"He doesn't work with folks": Sanders tension complicates health bill push

Sen. Bernie Sanders' push for sweeping legislation to address a growing shortage of primary care providers, the opioid crisis and other key health issues faces an unusual obstacle: escalating tensions among members of the health committee he chairs.

Why it matters: If the progressive firebrand secures passage of the roughly $25 billion package, it will overshadow complaints about how it got done.

• But the frustrations among committee members raise bigger questions about how Sanders, who took over the chairmanship this year, is running a panel that in recent years had managed to navigate health care's challenging politics and forge bipartisan cooperation on major legislation.

Driving the news: Senate aides and outside advocates say Democrats on the Senate HELP Committee, which also covers education and labor issues, at times have complained that Sanders hasn't sufficiently communicated or sought input from them.

• Sanders and Bill Cassidy of Louisiana, the panel's top Republican, have also clashed over the primary care bill, the timetable for taking up opioid legislation and other issues. However, they've collaborated on high-profile issues such as drug costs and cracking down on firms that manage prescription drug benefits.
• On the GOP side, aides say there is also some frustration among committee Republicans with Sen. Roger Marshall of Kansas, who went around Cassidy to work with Sanders on the primary care bill.
• Sanders and Cassidy are a new pairing atop the committee this year, and Sanders' progressive priorities are a contrast to the more practical-minded bipartisanship that the previous leaders, Sen. Patty Murray (D-Wash.) and retired Sen. Lamar Alexander (R-Tenn.), were known for.

The big picture: Much of the friction among members stems from the primary care bill, which includes significant new funding to expand community health centers and to address a shortage of doctors, dentists and mental health professionals.

• The measure was approved by the committee in September on a 14–7 vote, with three Republicans joining all of the panel's Democrats.
• Sources say there was concern among Democrats in July when Sanders released an earlier version of the bill that they had not had enough time to review or provide input on. That contributed to a decision to delay the markup until September.
• In May, a markup of legislation on firms that manage prescription drug benefits was postponed midway over confusion about the strategy for dealing with amendments. The legislation ended up winning committee approval despite the procedural hiccup.
• "He doesn't work with folks," an aide to a Democratic HELP Committee member said of Sanders. "Leadership is not doing whatever you want. It's talking to your members, figuring out what they want, and advocating on behalf of everyone."
• Asked about the concerns and the postponed primary care markup, Sanders told Axios in a phone interview: "You're right, that markup was postponed, but what was the result of that effort? The result of the effort is the HELP Committee passed the most significant piece of health care legislation, in my view, in many, many years, with bipartisan support by a 14–7 vote."

Yes, but: It was significant for Sanders to win over Marshall and advance the measure with some GOP support. But the prospects for full Senate passage, let alone support from the Republican-controlled House, are murky at best, especially without Cassidy's backing.

• Cassidy argues that the legislation is not fully paid for, and he has said he is open to more modest funding increases for community health centers. He has complained that the panel "wasted critical time" on an "aspirational" bill instead of one that could actually become law.

• The most likely path for health legislation to become law is usually in a year-end government funding package, which typically requires sign-off from the relevant chairs and ranking members in both chambers, as well as leadership.
• Without Cassidy's support, that becomes much more difficult.
• Sanders said he is working with other committees on additional measures to fund his legislation, and he is "talking every day, literally almost every day, with Republicans trying to gain their support." He thinks it is possible to eventually get 10 Republicans to pass the bill on the Senate floor.
• Sen. John Hickenlooper of Colorado, a moderate Democratic member of the panel, praised Sanders for his outreach to the GOP.
• "Several people talked to me when he was coming in as the chair, saying 'My gosh, you're never going to get anything done,'" Hickenlooper said. "And to the contrary, he's worked pretty hard to build relationships with some of the Republicans, and we've made a lot of progress."

What's next: Cassidy has also been pressuring Sanders to hold a markup to reauthorize major opioid crisis legislation that expired Sept. 30.

• Sanders told Axios that he is working on strengthening the legislation, known as the SUPPORT Act, which funds addiction treatment and recovery programs. "I intend to come forward with legislation that I hope has bipartisan support which significantly addresses [the opioid crisis]," he said.

A version of this story was published first on Axios Pro. Unlock more news like this by talking to our sales team.