vermont) said in a statement. Sanders and Sen. Roger “Doc” Marshall, MD (R-Kansas), are leading the charge to pass the legislation.

Sen. Bernie Sanders (I-Vermont)

Sen. Bernie Sanders (I-Vermont)

“Despite spending twice as much per capita as any other nation, millions of Americans are unable to access the primary care and dental care they desperately need and we have a massive shortage of doctors, nurses, dentists and mental health professionals,” Sanders said. “With today’s passage of bipartisan legislation in the Senate HELP Committee, we are beginning to address that crisis. I’m pleased this legislation passed with a strong bipartisan 14-7 vote.”

Sanders opened the hearing with a statement summarizing what primary care physicians already know well. Recounting physician shortages and shrinking federal support for primary care, health care is costly, Americans can’t find family doctors, and life expectancy is declining.

“In other words, we have a major, major crisis in primary healthcare which is getting worse every day,” Sanders said.

Throwing money at a problem

Lawmakers can agree with the diagnosis of a primary care crisis in America, but may disagree with the prescription, said Sen. Bill Cassidy, MD (R-Louisiana).

Sen. Bill Cassidy, MD (R-Louisiana)

Sen. Bill Cassidy, MD (R-Louisiana)

Cassidy talked about Republican support for community health centers and said he was open to a funding increase for them, proposing several alternatives while a program funding deadline is approaching. He mentioned his earlier bill that would provide two years of increased money for community health centers, and bipartisan support for that bill by the HELP Committee.

Sanders and Marshall’s legislation is not close to being paid for, with no evidence about how many new primary care physicians, other providers, and access points the money would support.

“I feel like we’re doing what is so typical in Washington, D.C.,” Cassidy said. “We don’t think through a problem, we throw money at it, and then we feel good because we’ve thrown money at it. And we put the press release out there and we speak about it on the campaign trail. But we actually don’t know that it’s going to help. Indeed, frontline stakeholders say it’s going to hurt.”

‘Doing the right thing’

Marshall claimed the bill would address a national nursing shortage within three years. He countered that he wanted to see the bill paid for in a responsible manner.

Sen. Roger "Doc" Marshall, MD (R-Kansas)

Sen. Roger "Doc" Marshall, MD (R-Kansas)

Regardless of the “financial voodoo” that takes place, the bill would save American taxpayers money, possibly billions of dollars, by investing in primary care that would prevent greater health care expenses later on, Marshall said.

He noted the bill is not perfect, but the HELP committee was to make a good bill better. More Americans also are relying on Medicare and investing in primary care will help make Medicare viable in the future, Marshall said.

“At the end of the day, this is doing the right thing,” Marshall said.

Public health hurting?

It appeared there is concern about the effects within the health care sector.

Sen. Tammy Baldwin (D-Wisconsin)

Sen. Tammy Baldwin (D-Wisconsin)

Some of the funding for the bill would be $980 million from the Prevention and Public Health Fund, created by the federal Affordable Care Act.

Cutting almost $1 billion from that fund will mean less for programs dealing with immunization, tobacco prevention, Alzheimer’s disease, heart disease, diabetes, lead poisoning in children, and more, said Sen. Tammy Baldwin (D-Wisconsin), who spoke in the Sept. 21 hearing.

“The overarching bill is critical and we should seek other funds to make it happen,” Baldwin said.

Politico reported that critics say that provision “will harm core public health programs, demonstrates a lack of learning from the COVID-19 pandemic and could hamper the funding of public health efforts in the future.”

“It trades off health promotion and disease prevention for acute and chronic clinical care,” American Public Health Association Executive Director Georges Benjamin told Politico.

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