PREPARED REMARKS: Chairman Sanders Leads HELP Committee in Markup of Major Legislation to Address the Primary Care Crisis In America

WASHINGTON, Sept. 21 – Sen. Bernie Sanders (I-Vt.), Chairman of the Senate Health, Education, Labor, and Pensions Committee (HELP), today led the committee in marking up critical legislation to address the primary care crisis in America, including the major shortage of nurses, doctors, dentists, mental health professionals, and other important health care workers across the country.

Sanders’ remarks, as prepared for delivery, are below and can be watched here:

The Senate Committee on Health, Education, Labor, and Pensions will come to order.

This morning we will be considering 4 bi-partisan healthcare bills.

The first bill is the PREEMIE Reauthorization Act led by Senators Bennet and Boozman.

This legislation would reauthorize $10 million over the next 5 years to conduct research and other activities that could not only lead to a reduction in preterm births – which affect over 10% of all babies born in America – but could also reduce the infant mortality rate in our country.

The second bill is the Preventing Maternal Deaths Act led by Senators Capito and Warnock.

In 2021, the maternal mortality rate in the United States was more than ten times the estimated rate in other developed countries.

This legislation would reauthorize state-based maternal mortality review committees that identify the root causes of maternal mortality and make recommendations to reduce the maternal death rate in America.

The next bill is the Gabriella Miller Kids First Research Act 2.0 led by Senators Kaine and Moran that authorizes a total of $188.4 million over the next 10-years for critical research into pediatric cancer and structural birth defects.

Let me thank Senator Kaine for his leadership on this bill. I know how important this bill is to him and to kids all over the United States who are struggling with cancer.

The final bill that we will be considering is the Bipartisan Primary Care and Health Workforce Act that I have been working on with Senator Marshall, the Ranking Member of the Primary Care Subcommittee for the past several months.

Let me thank Senator Marshall and his staff for their very hard work on this bill – as well as a number of other senators and their staff.

Let’s be clear. Our current health care system is broken. Despite spending almost twice as much per capita, an unsustainable $13,000 per year, 85 million Americans are either uninsured or underinsured; over 60,000 die each year because they can’t get to a doctor when they need to; we pay, by far, the highest prices in the world for prescription drugs; and our life expectancy, already far lower than other developed countries, is actually in decline.

Further, this country faces a major crisis in our healthcare workforce. According to the American Hospital Association, the United States will face a shortage of up to 124,000 physicians by the year 2033. And we will need to hire 200,000 nurses per year to meet the demands of an aging society. The Association of American Colleges, has said that we may lose as many as 55,000 primary care physicians by that time. In other words, we have a major crisis in terms of the number of doctors, nurses, dentists, and mental health professionals that we need.

According to the senior contributing editor of the Kaiser Family Foundation Health News: “American physicians have been abandoning traditional primary care practice – internal and family medicine - in large numbers. Those who remain are working fewer hours. And fewer medical students are choosing a field that once attracted some of the best and brightest because of its diagnostic challenges and the emotional gratification of deep relationships with patients. The percentage of US 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. Already, more than 100 million Americans don’t have usual access to primary care - a number that has nearly doubled since 2014.”

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

Further, the healthcare crisis we face also deals with the reality that millions of Americans are unable to get the dental care they desperately need.

According to Louisiana State University, “As many as 59 of Louisiana’s 64 parishes are designated Dental Health Professional Shortage Areas by the Louisiana Department of Health…More than a third of Louisiana parishes have either no dentist or can count all available providers on one hand.”

But it’s not just Louisiana. In Bennington County Vermont low-income children today are basically unable to get the dental care they need and frankly this is not just Louisiana or Vermont, this is a crisis all over this country.

And clearly, it’s not just Louisiana and Vermont. All over this country families and children are unable to access the dental care they need.

The legislation that Senator Marshall and I have introduced does not solve, by any means, all of the healthcare crises that we face. In fact, it is a far more modest piece of legislation than I would have liked to have seen. But, if this legislation is passed, it will not only save us substantial sums of money by making our healthcare system more efficient and rational; it will not only significantly increase the number of doctors, dentists and nurses that we desperately need – but it will go a long way towards making primary healthcare in America more affordable and accessible for millions of Americans.

This legislation increases mandatory funding for Federally Qualified Community Health Centers from $4 billion a year to $5.8 billion a year for three years which will enable more Americans to receive not only high-quality primary health care, but dental care, mental health counseling and low-cost prescription drugs. That’s what community health centers do, do well, and do in a very cost-effective way.

In addition, this bill includes a one-time allocation of $3 billion to be used to establish dental operatories so that community health centers can expand their dental care capabilities. In addition, it will also allow community health centers to build more space for mental health counselors – something they desperately need.

Let me be clear: This legislation will save substantial sums of money. Investing in primary healthcare will keep people healthier and out of hospitals; investing in community health centers will keep people out of emergency rooms which cost about ten times more per visit than a community health center.

There is a reason why most other major countries spend twice as much as we do on primary healthcare and end up with far lower capital costs than we do. To quote a senior member of this committee and Benjamin Franklin “An ounce of prevention is worth more than a pound of cure.”

In fact, according to the Director of the Center for Health Policy Research at George Washington University, the funding that we have included in this bill for community health centers alone will save the federal government over $40 billion over the next three years - far more than this bill costs.

Further, this legislation triples funding for the National Health Service Corps – from $310 million to $950 million for the next three years. As everyone knows, the National Health Service Corps provides student debt forgiveness and scholarships to doctors, dentists and other medical professionals who practice in underserved areas. We need to get healthcare professionals into rural areas and underserved areas and that’s exactly what the National Health Service Corps does.

This legislation more than doubles funding for Teaching Health Centers – going from $126 million a year to $300 million a year for the next 5 years.

Teaching Health Centers are extraordinarily important because they allow medical school graduates to do their residencies in community health centers and small rural hospitals instead of just large teaching hospitals in urban areas - and if we want more doctors and dentists and nurses to practice in rural areas and underserved areas this is an important way to do it.

We have also included $300 million in our bill which will go to those medical schools that focus on growing the number of graduates practicing primary care.

As I indicated earlier, this legislation will greatly increase the number of nurses in America by addressing the shortage of nurse educators in our country.

Unbelievably, in the midst of a massive shortage of nurses, the American Association of Colleges of Nursing tells us that U.S. nursing schools turned away over 91,000 qualified applications in 2021 because of a lack of qualified faculty and inadequate physical infrastructure.

Our legislation provides $1.2 billion in grants to community colleges and state colleges to train up to 60,000 2-year nurses all over America by expanding the number of nurse faculty and preceptors, among other things.

It will also provide $171 million in funding for the Nurse Faculty Loan Program.

And, thanks to the leadership of Senator Murkowski, it includes a program that will allow nursing schools to close the salary gap between nursing faculty and nurse clinicians. One of the reasons why there is a huge shortage of nurse faculty in America is because they are paid, in many instances, tens of thousands of dollars less than practicing nurses.

Is this a perfect piece of legislation? No, I don’t think so. And I’m sure that members in a few minutes will be telling us why they are opposed to it. In fact, Senator Cassidy will be giving us 67 reasons, in his amendments, as to why he opposes this bill. But let me conclude by saying this.

As every member of this committee knows, it is very difficult to get any substantive legislation passed in Congress today. Senator Marshall and I and other Senators have tried and what we have in front of us with your vote is the most significant piece of legislation in addressing the primary healthcare crisis in modern American history. That’s what it is.

And when you go home and people tell you they can’t find a doctor or they have to wait months to get their kids into a specialist I would like you to tell them that you voted for legislation which improves that situation.

And when young people tell you that they were rejected from nursing school because there weren’t enough faculty to teach them, and when hospitals tell you they’re spending outrageous sums of money on traveling nurses, I’d like you to be able to tell them that you voted to address those issues.

We have a major healthcare crisis here in America. This bill begins to address it. I ask for the support of every member of the Committee.