Sanders and Marshall Lead Push to Bolster Community Health and Access
On September 14, 2023, Senators Bernie Sanders (I-VT) and Roger Marshall (R-KS) introduced a bipartisan healthcare bill focused on expanding primary care services and reauthorizing key federal health programs. The legislation, aimed at addressing long-standing challenges in healthcare access and workforce shortages, signals a rare moment of bipartisan cooperation on a critical public health issue.
The proposed bill—introduced in the Senate Health, Education, Labor, and Pensions (HELP) Committee, which Sanders chairs—seeks to increase federal investment in community health centers (CHCs), teaching health centers, and the National Health Service Corps (NHSC). Together, these programs form the foundation of the nation’s safety-net healthcare system, particularly in medically underserved rural and urban communities.
Key Components of the Legislation
The bipartisan bill lays out a robust framework to improve primary care access and support the frontline workforce. Key provisions include:
1. Expanded Funding for Community Health Centers
- The legislation proposes a multi-year funding increase for CHCs, which serve over 30 million Americans annually, including uninsured and low-income patients.
- Funding would be used to support new clinic openings, expand services such as mental health and substance use treatment, and invest in telehealth and infrastructure improvements.
2. Support for Primary Care Workforce Development
- The bill calls for enhanced funding for the National Health Service Corps, which offers loan repayment and scholarships for clinicians working in shortage areas.
- It also strengthens Teaching Health Center Graduate Medical Education (THCGME) programs to train physicians, nurse practitioners, and physician assistants directly in community settings.
3. Focus on Underserved and Rural Communities
- New provisions ensure that resources are allocated equitably, with a special emphasis on rural and low-income urban regions where primary care access is most limited.
- The bill also includes strategies to address provider burnout and improve workforce retention, a major challenge since the COVID-19 pandemic.
Bipartisan Support Reflects Shared Recognition of Urgent Needs
Despite deep partisan divides in other areas of health policy, the legislation reflects a broad consensus on the importance of strengthening the primary care system, which is increasingly seen as a cornerstone of effective, equitable, and affordable healthcare.
Senator Sanders emphasized that “every American, regardless of income or zip code, deserves access to high-quality, affordable primary care.” Senator Marshall, a physician and staunch advocate for rural health, added that “this bill supports the boots on the ground—our primary care doctors, nurses, and community health professionals—who are essential to keeping America healthy.”
Public Health and Industry Reactions
The bill has drawn strong support from public health organizations, primary care associations, and community health advocates. Groups such as the National Association of Community Health Centers (NACHC) and the American Academy of Family Physicians (AAFP) praised the legislation’s commitment to expanding access and stabilizing funding for essential care delivery systems.
However, some analysts have raised questions about long-term funding mechanisms and whether additional reforms are needed to address deeper structural inefficiencies in the U.S. healthcare system.
The legislation is expected to move through committee deliberations in the fall, with lawmakers eyeing opportunities to attach it to broader healthcare or budget packages.
The Broader Context: A Primary Care System Under Pressure
The introduction of the bill comes amid increasing concern over the erosion of the primary care workforce. Nationwide, more than 100 million Americans live in primary care shortage areas, and many communities are grappling with clinic closures, limited appointment availability, and provider burnout.
At the same time, the nation faces rising rates of chronic disease, mental health needs, and aging populations, underscoring the urgency of building a more robust, accessible, and prevention-focused healthcare system.
If passed, this legislation could serve as a foundation for broader healthcare reform, aimed at closing the gaps in care that leave millions of Americans without regular access to a primary care provider.
