Hospitals face cuts for off-site and telehealth services under legislation the Senate health committee approved Thursday.
The Senate Health, Education, Labor and Pensions Committee advanced the Bipartisan Primary Care and Health Workforce Act of 2023 on a bipartisan 14-to-7 vote, despite objections from Sen. Dr. Bill Cassidy (La.), the panel's top Republican. The measure would provide funding to support a variety of programs, including federally qualified health centers, teaching hospitals, the National Health Service Corps, medical and nursing schools, and rural hospitals.
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The legislation drew ire from the hospital sector because of provisions barring facility fees for telehealth and evaluation and management services provided outside hospital walls, requiring outpatient providers to use separate identifiers to avoid overbilling, and stopping hospitals from demanding contracts with health insurance companies that forbid insurers from steering patients to other providers.
"While we appreciate that the bill contains numerous policies to address healthcare workforce shortages, we are concerned that these investments come directly at the expense of the hospitals, health systems and caregivers that need this support in the first place," American Hospital Association Executive Vice President Stacey Hughes wrote to HELP Committee leaders on Wednesday.
Cassidy noted the AHA's opposition during the markup Thursday. "The stakeholders, the ones that theoretically we're just throwing a lifeline to, don't like this bill," he said.
In addition, Cassidy criticized the committee for advancing legislation at odds with a similar measure the House Energy and Commerce Committee approved earlier this year, which carries a lower price tag, earned bipartisan support and largely adheres to the funding levels tied to this year's deal to raise the debt limit.
"How do you circumvent a hard-fought battle between House Republicans and the White House in order to achieve your goals, running over everybody else because, by golly, you're right and they're wrong?" Cassidy said. "That's not the way this place is supposed to work."
The Senate bill provides $5.8 billion for community centers, $950 million for the National Health Service Corps, $1.5 billion for the Teaching Health Center Graduate Medical Education program, $1.2 billion for nurse education at community colleges and $300 million to train primary care doctors.
"Americans are unable to access the primary care and dental care they desperately need and we have a massive shortage of doctors, nurses, dentists and mental health professionals," said Sen. Bernie Sanders (I-Vt.), the committee's chairman. “With today’s passage of bipartisan legislation in the Senate HELP Committee, we are beginning to address that crisis."
Sanders won the support of some Republicans because the bill could benefit rural providers and patients and reduce long-term costs by increasing access to primary care, said Sen. Dr. Roger Marshall (R-Kan.).
"Regardless of all the financial voodoo up here, at the end of the day this is going to save American taxpayers millions, if not billions, of dollars," Marshall said. "Whether it's a senior citizen by getting primary care sooner than later, that investment of a $100 visit may save a $30,000 hospital admission."
The HELP Committee on Thursday also approved the PREEMIE Reauthorization Act of 2023, the Preventing Maternal Deaths Reauthorization Act of 2023, and the Gabriella Miller Kids First Research Act 2.0 of 2022 on Thursday.
All of these measures, along with a slew of other healthcare priorities awaiting congressional action, remain mired in a politically fraught, last-minute rush to advance key spending bills and other matters before the fiscal year ends on Sept. 30.
House Republican leadership lost another battle with the most conservative wing of their conference on Thursday as the lower chamber failed to pass a military spending bill for the second time this month, which indicates Congress has difficult obstacles to surmount before it can prevent the expiration of numerous programs and a government shutdown.
