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primary care
Sanders Announces 'Historic' Bipartisan Bill to Confront US Primary Care Crisis
"It is unacceptable that millions of Americans throughout our country do not have access to affordable, high-quality primary care and are unable to get the healthcare they need when they need it."
Sep 14, 2023
After weeks of negotiations, Independent Sen. Bernie Sanders of Vermont and Republican Sen. Roger Marshall of Kansas announced Thursday that they have reached an agreement on a bill to confront the United States' primary care crisis, which has left millions of people across the nation without access to critical healthcare.
Sanders, the chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, said in a statement that the new legislation marks a "historic" effort "to expand primary care and to reduce the massive shortage of nurses and primary care doctors in America."
According to a report released earlier this year by the National Association of Community Health Centers, more than 100 million people in the U.S. face difficulty accessing primary care, which is often the initial point of contact for patients seeking care.
The U.S. underinvests in primary care compared to other wealthy nations, despite spending more on healthcare overall.
"It is unacceptable that millions of Americans throughout our country do not have access to affordable, high-quality primary care and are unable to get the healthcare they need when they need it," the Vermont senator said. "Every major medical organization understands that our investment in primary care is woefully inadequate. They understand that focusing on disease prevention and providing more Americans with a medical home instead of relying on expensive emergency rooms for primary care will not only save lives and human suffering, it will save money."
The new bipartisan legislation includes nearly $6 billion in mandatory annual funding for community health centers over the next three years, according to a summary of the measure. If Congress doesn't act by the end of the month, community health centers—which provide primary care to tens of millions of vulnerable Americans—will face steep funding cuts.
The Sanders-Marshall legislation also includes funding that would support an estimated 2,000 primary care physicians over the next decade.
Additionally, the measure would boost funding for the National Health Service Corps to support scholarships and debt relief for doctors, nurses, and other healthcare professionals.
Recent data suggests the U.S. could see a shortage of up to 124,000 physicians over the next decade. Elisabeth Rosenthal of KFF Health News noted last week that "the percentage of U.S. doctors in adult primary care has been declining for years and is now about 25%—a tipping point beyond which many Americans won't be able to find a family doctor at all."
The nursing shortage is also severe and could soon get much worse. One study released earlier this year estimated that around 100,000 registered nurses in the U.S. left their jobs over the past two years—often due to pandemic-related stress—and more than 610,000 more intend to leave over the next four years.
Sanders and Marshall's legislation, which is set to be marked up in the Senate HELP Committee on September 21, would provide $1.2 billion in grants to state universities and community colleges with the goal of boosting the number of students enrolled in registered nursing programs.
Marshall, the top Republican on HELP's Subcommittee on Primary Health and Retirement Security, said in a statement that the new bill "recognizes and addresses the challenges our healthcare industry is facing, like the shortage of nurses and primary care doctors, and includes programs to bolster the workforce in a fiscally responsible way."
According to Sanders' office, the legislation would be "fully paid for by combating the enormous waste, fraud, and abuse in the healthcare system, making it easier for patients to access low-cost generic drugs, and holding pharmacy benefit managers accountable, among other provisions."
In remarks on the Senate floor on Thursday, Sanders noted that "in Vermont and all over this country, our people often have to wait months in order to get an appointment with a doctor and, in some cases, they have to travel very long distances to get the healthcare they need."
"It is literally insane," said Sanders, "that millions of Americans with nonemergency healthcare needs get their primary care in a hospital emergency room."
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'Now Is the Time to Act': Sanders Pushes Bipartisan Bill to Solve Primary Care Crisis
"Providing Americans with a medical home will not only save lives and ease suffering," said the senator. "It will save billions of dollars. Providing primary care to all is not only smart healthcare, it is cost-effective healthcare."
Aug 16, 2023
In an op-ed on Wednesday, U.S. Sen. Bernie Sanders made the case for the bipartisan legislation he introduced last month to address the nation's shortage of doctors and nurses as well as the "primary care cliff" that he has warned millions of Americans are heading toward if Congress does not act to fund the community health centers that many Americans rely on.
Writing at The Daily Beast, the Vermont independent senator said the country's for-profit healthcare industry—in addition to leaving more than 27 million Americans without health insurance—has failed to recruit and retain a sufficient number of medical providers, with the American Association of Medical Colleges projecting a shortage of 122,000 doctors by 2032.
A shortage of 400,000 home health aides—badly needed in a country where the population of people over age 65 is expected to grow by nearly 50% in the next decade—is also expected, and as Sanders wrote, "over the next two years alone it is estimated that we will need between 200,000 and 450,000 more nurses."
The healthcare provider shortage can partially be blamed, said Sanders, on disinvestment in primary care and a heavy focus on "hospital and tertiary care," with the for-profit system forcing many uninsured people "with common illnesses into emergency rooms—the most expensive form of primary care."
"Most countries spend between 10% to 15% of their healthcare budgets on primary healthcare," wrote Sanders, who chairs the Senate Health, Education, Labor, and Pensions (HELP) Committee and has for decades pushed for a government-funded universal healthcare system. "Canada spends 13%, Germany spends 15%, Spain spends 17%, and Australia spends 18%. We spend less than 7%."
While spending less on preventive care than other wealthy countries, the U.S. spends three to four times more on its healthcare system overall than countries including New Zealand, South Korea, and Japan, and more than twice as much as the U.K., France, and Australia.
But with a system that "can seem designed to discourage people from using services," noted the Commonwealth Fund in a report earlier this year, the U.S. has a higher rate than other wealthy countries of adults with chronic health conditions, and "Americans see physicians less often than people in most other countries."
"Every major medical organization in the country agrees that what we are investing in primary healthcare is woefully inadequate," the senator wrote on Wednesday. "They understand that focusing on disease prevention and providing Americans with a medical home will not only save lives and ease suffering. It will save billions of dollars. Providing primary care to all is not only smart healthcare, it is cost-effective healthcare."
Sanders' bill, the Primary Care and Health Workforce Expansion Act, would expand the Graduate Medical Education and Teaching Health Center Graduate Medical Education programs as well as the National Health Service Corps—steps that would "significantly increase the number of doctors in our country" and ensure more doctors are licensed to provide primary rather than specialty care.
The bill would also provide incentives to encourage medical schools to graduate more primary care providers and expand programs that address the shortage of instructors in nursing programs—which has impacted the number of people who are able to go into the nursing field.
With community health centers currently facing a potential 70% funding cut if Congress does not act to expand federal investments, the legislation also provides funding to provide the facilities with $65.5 billion over five years. The funding would be used for expanded operating hours, the creation of school-based health centers, mental healthcare, substance use disorder care, and dental care.
"This bill would increase the number of these centers throughout the country, concentrating on rural and urban areas which are now medically underserved," wrote Sanders. "The result: millions more Americans would be able to receive the primary healthcare they need in a timely and cost-effective way."
Sanders noted that "the day must come, sooner than later, when we join the rest of the industrialized world and guarantee healthcare for every man, woman, and child as a human right through a Medicare for All single-payer system. That is the right thing to do, that is the humane thing, and that is the cost-effective thing to do."
Until then, he wrote, lawmakers must take action to significantly improve a healthcare system in which "tens of millions of Americans, even those with decent insurance, cannot find the medical care they need on a timely basis" due to provider shortages.
"For many years members of Congress have talked about our healthcare crises," said the senator. "Now is the time to act."
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