The Senate Health Committee advanced legislation Thursday that would fund community health centers and increase the number of primary care physicians and nurses, despite a clash between the panel’s top members.

The Health, Education, Labor and Pensions Committee advanced the bill in a bipartisan 14-7 vote, with Sens. Lisa Murkowski (R-Alaska) and Mike Braun (R-Ind.) joining co-sponsor Roger Marshall (R-Kan.) and all Democrats to support the measure.

However, it’s unclear if the bill has the support necessary to pass the full Senate, especially before funding expires Sept. 30.

“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 health care system more efficient and rational … but it will go a long way towards making primary health care in America more affordable and accessible for millions of Americans,” committee Chairman Bernie Sanders (I-Vt.) said.

The measure was crafted in an unusual bipartisan effort between Sanders and Marshall, circumventing ranking member Sen. Bill Cassidy (R-La.).

Cassidy said he tried to negotiate with Sanders, but claimed the chairman wanted an unrealistic amount of money for health centers that wasn’t going to be offset. 

“If you want to do something positive for patients, then actually do the work to find the offsets on a bipartisan, bicameral basis. Don’t just say someone else will figure it out. If you don’t pay for it, then all you have is a messaging bill. That is cynical. It is manipulative,” Cassidy said. 

Cassidy filed 67 amendments, though he withdrew them all and only called for votes on four of them.

The top Republican said he knew the bill was going to advance despite his opposition, but he said he wanted to make his objections known. 

Sanders and Marshall told reporters earlier this week that the bill will be fully paid for, with about $10 billion from bills in the Health Committee jurisdiction and “assurances” from other panels about being able to use additional bills outside the Health Committee’s jurisdiction.

There is no independent estimate on how much the bill could cost. The Health panel has put forward savings from the bill, but those estimates are produced by majority staff. Leaders and aides in other committees also did not have specific details about what those offsets could be.

In a statement after the bill advanced out of committee, Sen. Dick Durbin (Ill.), the No. 2 Senate Democrat and chairman of the Judiciary Committee, said his panel is working with the Health Committee “on the use of prescription drug competition measures” to provide savings. 

“The solutions to many of our pressing health care challenges are in hand. The question is whether we can find a bipartisan commitment to move them forward. I hope we can,” Durbin said. 

The legislation increases funding for community health centers to $5.8 billion per year for three years, an increase of almost $2 billion annually. The funding would go toward expanding hours of operation at community health centers as well as school-based health services.

It also includes funding for scholarships and debt forgiveness for medical professionals, as well as new primary care residency slots and more funding for nursing training programs.

But it also includes measures targeting hospital billing policies, drawing the ire of groups like the American Hospital Association and the Federation of American Hospitals, which wrote to the committee to oppose the bill.

It would ban hospitals from using anti-competitive practices in certain contracts when they negotiate prices with commercial insurance companies. It also would ban hospitals from charging “facility fees” for certain services like telehealth that don’t occur on a hospital campus.

On the other side of the Capitol, the House Energy and Commerce Committee previously advanced its own version of a community health center funding extension in a unanimous vote. But it hasn’t been brought to the floor yet, as GOP leaders have not been able to get the caucus to agree on any legislation that would fund the government.

Funding for community health centers as well as other expiring programs are in the balance.

“We’re marking up a new proposal six legislative days before the program expires. We have no time to align with House counterparts, guaranteeing that we’ll have to do at least a short-term, flat-funded patch. Not a good outcome for community health centers, who wished to have certainty,” Cassidy said.

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