Senate Health, Education, Labor and Pensions (HELP) Committee Chair Sen. Bernie Sanders, I-Vermont, unveiled a legislative package Wednesday with billions in funding for community health centers and training of primary care doctors and other clinicians.
The Primary Care and Health Workforce Expansion Act (PDF) is slated for markup July 26 but has already drawn condemnation from the committee’s Republican leadership, who said the legislation contains “irresponsible” increases in funding.
It also drew a swift rebuke from the hospital lobby for a provision enacting so-called “site-neutral billing” practices that forbid hospitals from adding additional charges for care services delivered at one of their outpatient settings.
“While the [American Hospital Association] strongly supports policies to bolster the healthcare workforce, it should not come at the expense of the same hospitals, health systems and caregivers that need this support in the first place,” Stacey Hughes, the industry group’s executive vice president, said in a statement. “This bill does exactly that, which is why we oppose it. The hospital field has long been against diverting hospital savings to other healthcare or non-related programs.”
The new bill would run about $20 billion annually, across five years, Sanders said in an accompanying release. Most of the funds would go toward community health centers (ranging from $10 billion in fiscal year 2024 to $13.4 billion in fiscal year 2028) and investments in capital projects ($6.9 billion).
Other top-line funding items include $8.3 billion across five years for the National Health Service Corps, extensions and hundreds of millions in expansions for physician Graduate Medical Education programs, a $400 million per year grant program for associate’s degree nursing programs and millions for other grant program funds related to training dentists, behavioral health workers and family caregivers.
“Tens of millions of Americans live in communities where they cannot find a doctor while others have to wait months to be seen,” Sanders said in a statement. “At the end of the day, this crisis not only increases human suffering and unnecessary deaths but wastes tens of billions a year as Americans flock to expensive ER rooms or hospitals because they could not access the primary care they need.”
Those price points came as a concern to Senate HELP Committee Ranking Member Sen. Bill Cassidy, M.D., R-Louisiana. In a statement released later Wednesday, Cassidy said that he and other committee Republicans hadn’t seen Sanders’ legislation until its public release.
“[The bill] has no scores, provisions from outside the committee’s jurisdiction, converts discretionary spending into mandatory spending and dramatically increases federal funding in some programs by over 300%,” Cassidy said in a statement. “None of these programs contain Hyde protections. This is partisan legislation that cannot pass the Senate.”
To continue funding community health centers and other health programs, Cassidy instead pointed to his Community Health Care Reauthorization Act. Introduced by the Louisiana senator last week, the bill mirrors another that has made its way through the House of Representatives' Energy and Commerce Committee.
“That is the bill we should mark up next week,” he said.
Sanders said his proposed bill “will be paid for by cutting a fraction of the enormous waste and abuse in our health care system and reduce what Americans pay for some of the most expensive prescription drugs on the market.”
More specifically, the bill would include measures that prohibit plans from certain “duplicative” prior authorization requirements and require them to adopt electronic prior authorization forms “which will significantly reduce the time it takes for physicians to treat their patients,” Sanders’ office wrote in a fact sheet.
Of concern to the hospital lobby, Sander’s bill would also cap the amount hospitals may charge payers for care delivered in a physician’s office and prevent hospitals from charging separate facility fees for healthcare services provided by an off-site physician. Hospitals also wouldn’t be able to charge facility fees for on-site primary care, telehealth and low-complexity services “that can be safely provided in an ambulatory setting,” according to a fact sheet.
Such restrictions have been a major focus of lobbying in recent years, with hospitals arguing that their outpatient facilities incur greater expenses than other ambulatory care sites due to the wider service capabilities they are required to maintain. Regardless, site-neutral payment policies have picked up support from lawmakers and key policy advisory panels.
In a statement, Federation of American Hospitals President and CEO Chip Kahn said those provisions “would have a devastating impact on patient care” that undercut the wider goal of healthcare workforce investment.
“This proposal includes unworkable and unprecedented policies that would irrevocably harm the ability of hospitals to provide access to care our patients deserve and expect,” he said. “The committee should hit pause before holding a mark-up next week. Moving too quickly on this ill-conceived legislation would create a cascade of unintended consequences that limits hospitals’ ability to ensure access to needed care for our patients.”
Hughes concurred on the “incoherent policy” she said would permanently harm hospitals and health systems’ ability to provide care.
“Instead of cutting hospitals and adding unnecessary and burdensome new mandates and costs, we urge lawmakers to work together on a bipartisan basis to find solutions that help solve the workforce crisis,” she said.