What’s in Sanders’ ‘bold’ plan for health care

By: Daniel Payne and Burgess Everett; Politico

His effort is the latest sign the progressive stalwart is toggling between his activist persona while pressing for a deal on what he thinks can pass a narrowly divided Senate.

Sen. Bernie Sanders is launching his latest push as one of the Senate’s most powerful committee chairs: to pour nearly $200 billion of new money into the health care system.

In an interview with POLITICO, Sanders (I-Vt.) described a plan that would, over five years, provide $130 billion for community health centers and $60 billion in funding to grow the workforce. Within the workforce funding, he would set aside $15 billion for graduate medical education programs, with an emphasis on boosting primary care access.

The new package is Sanders’ response to monthslong discussions on the Senate HELP Committee about how to address growing health workforce shortages and financial woes of community health centers in the wake of the Covid-19 pandemic.

“The goal right now is to take bold action to increase our health care workforce, to make sure that everybody in this country has access to a doctor or a dentist or nursing,” Sanders said Tuesday. “If we agree that there is a crisis, if we agree that inaction will only make the crisis worse, do we have the political will to do what we have to do for the American people?”

For Sanders, it’s another example of the balancing act the progressive stalwart faces as leader of one of the top power centers in Congress, the Senate Health, Education, Labor and Pensions Committee. He’s still pushing “Medicare for All,” but in a narrowly divided Senate he’s separating his roles, at times at least, as an advocate and legislator.

His top priorities on the panel at the moment are lowering the cost of prescription drugs, raising the minimum wage and the massive new infusion of health care money.

But Senate Republicans, as well as those in control of the House, are unlikely to endorse his first legislative proposal’s huge increases, even as there is broad bipartisan agreement that something should be done to alleviate the workforce shortages and help the community health centers.

HELP ranking member Sen. Bill Cassidy (R-La.) told POLITICO in a statement that his team has been in talks with Sanders’ staff to find “a reasonable solution” to address those issues — but implied that Sanders’ plan is unlikely to pass.

“This proposal to increase funding for health centers by 550% at a time when Congress is deadlocked trying to negotiate spending and a debt ceiling increase is not setting up a path for success for legislation that can pass the Senate with 60 votes, and make it through the House to be signed into law,” he said. “Let’s just be realistic.”

Republicans’ inclination to cut spending amid the debt ceiling debate threatens to further complicate the proposal.

Sanders acknowledged he doesn’t know whether he has the votes for the package and doesn’t have a clear path to pass it, whether as a standalone bill or part of another piece of legislation. But he said he will put it to a committee vote this Congress and seek to get it into law, possibly by attaching it to a must-pass bill on the Senate floor.

“Right now, we have focused on working with many Democrats, but we’re going to bring Republicans, and we all have a working group which is discussing this issue,” he said.

Sanders’ workforce plan could also go beyond funding alone to also consider scope of practice changes to increase patient access. He also said he wants to boost the number of Black doctors in addressing the workforce.

Success would likely require the backing of a united Democratic caucus in the Senate, the assent of at least nine Republican senators and the GOP-controlled House — an uphill climb.

The House is also looking to move legislation on community health centers and graduate medical education funding but is considering far smaller funding increases.

On Wednesday, the Energy and Commerce Health Subcommittee will mark up a bill that would extend current community health center funding levels through 2028.

An amendment to that measure, expected Wednesday, would increase those programs’ funding for 2024 and 2025, a congressional staffer told POLITICO. But even that increase would be well below Sanders’ proposal.

The legislative movement comes as community health center advocates have descended on Washington with concerns over what they say are historic financial challenges.

Community health centers, which often serve low-income patients, are grappling with pandemic funding drying up, Medicaid payments shrinking amid redetermination and labor costs increasing across the health sector — a convergence advocates say is “a perfect storm.”

“I’m painting a very doom-and-gloom picture, which is not typically who I am,” Amanda Pears Kelly, CEO of Advocates for Community Health, said in an interview. “But I just will be honest and say: This is not something I’ve ever seen, at least the years that I’ve been working with community health centers. … Something’s got to give.”

Advocates for Community Health told POLITICO that meetings will be with lawmakers and their staffs across the aisle — including Senate Majority Leader Chuck Schumer, Senate Minority Leader Mitch McConnell, Sens. Patty Murray (D-Wash.) and Kyrsten Sinema (I-Ariz.).