Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2024

Floor Speech

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Mr. MARSHALL. Thank you so much for sharing this moment with us. You know, one of my mentors here on the Hill has a saying that some Senators come here to make a point and others come to make a difference. The first time Senator Sanders and I sat down together, he said: Roger, do you want to make a difference?

We have worked so hard on this issue together, developing rapport, confidence in each other, in our staff--they have all done an incredible job--as we try to get through this riddle from healthcare challenges throughout this great Nation.

I think as both of us travel back to our home States of Vermont and Kansas, what we found is that not everybody has meaningful, affordable access to primary care. So we went out and tried to find the best actors, what is the best outcome, who is making a dent? And I think we both discovered that our community health centers were doing a great job. They had taken many pilot programs, and they were improving them.

I am not sure what Senator Sanders would talk about some of his, but what I saw was this meeting patients where they are a concept, integrating all the different elements of primary care--not just your blood pressure, not just your Accu-Chek, but also your mental health. Dental needs, as well, are just a few more things we are seeing being integrated into the community health centers--nutrition coaching, something that has seldom been done in clinics before. So I think we saw these community health centers as doing a great job. And we asked each other: How can we improve upon that?

And Senator Sanders and I agreed on this lofty goal that we could get more Americans into these clinics, and that was a great solution for primary care. So for the past 3 months, we have had a very thoughtful approach to this problem. And even before then, our committees had multiple hearings with different folks as they tried to address the problem as well. And then we had multiple Zooms and meetings with folks back home: How do we solve this primary care problem and, again, this mental health epidemic slapping us in the face every time we go back?

And, certainly, I think most of our committee would agree that the community health centers are a great solution, but they need to be bolstered and need to continue that mission across this great Nation.

So I am proud of the work that we have done on the community health centers in this legislation--again, thoughtful legislation. And our goal is to make sure it doesn't cost American taxpayers any more.

Again, Senator Sanders and I both said many times this country is spending plenty of money on healthcare, but maybe we need to refocus a little bit more of it to primary care. That is what we have done with this legislation, again, with a thoughtful approach. And our goal, again, is to make sure it is all paid for and it doesn't cost the American taxpayer any more.

I think the other big issue that we found in common with folks back home is a nursing shortage and a primary care doctor shortage. If there is one thing that this bill would do, it would turn around the nursing crisis in a matter of just 3 years.

My own wife is a community college graduate nurse. Ninety percent of the nurses in our hospitals in Kansas, especially the rural hospitals, are 2-year community college graduates. So what we have done with this legislation is bolster more money for nursing programs. And the other program, like Senator Sanders said, the other challenge, is colleges cannot afford the faculty, the nursing faculty. So we have some money to help bolster that program up as well.

We have young men and women standing in line for incredible jobs in healthcare, but we don't have the faculty to bring them in. So we help with scholarships. We help with the faculty. That alone will change the dynamics across America if we have more nurses who are just the glue to this healthcare system. And then the next challenge of the attack here is just a shortage of primary care doctors in so many ways as well.

So the legislation addresses that. It is great steps forward. I have been very proud, again, to work with Senator Sanders and his team, finding common ground. And I think we made incredible strides.

Senator Sanders and I have talked many times about our community health centers. I might just ask him about the successes that you are seeing in your community health centers and what your vision going forward looks like.

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Mr. MARSHALL. Senator Sanders and I discussed this vision of what primary care looks like in the future, making sure we are meeting patients where they are.

Some of our community health centers back home are bringing in the food bank; they are bringing in the WIC Programs, social services, basic mammography. We lose track of the patients when we have to say: Come back in a month for your mammogram. Instead, it is a great thing to say: Let's get it done today.

One of the biggest underserved areas of medicine is dental. I know that one of Senator Sanders' visions, specifically, in this legislation is to address the dental crisis. As an obstetrician myself, the only known cause of preterm labor is poor dental health, caries, cavities, whatever you want to call it. There are lots of links to having cavities and poor gum health to having heart attacks as well. It is a way underrecognized challenge for primary care.

I can't tell you how many times I have been called at 10 at night or 2 in the morning on a Saturday with one of my OB patients who is obviously very pregnant, but she has a cavity, and now, it turned into an abscess. I can't get her into a dentist. I call all my buddies. It is Saturday, 10 p.m., and all my buddies, the dentists, are gone.

Share your vision on dental and how this bill impacts that.

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Mr. MARSHALL. I want to turn this discussion to what our vision is for these primary care community health centers.

I think we all realize we have an obesity epidemic in this country, too, and a type 2 diabetic epidemic in this country that we need to address on the front end.

I am so happy to see some of my community health centers coming in and doing nutrition classes. They are doing cooking classes. I think so many folks of our current generation maybe learned how to do some cooking, but fast foods were a little bit too easy. It is that out-of- the-box thinking you get with different programs. I call it coaching. We need to be coaching folks up and teaching them but also give them the opportunities. So whether we are on the Ag Committee and working on food programs, we try to bring all these pieces together in the program as well.

I know Senator Sanders is also certainly committed to helping us address this. He has been a leader on this issue, trying to take care of folks with diabetes as well.

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Mr. MARSHALL. I might close with a couple of thoughts. Again, we came in with the lofty expectations that we could make a difference in primary care for people across the Nation. I think our bill accomplishes just that.

Again, I can't thank the staff enough for their support through this. Senator Sanders and I spent most of the August recess--and our staff spent every moment of every hour of every day on this August recess-- working on this legislation. I think it is a good product. I think there is always opportunity for improvement. We are welcome to those ideas.

I appreciate the Senator using traditional Hyde protections at the appropriate places, so we maintained that, which is important to many folks, including to myself. I think we addressed primary care issues. I think we have a plan to increase the nursing workforce. Again, in 3 years' time, we can turn that problem around and long-term address some of the primary care issues. Addressing dental, as well, I think will be a huge improvement.

At the end of the day, you cannot overestimate how much money this will save in programs like Medicare and Medicaid and the health insurance back home and help drive the cost of healthcare down for people. I am glad to see us try to emphasize maybe some better ways to spend the American taxpayer moneys.

But most importantly to me, the physician, is just this is the right thing to do. This is absolutely the right thing to do. It is a chance to improve the health of Americans. I am just proud to stand here beside Senator Sanders and introduce this legislation. Thank you.

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