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Sanders and Marshall plot next steps on primary care bill

Sens. Roger Marshall and Bernie Sanders. Photos: Kevin Dietsch/Getty Images, Alex Wong/Getty Images

Amid the shutdown brinkmanship, the bipartisan duo of Sens. Bernie Sanders and Roger Marshall are plotting a path forward for their primary care–health workforce bill.

Driving the news: Marshall told Axios that he met with Sanders on Wednesday to talk strategy, and that he'll be reaching out to other GOP senators not on the HELP Committee to try to build support.

  • Sanders also told Axios on Thursday that he thinks there is a "good chance" of getting the measure into an end-of-year funding package. "We had three Republicans on the committee," he said. "I think there are a lot more Republicans who are supportive in general."
  • Sanders also said he had talked to Senate Majority Leader Chuck Schumer about the bill. Asked whether Schumer is supportive, Sanders replied, "Yeah, I think he is."

Yes, but: A year-end funding package would be the natural place to try to attach this package. But there is great uncertainty about what the funding vehicles will look like and when they will be moving.

  • Getting items into a year-end package would also generally need sign-off from the chair and ranking members and leadership in both parties and chambers. That is problematic right now, considering that Ranking Member Bill Cassidy currently opposes the bill.
  • Marshall also said he had not yet spoken to Senate Minority Leader Mitch McConnell about the measure.
  • Sanders acknowledged that he will "absolutely" have to negotiate with the House, where the Energy and Commerce Committee has reached bipartisan agreement on primary care legislation with a more modest funding increase for community health centers.

What's next: Sanders, Marshall and their allies also still have to find more payfors to cover the full cost of the legislation, including possibly borrowing offsets from other committees.

  • "We understand there's a lot of work ahead of us," Marshall said. "We need to garner some more support. We're working on the payfors as well."

What we're watching: While the legislation seeks to pump money into addressing a shortage of doctors, nurses and mental health providers, backers will have to overcome opposition from hospitals. Some of the existing payfors target hospital costs, including facility fees for certain services.

  • Negotiations with the House also pose uncertainty, but Senate backers can at least try to increase spending on community health centers and the health workforce as much as they can.
  • The House's transparency bill, which also includes health center funding, is also in limbo at the moment amid the shutdown drama.
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