From retail to agriculture or healthcare, digitization has affected all sectors and allowed more industries to engage with customers and partners around the globe. Many U.S. companies thrived in the initial online environment, which lacked clear rules and guidelines, quickly expanding their offerings and entering foreign markets. As the internet has evolved, however, governments have begun to impose national laws and regulations to pursue data protection, data security, privacy, and other policy objectives. The lack of global rules and norms for data and digital trade is leading to differences in these domestic internet regimes. Competing internet regimes and conflicting data governance rules increase trade barriers and limit investment flows and international commerce, restricting the ability of U.S. businesses and consumers to enter and compete in some markets. For example, foreign internet regimes may use national security regulations to block cross-border data flows, disrupting global supply chains and limiting the potential use of and gains from emerging technologies. The creation of national technology standards can also limit market access by foreign firms. As the digital economy expands, the diversity in digital rules is poised to grow in complexity and create new trade restrictions. The resulting patchwork of technical standards and national systems creates challenges for international trade, and may signal an impending fracturing of the global internet. Without agreement on global norms or common trade rules, some analysts foresee a splitting of the internet into distinct nation-led "dataspheres" and virtual trading blocs. The internet is global, governed by common technical protocols; it may also be regulated at the national level, although there is no international consensus on the proper role for governments. The lack of multilateral trade rules governing the digital economy has led to efforts to establish common global rules and norms. Over 75 countries, including the United States, are participating in World Trade Organization e-commerce negotiations, which aim to establish a global framework and obligations to enable nondiscriminatory digital trade. Proposals by the United States, the European Union (EU), and China illustrate the variation in member objectives, highlight potentially controversial issues, and raise questions about the likelihood of meaningful consensus. In general, the United States adopts a market-driven approach that supports an open, interoperable, secure, and reliable internet that facilitates the free flow of online information and supports other policy objectives such as privacy and national security. The EU, while supporting the role of the market and free flow of information also emphasizes the need for data protection, internal regional integration, and "technological sovereignty," a recent and evolving concept in the EU. In contrast to the U.S. and EU approaches, which both emphasize the open global internet, China pursues a state-led approach that maintains a firewall between the Chinese internet and the rest of the world. China's government strictly controls the flow of information on its networks and restricts the companies who can participate in its digital economy. Many aspects of internet service and content in China are prohibited to U.S. firms. China is exporting its system through its direct export of goods and services, including surveillance technologies, and is trying to influence international standards and norms to allow space for China's model of strict state controls. Other countries, such as India and Vietnam, are building their own internet regimes, borrowing from the Chinese, European, and U.S. approaches. Congress has an interest in addressing growing protectionist policies and trade barriers, and in developing U.S. rules and standards for internet governance that promote digital trade and economic growth, balanced among other policy objectives. The divergence in national internet regimes and its impact on digital trade raises numerous complex issues of potential concern to Congress. These include whether to support initiating new bilateral trade negotiations specific to digital trade; how the United States can conclude a successful plurilateral WTO e-commerce negotiation that achieves greater reciprocity and market access for U.S. exporters and removes barriers to trade; how such an outcome can be balanced with other policy objectives; and whether federal engagement in and support for international standards-setting bodies is sufficient.


Funds for the judicial branch are included annually in the Financial Services and General Government (FSGG) appropriations bill. The bill provides funding for the U.S. Supreme Court; the U.S. Court of Appeals for the Federal Circuit; the U.S. Court of International Trade; U.S. courts of appeals and district courts; the Administrative Office of the U.S. Courts; the Federal Judicial Center; the U.S. Sentencing Commission; federal defender organizations that provide legal representation to defendants financially unable to retain counsel in federal criminal proceedings; security and protective services for courthouses, judicial officers, and judicial employees; and fees and allowances paid to jurors. The judiciary's FY2020 budget request of $8.29 billion was submitted to Congress on March 11, 2019. By law, the President includes, without change, the appropriations request submitted by the judiciary in the annual budget submission to Congress. The FY2020 budget request included $7.62 billion in discretionary funds, representing a 5.1% increase over the FY2019 enacted level of $7.25 billion provided in the Consolidated Appropriations Act, 2019 ( P.L. 116-6 ; February 15, 2019). The FY2020 budget request also included $669.8 million in mandatory funds to pay the salaries and benefits of certain types of federal judges and to also provide for judicial retirement accounts. The House Appropriations Committee held a markup ( H.R. 3351 ) on June 11, 2019, and recommended the judiciary receive a total of $7.51 billion in discretionary funds. The House passed H.R. 3351 on June 26, 2019. The Senate Appropriations Committee held a markup ( S. 2524 ) on September 19, 2019, and recommended the judiciary receive a total of $7.42 billion in discretionary funds. The FSGG appropriations bill was not enacted prior to the beginning of FY2020 on October 1, 2019. Subsequently, the judiciary was funded through November 21, 2019, by the Continuing Appropriations Act, 2020 ( P.L. 116-59 , September 27, 2019) and from November 22, 2019, through December 20, 2019, by the Further Continuing Appropriations Act, 2020 ( P.L. 116-69 , November 21, 2019). Final FY2020 appropriations for the judiciary were included in the FY2020 Consolidated Appropriations Act ( P.L. 116-93 ). Congress provided a total of $8.19 billion, with $7.49 billion in discretionary funds and $705.5 million in mandatory funds. The act passed the House on December 17, 2019, the Senate on December 19, 2019, and was signed by the President on December 20, 2019. In recent years, appropriations for the judiciary have comprised approximately 0.2% of total budget authority.


GAO has regularly reported on government operations identified as high-risk because of their increased vulnerability to fraud, waste, abuse, and mismanagement, or the need for transformation to address economic, efficiency, or effectiveness challenges. In 2003, shortly after the department was formed, we designated Implementing and Transforming DHS as a high risk area to the federal government because DHS had to transform 22 agencies into one department, and failure to address associated risks could have serious consequences for U.S. national security. In 2013, we reported that although challenges remained for DHS, the department had made considerable progress. As a result, we narrowed the scope of the high-risk area to focus on strengthening DHS management functions (human capital, acquisition, financial management, and information technology). discusses DHS's progress and remaining actions needed to strengthen and integrate its management functions. This statement discusses DHS’s progress and remaining actions needed to strengthen and integrate its management functions. This statement is based on our 2019 high-risk update and other reports issued from February 2017 through March 2019. Among other things, GAO analyzed DHS strategies and other documents related to the department's efforts to address its high-risk areas. As GAO reported in its 2019 high-risk update, the Department of Homeland Security (DHS) has continued its efforts to strengthen and integrate its acquisition, information technology, financial, and human capital management functions. As a result, the department has continued to meet three out of five criteria for removal from GAO's High-Risk List (leadership commitment, action plan, and monitoring) and partially meet the remaining two criteria (capacity and demonstrated progress). With regard to leadership commitment, DHS's top leadership has continued to demonstrate support for addressing the department's management challenges through, for example, its Integrated Priorities initiative to strengthen the integration of DHS's business operations across the department. Additionally, DHS has established an action plan for addressing the high-risk area and has issued 14 updated versions since 2011.This action plan also demonstrates DHS's ongoing monitoring of these efforts as it describes DHS's progress to-date and planned corrective actions. The two key areas where additional work is needed are DHS's capacity and demonstrated progress. With regard to capacity, DHS needs to make additional progress identifying and allocating resources in the areas of acquisition, information technology, and financial management. With regard to demonstrated progress, DHS should show the ability to achieve sustained improvement across 30 outcomes that GAO identified and DHS agreed were needed to address the high-risk area. GAO found in its 2019 high-risk update that DHS fully addressed 17 of these outcomes, while work remains to fully address the remaining 13. DHS has made some progress in recent years regarding human capital and information technology outcomes, but needs to continue implementing its action plan to show measurable, sustainable progress in achieving the 13 outcomes not yet fully addressed.


GAO has reported on the inherent fragmented nature of the federal and nonfederal resources needed to protect the nation from potentially catastrophic biological threats. GAO called for a strategic approach to help the federal government better leverage resources and manage risk The White House issued the National Biodefense Strategy and the Presidential Memorandum on the Support for National Biodefense to promote a more efficient and coordinated biodefense enterprise. The National Defense Authorization Act for Fiscal Year 2017 included a provision that GAO review the strategy. This report addresses the extent to which the Strategy and implementation efforts are designed to enhance national biodefense capabilities and any implementation challenges that exist. GAO analyzed the Strategy, plans, and NSPM-14, and compared them to selected characteristics of GAO's work on effective national strategies, enterprise risk management, organizational transformation, and interagency coordination. GAO interviewed officials from the eight federal agencies that comprised the Biodefense Steering Committee to learn about early implementation. Issued in September 2018, the National Biodefense Strategy (Strategy) and implementation plan, along with National Security Presidential Memorandum-14 (NSPM-14), are designed to enhance national biodefense capabilities. NSPM-14 established a governance structure composed of relevant federal agencies and chaired by the Secretary of Health and Human Services (HHS) to guide implementation. It also required federal agencies with biodefense responsibilities to collect and assess data on their biodefense activities to, among other things, identify gaps. The Strategy defined the scope of the biodefense enterprise (which includes partners at all levels of government and the private sector) and brought all of the biological threats—intentional, accidental, and naturally-occurring—together, establishing an overarching vision, goals, and objectives. There are a number of challenges, however, that could limit long-term implementation success. Among other things, there was no documented methodology or guidance for how data are to be analyzed to help the enterprise identify gaps and opportunities to leverage resources, including no guidance on how nonfederal capabilities are to be accounted for in the analysis. Many of the resources that compose national capbilities are not federal, so enterprise-wide assessment efforts should account for nonfederal capabilities. Agency officials were also unsure how decisions would be made, especially if addressing gaps or opportunties to leverage resources involved redirecting resources across agency boundaries. Although HHS officials pointed to existing processes and directives for interagency decision making, GAO found there are no clear, detailed processes, roles, and responsibilities for joint decision-making, including how agencies will identify opportunities to leverage resources or who will make and enforce those decisions. As a result, questions remain about how this first-year effort to catalogue all existing activities will result in a decision-making approach that involves jointly defining and managing risk at the enterprise level. Without clearly documented methods, guidance, processes, and roles and responsibilities for enterprise-wide decision-making, the effort runs the risk of failing to move away from traditional mission stovepipes toward a strategic enterprise-wide approach that meaningfuly enhances national capabilities.


GAO has reported on the inherent fragmented nature of the federal and nonfederal resources needed to protect the nation from potentially catastrophic biological threats. GAO called for a strategic approach to help the federal government better leverage resources and manage risk The White House issued the National Biodefense Strategy and the Presidential Memorandum on the Support for National Biodefense to promote a more efficient and coordinated biodefense enterprise. The National Defense Authorization Act for Fiscal Year 2017 included a provision that GAO review the strategy. This testimony highlights key findings from our February 2020 report, which analyzed the extent to which the Strategy and related implementation efforts are designed to allow an enterprise-wide approach. Issued in September 2018, the National Biodefense Strategy (Strategy) and implementation plan, along with National Security Presidential Memorandum-14 (NSPM-14), are designed to enhance national biodefense capabilities. NSPM-14 established a governance structure composed of relevant federal agencies and chaired by the Secretary of Health and Human Services (HHS) to guide implementation. It also required federal agencies with biodefense responsibilities to collect and assess data on their biodefense activities to, among other things, identify gaps. There are a number of challenges, however, that could limit long-term implementation success. Among other things, there was no documented methodology or guidance for how data are to be analyzed to help the enterprise identify gaps and opportunities to leverage resources, including no guidance on how nonfederal capabilities are to be accounted for in the analysis. Agency officials were also unsure how decisions would be made, especially if addressing gaps or opportunities to leverage resources involved redirecting resources across agency boundaries. Although HHS officials pointed to existing processes and directives for interagency decision making, GAO found there are no clear, detailed processes, roles, and responsibilities for joint decision-making, including how agencies will identify opportunities to leverage resources or who will make and enforce those decisions. As a result, questions remain about how this first-year effort to catalogue all existing activities will result in a decision-making approach that involves jointly defining and managing risk at the enterprise level. Without clearly documented methods, guidance, processes, and roles and responsibilities for enterprise-wide decision-making, the effort runs the risk of failing to move away from traditional mission stovepipes toward a strategic enterprise-wide approach that meaningfully enhances national capabilities.


Administered by EPA, Superfund is the principal federal program for addressing sites containing hazardous substances. EPA lists some of the most seriously contaminated sites—most of which are nonfederal—on the NPL and has recorded over 500 contaminants, including arsenic and lead, at those sites. Climate change may make some natural disasters more frequent or more intense, which may damage NPL sites and potentially release contaminants, according to the Fourth National Climate Assessment. GAO was asked to review issues related to the impact of climate change on nonfederal NPL sites. This report examines, among other objectives, (1) what available federal data suggest about the number of nonfederal NPL sites that are located in areas that may be impacted by selected climate change effects and (2) the extent to which EPA has managed risks to human health and the environment from the potential impacts of climate change effects at such sites. GAO analyzed available federal data; reviewed laws, regulations, and documents; interviewed federal officials and stakeholders; visited three nonfederal NPL sites that experienced natural disasters; and compared EPA actions to manage risk to GAO’s six essential elements of enterprise risk management. Available federal data—from the Environmental Protection Agency (EPA), Federal Emergency Management Agency, National Oceanic and Atmospheric Administration, and U.S. Forest Service—on flooding, storm surge, wildfires, and sea level rise suggest that about 60 percent of all nonfederal National Priorities List (NPL) sites are located in areas that may be impacted by these potential climate change effects. Additional information on these sites can be viewed in an interactive map and downloadable data file, available here (see figure). EPA’s actions to manage risks to human health and the environment from potential impacts of climate change effects at nonfederal NPL sites align with three of the six essential elements of enterprise risk management GAO previously identified, partially align with two essential elements, and do not align with one essential element. For example, EPA has not taken actions consistent with one essential element because it has not aligned its process for managing risks with agency-wide goals and objectives, which do not mention climate change. Without clarifying this alignment, EPA cannot ensure that senior officials will take an active role in strategic planning and accountability for managing these risks.


GAO's High-Risk List identifies federal program areas that are high risk due to their vulnerability to mismanagement, among other things. GAO added the federal management of programs that serve Indian tribes and their members to its February 2017 biennial update of high-risk areas in response to management weaknesses at Interior and HHS. GAO's recommendations identified in this high-risk area are neither reflective of the performance of programs administered by tribes nor directed at any tribally operated programs and activities. This testimony, which is based on GAO's March 2019 High Risk report, provides examples of actions taken and progress made by these agencies to address the five criteria GAO uses for determining whether to remove a high-risk designation. For this statement, GAO also drew on findings from its reports issued from September 2011 through August 2018 and updated that work by reviewing agency documentation and interviewing agency officials. GAO designated the federal management of programs that serve tribes and their members as high risk in 2017. Officials from the Department of the Interior's Office of the Assistant Secretary-Indian Affairs (Indian Affairs), the Bureau of Indian Education (BIE), the Bureau of Indian Affairs (BIA), and the Department of Health and Human Services' (HHS) Indian Health Service (IHS) have expressed their commitment to addressing the issues that led to the designation. Since GAO last testified before this committee on June 13, 2018, Indian Affairs, BIE, BIA, and IHS have demonstrated progress to partially meet each of the five criteria for removing a high-risk designation (leadership commitment, capacity, action plan, monitoring, and demonstrated progress). However, additional progress is needed to fully address management weaknesses—particularly in the areas of retaining permanent leadership and a sufficient workforce. For example, to meet the capacity criterion, an agency needs to demonstrate that it has the capacity (i.e., people and other resources) to resolve its management weaknesses. While Indian Affairs, BIE, BIA, and IHS each made progress identifying capacity and resources to partially meet this criterion, BIE and IHS continue to face significant workforce challenges. Specifically, although BIE has conducted hiring in recent years as part of an effort to reorganize the bureau, about 50 percent of all BIE positions have not been filled according to recent BIE documentation. IHS also faces workforce challenges—GAO's August 2018 report found that IHS's overall vacancy rate for clinical care providers was 25 percent. GAO has identified varying levels of progress at the agencies in understanding what they need to do to be removed from the list and will continue to closely monitor their progress.


GSA is responsible for contracts that provide telecommunications services for federal agencies. In preparation for the expiration of current telecommunications programs, GSA has developed a successor program, called EIS. GSA and agencies now must carry out the task of successfully transitioning to EIS. Previous contract transitions experienced significant delays. Those delays during the last transition resulted in hundreds of millions of dollars in missed savings. GAO was asked to summarize its draft report currently out for comment at selected agencies. The draft discusses (1) selected agencies' plans for, and status in, transitioning to EIS; and (2) the extent to which selected agencies were implementing established transition planning practices. In preparing the report on which this testimony is based, GAO administered a survey to 19 selected agencies that spent at least $10 million on telecommunications in fiscal year 2018 regarding their plans for and status in transitioning to EIS. GAO also selected five of these agencies for further review based on, among other things, agency size and structure. For these agencies, GAO evaluated documentation to determine the extent to which they had implemented five planning practices identified in a previous GAO report. GAO's preliminary results show that, as of October 2019, the 19 selected agencies reviewed were in different stages of transitioning from their soon-to-be-expiring telecommunications contracts to the new Enterprise Infrastructure Solutions (EIS) program, which has generally lower rates for services. All of these agencies reported that they plan to fully transition to EIS program contracts before the current contracts expire in May 2023. However, 11 agencies did not plan to fully transition by the General Services Administration's (GSA) September 30, 2022, milestone. The majority of the selected agencies also did not meet GSA's milestones for completing critical contracting actions in 2019 (see table). While transitioning to EIS is a complex undertaking, delays in making this transition will cause agencies to miss out on potential cost savings that would result from the generally lower rates for services on the EIS program contracts. Dates GAO's preliminary results indicate that five of the 19 agencies that were selected for further review had partially implemented established planning practices that can help agencies successfully transition their telecommunications services to new contracts. These practices are to: (1) develop an accurate inventory of telecommunications services, (2) perform a strategic analysis of telecommunications requirements, (3) develop a structured transition management approach, (4) identify the resources needed for the transition, and (5) develop a transition plan. The agencies provided several reasons for partially implementing the practices. For example, transition officials at three agencies said that they were not responsible for tracking all of the telecommunications services in use at their agencies; as such, they were unable to provide complete telecommunications inventories. The agencies also planned to implement certain practices after they issue their EIS task orders. However, the limited time remaining to complete the transition makes it critical that agencies conduct early planning with the information available and fully implement these transition planning practices to reduce the risk that the agencies experience the types of delays and missed savings that occurred in previous transitions.


GSA is responsible for contracts that provide telecommunications services for federal agencies. In preparation for the expiration of current telecommunications programs, including one called Networx, GSA has developed a successor program, known as EIS. GSA and agencies now must carry out the task of successfully transitioning to EIS contracts. Previous contract transitions experienced significant delays. Those delays during the transition to Networx resulted in hundreds of millions of dollars in missed savings. GAO was asked to review agencies' EIS transition preparations. This report discusses (1) selected agencies' plans for, and status in, transitioning to EIS; and (2) the extent to which selected agencies were implementing established transition planning practices. GAO administered a survey to 19 selected agencies that spent at least $10 million on telecommunications in fiscal year 2018 regarding their plans for and status in transitioning to EIS. GAO also selected five of these agencies for further review—Commerce, HHS, NASA, State, and VA—based on, among other things, agency size and structure. For these agencies, GAO evaluated documentation to determine the extent to which they had implemented five planning practices identified in a previous GAO report. As of October 2019, the 19 selected agencies were in different stages of transitioning from their soon-to-be-expiring telecommunications contracts to the new Enterprise Infrastructure Solutions (EIS) program. All of these agencies reported that they plan to fully transition to EIS before current contracts expire in May 2023. However, 11 agencies did not plan to fully transition by the General Services Administration's (GSA) September 30, 2022, milestone. The majority of the selected agencies also did not meet GSA's milestones for completing critical contracting actions in 2019 (see table). While transitioning to EIS is a complex undertaking, delaying this transition will cause agencies to miss potential cost savings that would result from the generally lower rates for services on EIS. Five selected agencies—the Departments of Commerce (Commerce), Health and Human Services (HHS), State (State), and Veterans Affairs (VA); and the National Aeronautics and Space Administration (NASA)—had partially implemented established planning practices that can help agencies successfully transition their telecommunications services to new contracts. These practices are to: (1) develop an accurate inventory of telecommunications services, (2) perform a strategic analysis of telecommunications requirements, (3) develop a structured transition management approach, (4) identify the resources needed for the transition, and (5) develop a transition plan. The agencies provided several reasons for partially implementing the practices. For example, transition officials at Commerce, NASA, and VA said that they were not responsible for tracking all of the telecommunications services in use at their agencies; as such, they were unable to provide complete telecommunications inventories. The agencies also planned to implement certain practices after they issue their EIS task orders. However, the limited time remaining to complete the transition makes it critical that agencies conduct early planning with the information available and fully implement these transition planning practices to reduce the risk that the agencies experience the types of delays that occurred in previous transitions.


Generic drugs—copies of brand-name drugs—lead to significant cost savings. Before a generic drug can be marketed, FDA must approve the generic drug application. According to FDA, applications go through an average of three cycles of review before being approved, which may take years. The FDA Reauthorization Act of 2017 included a provision for GAO to study issues regarding the approval of generic drug applications in the first review cycle. This report examines 1) the first review cycle approval rate of generic drug applications in recent years and factors that may have contributed to whether applications were approved; and 2) changes FDA has made to increase the first review cycle approval rate. GAO reviewed FDA data on all generic drug applications reviewed from fiscal years 2015 through 2017 and documentation from the first review cycle for a judgmental selection of 35 applications from fiscal years 2017 and 2018. GAO also interviewed a non-generalizable selection of stakeholders. Applications and stakeholders were chosen to ensure variation in experience with the approval process. GAO found that 12 percent of the 2,030 generic drug applications reviewed by the Food and Drug Administration (FDA) from fiscal years 2015 through 2017 were approved in the first review cycle. The first review cycle begins when FDA accepts a generic drug application for review and ends when FDA makes its first decision about whether the drug should be approved for marketing and sale. For applications that were not approved in that first cycle, the application must undergo one or more subsequent review cycles to obtain approval, delaying the generic drug's arrival to market. GAO identified several factors that may have contributed to whether a generic drug was approved during the first review cycle. For example, certain types of complex drugs were less likely to receive approval in the first review cycle, such as eye drops or other drugs administered through the eye. FDA has taken steps to increase the rate of generic drug approvals in the first review cycle. For example, FDA has increased communication with applicants and introduced templates for reviewers to improve the consistency and clarity of their comments. However, GAO's review of a judgmental selection of 35 applications found examples of variation in the clarity and content of FDA's comments to applicants. Such variation may have contributed to whether applicants could adequately address deficiencies within the first cycle, and therefore whether the applications were approved. In addition, stakeholders GAO interviewed expressed concern that changes to the brand-name drug's labeling mid-cycle could delay or prevent generic drugs' approval in the first review cycle, and some stakeholders said they believe that the labeling changes may be strategically timed to delay approvals. Although FDA officials noted that it would be difficult for brand-name companies to time labeling changes in this way, they said that the agency has not conducted analysis that would enable it to assess the validity of these concerns. Therefore, FDA lacks the information needed to respond to these concerns or address problems should they exist.


Ghana, a country of 28 million people on West Africa's Atlantic coast, faces diverse development challenges, but has built a robust democracy notable for consistent peaceful turnovers of executive power since a transition to multiparty rule in the early 1990s. The country also has made progress toward many of the socioeconomic outcomes that successive U.S. administrations have sought to foster in Africa, and U.S. policymakers have tended to view Ghana as a stable U.S. partner in an often volatile region. Substantial U.S. bilateral aid has both been premised on and arguably contributed to Ghana's generally positive development trajectory. Amicable relations between the United States and Ghana, a former British colony, have persisted since 1957, when Ghana became the first colonized sub-Saharan African country to gain independence. In 2008, then-President George W. Bush visited Ghana to showcase U.S. aid programs on trade, entrepreneurship, health, education, and Ghana's first Millennium Challenge Corporation (MCC) compact. In 2009, then-President Barack Obama traveled to Ghana to highlight the nation as a democratic model for other African countries. The Trump Administration has not pursued any major policy shifts toward Ghana, but bilateral ties have recently come under strain with imposition, in early 2019, of selected visa sanctions on Ghanaian nationals by the U.S. Department of Homeland Security. In practice, the sanctionsâimposed in response to reported noncooperation with U.S. immigration law enforcement proceedings and deportation ordersâmean that U.S. consular officials are restricting the issuance of certain U.S. visas to Ghanaian citizens. The Administration also has proposed sharp cuts in bilateral aid as part of its emphasis on reducing foreign assistance, which could affect relations. During the Obama Administration, U.S. aid to Ghana was provided primarily under U.S. Agency for International Development (USAID)-administered global presidential development initiatives. These included Feed the Future (FTF, a global food security effort), the Global Health Initiative (GHI), the Global Climate Change Initiative (GCCI), and several Africa-specific initiatives: Power Africa, Trade Africa, and the Young African Leaders Initiative (YALI). In 2014 Ghana signed a second MCC compact focused on the electrical power sector. Ghana was also selected to join the Obama Administration's African Peacekeeping Rapid Response Partnership (APRRP) and its Security Governance Initiative (SGI), both launched in 2014. Ghana is a key international peacekeeping troop contributor in Africa, and engages in regular joint military training exercises and other security cooperation with the United States. According to a March 2019 State Department fact sheet on U.S.-Ghana relations, the United States and Ghana "share a long history promoting democracy, human rights, and the rule of law," and Ghana is a model for other African countries "in promoting resilient democratic institutions, transparent and peaceful transitions of power and regional stability." There have also been robust "people-to-people" relations since the late 1950s, notably in the form of learning exchange visits and cooperation among educational and scientific institutions, and thousands of Ghanaians have been educated in the United States. There are close cultural ties, notably between Ghanaians and African-Americans; there is a substantial African-American expatriate community in Ghana.


Globally, government procurement constitutes about a $4 trillion market for international trade. However, little is known about foreign sourcing in government procurement—how much governments procure from foreign-located suppliers or how much they acquire in foreign-made goods. GAO was asked to review the extent of foreign sourcing in government procurement across countries. GAO focused on the United States and the other six main parties to the GPA and NAFTA, selected international agreements that open procurement markets on a reciprocal basis. This report, the fourth of a related series, (1) provides broad estimates of foreign sourcing by the U.S. government and central governments of the other six main parties, and (2) assesses foreign sourcing as a share of estimated central government procurement and of estimated procurement by all levels of government, and the extent to which central government contracts that are covered under selected international procurement agreements are foreign-sourced. GAO analyzed the most recent comparable data available from two sources: (1) government procurement databases used in Canada, the European Union, South Korea, Mexico, Norway, and the United States, for 2015, and (2) 2014 trade data merged with data on the types of goods and services purchased by the public sector. Since Japan does not have a government procurement database, data for Japan were based on its 2015 GPA submission of 2013 data. GAO also interviewed cognizant government officials in Washington, D.C.; Ottawa, Canada; Mexico City, Mexico; Seoul, South Korea; and Tokyo, Japan. The U.S. government awarded contracts valued at about $12 billion to foreign-located firms, of which about $5 billion went to firms with reported locations in the other six main parties to the World Trade Organization Agreement on Government Procurement (GPA) and the North American Free Trade Agreement (NAFTA) (see figure). Conversely, government procurement databases indicated the central governments of these parties awarded an estimated $7 billion to foreign sources, out of which about $2 billion was U.S.-sourced. Canada and Mexico awarded most of the U.S.-sourced contracts. GAO was able to determine that the U.S. government awarded more, by contract value, to foreign-owned firms located abroad than to foreign-owned, U.S.-located firms. Moreover, more than 80 percent of U.S. government contracts awarded to foreign-owned firms located abroad were Department of Defense contracts performed abroad. Overall, while available contract data enable broad cross-country comparisons, they do not necessarily show where the goods are produced, where the services are delivered, or where the profits go, among other economic effects. Foreign sourcing by the seven GPA and NAFTA parties within the scope of the study, using two alternative methods, is less than 20 percent of overall central government procurement. Foreign sourcing by central governments, estimated from government procurement databases of the United States and the other six main parties, varied in value by party from about 2 to 19 percent of overall central government procurement. Foreign sourcing by all levels of government, estimated from data on trade and public sector purchases, showed that the governments' imports likely ranged from about 7 to 18 percent of the goods and services the governments purchased. In addition, contract data show that U.S., South Korean, and Mexican central government foreign sourcing was greater in value under contracts covered by GPA and NAFTA than under noncovered contracts, but the opposite was true for Canada and Norway. For the European Union and Japan, GAO found little difference or could not calculate an estimate.


Ground electronic warfare (EW) is a group of programs directed by the Army and Marine Corp which are designed to effect ground forces use of the electromagnetic spectrum. The U.S. military has several ground EW programs that are used for different missions. These programs can broadly be categorized into counter-improvised explosive device (C-IED) systems, counter-unmanned aerial systems (C-UAS), and communications and radar jammers. Over the past several years, senior leaders in the Army and Marine Corps have testified about the need to improve EW capabilities. Role of EW in Ground Operations EW is a component of modern warfare, particularly in response to threats posed by potential adversaries such as Russia and China. EW refers to operations that use the electromagnetic spectrum (i.e., the "airwaves") to detect, listen to, jam, and deceive (or "spoof") enemy radars, radio communication systems, data links, and other electronic systems. EW also refers to operations that defend against enemy attempts to do the same. Ground EW programs have gained importance in an era of "great power competition." Countries like Russia and China have developed so-called anti-access/area denial (A2/AD) systems, some of which are designed to prevent U.S. military access to radio and satellite communications, and to deny the use of radars for artillery and air defense operations. Ground Forces EW Programs This report focuses on three categories of unclassified EW programs in the Army and Marine Corps, along with their respective programs and systems: C ounter -IED : the Thor and Duke Version III systems. C ounter -UAS : the Batelle Drone Defender, Blighter Counter-UAS system, the Mobile Expeditionary High Energy Laser, the Marine Air Defense Integrated System (MADIS), and the Compact Laser Weapons System (CLaWS). C ommunications and radar jammers : the EW Tactical Vehicle (EWTV), the EW Planning and Management Tool (EWPMT), the Communication Emitter Sensing and Attacking System II (CESAS II), and the Mobile EW Support System (MEWSS). Potential Oversight Issues for Congress Congress has continually shown interest in EW, and the decisions it makes regarding EW could affect future military capabilities and funding requirements. In particular, EW programs pose several potential issues for Congress: Is DOD's proposed mix of ground EW capabilities and investments appropriate? How do the Army and Marine Corps transition emerging technologies from demonstrations into programs, and are these programs funded adequately? What role might emerging technologies have in shaping current EW plans and programs?


Heads of state and government from NATO's 30 member states met in London, United Kingdom (UK), on December 3-4, 2019. Two key goals for the meeting were to commemorate the alliance's past achievementsâ2019 marks NATO's 70 th anniversaryâand to advance efforts to address new and emerging security challenges, including Russian aggression, terrorism and instability in the Middle East and North Africa, and cyber and hybrid threats. The meeting also exposed heightened political tension within the alliance and divergent views on a range of issues, including U.S. policy toward NATO and Europe, relations with NATO member Turkey, and relations with Russia. In the six years since Russia occupied Crimea and invaded Eastern Ukraine, the United States has played a key role in renewing NATO's focus on territorial defense and deterring Russian aggression. Among other measures, NATO member states have deployed an Enhanced Forward Presence (EFP), totaling about 4,500 troops to the three Baltic States and Poland and including increased military exercises and training activities in Central and Eastern Europe. At the behest of the United States, the alliance also has sought to bolster its response to security threats posed by growing instability in the Middle East and North Africa, primarily through partnerships and training activities. NATO continues to lead a "train and assist" mission of about 16,500 troops in Afghanistan. In February 2020, NATO defense ministers agreed to expand NATO's training mission in Iraq, which currently consists of between 300 and 500 military trainers. The London meeting came at a tense time for NATO. Some allied governments argue that growing divergence between the United States and many European allies on a range of key foreign and security policy issues, from Iran's nuclear program to fighting the Islamic State terrorist organization in Syria, has impeded cooperation in NATO and exposed strategic rifts within the alliance. Some European allies have expressed particular concern about what they portray as a lack of U.S. coordination on policy in Syria, where many European countries have been assisting U.S.-led efforts to counter the Islamic State. Many allies also have criticized fellow NATO member Turkey for its military operations in Syria and its acquisition of a Russian-made air defense system. Although many Members of Congress have criticized specific developments within NATOâregarding burden sharing, for exampleâCongress as a whole has demonstrated consistent support for NATO. During the Trump Administration, congressional support at times has been viewed by some as an effort to reassure allies troubled by President Trump's criticisms of the alliance. Over the past several years, both chambers of Congress have passed legislation reaffirming U.S. support for NATO (e.g., H.Res. 397, H.R. 676 , H.R. 5515 / P.L. 115-232 , and H.Res. 256 in the 115 th Congress; S. 1790 / P.L. 116-92 in the 116 th Congress) and in some cases have sought to limit the President's ability to withdraw from NATO unilaterally ( H.R. 676 ; S. 1790 / P.L. 116-92 ). At the same time, Congress continues to assess NATO's utility and value to the United States, and some Members are concerned about key challenges facing NATO, including burden sharing, managing relations with Russia and China, and divergent threat perceptions within the alliance.


High demand and constant combat operations have created challenges for Air Force RPA pilots and sensor operators who conduct missions across the world. In January 2017, the Air Force approved a combat-to-dwell policy to better balance RPA units' time in combat with non-combat activities. It plans to fully implement the policy in 2024. Senate Report 115-262 included a provision that GAO review ongoing challenges in the Air Force RPA community. This report assesses, among other things, the extent to which the Air Force (1) met overall RPA pilot and sensor operator staffing targets and tracked its progress in implementing its combat-to-dwell policy and (2) identified and met instructor staffing levels at its RPA formal training unit. GAO analyzed selected Air Force accession, retention, and instructor staffing data; held non-generalizable focus groups at three RPA military bases; and interviewed officials at various levels of the RPA enterprise. The Air Force does not have enough pilots and sensor operators to meet its staffing targets for its unmanned aircraft—also called remotely piloted aircraft (RPA). It also does not track its overall progress in accessing and retaining enough RPA personnel needed to implement its combat-to-dwell policy, which is intended to balance RPA units' time spent in combat with non-combat activities. Officials stated that to fully implement combat-to-dwell the Air Force needs to access and retain more RPA personnel because since fiscal year 2016 it has had fewer RPA personnel than authorized (see figure for RPA sensor operator example). The Air Force has provided financial incentives to address retention of RPA personnel, but it does not yet have enough historical data to help predict RPA pilot retention trends going forward given the newness of the career field. Officials additionally expressed specific concerns about sensor operator retention particularly due to the possibility of lucrative private-sector jobs. Further, the Air Force does not have a comprehensive metric (or set of metrics) to know whether its accession and retention efforts are on track to generate the additional RPA personnel needed to implement its combat-to-dwell policy by 2024. Without a metric (or set of metrics), it is unclear whether any adjustments are needed to meet its implementation timeframes. The Air Force has not fully identified the number of RPA pilot and sensor operator instructor positions needed at its formal training unit and since 2016 has experienced instructor staffing shortages. Specifically, the number of instructor positions required is understated because they are based on a 2009 program of instruction with 49 training days while the current program of instruction is 83 training days. Moreover, since fiscal year 2016, the formal training unit has had fewer assigned instructors than authorized positions even though those numbers of instructor positions are underestimates of actual needs. To help address the effect of the instructor gap, officials temporarily reduced the length of training. Without updated information to inform the number of required instructors, the Air Force does not know the correct number of instructor positions necessary to train RPA aircrews to be ready to complete their mission.


Historically, the U.S. Department of Health and Human Services (HHS) has been one of the larger federal departments in terms of budgetary resources. Estimates by the Office of Management and Budget (OMB) indicate that HHS has accounted for at least 20% of all federal outlays in each year since FY1995. Most recently, HHS is estimated to have accounted for 27% of all federal outlays in FY2018. Final FY2019 appropriations had not been enacted for a few HHS operating divisions and accounts prior to the development of the FY2020 President's budget request. As a result, the FY2019 estimates contained in FY2020 President's budget materials (and this report) are based on annualized amounts provided in the FY2019 continuing resolution for this subset of HHS accounts. The remainder of the HHS estimates for FY2019 are based on enacted full-year appropriations contained in Division B of P.L. 115-245 , along with current services estimates for mandatory spending. Under the FY2020 President's budget request, HHS would spend an estimated $1.286 trillion in outlays in FY2020. This is $56 billion (+5%) more than estimated HHS spending in FY2019 and $166 billion (+15%) more than actual HHS spending in FY2018. Mandatory spending typically comprises the majority of the HHS budget. Two programsâMedicare and Medicaidâare expected to account for 86% of all estimated HHS spending in FY2020, according to the President's budget request. Medicare and Medicaid are "entitlement" programs, meaning the federal government is required to make mandatory payments to individuals, states, or other entities based on criteria established in authorizing law. Discretionary spending accounts for about 8% of HHS outlays in the FY2020 President's budget request. Although discretionary spending represents a relatively small share of total HHS spending, the department nevertheless receives more discretionary money than most federal departments. According to OMB data, HHS accounted for 7% of all discretionary budget authority across the government in FY2018. This report provides information about the FY2020 HHS budget request. It begins with a review of the department's mission and structure. Next, the report provides some context for the FY2020 President's budget request. It then discusses the concept of the HHS budget as a whole, in comparison to how funding is provided to HHS through the annual appropriations process. The report continues with a breakdown of the HHS request by operating division. An appendix summarizes the mission of each HHS operating division and identifies additional agency-level resources related to the FY2020 budget request.


Advanced technologies—including artificial intelligence and robotics—are continually changing and emerging. While robots have existed for decades, modern robots may be equipped with learning capabilities that enable them to perform an expansive array of tasks. Advanced technologies are likely to affect the U.S. workforce by enabling firms to automate certain work tasks. Questions exist about how prepared federal agencies are to monitor workforce changes, promote economic growth, and support workers who may be negatively affected by automation. GAO was asked to examine workforce issues related to the adoption of advanced technologies. This report examines (1) what is known about how the adoption of advanced technologies affects the U.S. workforce ; (2) federal efforts to track these effects; (3) considerations that led selected firms to adopt advanced technologies and the risks they faced; and (4) ways technology adoption has affected the workforce at selected firms. GAO identified available federal workforce data, analyzed the extent to which those data could identify and measure workforce effects due to advanced technologies, reviewed selected research, and analyzed federal data on occupations susceptible to automation. GAO used data from the American Community Survey (2010-2016), the Current Population Survey's Displaced Worker Supplement (2016), and the Occupational Employment Statistics (2017). GAO met with 16 firms that are using advanced technologies in their operations and seven firms that develop advanced technologies, and interviewed managers and workers, and observed firms' use of technologies. The selected firms varied in size, industry sector, types of technologies used, and geographic location. Findings from discussions with the fims are not generalizable, but provide illustrative examples about the adoption of advanced technologies. GAO interviewed officials from federal agencies, including Commerce and DOL, academic researchers, economists, labor union officials, industry association officials, officials from state economic development associations, and other knowledgeable individuals. GAO also reviewed relevant academic work. Although existing federal data provide useful information on the U.S. workforce, they do not identify the causes of shifts in employment. As a result, it is difficult to determine whether changes are due to firms adopting advanced technologies, such as artificial intelligence and robots (see photo), or other unrelated factors. In lieu of such data, GAO analyzed employment trends and characteristics of jobs that selected researchers identified as susceptible to automation, and found that: industries with a greater proportion of jobs susceptible to automation were more likely to have experienced growth in tech jobs (i.e., computing, engineering, and mathematics) from 2010 to 2016—possibly an indicator of industries preparing to adopt advanced technologies; occupations susceptible to automation and industries with a greater share of these jobs did not experience meaningfully higher job loss rates in this period, though it could be too soon to observe these effects; and certain groups, such as workers with no college education and Hispanic workers, tended to hold jobs susceptible to automation in 2016, and thus could be disproportionately affected by changes if they occur. The Department of Labor (DOL) has a role in tracking changes in the U.S. workforce, but the data it collects related to the workforce effects of advanced technologies are limited. DOL's Bureau of Labor Statistics (BLS) identifies occupations projected to experience staffing pattern changes and the most significant causes, such as use of robotics, but its efforts are not designed to capture all instances of changes due to advanced technologies. DOL's Occupational Information Network program also collects data on tasks and technologies in occupations, such as robotics, but it was not designed to track changes over time. According to BLS, these efforts and other data they collect provide some, but not all, of the information required to identify and systematically track the impact of automation on the workforce. Without comprehensive data that link technological changes to shifts in the workforce, DOL lacks a valuable tool for ensuring that programs it funds to support workers are aligned with local labor market realities, and employers and job seekers need to rely on other sources of information to decide what training to offer or seek. The Department of Commerce's Census Bureau (Census) has started tracking technology adoption and resulting workforce effects in the new Annual Business Survey, which was administered for the first time in June 2018 with significant support from the National Science Foundation. This first survey asked firms about their use of advanced technologies and initial results will be available in late 2019. When the survey is next administered in summer 2019, Census plans to ask additional questions about firms' motivations for adopting technologies and effects the technologies might have on workers. This survey could provide information about the prevalence of technology adoption and workforce changes (e.g., declines in production workers or increases in supervisory workers), but it is not intended to provide information on the magnitude of workforce changes. Also, it remains unclear what limitations, if any, the survey data may have. According to officials from the 16 firms GAO interviewed, cost savings and other considerations led them to adopt advanced technologies, despite facing certain risks with the new technologies. Officials from these firms typically identified cost savings and improving job or product quality as primary motivations for adopting advanced technologies. For example, an automotive parts manufacturer said the firm adopted robots to reduce costs by using fewer workers. A door manufacturer said the firm installed two robots to lift heavy doors onto a paint line to reduce the number of worker injuries. A rubber stamp manufacturer said acquiring a robot (pictured above) allowed it to purchase and process raw materials instead of buying precut materials. Firm officials also identified risks related to adopting advanced technologies that could affect their return on investment, such as risks related to the reliability of technology and working with new tech developers. Among the firms GAO met with, officials described various ways technology adoption has affected their workforces. On one hand, officials at many firms said they needed fewer workers in certain positions after adopting technologies. The firms generally redeployed workers to other tasks, and in some cases, reduced the size of their workforces, typically through attrition. For example, a medical center GAO visited adopted autonomous mobile robots to transport linens and waste, among other things, which officials said eliminated 17 positions and shifted workers to other positions. On the other hand, officials at some firms said advanced technologies helped them increase competitiveness and add positions. An appliance manufacturer used advanced technologies to produce more of its own parts instead of relying on suppliers and, as a result, increased the number of production jobs, according to officials. Firm officials also noted that workers' tasks and skills have been changing due to advanced technologies (see figure). Workers who can adapt to new roles may experience positive effects, such as work that is safer, while those who cannot adapt may be negatively affected.


Honduras, a Central American nation of 9.1 million people, has had close ties with the United States for many years. The country served as a base for U.S. operations designed to counter Soviet influence in Central America during the 1980s, and it continues to host a U.S. military presence and cooperate on antidrug efforts today. Trade and investment linkages are also long-standing and have grown stronger since the implementation of the Dominican Republic-Central America-United States Free Trade Agreement (CAFTA-DR) in 2006. In recent years, instability in Honduras—including a 2009 coup and significant outflows of migrants and asylum-seekers since 2014—has led U.S. policymakers to focus greater attention on conditions in the country and their implications for the United States. Domestic Situation President Juan Orlando Hernández of the conservative National Party was inaugurated to a second four-year term in January 2018. He lacks legitimacy among many Hondurans, however, due to allegations that his 2017 reelection was unconstitutional and marred by fraud. Over the past five years, Honduras has made some progress in reducing violence and putting public finances on a more sustainable path. Anti-corruption efforts have also made some headway, largely as a result of cooperation between the Honduran public prosecutor's office and the Organization of American States-backed Mission to Support the Fight Against Corruption and Impunity in Honduras. Nevertheless, considerable challenges remain. Honduras continues to be one of the poorest countries in Latin America, with more than 67% of Hondurans living below the poverty line. It also remains one of the most violent countries in the world and continues to suffer from persistent human rights abuses and widespread impunity. Moreover, the country's tentative progress in combating corruption has generated a fierce backlash, calling into question the sustainability of those efforts. U.S. Policy In recent years, U.S. policy in Honduras has been guided by the U.S. Strategy for Engagement in Central America, a whole-of-government effort designed to promote economic prosperity, strengthen governance, and improve security in Honduras and the rest of the region. Congress has appropriated more than $2.6 billion for the strategy since FY2016, at least $431 million of which has been allocated to Honduras. Continued U.S. engagement in the region is uncertain, however, as the Trump Administration announced in March 2019 that it intends to end foreign assistance programs in Honduras, El Salvador, and Guatemala due to the continued northward flow of migrants and asylum-seekers to the United States. The 116th Congress could play an important role in shaping U.S. policy toward Honduras and the broader region. Several legislative initiatives that have been introduced—including H.R. 2615, S. 1445, and H.R. 2836—would authorize foreign assistance for certain activities in Central America. Congress will also consider FY2020 foreign aid appropriations. H.R. 2839 would appropriate $540.9 million for the Central America strategy, including at least $75 million for Honduras. That would be $96 million more than the Administration requested for Central America and about $9 million more than the Administration requested for Honduras. Other bills Congress may consider would tie U.S. security assistance to human rights conditions in Honduras (H.R. 1945), tie U.S. assistance to the number of unaccompanied Honduran children that arrive at the U.S. border (H.R. 2049), and expand in-country refugee processing in Honduras (H.R. 2347).


Human health and well-being require clean and safe water, according to the Water Research Foundation. The Fourth National Climate Assessment states that the potential impacts of extreme weather events from climate change will vary in severity and type and can have a negative effect on drinking water and wastewater utilities. GAO's previous work on climate change and resilience to extreme weather and disasters has shown how the federal government can provide information and technical and financial assistance to promote and enhance climate resilience. In 2015, GAO reported that enhancing climate resilience means taking action to reduce potential future losses by planning and preparing for climate-related impacts, such as extreme rainfall. This report examines federal technical and financial assistance to utilities for enhancing climate resilience, and options experts identified for providing additional assistance, among other things. GAO reviewed relevant federal laws, regulations, and guidance from four federal agencies—EPA, FEMA, HUD, and USDA—and interviewed federal officials, representatives from 15 water utilities selected for diversity of size and geography, and 10 experts selected to represent different views. Four federal agencies—the Environmental Protection Agency (EPA), the Federal Emergency Management Agency (FEMA), and the Departments of Housing and Urban Development (HUD) and Agriculture (USDA)—provide technical and financial assistance (e.g., loans and grants), to drinking and wastewater utilities. Technical assistance. EPA provides technical assistance to drinking water and wastewater utilities to enhance their infrastructure's resilience to climate change. However, according to EPA officials, EPA's program is small and cannot assist utilities nationwide. All of the selected experts GAO interviewed stated that utilities need additional technical assistance on an ongoing basis to manage climate risks, and most experts said that organizing a network of existing technical assistance providers, including federal and state agencies, universities, and industry groups, would be needed to provide such assistance. Under a presidential policy directive, EPA is to work to enable efficient information exchanges among federal agencies and to help inform planning and operational decisions for water and wastewater infrastructure. By identifying existing technical assistance providers and engaging them in a network to help utilities incorporate climate resilience into their infrastructure projects on an ongoing basis, EPA would have better assurance that climate information was effectively exchanged among federal agencies and utilities. Financial assistance. Federal agencies have taken some actions to promote climate resilience when providing financial assistance for water infrastructure projects, but agencies do not consistently include the consideration of climate resilience when funding such projects. Most selected experts suggested that federal agencies should require that climate information be considered in the planning of water infrastructure projects as a condition of providing financial assistance. Moreover, representatives from several utilities said that such a requirement could be an effective and feasible way to help enhance utilities' climate resilience. A requirement would ensure that utilities consider climate resilience in planning for water infrastructure projects and potentially limit future fiscal exposures. For example, from fiscal years 2011 through 2018, the federal government provided at least $3.6 billion in disaster recovery financial assistance for drinking water and wastewater infrastructure related projects (see figure).


Hurricanes Irma and Maria hit the U.S. Virgin Islands and Puerto Rico within two weeks of each other in September 2017, causing catastrophic damage. HHS is responsible for leading the federal public health and medical services response during a disaster, such as these hurricanes. As part of its lead federal role during these hurricanes, HHS called upon support agencies, including the Departments of Defense, Homeland Security, and Veterans Affairs, to assist with the public health and medical services response. GAO was asked to review the federal public health and medical services response to Hurricanes Irma and Maria in the U.S. Virgin Islands and Puerto Rico. This report examines HHS's actions and leadership of this response, among other things. GAO reviewed documentation on the preparedness for, and response to, the hurricanes. It also interviewed federal and territory officials and interviewed or received written responses from eight nonfederal stakeholders involved in the response, such as nongovernmental organizations. GAO identified these stakeholders through research and referrals. The catastrophic destruction encountered as a result of Hurricanes Irma and Maria proved overwhelming to the U.S. Virgin Islands and Puerto Rican governments and resulted in a large federal disaster response, complicated by losses of power, communication, and health care infrastructure. The Department of Health and Human Services (HHS) led the federal public health and medical services response and undertook numerous actions to address the needs in the territories—including evacuating critical care and dialysis patients from the U.S. Virgin Islands and Puerto Rico and providing medical personnel and facilities. However, GAO identified several shortcomings in HHS's leadership. While the scale, location, and timing of these storms complicated response efforts, the deficiencies GAO identified were in many cases a function of preparedness policies, or lack thereof. As a result, they could adversely affect future large-scale responses unless addressed. For example, as the lead agency, HHS is responsible for ensuring that appropriate planning activities are undertaken, including monitoring the federal ability to provide core public health and medical services response capabilities. However, GAO found that HHS did not have a full understanding of the capabilities and limitations of its support agencies, including the Departments of Defense, Homeland Security, and Veterans Affairs. Consequently, HHS's needs were not always aligned with the resources that its support agencies could provide, resulting in some deployed resources not being properly and efficiently utilized. For example, HHS requested Department of Defense medical teams, but these teams specialized in trauma and surgical care, not the chronic and primary care needed. HHS lacked plans for the territories that accounted for the chronic and primary care needs in isolated communities. This care was greatly needed, given that many, especially the elderly, could not easily access hospitals.


IHS provides care to American Indians and Alaska Natives through a system of health care facilities. The Patient Protection and Affordable Care Act (PPACA) provided states with the option to expand their Medicaid programs, and created new coverage options beginning in 2014, including for American Indians and Alaska Natives. GAO was asked to review how PPACA has affected health care coverage and services for American Indians and Alaska Natives. In this report, GAO describes (1) trends in health insurance coverage and third-party collections at federally operated and tribally operated facilities from fiscal years 2013 through 2018, and (2) the effects of any changes in coverage and collections on these facilities. To address these objectives, GAO analyzed IHS data on coverage, third-party collections, and PRC. GAO interviewed IHS officials from headquarters and all 12 area offices, as well as from 17 facilities selected to include a mix of federally operated and tribally operated hospitals and health centers in states that both had and had not expanded their Medicaid programs as of September 2018. GAO interviewed officials from 11 federally operated IHS facilities and 6 tribally operated facilities. GAO provided a draft of this report to the Secretary of Health and Human Services for comment. The Department did not have any comments on the draft report. GAO's analysis of Indian Health Service (IHS) data shows that from fiscal years 2013 through 2018, the percent of patients at federally operated IHS hospitals and health centers that reported having health insurance coverage increased an average of 14 percentage points. While all federally operated IHS facilities reported coverage increases, the magnitude of these changes differed by facility, with those located in states that expanded access to Medicaid experiencing the largest increases. Federally operated IHS facilities' third-party collections—that is, payments for enrollees' medical care from public programs such as Medicaid and Medicare, or from private insurers—totaled $1.07 billion in fiscal year 2018, increasing 51 percent from fiscal year 2013. Although exact figures were not available, tribally operated facilities, which include hospitals and health centers not run by IHS, also experienced increases in coverage and collections over this period, according to officials from selected facilities and national tribal organizations. Increases in health insurance coverage and third-party collections helped federally operated and tribally operated facilities continue their operations and expand the services offered, according to officials from 17 selected facilities. These officials told GAO that their facilities have been increasingly relying on third-party collections to pay for ongoing operations including staff payroll and facility maintenance. Officials at most facilities with increases in third-party collections also stated that they expanded their onsite services, including increasing the volume or scope of services offered by, for example, adding new providers or purchasing medical equipment. Increased coverage and collections also allowed for an expansion in the complexity of services provided offsite through the Purchased/Referred Care (PRC) program, which enables patients to obtain needed care from private providers if the patients meet certain requirements and funding is available. According to IHS and facility officials, increases in coverage have allowed some patients to access care offsite using their coverage, and an expansion of onsite services has reduced the need for some patients to access PRC. Officials GAO interviewed from federally operated and tribally operated facilities stated that facilities' expansion of onsite and offsite services has led to enhancements in patients' access to care in some instances.


IRA owners are able to invest in a wide variety of assets, but they are prohibited from engaging in certain transactions involving IRA assets. IRA owners who engage in prohibited transactions may incur increased income tax liability, additional taxes, and the loss of the tax-advantaged status of their accounts. DOL can grant exemptions from the prohibited transaction rules. IRS enforces tax laws relating to IRAs and can assess additional taxes. GAO was asked to examine (1) DOL's process for granting exemptions for prohibited IRA transactions and outcomes of that process, and (2) the extent to which DOL and IRS collaborate on oversight of prohibited transaction rules for IRAs. GAO reviewed relevant federal laws and regulations; examined agency guidance, exemption process documentation, and application case files; assessed interagency coordination using internal control standards and prior work on interagency collaboration; and interviewed DOL and IRS officials. The Department of Labor (DOL) has a process to grant administrative exemptions for individual retirement account (IRA) transactions that would otherwise be prohibited by law, such as an IRA buying investment property from the IRA owner. DOL evaluates applications using statutory criteria and follows administrative procedures codified in regulations. Applications for proposed transactions that are substantially similar to certain other transactions previously granted exemptions may follow an expedited process. As shown in the figure, GAO found that roughly half (56) of the IRA prohibited transaction exemption applications it reviewed were withdrawn by the applicant before the review process was completed. In reviewing processed applications, GAO found that most of the prohibited transactions for which an exemption was sought involved the sale of IRA assets. With regard to DOL's application review process, GAO found that DOL has not sufficiently documented internal policies and procedures to help ensure effective internal control of its process. Documenting procedures could increase transparency about how applications are handled, reduce the risk of DOL employees carrying out their duties inconsistently, and provide a means to retain organizational knowledge should key personnel leave unexpectedly. Although DOL and the Internal Revenue Service (IRS) share some information as part of their oversight responsibility for prohibited IRA transactions, no formal mechanism exists to help guide collaboration between the agencies. Of the 124 IRA applications GAO reviewed, only eight reflected DOL contact with IRS. GAO found that DOL has information about requested exemptions to prohibited IRA transaction rules that could be useful to IRS in carrying out its oversight responsibilities. For example, DOL does not share information on denials—information that could be useful as prohibited transaction examples for IRS examiner training and educational outreach to IRA owners. In prior work on interagency collaboration, GAO has found that formal agreements, such as a memorandum of understanding, can help agencies monitor, evaluate, and update interagency collaboration. Formalizing the sharing of information between DOL and IRS regarding IRA prohibited transaction exemptions could help the agencies better support their current coordination efforts and identify additional opportunities for greater collaboration.


IRS recognizes that taxpayers want more choices in how they interact with IRS, including through online services. GAO was asked to review IRS's online services—those which allow IRS and individual taxpayers to exchange personalized information electronically. This report (1) examines what is known about how IRS's current online services are meeting taxpayers' needs, and provides information about selected foreign and state revenue agencies' online services; (2) evaluates the extent to which IRS's strategy for identifying and prioritizing the development of new online services is consistent with relevant requirements and leading practices; and (3) examines how IRS is addressing key challenges in providing online services. GAO assessed IRS's online services against relevant requirements, agency goals, and leading practices; interviewed IRS officials; and identified additional services and practices from six foreign and state revenue agencies selected for offering multiple online services for exchanging personalized information with taxpayers. The Internal Revenue Service's (IRS) online services for individual taxpayers primarily provide taxpayers one-way communication of key information derived from their tax return, such as when an anticipated refund should arrive, or allow taxpayers to pay money owed or make payment arrangements. IRS has done little research or reporting on the extent to which its online services are satisfying taxpayers' needs. Also, IRS has not set a target for using online services to help reduce taxpayer burden. Selected foreign and state revenue agencies' online services have developed online filing and communication capabilities, such as filing a tax return on the agency's website and offering electronic chats between revenue agency employees and taxpayers (see figure). IRS has long-term planning documents which detail online services it intends to develop, which include services to communicate digitally with taxpayers, to achieve its goal of modernizing the taxpayer experience. However, GAO found that IRS has not sufficiently considered taxpayer input in the prioritization process for these new services and instead prioritizes services primarily based on the potential benefit to IRS operations or how quickly a service might be developed. Without considering taxpayer input on user needs and preferences, IRS risks developing services that taxpayers do not use. A group of private sector tax preparation companies known as Free File, Inc., has a long-standing agreement with IRS in which the companies provide free electronic tax preparation and filing services to eligible taxpayers in exchange for IRS not offering its own filing capability. However, few taxpayers use these services and GAO found that IRS has given inadequate consideration to the full benefits and costs of the Free File agreement to all parties. Not considering these costs and benefits has implications for the future evolution of IRS's online services, including helping taxpayers electronically file amended returns.


Illicit finance activity, such as terrorist financing and money laundering, can pose threats to national security and the integrity of the U.S. financial system. FinCEN is responsible for administering BSA and has delegated examination responsibility to supervisory agencies. FinCEN also is to collect and disseminate BSA data. BSA requires that financial institutions submit reports, which may be used to assist law enforcement investigations. Industry perspectives on BSA reporting have included questions about its usefulness. This report examines, among other objectives, how FinCEN and supervisory and law enforcement agencies (1) collaborate and (2) provide metrics and feedback on the usefulness of BSA reporting. GAO reviewed related laws and regulations; agency documentation; examination and enforcement action data; and interviewed FinCEN, supervisory agencies, and a nongeneralizable selection of six law enforcement agencies and seven industry associations. The Financial Crimes Enforcement Network (FinCEN)—within the Department of Treasury—supervisory agencies (such as banking, securities, and futures regulators), and law enforcement agencies collaborate on implementing Bank Secrecy Act/anti-money laundering (BSA/AML) regulations, primarily through cross-agency working groups, data-sharing agreements, and liaison positions. FinCEN and law enforcement agencies provided some metrics and institution-specific feedback on the usefulness of BSA reporting (such as suspicious activity reports) to the financial industry but not regularly or broadly. FinCEN and some agencies have metrics on the usefulness of BSA reports. One law enforcement agency annually publishes aggregate metrics on BSA reports that led to investigations and indictments. But FinCEN did not consistently communicate available metrics; it generally did so on an ad-hoc basis such as through published speeches. In 2019, FinCEN began a study to identify measures on the value and usefulness of BSA reporting—to be completed by the end of 2019. By consistently communicating currently available metrics (summary data), and any later identified by the study, FinCEN may assist financial institutions in more fully understanding the importance of their efforts. Industry associations GAO interviewed noted financial institutions would like to receive more institution-specific feedback on the usefulness of their BSA reporting; they also identified suspicious activity reports as labor-intensive. In 2017, FinCEN began providing such feedback and some law enforcement agencies have ongoing efforts to provide institution-specific briefings. But these efforts have not been regularly made and involved relatively few institutions. Additional and more regular feedback, designed to cover different types of financial institutions and those with significant financial activity, may enhance the ability of the U.S. financial industry to effectively target efforts to identify suspicious activity and provide quality BSA reporting.


Imports account for over 90 percent of U.S. seafood consumption. FDA and the Department of Homeland Security (DHS) both play a role in overseeing imported seafood. FDA is responsible for ensuring the safety of most imported seafood. DHS provides FDA with import data on FDA-regulated products, including seafood. If FDA finds that imported seafood products appear to violate U.S. laws, FDA may place the products, firms, or countries on an import alert. GAO was asked to review FDA's efforts to use import alerts to ensure the safety of imported seafood. This report, among other things, (1) describes FDA's import alert process for seafood products, (2) examines FDA oversight of key activities to support import alert removal decisions, and (3) examines the extent to which FDA has assessed the effectiveness of its seafood import alerts. GAO reviewed FDA procedures and data, including data on 274 removal decisions, for a non-generalizable sample of seven import alerts selected for a range of violations of federal law. GAO also interviewed FDA officials. The Food and Drug Administration's (FDA) import alert process for seafood products includes three key components: (1) establishing new import alerts, which inform FDA field staff and the public that the agency has enough evidence that products appear to violate a federal food safety law to detain those products at U.S. ports of entry without physically examining them; (2) placing firms and products on existing import alerts; and (3) removing firms and products from those import alerts when violations are resolved. As of July 3, 2018—the most recent data at the time of GAO's analysis—FDA had 52 active import alerts affecting imported seafood that addressed a wide range of violations of federal law, including the presence of foodborne pathogens, such as Salmonella , or unapproved animal drug residues. FDA has established audit goals, requirements, and expectations related to sampling and inspections—key activities to support import alert removal decisions—but does not monitor the extent to which it is meeting them. GAO's review of 274 removal decisions from October 1, 2011, through July 3, 2018, found that FDA had supported only a small percentage of its removal decisions by conducting sampling and inspections. For example, FDA has a goal to audit samples from at least one of the shipments used to support each removal decision to ensure the validity of the analysis that a private laboratory performed. However, GAO found that within a year prior to the 274 removal decisions, FDA did not conduct any audits for 260 (95 percent) of the 274 removal decisions. FDA officials said they conducted limited sampling because many import alert removal decisions can be supported by documentary evidence provided by firms. Additionally, for certain violations that indicate a firm failed to meet regulatory or administrative requirements and may pose a public health hazard, an FDA directive establishes a goal for FDA staff to conduct a follow-up inspection within 6 months. However, GAO's review of removal decisions found that for 31of the 32 firms that received such a finding, FDA did not conduct a follow-up inspection before removing them from an import alert. FDA officials said they did not know whether they were meeting their audit goals because the agency does not have a process to monitor the extent to which it is conducting its sampling and inspections. Establishing such a process would provide greater assurance that FDA is conducting its expected level of sampling and inspections to support its removal decisions and has confidence in continued compliance. FDA has not established performance goals and measures for seafood import alerts—key elements for assessing the effectiveness of programs. Goals explain the outcomes a program seeks to achieve, and measures track progress towards those goals. In February 2019, FDA published a broad plan for the safety of imported food. The plan states that FDA intends to develop performance goals and measures related to imported food safety, but FDA has not established a time frame for doing so. By establishing a time frame and developing such goals and measures, FDA would be better positioned to assess how well its seafood import alert activities are supporting the agency in achieving its food safety mission.


Improper payments, estimated at almost $175 billion for fiscal year 2019, are a significant problem in the federal government. IPIA and OMB guidance directs agencies to analyze the root causes of improper payments and develop corrective actions to reduce improper payments. This report examines (1) actions that agencies took to identify root causes of improper payments for selected programs, (2) the extent to which their corrective action plans correspond to identified root causes, and (3) the extent to which they monitored progress and evaluated the effectiveness of corrective actions. GAO analyzed corrective action plans reported in fiscal year 2018 for the following eight programs: Department of Education's Direct Loan and Pell Grant; HHS's Children's Health Insurance Program; SSA's Old Age, Survivors, and Disability Insurance and Supplemental Security Income; Treasury's EITC; USDA's SNAP; and VA's Prosthetic and Sensory Aids Service. GAO selected these programs based, in part, on those programs with at least $1 billion in fiscal year 2018 improper payment estimates. Five out of six agencies used their improper payment estimation results to identify the root causes for the eight programs GAO reviewed. However, the Department of the Treasury (Treasury) used 2006 through 2008 taxpayer data to identify root causes of fiscal year 2018 Earned Income Tax Credit (EITC) improper payments. Without timely data on the true root causes of EITC improper payments, Treasury will lack quality information needed to develop appropriate corrective actions to reduce them. In addition, only one agency we reviewed—the Department of Veterans Affairs (VA)—adhered to relevant Improper Payments Information Act of 2002, as amended (IPIA), requirements and Office of Management and Budget (OMB) guidance. The Department of Agriculture (USDA) and Treasury did not develop agency corrective action plans corresponding to the identified root causes of improper payments for the Supplemental Nutrition Assistance Program (SNAP) and EITC, respectively. In addition, the remaining three agencies did not have processes in place to either establish planned completion dates, monitor progress, or measure the effectiveness of their corrective actions in reducing improper payments. Unless agencies develop corrective action plans that correspond to root causes of improper payments and implement processes to monitor progress and measure their effectiveness, their ability to ensure that their efforts will reduce improper payments will be limited


Improper payments—including payments that should not have been made or were made in an incorrect amount—are a long-standing, significant challenge in the federal government. Both GAO and the DOD Inspector General have reported on problems related to improper payments in DOD's travel pay program. This report examines (1) the amount DOD spent on DTS travel payments for fiscal years 2016 through 2018 and how much of those payments DOD estimated to be improper and the extent to which DOD has (2) implemented its Remediation Plan and (3) identified travel payment errors, the root causes of those errors, and the cost-effectiveness of addressing root causes. GAO analyzed fiscal years 2016 through 2018 data on DTS payments, reviewed DOD's Plan and documentation, interviewed officials about implementation efforts, and surveyed 52 DOD components about steps taken to address improper travel payments. The Department of Defense's (DOD) Defense Travel System (DTS)—the primary system DOD uses to process travel payments—accounts for most of DOD's travel payments. DOD spent $18.3 billion on DTS travel payments from fiscal years 2016 through 2018, while incurring a reported $965.5 million in improper travel payments. In that period, DOD averaged $6.1 billion in DTS travel payments and $322 million in improper travel payments annually. Not all improper travel payments—such as legitimate payments that initially lacked supporting documentation―represented a monetary loss to the government. Officials said DOD first estimated a monetary loss from improper travel payments in fiscal year 2017. For fiscal years 2017 and 2018 it estimated a total monetary loss of $205 million out of $549 million in improper DTS payments (see fig.). In October 2016, DOD established a Remediation Plan to reduce improper travel payments and a committee to monitor implementation of the plan at 10 DOD components. DOD selected these 10 components because they accounted for a significant percentage of total travel payments. However, DOD did not take into account the components' own estimates of their improper payment rates. As of March 2019, only 4 of the 9 components that responded to GAO's survey had completed all of the plan's requirements, in part because of a lack of milestones in the plan and ineffective monitoring for required actions. As a result, DOD does not have reasonable assurance that its actions have been sufficient. DOD has mechanisms to identify errors leading to improper travel payments, and some components have developed specific corrective plans to address the errors. However, GAO found that these efforts did not clearly identify the root causes of the errors, in part because there is no common understanding of what constitutes the root cause of improper travel payments. DOD components also have not incorporated considerations of cost-effectiveness into decisions about whether to take actions that could reduce improper payments. Without addressing these issues, DOD will likely miss opportunities to implement the changes necessary to address the root causes of improper travel payments.


Advances in technology allow for innovation in the ways businesses and individuals perform financial activities. The development of financial technologyâcommonly referred to as finte c h âis the subject of great interest for the public and policymakers. Fintech innovations could potentially improve the efficiency of the financial system and financial outcomes for businesses and consumers. However, the new technology could pose certain risks, potentially leading to unanticipated financial losses or other harmful outcomes. Policymakers designed many of the financial laws and regulations intended to foster innovation and mitigate risks before the most recent technological changes. This raises questions concerning whether the existing legal and regulatory frameworks, when applied to fintech, effectively protect against harm without unduly hindering beneficial technologies' development. The underlying, cross-cutting technologies that enable much of fintech are subject to such policy trade-offs. The increased availability and use of the internet and mobile devices could offer greater convenience and access to financial services, but raises questions over how geography-based regulations and disclosure requirements can and should be applied. Rapid growth in the generation, storage, and analysis of dataâand the subsequent use of Big Data and alternative dataâcould allow for more accurate risk assessment, but raises concerns over privacy and whether individuals' data will be used fairly. Automated decisionmaking (and the related technologies of machine learning and artificial intelligence) could result in faster and more accurate assessments, but could behave in unintended or unanticipated ways that cause market instability or discriminatory outcomes. Increased adoption of cloud computing allows specialized companies to handle technology-related functions for financial institutions, including providing cybersecurity measures, but this may concentrate financial cyber risks at a relatively small number of nonfinancial companies who may not be entirely comfortable with their regulatory obligations as financial institution service providers. Concerns over cyber risks and whether adherence to cybersecurity regulations ensure appropriate safeguards against those risks permeate all fintech developments. Fintech deployment in specific financial industries also raises policy questions. The growth of nonbank, internet lenders could expand access to credit, but industry observers debate the degree to which the existing state-by-state regulatory regime is overly burdensome or provides important consumer protections. As banks have increasingly come to rely on third-party service providers to meet their technological needs, observers have debated the degree to which the regulations applicable to those relationships are unnecessarily onerous or ensure important safeguards and cybersecurity. New consumer point-of-sale systems and real-time-payments systems are being developed and increasingly used, and while these systems are potentially more convenient and efficient, there are concerns about the market power of the companies providing the services and the effects on people with limited access to these systems. Meanwhile, cryptocurrencies allow individuals to make payments entirely outside traditional financial systems, which may increase privacy and efficiency but creates concerns over money laundering and consumer protection. Fintech is providing new avenues to raise capitalâincluding through crowdfunding and initial coin offeringsâand changing the way companies trade securities and manage investments and may increase the ability to raise funds but present investor protection challenges. Under statute passed by Congress, insurance is primarily regulated at the state level where agencies are considering the implications to efficiency and risk that fintech poses in that industry, including peer-to-peer insurance and insurance on demand. Finally, firms across industries are using fintech to help them comply with regulations and manage risk, which raises questions about what role finetch should play in these systems. Regulators and policymakers have undertaken a number of initiatives to integrate fintech in existing frameworks more smoothly. They have made efforts to increase communication between fintech firms and regulators to help firms better understand how regulators view a developing technology, and certain regulators have established offices within their organizations to conduct outreach. In another approach, some regulators have announced research collaborations with fintech firms to improve their understanding of new products and technologies. If policymakers determine that particular regulations are unnecessarily burdensome or otherwise ill-suited to a particular technology, they might tailor the regulations, or exempt companies or products that meet certain criteria from such regulations. In some cases, regulators can do so under existing authority, but others might require congressional action.