The U.S. population is aging and, by 2030, the U.S. Census Bureau projects that one in five Americans will be 65 or older. Recognizing that adequate nutrition is critical to health, physical ability, and quality of life, the federal government funds various programs to provide nutrition assistance to older adults through meals, food packages, or assistance to purchase food. This report examines (1) the relationship of older adults' nutrition to health outcomes and the extent to which federal nutrition guidelines address older adults' nutritional needs, (2) nutrition requirements in federal nutrition assistance programs serving older adults and how these requirements are overseen, and (3) challenges program providers face in meeting older adults' nutritional needs. GAO reviewed relevant federal laws, regulations, and guidance and conducted a comprehensive literature search; visited a nongeneralizable group of four states—Arizona, Louisiana, Michigan, and Vermont—and 25 meal and food distribution sites, selected for a high percentage of adults 60 or older, and variations in urban and rural locations, and poverty level; and interviewed officials from HHS, USDA, states, national organizations, and local providers. Research shows that nutrition can affect the health outcomes of older adults. Federal nutrition guidelines provide broad guidance for healthy populations, but do not focus on the varying nutritional needs of older adults. Department of Health and Human Services (HHS) data show that the majority of older adults have chronic conditions, such as diabetes or heart disease. Research shows that such individuals may have different nutritional needs. As older adults age, they may also face barriers, such as a reduced appetite, impairing their ability to meet their nutritional needs. HHS plans to focus on older adults in a future update to the guidelines, but has not documented a plan for doing so. Documenting such a plan could help ensure guidelines better address the needs of the population. Of the six federal nutrition assistance programs serving older adults, four have requirements for food that states and localities provide directly to participants, and federal agencies oversee states' monitoring of these requirements. In HHS's and U.S. Department of Agriculture's (USDA) meal programs, states must ensure meals meet requirements. Yet, HHS does not gather information from states, such as approved menus, to confirm this, and localities in two of the four selected states said state monitoring of menus was not occurring. Further, USDA regional officials told GAO they lack information on how meal programs operate at adult day care centers as they primarily focus on other sites for their on-site reviews. Additional monitoring could help HHS and USDA ensure meal programs meet nutritional requirements and help providers meet older adults' varying needs. In the states GAO selected, meal and food providers of the four nutrition programs with nutrition requirements reported various challenges, such as an increased demand for services. Providers in three of the four states reported having waiting lists for services. Providers of HHS and USDA meal programs in all four states also reported challenges tailoring meals to meet certain dietary needs, such as for diabetic or pureed meals. HHS and USDA have provided some information to help address these needs. However, providers and state officials across the four states reported that more information would be useful and could help them better address the varying nutritional needs of older adults.


The U.S. spent about $1.3 billion in 2017 to produce, process, and circulate coins and paper notes for use in the economy. Since 2006, both the penny and nickel have cost more to make than their face value. Other countries have replaced notes with coins of the same value to reduce costs. Since 1990, GAO had estimated replacing the $1 note with a $1 coin would provide a benefit to the federal government. GAO was asked to examine the potential cost savings to the government from making changes to currency. This report (1) estimates the net benefit to the government, if any, of replacing the $1 note with a $1 coin and selected stakeholders' views on this change; and (2) examines what is known about potential cost savings from suspending penny production and changing the metal composition of the nickel, and selected stakeholders' views on these changes. GAO conducted economic simulations of continued use of $1 notes and replacing notes with $1 coins, examined cost data from the U.S. Mint, and interviewed officials from the Federal Reserve, U.S. Mint and Bureau of Engraving and Printing as well as 10 selected stakeholders representing industries that could potentially be affected by currency changes. GAO's analysis found that replacing the $1 note with a $1 coin would likely result in a net loss to the government over 30 years. GAO found the government would incur a loss of about $611 million if notes were actively replaced and about $2.6 billion if $1 notes were replaced gradually (see figure). These simulations represent the first time GAO has found that replacing the $1 note with a $1 coin would result in a net loss to the government rather than a net benefit. GAO's estimates are based on current data and economic projections, which have changed over time. For example, the lifespan of the $1 note has more than doubled since a 2011 GAO analysis, from 3.3 years to 7.9 years, largely due to changes in note processing technology. Stakeholders generally identified few benefits from replacing $1 notes with $1 coins. Seven of 10 stakeholders GAO met with said that replacing the $1 note with a $1 coin would result in additional costs. For example, armored carriers told GAO that their transportation costs would increase because coins weigh more than notes. The U.S. Mint estimates that it could save approximately $250 million over 10 years by suspending penny production and between $2 million and $9 million per year by changing the metal composition of the nickel. It also estimates that it could save about $74 million over 10 years by changing the metal composition of the dime and quarter. However, Federal Reserve officials and some stakeholders expressed concern about temporarily suspending the penny due to the potential for external effects, such as penny shortages. Stakeholders were unconcerned about changes to the nickel as long as the changes would not affect how the coin functioned, for example, in vending machines. Since Congress specifies in law which coins are made and their metal composition, the Mint has proposed legislation to enable the Secretary of the Treasury to change the metal content of coins as long as the weight or machine acceptance of the coins is unaffected. Without such authority, the Mint might not be producing coins as cost-effectively as possible.


The Unfunded Mandates Reform Act of 1995 (UMRA) culminated years of effort by state and local government officials and business interests to control, if not eliminate, the imposition of unfunded intergovernmental and private-sector federal mandates. Advocates argued the statute was needed to forestall federal legislation and regulations that imposed obligations on state and local governments or businesses that resulted in higher costs and inefficiencies. Opponents argued that federal mandates may be necessary to achieve national objectives in areas where voluntary action by state and local governments and business failed to achieve desired results. UMRA provides a framework for the Congressional Budget Office (CBO) to estimate the direct costs of mandates in legislative proposals to state and local governments and to the private sector, and for issuing agencies to estimate the direct costs of mandates in proposed regulations to regulated entities. Aside from these informational requirements, UMRA controls the imposition of mandates only through a procedural mechanism allowing Congress to decline to consider unfunded intergovernmental mandates in proposed legislation if they are estimated to cost more than specified threshold amounts. UMRA applies to any provision in legislation, statute, or regulation that would impose an enforceable duty upon state and local governments or the private sector. It does not apply to duties stemming from participation in voluntary federal programs; rules issued by independent regulatory agencies; rules issued without a general notice of proposed rulemaking; and rules and legislative provisions that cover individual constitutional rights, discrimination, emergency assistance, grant accounting and auditing procedures, national security, treaty obligations, and certain elements of Social Security. In most instances, UMRA also does not apply to conditions of federal assistance. State and local government officials argue that UMRA's coverage should be broadened, with special consideration given to including conditions of federal financial assistance. During the 116th Congress, H.R. 300, the Unfunded Mandates Information and Transparency Act of 2019, would broaden UMRA's coverage to include both direct and indirect costs, such as foregone profits and costs passed onto consumers, and, when requested by the chair or ranking member of a committee, the prospective costs of legislation that would change conditions of federal financial assistance. The bill also would make private-sector mandates subject to a substantive point of order and remove UMRA's exemption for rules issued by most independent agencies. The House approved similar legislation during the 112th, 113th, 114th, and 115th Congresses. This report examines debates over what constitutes an unfunded federal mandate and UMRA's implementation. It focuses on UMRA's requirement that CBO issue written cost estimate statements for federal mandates in legislation, its procedures for raising points of order in the House and Senate concerning unfunded federal mandates in legislation, and its requirement that federal agencies prepare written cost estimate statements for federal mandates in rules. It also assesses UMRA's impact on federal mandates and arguments concerning UMRA's future, focusing on UMRA's definitions, exclusions, and exceptions that currently exempt many federal actions with potentially significant financial impacts on nonfederal entities. An examination of the rise of unfunded federal mandates as a national issue and a summary of UMRA's legislative history are provided in Appendix A. Citations to UMRA points of order raised in the House and Senate are provided in Appendix B.


The Uniform Code of Military Justice (UCMJ) was established to provide a statutory framework that promotes fair administration of military justice. Every active-duty servicemember is subject to the UCMJ, with more than 258,000 individuals disciplined from fiscal years 2013-2017, out of more than 2.3 million unique active-duty servicemembers. A key principle of the UCMJ is that a fair and just system of military law can foster a highly disciplined force. House Report 115-200, accompanying a bill for the National Defense Authorization Act for Fiscal Year 2018, included a provision for GAO to assess the extent that disparities may exist in the military justice system. This report assesses the extent to which (1) the military services collect and maintain consistent race, ethnicity, and gender information for servicemembers investigated and disciplined for UCMJ violations that can be used to assess disparities, and (2) there are racial and gender disparities in the military justice system, and whether disparities have been studied by DOD. GAO analyzed data from the investigations, military justice, and personnel databases from the military services, including the Coast Guard, from fiscal years 2013-2017 and interviewed agency officials. The military services collect gender information, but they do not collect and maintain consistent information about race and ethnicity in their investigations, military justice, and personnel databases. This limits their ability to collectively or comparatively assess these data to identify any disparities (i.e., instances in which a racial, ethnic, or gender group was overrepresented) in the military justice system within and across the services. For example, the number of potential responses for race and ethnicity across the military services' databases ranges from five to 32 options for race and two to 25 options for ethnicity, which can complicate cross-service assessments. The services also are not required to and, thus, do not report demographic information in their annual military justice reports—information that would provide greater visibility into potential disparities. GAO's analysis of available data found that Black, Hispanic, and male servicemembers were more likely than White or female members to be the subjects of investigations recorded in databases used by the military criminal investigative organizations, and to be tried in general and special courts-martial in all of the military services when controlling for attributes such as rank and education. GAO also found that race and gender were not statistically significant factors in the likelihood of conviction in general and special courts-martial for most services, and minority servicemembers were either less likely to receive a more severe punishment than White servicemembers or there was no difference among racial groups; thus, disparities may be limited to particular stages of the process. The Department of Defense (DOD) has taken some steps to study disparities, but has not comprehensively evaluated the causes of racial or gender disparities in the military justice system. Doing so would better position DOD to identify actions to address disparities and help ensure the military justice system is fair and just. Note: These analyses, taken alone, should not be used to make conclusions about the presence or absence of unlawful discrimination. These multivariate regression analysis results estimate whether a racial or gender group is more likely or less likely to be the subject of an investigation or a trial in general or special courts-martial after controlling for race, gender, rank, and education, and in the Air Force, years of service. GAO made all racial comparisons to White servicemembers and all gender comparisons to females. GAO grouped individuals of Hispanic ethnicity together, regardless of race.


The Uniform Code of Military Justice (UCMJ) was established to provide a statutory framework that promotes fair administration of military justice. Every active-duty servicemember is subject to the UCMJ, with more than 258,000 individuals disciplined from fiscal years 2013-2017, out of more than 2.3 million unique active-duty servicemembers. A key principle of the UCMJ is that a fair and just system of military law can foster a highly disciplined force. This statement provides information on 1) the collection of race and ethnicity information in the military services' databases, 2) the extent of racial disparities in investigations, disciplinary actions, and case outcomes in the military justice system, and 3) steps taken by DOD to study any identified disparities. This statement is based on GAO -19-344 issued on May 30, 2019. As part of that work, GAO analyzed data from the investigations, military justice, and personnel databases from the military services, including the Coast Guard, from fiscal years 2013-2017 and interviewed agency officials. In May 2019, GAO found that the military services did not collect consistent information about race and ethnicity in their investigations, military justice, and personnel databases. Thus, the military services are limited in their ability to identify disparities (i.e., instances in which a racial or ethnic group was overrepresented) in the military justice system. The military services were not required to, and thus did not, report demographic information that would provide greater visibility into potential disparities in their annual military justice reports. GAO's analysis of available data identified disparities in how likely servicemembers of different races were to be subjects of investigations recorded in military criminal investigative organization databases and tried in general and special courts-martial in particular. For example, in three military services, Black servicemembers were about twice as likely as White servicemembers to be tried in general and special courts-martial. Racial disparities generally were not present in convictions or punishments. These findings show an association for disparities at particular stages of the military justice process, but are inconclusive regarding other stages. However, GAO's findings of racial disparities, taken alone, do not establish whether unlawful discrimination has occurred, as that is a legal determination that would involve other corroborating information and supporting statistics. Note: These analyses, taken alone, should not be used to make conclusions about the presence of unlawful discrimination. These multivariate regression analysis results estimate whether a racial group is more likely or less likely to be the subject of an investigation or a trial in general or special courts-martial after controlling for race, gender, rank, and education, and in the Air Force, years of service. GAO made all racial comparisons to White servicemembers, and grouped individuals of Hispanic ethnicity together, regardless of race. The Other race category includes individuals who identified as American Indian/Alaska Native, Asian, Native Hawaiian/Other Pacific Islander, and multiple races. The Department of Defense (DOD) has taken some steps to study disparities but has not comprehensively evaluated the causes of racial disparities in the military justice system. Doing so would better position DOD to identify actions to address disparities and to help ensure the military justice system is fair and just.


The United Kingdom (UK) formally withdrew from membership in the European Union (EU) on January 31, 2020. Under the withdrawal agreement negotiated by the two sides, the UK is to continue applying EU rules during a transition period scheduled to run through the end of 2020. During the transition period, the UK and the EU are expected to begin negotiating the terms of their future relationship, including trade and economic relations as well as cooperation on foreign policy, security, and a range of other issues. Overview of Developments After the 2016 referendum in which 52% of voters in the UK favored leaving the EU, Brexit was originally scheduled to occur in March 2019. In early 2019, Parliament repeatedly rejected the withdrawal agreement negotiated between then-Prime Minister Theresa May's government and the EU. Boris Johnson became prime minister in July 2019, following May's resignation. Given continued deadlock over Brexit in the UK, the EU granted the UK a series of extensions. In October 2019, EU and UK negotiators reached a new withdrawal agreement altering the Northern Ireland backstop provision, which was a main sticking point to Parliament passing the original deal. Under the new deal, Northern Ireland (part of the UK) is to maintain regulatory alignment with the EU (essentially creating a customs border in the Irish Sea) to preserve an open border with the Republic of Ireland (an EU member state) while safeguarding the rules of the EU single market. At the end of the transition period, the UK (including Northern Ireland) is expected to leave the EU customs union and pursue an independent national trade policy. Prime Minister Johnson encountered difficulties in securing Parliament's approval of the new deal. Seeking to break the deadlock, the UK Parliament agreed to set an early general election for December 12, 2019. Johnson's Conservative Party won a decisive victory in the election, winning 365 out of 650 seats in the UK House of Commons. The result allowed the UK to ratify the new withdrawal agreement and end its EU membership. Brexit, Trade, and Economic Impact Brexit has considerable implications for the UK's trade arrangements. Outside the EU customs union, the UK would regain an independent national trade policy, a major selling point for many Brexit supporters who advocate negotiating new bilateral trade deals around the world, including with the United States and the EU. The unlikely prospect in which the UK remains a member of the EU single market or customs union would provide more barrier-free access to the EU, but the UK would have to follow most EU rules without having a say in how those rules are made. Analysts predict the disruption resulting from Brexit likely will have at least a short-term negative economic impact on the UK, and many businesses in the UK have been taking steps to mitigate potential economic losses. Northern Ireland Many observers have expressed concerns that Brexit could destabilize the Northern Ireland peace process, especially if it resulted in a hard border with physical infrastructure and customs checks between Northern Ireland and the Republic of Ireland. Conditions have improved considerably since the 1998 peace accord (known as the Good Friday Agreement or the Belfast Agreement), but many analysts assess that peace and security in Northern Ireland remains fragile. Concerns about a hard border developing have receded in light of Johnson's election victory and Parliament's approval of the renegotiated withdrawal agreement. Still, Brexit has added to divisions within Northern Ireland and continues to pose challenges for Northern Ireland's peace process, economy, and, possibly in the longer term, its constitutional status as part of the UK. U.S.-UK Relations and Congressional Interest President Trump and Administration officials have expressed support for Brexit. Members of Congress hold mixed views. The UK likely will remain a leading U.S. partner in addressing many foreign policy and security challenges, but Brexit has fueled a debate about whether the UK's global role and influence are likely to be enhanced or diminished. In 2018, the Administration notified Congress of its intention to negotiate a bilateral free trade agreement (FTA) with the UK after Brexit. Congress likely would need to pass implementing legislation before the potential FTA could enter into force. Many in Congress also are concerned about Brexit's possible implications for Northern Ireland's peace process, stability, and economic development.


Aviation workers using their access privileges to exploit vulnerabilities and potentially cause harm at the nation's airports is known as an “insider threat.” TSA, airport operators, and air carriers share the responsibility to mitigate all insider threats at airports. In October 2019, TSA estimated there are about 1.8 million aviation workers at the nation's airports. GAO was asked to review TSA's and aviation stakeholders' efforts to mitigate insider threats at airports. This report (1) discusses the efforts that TSA, airport operators, and air carriers have taken to help mitigate insider threats at airports and (2) evaluates the extent to which TSA's Insider Threat Program is guided by a strategic plan and has performance goals. GAO reviewed TSA guidance; analyzed TSA data from a questionnaire sent to a representative sample of airport operators; and obtained information from TSA officials, officials from selected larger U.S.-based air carriers, and a nongeneralizable sample of seven airport operators, selected, in part, based on the number of aircraft take-offs and landings. The Transportation Security Administration (TSA), airport operators, and air carriers mitigate insider threats through a variety of efforts. TSA's Insider Threat Program comprises multiple TSA offices with ongoing insider threat mitigation activities, including long-standing requirements addressing access controls and background checks, and compliance inspections. TSA also initiated activities more recently, such as implementing TSA-led, randomized worker screenings in 2018. Airport and air carrier officials implement security measures in accordance with TSA-approved programs and may implement additional measures to further mitigate threats. For example, many airport operators reported using sophisticated access control technologies (e.g. fingerprint readers). Additionally, some air carriers reported conducting more rigorous background checks prior to issuing identification credentials to employees. TSA‘s Insider Threat Program is not guided by a strategic plan with strategic goals and objectives nor does it have performance goals. TSA does not have an updated strategic plan that reflects the Program's current status. TSA officials said that the plan was not updated due to turnover of key senior leadership. As of January 2020, TSA officials said they were developing a roadmap that could serve as a new strategic plan for the Program. However, officials had not finalized the contents and were uncertain when it would be completed and implemented. Developing and implementing a strategic plan will help guide TSA's ongoing efforts and coordinate TSA's agency-wide approach. TSA has not defined performance goals with targets and timeframes to assess progress achieving the Program's mission. Without a strategic plan and performance goals, it is difficult for TSA to determine if its approach is working and progress is being made toward deterring, detecting, and mitigating insider threats to the aviation sector.


The United Nations Framework Convention on Climate Change (UNFCCC) has been the principle forum for cooperation among nations on greenhouse gas (GHG)-induced climate change since its adoption in 1992. Its objective is "to stabilize greenhouse gas concentrations in the atmosphere at a level that will prevent dangerous human interference with the climate system, in a time frame which allows ecosystems to adapt naturally and enables sustainable development." Stabilizing GHG concentrations in the atmosphere requires that the balance of "gross" emissions of GHG minus the removals of GHG from the atmosphere reach "net zero." Two principles agreed in the UNFCCC are that (1) Parties should act "on the basis of equity and in accordance with their common but differentiated responsibilities and respective capabilities" and (2) developed country Parties should take the lead in combating climate change. The bifurcation of responsibilities among Parties into developed (Annex I) and developing countries has been a major point of contention. Annex I Parties, including the United States, had stronger obligations, such as more rigorous reporting and reviews. A subset listed in Annex II, including the United States, committed to provide agreed financial resources and technology transfers. The commitments are qualitative and collective, not binding on individual Parties. The first subsidiary agreement to the UNFCCC was the 1997 Kyoto Protocol (KP), which entered into force in 2005. The United States signed but did not ratify the KP and so is not a Party. The developed Parties agreed to reduce GHG emissions by 5% below their 1990 levels, with different targets for each Party. In 2009, a political declaration, the Copenhagen Accord, led to explicit pledges from many Parties to mitigate GHG, though they remained bifurcated as Annex I and non-Annex I (i.e., developing countries) by both the type of action and the frequency and format of the reporting requirements. In 2010, the Cancun agreements took note of a Copenhagen pledge by developed country Parties to jointly mobilize $100 billion per year by 2020. Funds provided "may come from a wide variety of sources, public and private, bilateral and multilateral, including alternative sources." The Paris Agreement (PA) is the second major subsidiary agreement under the UNFCCC. The PA defines a collective, long-term objective to hold the GHG-induced increase in temperature to well below 2 o Celsius (C) and to pursue efforts to limit the temperature increase to 1.5 o C above the pre-industrial level. In the PA, for the first time under the UNFCCC, all Parties participate in a common framework with common guidance, though some Parties are allowed limited flexibility. The negotiators intended the PA to be legally binding on its Parties, though not all provisions are mandatory. All Parties must submit "Nationally Determined Contributions" (NDCs) containing nonbinding pledges to mitigate GHG emissions. The Parties are to update or submit new NDCs by 2020 and every five years thereafter. Each successive NDC of a Party "will represent a progression" and "reflect its highest possible ambition, reflecting its common but differentiated responsibilities and respective capabilities, in light of different national circumstances." The PA reiterates the obligation in the UNFCCC for developed country Parties to seek to mobilize financial support to assist developing country Parties with climate change mitigation and adaptation efforts, encouraging all Parties to provide financial support voluntarily. The decision to carry out the PA calls for continuing the Cancun collective mobilization through 2025. The Parties agree to set, prior to their 2025 meeting, a new collective, quantified goal of not less than $100 billion annually to assist developing country Parties. President Trump announced his intention in 2017 to withdraw the United States from the PA as soon as it was eligible. The U.S. Department of State notified the United Nations of U.S. withdrawal on November 4, 2019. The withdrawal takes effect on November 4, 2020, unless the U.S. government postpones or rescinds the withdrawal. A Party may reenter the PA 30 days after depositing notice that it has ratified, accepted, or acceded to the PA.


The United States and Canada share the longest common non-militarized border between two countries, spanning nearly 4,000 miles of land and maritime borders from the states of Washington to Maine. CBP, within DHS, has primary responsibility for securing U.S. borders at and between ports of entry. GAO was asked to review CBP's efforts to secure the northern border between ports of entry. This report examines, among other things, (1) the staffing and resource challenges that CBP identified and actions it has taken to address those challenges and (2) the extent to which CBP has developed and implemented performance measures to assess its effectiveness at securing the northern border between ports of entry. GAO reviewed agency documentation and met with DHS and CBP officials in headquarters and field locations. This is a public version of a sensitive report that GAO issued in March 2019. Information that DHS deemed sensitive has been omitted. U.S. Customs and Border Protection (CBP) identified staffing and resource challenges affecting its enforcement activities along the U.S.-Canada (northern) border and actions to address them, but faces competing priorities. The U.S. Border Patrol (Border Patrol) and Air and Marine Operations (AMO) are the components within CBP responsible for securing U.S. borders between ports of entry in the land, air, and maritime environments. Border Patrol identified an insufficient number of agents that limited patrol missions along the northern border. AMO identified an insufficient number of agents along the northern border, which limited the number and frequency of air and maritime missions. Border Patrol and AMO also identified a variety of resource challenges along the northern border, such as limited radar and surveillance technology coverage and inadequate facilities to process and temporarily hold apprehended individuals. While the Department of Homeland Security (DHS) and CBP identified actions to address staffing and resource challenges, it is unknown whether these challenges will be addressed. This is primarily because CBP's priority is to secure the U.S.-Mexico (southwest) border. Issued in January 2017, Executive Order 13767 directed DHS to take actions to secure the southwest border by, among other things, constructing physical barriers and hiring thousands of agents. While CBP has performance measures that assess selected border security operations or programs, some of which include data from the northern border, it does not have specific measures to assess its effectiveness at securing the northern border between ports of entry. For example, Border Patrol has performance measures that assess security in remote areas on the northern border, but the measures do not include data from maritime border areas. Developing and implementing such measures could help Border Patrol and AMO better assess the effectiveness of their northern border operations between ports of entry, including addressing challenges due to limited staffing and resources.


The United States and Russia signed the New START Treaty on April 8, 2010. After more than 20 hearings, the U.S. Senate gave its advice and consent to ratification on December 22, 2010, by a vote of 71-26. Both houses of the Russian parliament—the Duma and Federation Council—approved the treaty in late January 2011 and it entered into force on February 5, 2011. Both parties met the treaty's requirement to complete the reductions by February 5, 2018. The treaty is due to expire in February 2021, unless both parties agree to extend it for no more than five years. New START provides the parties with 7 years to reduce their forces, and will remain in force for a total of 10 years. It limits each side to no more than 800 deployed and nondeployed land-based intercontinental ballistic missile (ICBM) and submarine-launched ballistic missile (SLBM) launchers and deployed and nondeployed heavy bombers equipped to carry nuclear armaments. Within that total, each side can retain no more than 700 deployed ICBMs, deployed SLBMs, and deployed heavy bombers equipped to carry nuclear armaments. The treaty also limits each side to no more than 1,550 deployed warheads; those are the actual number of warheads on deployed ICBMs and SLBMs, and one warhead for each deployed heavy bomber. New START contains detailed definitions and counting rules that will help the parties calculate the number of warheads that count under the treaty limits. Moreover, the delivery vehicles and their warheads will count under the treaty limits until they are converted or eliminated according to the provisions described in the treaty's Protocol. These provisions are far less demanding than those in the original START Treaty and will provide the United States and Russia with far more flexibility in determining how to reduce their forces to meet the treaty limits. The monitoring and verification regime in the New START Treaty is less costly and complex than the regime in START. Like START, though, it contains detailed definitions of items limited by the treaty; provisions governing the use of national technical means (NTM) to gather data on each side's forces and activities; an extensive database that identifies the numbers, types, and locations of items limited by the treaty; provisions requiring notifications about items limited by the treaty; and inspections allowing the parties to confirm information shared during data exchanges. New START does not limit current or planned U.S. missile defense programs. It does ban the conversion of ICBM and SLBM launchers to launchers for missile defense interceptors, but the United States never intended to pursue such conversions when deploying missile defense interceptors. Under New START, the United States can deploy conventional warheads on its ballistic missiles, but these will count under the treaty limit on nuclear warheads. The United States may deploy a small number of these systems during the time that New START is in force. The Obama Administration and outside analysts argued that New START strengthens strategic stability and enhances U.S. national security. Critics, however, questioned whether the treaty serves U.S. national security interests, as Russia was likely to reduce its forces with or without an arms control agreement and because the United States and Russia no longer need arms control treaties to manage their relationship. Secretary of State-designate Tillerson offered support for the treaty during his confirmation hearings, noting that he supports "the long-standing bipartisan policy of engaging with Russia and other nuclear arms states to verifiably reduce nuclear stockpiles" and that it is important for the United States "to stay engaged with Russia [and] hold them accountable to commitments made under the New START." The 2018 Nuclear Posture Review confirmed that the United States would continue to implement the treaty, at least through 2021. The Administration has not yet determined whether it will request or support an extension of the treaty through 2026.


The United States and the People's Republic of China (PRC or China) are involved in a prolonged stand-off over trade and in competition that is spilling from political and military areas into a growing number of other spheres, including technology, finance, and education, severely straining ties on the 40 th anniversary of the two countries' establishment of diplomatic relations. The two lead the world in the size of their economies, their defense budgets, and their global greenhouse gas emissions. Both countries are permanent members of the United Nations (U.N.) Security Council. In 2018, they were each other's largest trading partners. During the Trump Administration, competition has dominated the relationship and areas of cooperation have shrunk. The 2017 National Security Strategy (NSS) describes both China and Russia as seeking to "challenge American power, influence, and interests, attempting to erode American security and prosperity." To pressure China to change its economic practices, the United States has imposed tariffs on hundreds of billions of dollars of U.S. imports from China, with almost all imports from China scheduled to be subject to additional tariffs by December 15, 2019. U.S. tariffs and China's retaliatory tariffs have reordered global supply chains and hit U.S. farmers and manufacturers particularly hard. Twelve rounds of negotiations have not resolved the dispute. On August 5, 2019, the U.S. Treasury Department labeled China a currency manipulator for the first time in a quarter century. The Administration has placed restrictions on the ability of U.S. firms to supply PRC telecommunications giant Huawei. The United States has also sought to warn other nations away from business dealings with Huawei and from cooperation with China on infrastructure projects under the framework of China's Belt and Road Initiative (BRI). Many analysts ascribe the rising friction in the relationship today not only to the arguably more confrontational inclinations of the Trump Administration, but also to more assertive behavior by China under President Xi Jinping. Xi assumed the top posts in the Communist Party of China in November 2012 and added the state presidency in March 2013. Later in 2013, China began building military outposts in the South China Sea and Xi launched BRI, an ambitious effort to boost economic connectivityâand China's influenceâacross the globe. In 2015, China began enacting a suite of national security legislation that shrank the space for independent thought and civil society, subjected ordinary citizens to stepped-up surveillance, and imposed onerous conditions on foreign firms operating in China. The same year, China launched its "Made in China 2025" plan, seeking to reduce China's reliance on foreign technology and directing the considerable resources of the state toward supporting the development of "national champion" Chinese firms in 10 strategic industries. In 2017, at the end of his first five-year term in his Party posts, Xi tasked China's military with turning itself into a "world-class" force by mid-century. Also in 2017, his government began forcing more than 1 million of his Turkic Muslim fellow citizens in the northwest region of Xinjiang into reeducation camps. Increasingly, the United States and China appear to be seeking to draw other countries into competing campsâthose who agree to sign (often vague) BRI cooperation agreements with China (some 125 countries as of April 2019, by China's count), and those who, at the U.S. government's behest, do not; those who do business with Huawei, and those who, similarly at the U.S. government's behest, do not; those who publicly censure China for its actions in Xinjiang, and those who offer support. U.S. allies are sometimes in China's "camp." China represents "a new kind of challenge," Secretary of State Michael R. Pompeo has suggested, because "It's an authoritarian regime that's integrated economically into the West in ways the Soviet Union never was." Important areas of remaining U.S.-China cooperation include maintaining pressure on North Korea to curb its nuclear weapons and missile programs; supporting the Afghanistan peace process; managing international public health challenges, from tuberculosis to influenza; and stemming the flow into the United States of China-produced fentanyl, a class of deadly synthetic opioids.


The United States enacted the drawback program in 1789 to create jobs and encourage manufacturing and exports, according to CBP. CBP has primary responsibility for overseeing the drawback program. It disburses about $1 billion in drawback refunds per year. According to CBP, TFTEA modernized the drawback program, generally broadening the scope of potential claims and allowing electronic filing starting February 24, 2018. As of February 24, 2019, claimants could only file claims under the drawback statute as amended by TFTEA. TFTEA also included a provision for GAO to assess drawback modernization. This report examines the extent to which (1) modernization affects drawback refund eligibility and CBP's management of its workload, (2) CBP has taken steps to address risks of improper payments in the program, and (3) CBP has analyzed the impact of the changes to the program on industry and government. GAO reviewed statutory, regulatory, and agency documents, and interviewed agency officials and industry representatives. The Trade Facilitation and Trade Enforcement Act of 2015 (TFTEA) generally expanded eligibility for the drawback program, which provides refunds to claimants of up to 99 percent of certain customs duties, taxes, and fees. For example, a claimant could claim a drawback refund on exported pants made in the United States using imported foreign fabric. The expansion from TFTEA has resulted in Customs and Border Protection (CBP) facing a growing workload. According to CBP officials, the most significant change from TFTEA is that it is now easier to qualify for certain drawback refunds. Industry representatives explained that new claimants are seeking drawback refunds and existing claimants are able to increase claim amounts. However, CBP has not adequately managed the increased workload and has not developed a plan for doing so. As a result, CBP faces delays in processing drawback claims that could result in uncertainty for industry, potentially impeding trade. GAO Example of One Potential Drawback Claim CBP has taken some steps to address risks of improper payments in the drawback program, but several risks remain. To help ensure it does not overpay funds, CBP now electronically verifies drawback claims against underlying import information. However, CBP cannot verify drawback claims against underlying export information because it does not maintain detailed information about exports in its new electronic system. To compensate for this lack of automated controls, CBP requires manual full desk reviews of a selection of claims to mitigate improper payment risks. However, CBP has not targeted certain claims for a full desk review since switching to the new system on February 24, 2018. The lack of review for claims, which numbered over 35,000 and represented an estimated $2 billion in claims filed as of August 23, 2019, increases the risk of improper payments. CBP has not produced a reliable assessment of the economic impact of the changes to drawback refund eligibility because of data availability constraints, systems limitations, and other factors. CBP has not prioritized developing a plan to revisit its economic analysis, although new data and systems capabilities are becoming available. Without such a plan, CBP will not have a reliable assessment of the impact of the changes on industry and government.


The United States has 57.2 MT of weapons-usable plutonium that it has declared surplus and that still requires disposition. This plutonium exists in various metal and non-metal forms, including pits—the central core of a nuclear weapon. To prevent insidious use of this plutonium, DOE plans to disassemble pits into metal; convert the plutonium metal to plutonium oxide, a powder-like substance; dilute it with inert material; and dispose of it at WIPP. In May 2018, NNSA issued a plan conceptualizing the dilution and disposal of 34 MT of surplus plutonium at an estimated cost of $19 billion over the next 3 decades. Under this conceptual plan, pit disassembly and production of plutonium oxide would take place at one facility and dilution would be performed in another, with both operations expanding over the next decade. GAO was asked to review DOE's plans for plutonium oxide production to dispose of surplus plutonium. This report (1) examines the amount of surplus plutonium in DOE's inventory that could be converted to plutonium oxide for dilution and disposal and (2) examines DOE's capacity to produce plutonium oxide. GAO reviewed the inventory of surplus plutonium, plutonium oxide production requirements and production capacity, and DOE planning documents, and interviewed DOE officials. Of the Department of Energy‘s (DOE) inventory of surplus plutonium, about 43.8 metric tons (MT), or 77 percent, is plutonium metal that could be converted to plutonium oxide for dilution and disposal. Of this amount, the National Nuclear Security Administration (NNSA) manages 33.3 MT in the form of pits, DOE's Office of Environmental Management (EM) manages 6.5 MT, and DOE's Office of Nuclear Energy manages 4 MT in the form of reactor fuel. EM manages another 11 percent, or 6.4 MT, of DOE's surplus plutonium that is already in oxide form. Most of this is suitable for dilution and disposal at the Waste Isolation Pilot Plant (WIPP), a repository in New Mexico. An additional 12 percent, or 7 MT, of DOE's surplus plutonium is contained in spent nuclear fuel that is planned for disposal in a geologic repository. See figure. NNSA's 2018 conceptual plan calls for converting 26.2 MT of this surplus plutonium into oxide by 2045. In September 2019, NNSA approved the production of about 1.2 MT of plutonium oxide through 2025 at its Los Alamos National Laboratory (LANL) located in New Mexico. However, plans for converting additional surplus plutonium into plutonium oxide are uncertain because of two issues. These issues include NNSA's still-developing plans for new pit production, which will also take place at LANL, and issues surrounding the agency's ability to ship newly produced plutonium oxide for dilution to DOE's Savannah River Site (SRS) in South Carolina. According to agency officials, NNSA and DOE are taking several actions that, if successfully implemented, are designed to allow NNSA to meet its long-term plutonium oxide production goals. These actions include continuing to review plutonium oxide and pit production plans, increasing plutonium storage at LANL, reducing the amount of SRS's surplus plutonium, and accelerating the shipment of diluted plutonium from SRS to WIPP.


The United States has actively pursued the development of hypersonic weaponsâmaneuvering weapons that fly at speeds of at least Mach 5âas a part of its conventional prompt global strike program since the early 2000s. In recent years, the United States has focused such efforts on developing hypersonic glide vehicles, which are launched from a rocket before gliding to a target, and hypersonic cruise missiles, which are powered by high-speed, air-breathing engines during flight. As Vice Chairman of the Joint Chiefs of Staff and former Commander of U.S. Strategic Command General John Hyten has stated, these weapons could enable "responsive, long-range, strike options against distant, defended, and/or time-critical threats [such as road-mobile missiles] when other forces are unavailable, denied access, or not preferred." Critics, on the other hand, contend that hypersonic weapons lack defined mission requirements, contribute little to U.S. military capability, and are unnecessary for deterrence. Funding for hypersonic weapons has been relatively restrained in the past; however, both the Pentagon and Congress have shown a growing interest in pursuing the development and near-term deployment of hypersonic systems. This is due, in part, to the growing interest in these technologies in Russia and China, both of which have a number of hypersonic weapons programs and are expected to field an operational hypersonic glide vehicleâpotentially armed with nuclear warheadsâas early as 2020. The United States, in contrast to Russia and China, is not currently considering or developing hypersonic weapons for use with a nuclear warhead. As a result, U.S. hypersonic weapons will likely require greater accuracy and will be more technically challenging to develop than nuclear-armed Chinese and Russian systems. The Pentagon's FY2021 budget request for all hypersonic-related research is $3.2 billionâup from $2.6 billion in the FY2020 requestâincluding $206.8 million for hypersonic defense programs. At present, the Department of Defense (DOD) has not established any programs of record for hypersonic weapons, suggesting that it may not have approved either requirements for the systems or long-term funding plans. Indeed, as Assistant Director for Hypersonics (Office of the Under Secretary of Defense for Research and Engineering) Mike White has stated, DOD has not yet made a decision to acquire hypersonic weapons and is instead developing prototypes to assist in the evaluation of potential weapon system concepts and mission sets. As Congress reviews the Pentagon's plans for U.S. hypersonic weapons programs, it might consider questions about the rationale for hypersonic weapons, their expected costs, and their implications for strategic stability and arms control. Potential questions include the following: What mission(s) will hypersonic weapons be used for? Are hypersonic weapons the most cost-effective means of executing these potential missions? How will they be incorporated into joint operational doctrine and concepts? Given the lack of defined mission requirements for hypersonic weapons, how should Congress evaluate funding requests for hypersonic weapons programs or the balance of funding requests for hypersonic weapons programs, enabling technologies, and supporting test infrastructure? Is an acceleration of research on hypersonic weapons, enabling technologies, or hypersonic missile defense options both necessary and technologically feasible? How, if at all, will the fielding of hypersonic weapons affect strategic stability? Is there a need for risk-mitigation measures, such as expanding New START, negotiating new multilateral arms control agreements, or undertaking transparency and confidence-building activities?


The United States has implemented dozens of sanctions programs to counteract activities that threaten U.S. national interests. Sanctions may place restrictions on entire countries, sectors of countries' economies, or specific corporations or individuals. Examples of restrictions include limiting access to the U.S. financial system, freezing assets under U.S. jurisdiction, and restricting trade. The United States has implemented an increasing number of sanctions in recent years, including sanctions on countries that conduct a significant amount of international trade, such as Russia, Venezuela, and Iran. GAO was asked to examine the resources U.S. agencies have devoted to sanctions implementation. This report examines (1) agencies' roles in sanctions implementation, (2) resources available to agency units that focus primarily on sanctions implementation, (3) the extent to which agency units that focus primarily on sanctions implementation have assessed their resource needs, and (4) agencies' reporting to Congress on sanctions implementation expenses and activities. GAO gathered data from 13 agencies and their sub-units to identify their roles and the personnel they used for sanctions implementation. GAO also reviewed agency reporting, planning, and budget documents and interviewed agency officials. Agencies may have one or more roles in sanctions implementation—for example, developing policy and investigating, enforcing, and prosecuting violations. The Departments of the Treasury, State, and Commerce each have a unit focused primarily on sanctions—Treasury's Office of Foreign Assets Control (OFAC), State's Office of Economic Sanctions Policy and Implementation (SPI), and Commerce's Bureau of Industry and Security's (BIS) Foreign Policy Division (FPD). GAO identified 10 other agencies with roles in sanctions implementation. OFAC, SPI, and FPD generally received steady or growing resources in recent years, but OFAC and SPI face hiring challenges. In fiscal years 2014 to 2019, OFAC received a 58 percent budget increase and additional hiring authority, but vacancies ranged from 6 to 26 percent of its authorized full time equivalents (FTEs). OFAC attributed its hiring challenges to competition from other agencies and the private sector and the time needed for security clearances. State SPI received authority to hire six additional FTEs in fiscal year 2020, for a total of 21, but more than half of its authorized positions were vacant at the start of the fiscal year. FPD lacks funding to fill one of its 10 authorized positions. OFAC, SPI, and FPD all consider resource needs as part of annual budget processes, and OFAC has an ongoing process to assess its workforce needs. OFAC began its workforce planning process in fiscal year 2019 and expects to make preliminary recommendations in March 2020. According to SPI officials, SPI cited the increasing use of sanctions across multiple regions in justifying its request for additional fiscal year 2020 positions. BIS prepared a 2016 plan that assessed its workforce, including FPD, but stated that it no longer uses the plan. Agencies provide information on selected sanctions expenses and activities in mandated reports. Treasury's reports on 25 sanctions programs include expenses for Treasury, State, and other agencies if relevant executive orders identify them. State reported activities for a weapons of mass destruction sanctions program but also reported no specific expenditures for the program. State reviewed program information to prepare the reports, but the reports do not describe what it considered, limiting information available to Congress.


The United States has made a commitment to building Afghanistan's security and governance structure in order to counter terrorist threats and create sustainable security and stability in Afghanistan. Since 2005 Congress has appropriated more than $78.8 billion for the ASFF to build, equip, train, and sustain the Afghan National Defense and Security Forces. Over that period, nearly $4.3 billion has been expended to support the training and operations of the Afghan National Army. Training requirements are primarily fulfilled through contracts. In recent years, concerns have been raised in Congress about the high costs of some of these training contracts. The Joint Explanatory Statement accompanying the Consolidated Appropriations Act, 2018, included a provision for GAO to examine the ASFF training contracts. This report describes DOD's processes to (1) identify Afghan National Army training needs and associated funding requirements; (2) develop and execute ASFF training contracts; and (3) provide visibility over ASFF training contracts. GAO reviewed DOD guidance for identifying and executing training needs, and interviewed DOD officials. GAO also reviewed documentation associated with task orders issued against an indefinite delivery, indefinite quantity contract for training completed in fiscal years 2017 through 2019 for the Afghan National Army. Combined Security Transition Command-Afghanistan (CSTC-A) has established processes to identify capability gaps within the Afghan National Defense and Security Forces (ANDSF), develop and select training needed to address those gaps, and identify associated funding requirements. CSTC-A generally includes these requirements in the Afghanistan Security Forces Fund (ASFF) budget justification book. Many of the key decisions and associated cost assumptions on how CSTC-A and Train Advise Assist Command–Air (in the case of Afghan pilot training) intend to carry out ASFF training efforts are proposed 18-24 months before the training will occur (see figure). ASFF-funded training contracts are developed and executed under a process modeled on the U.S. government's foreign military sales program. Prior to April 2019, most ASFF-funded training requirements were filled under a single-award indefinite delivery, indefinite quantity (IDIQ) contract that supported a wide range of DOD training needs. An IDIQ contract provides for an indefinite quantity, within stated limits, of supplies or services during a fixed period. The government places orders for individual requirements. According to an Army official, that contract's broad scope and high contract value ceiling made it a highly expedient way to contract for various types of training for the ANDSF. However, contracting officals stated that using a single-award contract limited DOD's ability to negotiate some costs. At that point, DOD began to transition to an approach using several contracts, including one with multiple providers. Given that DOD executed its first task order under these new contracts in April 2019, it is too early for GAO to comment on the efficacy of this new approach. DOD has varying degrees of visibility over ASFF-funded contracts. DOD officials stated that they have visibiliity at the broadest level of the overall execution of the ASFF budget, including funding associated with Afghan National Army training. At the individual contract level, the military services' contracting commands maintain contract files, but the services' systems do not interface with one another. According to DOD officials, although DOD can obtain visibility over ASFF training contracts in the aggregate, the department must work with the contracting commands at the respective military services to gather information specific to training contracts.


The United States has provided assistance to the Northern Triangle of Central America for many years to address poverty, weak governance, and insecurity. Introduced in 2014, and updated in 2017, the U.S. Strategy for Engagement in Central America (Strategy) supports the objectives of improving prosperity, governance, and security. State coordinates implementation of the Strategy's objectives among agencies. This report examines: (1) the projects the U.S. government has implemented from fiscal years 2013 through 2018 to support the Strategy's objectives in the Northern Triangle, (2) what is known about project results, and (3) what is known about progress toward the objectives. GAO reviewed results for a subset of 190 projects in a nongeneralizable sample of six sectors selected based on funding, country, and objective; analyzed Strategy documents and key elements of effective strategies; interviewed officials; and conducted fieldwork in the Northern Triangle. To support their prosperity, governance, and security objectives, the Departments of State (State), Defense (DOD), Agriculture (USDA), and the U.S. Agency for International Development (USAID) allocated about $2.4 billion from fiscal years 2013 through 2018 for 370 projects in the Northern Triangle—El Salvador, Guatemala, and Honduras. USAID and State implemented most of these projects, with some supporting more than one sector and objective. For example, USAID implemented projects to address poverty, while State trained prosecutors and police to address governance and security needs. State, USAID, and other agencies reported mixed results for the 190 projects in the six sectors GAO reviewed. For example, in fiscal year 2018, USAID assisted 1,376 individuals in workforce development programs in Guatemala, exceeding the target of 1,000, while it assisted 651 individuals in Honduras, falling short of the target of 5,000. State and USAID trained 12,557 justice system personnel in the Northern Triangle, exceeding the target of 2,275. USDA rehabilitated school kitchens in Honduras as part of its school feeding program. DOD helped Guatemala establish a budget system to increase accountability for military funds, but DOD reported persistently low public trust in Northern Triangle militaries. Limited information is available about how U.S. assistance improved prosperity, governance, and security in the Northern Triangle. Agencies generally reported more information about progress toward prosperity than toward governance and security, in part because evaluations were conducted unevenly across agencies and sectors. In addition, project implementers did not consistently collect key information needed to evaluate progress, but officials noted improvements. Nevertheless, agency officials described examples of progress through technical assistance, and noted challenges, such as drought. GAO has reported that development of a monitoring and evaluation plan is key to assessing agencies' common goals and objectives, and mutually reinforcing results. While State has a monitoring and evaluation plan for the Strategy, the plan does not include activities by DOD and USDA that support the Strategy's objectives and thus does not establish a comprehensive approach to assessing progress.


BIE funds 185 elementary and secondary schools that serve more than 6,000 Native American students with special needs. The Department of Education has raised concerns about BIE's implementation of IDEA in recent years, including its long-standing noncompliance with IDEA requirements. GAO was asked to examine the provision of special education and related services to eligible BIE students. This report examines the extent to which (1) BIE students with disabilities are provided the special education and related services required by their IEPs, and (2) BIE oversees and supports the provision of special education at its schools. GAO analyzed data on special education and related services for a generalizable sample of 138 BIE students with IEPs at 30 schools over a 4-month period in school year 2017-2018 (the most recent complete school year at the time of our analysis); compared BIE special education practices with its policies and Interior and IDEA requirements; visited schools in two states selected for their large numbers of BIE schools; and interviewed school and agency officials. Schools funded by the Bureau of Indian Education (BIE) are required under the Individuals with Disabilities Education Act (IDEA) to provide services for eligible students with disabilities, such as learning disabilities or health impairments. Services for these students are listed in individualized education programs (IEP). GAO found that BIE schools did not provide or did not account for 38 percent of special education and related service time for students with disabilities, according to analysis of school documentation for a 4-month review period (see fig.). This included one school that did not provide any services to three students. While BIE has plans to improve documentation of such services, it has not established whether and when missed services should be made up, which has led to inconsistent practices among schools. Establishing consistent requirements for making up missed services could help students receive the special education and related services they need to make academic progress. BIE's limited monitoring and technical assistance have hindered its oversight and support for special education at schools. For example: A division of BIE responsible for overseeing about half of all BIE schools decided to verify the provision of special education services at only one-third of its schools per year, although the Department of the Interior (Interior) requires BIE to annually verify the provision of services at all schools. BIE provided required monitoring reports late and did not provide required technical assistance plans to 14 schools that BIE determined were at high risk of not complying with IDEA and other federal education programs in school year 2018-2019. BIE officials said that the field office staff responsible for working with schools on special education often do not have the requisite expertise, which has hampered their oversight and support to schools. Without verifying special education services at every school annually, following high-risk monitoring and technical assistance requirements, and providing training to its staff, BIE cannot ensure that the schools it funds are meeting their responsibilities under IDEA. Strengthening such oversight and support activities can help BIE as it works to address the unique needs of students with disabilities to help prepare them for future education, employment, and independent living.


The United States has supported North Macedonia since its independence from Yugoslavia in 1991 and strongly backs its European Union (EU) and NATO ambitions. (The country's constitutional name was the Republic of Macedonia until February 2019, when it was renamed the Republic of North Macedonia.) On multiple occasions, the United States played a key role in defusing political crises and interethnic tensions in North Macedonia. For more than two decades, a U.S. diplomat led United Nations–brokered negotiations between Greece and then-Macedonia to resolve their bilateral dispute over the latter's use of the name Macedonia. With strong U.S. support, in 2018 North Macedonia and Greece reached the landmark Prespa Agreement, which resulted in the name change and resolved their bilateral dispute. Many Members of Congress have supported North Macedonia's integration into Euro-Atlantic institutions. In 2007, the NATO Freedom Consolidation Act (P.L. 110-17) was passed to affirm congressional support for enlargement and make North Macedonia eligible for assistance under the NATO Participation Act of 1994. Resolutions were also sponsored in both chambers in 2018 to support the Prespa Agreement with Greece and endorse North Macedonia's bid for NATO membership. Congressional interest in North Macedonia is also connected to broader policy concerns over the influence of Russia, China, and other external actors in the Western Balkans. In 2017, North Macedonia emerged from a destabilizing two-year crisis with a new government that pledged to redouble the country's Euro-Atlantic integration efforts and enact reforms to tackle the corruption and state capture that took root under previous governments. The Prespa Agreement removes Greece's veto over North Macedonia's NATO and EU membership bids. Many expect North Macedonia to become NATO's 30th member in 2019 or 2020 and the EU to decide in 2019 whether to launch formal accession negotiations with the country. Despite positive assessments of North Macedonia's progress, the forthcoming period is generally viewed as critical to consolidating North Macedonia's recent gains and implementing reforms to bolster economic growth, reduce unemployment, and depoliticize state institutions. Given U.S. and NATO involvement in conflicts in the Balkans in the 1990s, as well as the U.S. role in defusing crises in North Macedonia, Members of Congress may be interested in North Macedonia's stability during what many U.S. and EU officials consider to be a crucial, albeit fragile, opening for reforms. Members may also consider the role that external actors such as Russia and China have played in recent years or could play going forward, particularly if North Macedonia's EU accession negotiations are further delayed.


The United States is in the midst of an unprecedented opioid epidemic. Opioids are prescribed to treat conditions such as chronic pain. However, opioid misuse can lead to addiction, disability, overdose, and death. Prior GAO and other reports have discussed the use of prescription opioids within federal programs, particularly Medicare. Less is known about the use of opioids in relation to SSA's DI program. GAO was asked to review any correlation between prescription opioids and rates of DI claims, and any related challenges for SSA. This report examines (1) what is known about the relationship between trends in prescription opioids and DI claims, and (2) how SSA considers potential prescription opioid misuse in its DI eligibility decisions. GAO analyzed county-level data on opioid prescriptions and DI claims from 2006 through 2017; interviewed program staff involved in DI eligibility decisions in Alabama, Kentucky, and West Virginia, selected because of their high rates of opioid prescriptions and percentage of the adult population on DI; and reviewed case files for DI beneficiaries identified by the Centers for Medicare & Medicaid Services as being at risk for prescription opioid misuse or abuse. The numbers of opioid prescriptions and claims for the Social Security Administration's (SSA) Disability Insurance (DI) program have each declined nationally in recent years, but rates vary widely across the country. National trends show both peaking between 2010 and 2014 and then declining. GAO's analysis shows counties with the highest rates of both were concentrated in the Southeast (see figure). After accounting for economic, demographic, and other factors, GAO found that counties with higher rates of opioid prescriptions tended to have higher rates of DI claims from 2010 through 2017. These rates were also correlated with other factors. For example, counties with higher rates of each tended to have higher poverty rates. However, GAO was unable to determine whether there is a causal relationship between rates of opioid prescriptions and DI claims or other factors, given readily available data. Program staff are required to evaluate and document substance use disorders (including opioids not taken as prescribed) when making certain DI eligibility decisions. Specifically, staff are required to evaluate potential substance use disorders for certain DI claims and deny benefits, for example, if the claimant would not be considered disabled if they stopped using drugs or alcohol. In addition, staff are generally required to document the rationale for their decision so that another reviewer can understand how they made the decision. However, staff in five of the six offices GAO visited in three states were confused about when to evaluate substance use disorders, and nine of 15 case files that GAO reviewed in which an evaluation was conducted did not have a documented rationale. SSA officials acknowledged the need to clarify policies on when to evaluate substance use disorders, and that a poorly documented rationale could lead to reversals or remands of decisions. Without ensuring that SSA's policies are understood and that staff document their rationale, the agency may expend resources re-working cases and, in turn, delay benefits to individuals eligible for assistance.


The United States is making significant efforts to pursue a strategy that ensures continued access to space for national security missions. The current strategy is embodied in the National Security Space Launch (NSSL) program. The NSSL supersedes the Evolved Expendable Launch Vehicle (EELV) program, which started in 1995 to ensure that National Security Space (NSS) launches were affordable and reliable. For the same reasons, policymakers provide oversight for the current NSSL program and encourage competition, as there was only one provider for launch services from 2006 to 2013. Moreover, Congress now requires DOD to consider both reusable and expendable launch vehicles for solicitations after March 1, 2019. To date, only expendable, or single-use, launch vehicles have been used for NSSL missions. The NSSL program is the primary provider for NSS launches. Factors that prompted the initial EELV effort in 1995 are still manifestâsignificant increases in launch costs and concerns over procurement and competition. In addition, the Russian backlash over the 2014 U.S. sanctions against Russian actions in Ukraine exacerbated a long-standing undercurrent of concern over U.S. reliance on a Russian rocket engine (RD-180) for critical national security space launches. Moreover, significant overall program cost increases and unresolved questions over individual launch costs, along with legal challenges to the Air Force rocket development and launch procurement contract awards, have resulted in legislative action. In 2015, the Air Force began taking steps to transition from reliance on the Russian made RD-180 engine used on the Atlas V rocket. Some in Congress pressed for a more flexible transition to replace the RD-180 that allowed for development of a new launch vehicle, while others in Congress sought legislation that would move the transition process forward more quickly with a focus on developing an alternative U.S. rocket engine. Transitioning away from the RD-180 to a domestic U.S. alternative provided opportunities for space launch companies that sought to compete for NSS space launches. Because of the technical, program, and schedule risk, as a worst-case scenario, the transition could leave the United States in a situation in which some of its national security space payloads lack an available certified launcher. The Space and Missile System Center (SMC), together with the National Reconnaissance Office (NRO), released a request for proposals in May 2019 to award two domestic launch service contracts. DOD plans to select two separate space launch companies in the summer of 2020 that will be responsible for launching U.S. military and intelligence satellites through 2027. NSS launch has been a leading legislative priority in the defense bills over the past few years and may continue to be so into the future.


The United States is the world's largest donor of global health assistance. Congress provided about $8.7 billion for the Global Health Programs (GHP) account in fiscal year 2018. In 2017, the President reinstated and expanded a policy, which now requires foreign NGOs to agree that, as a condition of receiving global health assistance, they will not perform or actively promote abortion as a method of family planning or provide financial support during the award term to other foreign NGOs that conduct such activities. The Reagan administration first implemented this policy, known as the Mexico City Policy, in 1984, and subsequent administrations have rescinded and reinstated it. The Mexico City Policy initially applied only to family planning and reproductive health assistance, which received about $560 million of GHP funds in fiscal year 2018. Upon reinstating the policy, the Trump Administration renamed it PLGHA and applied it to all global health assistance to the extent allowable by law. GAO was asked to review the implementation of the PLGHA policy. This report identifies (1) global health assistance awards that U.S. agencies determined to be subject to the U.S. government's PLGHA policy requiring foreign NGOs to agree that they would not perform or actively promote abortion as a method of family planning, and (2) planned funding for awards involving NGOs that declined to accept the terms and conditions of this policy. GAO analyzed data provided by U.S. agencies of awards subject to the PLGHA policy and awards in which NGOs declined to accept the terms and conditions of this policy. U.S. agencies reported to GAO that from May 2017 through fiscal year 2018, they applied the Protecting Life in Global Health Assistance (PLGHA) policy to over 1,300 global health awards. The policy's restrictions on performing or actively promoting abortion as a method of family planning applied to active awards that received new funding after the policy was implemented, and all funding for new awards made after May 2017. As of September 30, 2018, about $12 billion in estimated planned award funding was subject to the policy. The U.S. Agency for International Development (USAID), with over $6 billion, and the Centers for Disease Control and Prevention (CDC), with over $5 billion, awarded about 96 percent of this amount. Agencies implemented these awards across multiple geographic regions and global health assistance areas. About two-thirds of estimated planned funding subject to the policy supported HIV/AIDS assistance, while the remaining third supported other global health areas, such as maternal and child health, and family planning and reproductive health. Over two-thirds of planned funding subject to the policy was for awards in Africa. U.S. agencies identified seven prime awards and 47 sub-awards in which non-governmental organizations (NGOs) declined to accept the terms and conditions of the PLGHA policy, and these awards had about $153 million remaining in estimated planned funding not obligated as of September 30, 2018. The seven prime awards that were declined included six USAID awards and one CDC award and amounted to about $102 million of the $153 million in estimated planned funding that was not obligated. Marie Stopes International and the International Planned Parenthood Foundation declined the two largest of these awards, resulting in about $79 million in planned funding that was not obligated. These two awards included, among other activities, mobile family planning and reproductive health outreach activities to underserved, rural populations in multiple countries. USAID identified all of the 47 sub-awards that were declined, which had a total of about $51 million in planned funds that was not obligated. Thirty-two of the 47 subawards were intended for Africa. by Global Health Assistance Area Source: GAO analysis of agency reported data | GAO-20-347


The United States maintains dozens of economic sanctions programs to counteract activities that threaten U.S. national interests. There are currently 20 country-based or country-related sanctions programs, according to lists of sanctions programs published by Treasury and State (see map). Additional countries may also be affected by sanctions programs that target entities regardless of their geographic location, such as counter-narcotics sanctions. Treasury, State, and Commerce, among other agencies, coordinate to implement these programs. Sanctions may place restrictions on a country's entire economy, targeted sectors of the economy, or individuals or corporate entities. Reasons for sanctions range widely, including support for terrorism, narcotics trafficking, weapons proliferation, and human rights abuses. Economic restrictions can include, for example, denying a designated entity access to the U.S. financial system, freezing an entity's assets under U.S. jurisdiction, or prohibiting the export of restricted items. GAO was asked to review issues related to the implementation and effectiveness of economic sanctions. Among other things, this report (1) examines the extent to which U.S. agencies assess the effectiveness of sanctions, and (2) identifies factors that have been shown by publicly available studies to contribute to the effectiveness of economic sanctions. GAO reviewed documents and interviewed officials at Treasury, State, and Commerce and in the U.S. Intelligence Community. GAO also reviewed academic studies that used rigorous statistical methods to analyze the impact and effectiveness of economic sanctions across many sanctions programs. The Departments of the Treasury (Treasury), State (State), and Commerce (Commerce) each undertake efforts to assess the impacts of specific sanctions on the targets of those sanctions. For example, Treasury and State both analyze or compile information on sanctions programs' impacts, such as on a target country's economy. In addition, Commerce assesses prospective impacts of some sanctions on targeted countries and others. According to Treasury and State officials, the agencies also use Intelligence Community assessments to gauge sanctions' impacts. However, agency officials cited several difficulties in assessing sanctions' effectiveness in meeting broader U.S. policy goals, including challenges in isolating the effect of sanctions from other factors as well as evolving foreign policy goals. According to Treasury, State, and Commerce officials, their agencies have not conducted such assessments on their own. However, they stated that agency assessments of sanctions' impacts often contribute to broader interagency discussions that examine the effectiveness of sanctions in achieving policy goals. The academic studies GAO reviewed suggest that several factors have contributed to more-effective sanctions. Studies examining factors that contribute to the effectiveness of sanctions in changing targeted countries' behavior provided evidence that sanctions have been more effective when (1) they were implemented through an international organization (e.g., the United Nations) or (2) the targeted countries had some existing dependency on, or relationship with, the United States, such as a trade or military relationship. In addition, studies examining factors that increased sanctions' economic impact provided evidence that the impact has generally been higher when the sanctions were more comprehensive in scope or severity, or—similar to the findings on effectiveness in changing behavior—were imposed through an international organization. Sanctions may also have unintended consequences for targeted countries, such as negative impacts on human rights or public health. In some studies, larger economic impacts were associated with more unintended consequences.


The United States maintains strong linkages with neighboring Latin America and the Caribbean based on geographic proximity and diverse U.S. interests, including economic, political, and security concerns. The United States is a major trading partner and source of foreign investment for many countries in the region, with free-trade agreements enhancing economic linkages with 11 countries. The region is a large source of U.S. immigration, both legal and illegal; proximity and economic and security conditions are major factors driving migration. Curbing the flow of illicit drugs has been a key component of U.S. relations with the region for more than four decades and currently involves close security cooperation with Mexico, Central America, and the Caribbean. U.S. support for democracy and human rights in the region has been long-standing, with particular current focus on Cuba, Nicaragua, and Venezuela. Under the Trump Administration, U.S. relations with Latin America and the Caribbean have moved toward a more confrontational approach from one of engagement and partnership during past Administrations. Since FY2018, the Administration's proposed foreign aid budgets for the region would have cut assistance levels significantlyâthe FY2021 request would cut aid to the region by 18%. (A large increase for Venezuela masks significantly larger cuts for many countries and programs.) To deter increased unauthorized migration from Central America, the Administration has used a variety of immigration policy tools (including Migrant Protection Protocols and "safe third country" agreements), as well as aid cuts and threats of increased U.S. tariffs and taxes on remittances. Other Administration actions on immigration include efforts to end the deportation relief program known as Deferred Action for Childhood Arrivals (DACA) and Temporary Protected Status (TPS) designations for Nicaragua, Haiti, El Salvador, and Honduras. Among trade issues, President Trump strongly criticized and repeatedly threatened to withdraw from the North American Free Trade Agreement (NAFTA), which led to the new United States-Mexico-Canada Agreement (USMCA) negotiated in 2018. The Trump Administration also did not follow the policy of engagement with Cuba advanced by the Obama Administration and imposed new sanctions. Congressional Action in the 116 th Congress . Congress traditionally has played an active role in policy toward Latin America and the Caribbean in terms of both legislation and oversight. The 116 th Congress did not implement the Trump Administration's downsized foreign aid budget requests for the region for FY2019 ( P.L. 116-6 ) and FY2020 ( P.L. 116-94 ), instead providing aid amounts roughly similar to those provided in recent years. Congress approved the Venezuela Emergency Relief, Democracy Assistance, and Development Act of 2019 in December 2019 (included in Division J of P.L. 116-94 ), which, among its provisions, codifies several types of sanctions imposed on Venezuela and authorizes humanitarian assistance to Venezuelans and support for international election observation and democratic civil society. In January 2020, Congress completed action on implementing legislation ( P.L. 116-113 ) for the USMCA, but before final agreement, the trade agreement was amended to address congressional concerns regarding provisions on labor, the environment, dispute settlement procedures, and intellectual property rights. The FY2020 National Defense Authorization Act ( P.L. 116-92 ), approved in December 2019, includes provisions on Venezuela and Guatemala and reporting requirements on Brazil, Honduras, Central America, and Mexico. Either or both houses approved several bills and resolutions on a range of issues and countries: H.R. 133 , which would promote economic cooperation and exchanges with Mexico; H.R. 2615 , which would authorize assistance to Central America's Northern Triangle countries to address the root causes of migration; S.Res. 35 and S.Res. 447 on the political situation in Bolivia; H.Res. 441 and S.Res. 277 , commemorating the 25 th anniversary of the 1994 bombing of the Argentine-Israeli Mutual Association in Buenos Aires; and H.Res. 754 , expressing continued U.S. support for the people of Nicaragua and pressure on the government of Daniel Ortega. To date, congressional committees have held 20 oversight hearings on the region in the 116 th Congress (see Appendix ).


The United States, which relies on imports for most of the seafood it consumes, imported about $40 billion in fishery products in 2018. Seafood imports often involve complex supply chains, which may include forced labor. A 2017 United Nations report estimated that there are 24.9 million people in forced labor around the world, 12 percent of whom work in the agriculture and fishing sectors. Section 307 of the Tariff Act of 1930, as amended in 2016, prohibits the importation of goods, including seafood, produced or manufactured, wholly or in part, in any foreign country by forced labor, among other things. GAO was asked to review CBP's enforcement of section 307. This report examines (1) the process CBP uses to enforce section 307 for seafood imports and the results of its civil enforcement actions; and (2) the external sources of information CBP uses to help carry out enforcement of section 307 for seafood imports and stakeholder perspectives on CBP's communication of its information needs. GAO reviewed laws and CBP documents pertaining to section 307 enforcement and interviewed officials from CBP, other federal agencies, and 18 NGO stakeholders. GAO selected NGOs with various goals and missions related to seafood and forced labor. The Department of Homeland Security's U.S. Customs and Border Protection (CBP) uses a four-phase process to enforce section 307 of the Tariff Act of 1930, which prohibits imports produced with forced labor, including seafood. CBP's Forced Labor Division, established in 2018, largely carries out this process. In phase 1, CBP assesses leads when deciding to initiate a case involving potential forced labor. In phase 2, CBP investigates cases using a variety of information to determine whether evidentiary standards have been met. In phase 3, CBP reviews information for legal sufficiency and, in phase 4, may take action at a port of entry to detain imports in violation by issuing a withhold release order. Between 2016 and March 2020, CBP issued one order for seafood, prohibiting tuna shipments from a specific fishing vessel from entering U.S. commerce. CBP uses information from external sources to help enforce section 307 for seafood imports but may miss opportunities to obtain key information from stakeholders. CBP officials said they use media reports and information from federal agencies and stakeholders to develop forced labor cases. For example, CBP initiated the case that resulted in the seafood order based partly on media reports and investigated it using vessel data from the Department of Commerce. CBP officials said that stakeholders such as nongovernmental organizations (NGOs) often have firsthand accounts of forced labor—valuable information for investigations. However, most stakeholders told GAO that they do not have a clear understanding of the information CBP needs to investigate seafood cases because CBP has not communicated such information. For example, CBP's website provides general information about what individuals can submit if forced labor is suspected but does not provide specific types of information that could be useful. With better communication to stakeholders about the types of information it needs to develop forced labor cases, CBP may be able to improve its enforcement efforts.


The Universal Service Fund's high-cost program provides financial support to telecommunications carriers in areas where the cost to provide broadband is high. Through this program, FCC provides about $2.5 billion in annual support payments to rate-of-return carriers. The manner in which FCC currently provides the support payments to some of these carriers is prone to fraud risks. A prior case involved a rate-of-return carrier that received at least $27 million in improper payments from the program. GAO was asked to review funding reforms and fraud controls FCC has implemented for rate-of-return carriers. This report examines the extent to which FCC: (1) has implemented funding reforms specific to rate-of-return carriers, and (2) is managing fraud risks for the high-cost program in accordance with leading practices. GAO reviewed FCC's and USAC's procedures, relevant regulations, and guidance, and assessed these documents against applicable criteria, including federal internal-control standards, FCC's strategic plan, and GAO's fraud risk framework. GAO interviewed FCC and USAC officials, in addition to industry and other stakeholders representing a variety of non-generalizable viewpoints. The Federal Communications Commission (FCC) has implemented several funding reforms for small, rural telecommunications carriers—referred to as “rate-of-return carriers”—receiving high-cost program support. These reforms are aimed at controlling the program's expenditures and incentivizing efficient broadband deployment. According to FCC's strategic plan, FCC must ensure the high-cost program is well managed, efficient, and fiscally responsible. One of the reforms that GAO reviewed established a funding mechanism for the carriers whereby FCC determines the level of financial support to provide the carriers based on cost and revenue estimates produced by a model. Stakeholders told GAO that this model-based funding mechanism is less prone to fraud risks than the traditional cost-accounting funding mechanism, which reimburses carriers for their reported costs. However, FCC did not make use of this reform mandatory and a substantial number of rate-of-return carriers continue to receive support from the traditional funding mechanism. FCC officials said they developed the model-based funding mechanism in consultation with industry stakeholders. However, FCC officials said they did not have plans to assess the accuracy of cost estimates from the model, which has been in use for several years, or require carriers to receive model-based support as a way to reduce fraud risks. By assessing the model, FCC would have greater assurance that it is producing reliable cost estimates and be better positioned to determine whether to make its use mandatory. FCC has some policies and processes in place to manage fraud risks for the high-cost program. For example, the Universal Service Administrative Company (USAC)—the not-for-profit corporation that administers the program—reviews and audits rate-of-return support payments and forwards potential fraud cases to FCC's Office of Inspector General and Enforcement Bureau for further investigation. FCC is also developing a data-analytics tool to help detect fraud, and in August 2019 launched a new Fraud Division to focus on investigating fraud in the Universal Service Fund's programs. However, FCC's efforts do not fully align with some elements of GAO's fraud risk framework, including: designing and implementing an antifraud strategy for the program. Without regular fraud-risk assessments of the high-cost program, FCC has no assurance that it has fully considered important fraud risks, determined its tolerance for risks that could be lower priorities, or made sound decisions on how to allocate resources to respond to fraud risks. Not doing so could result in FCC compensating carriers for improper, ineligible, or inflated costs. Furthermore, in the absence of an antifraud strategy, FCC has little assurance that it can prevent or detect the types of documented rate-of-return carrier misconduct that have previously occurred. Designing and implementing an antifraud strategy that conforms to leading practices would help FCC effectively manage and respond to the fraud risks identified during the fraud-risk assessments.


The Veterans Health Administration (VHA), of the Department of Veterans Affairs (VA), is leveraging the use of telehealth with the goal of expanding veterans' access to VA care. Telehealth generally refers to the use of information and communication technology to deliver a health care service. It is a mode of health care delivery that extends beyond the "brick-and-mortar" health care facilities of the VHA. VA telehealth services are generally provided on an outpatient basis and supplement in-person care. Such services do not replace VA in-person care. The VA copay requirements for telehealth are the same as for VA in-person care, but in some cases may be lower than the copays for VA in-person outpatient health care services delivered through the VHA. President Trump and Congress have recently enacted measures such as the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks of 2018 (VA MISSION Act; P.L. 115-182 ) that aim to address the access barriers that veterans may experience when accessing VA telehealth services across states lines. The VA MISSION Act, among other things, removes all geographic and licensing barriers to VA telehealth, thereby allowing veterans to access VA telehealth services in their communities from any location in the United States, U.S. territories, District of Columbia, and Commonwealth of Puerto Rico. VA Telehealth Modalities In FY2018, more than 9.3 million veterans were enrolled in VA care. In that same fiscal year, the VA provided 2.29 million telehealth episodes of care to 782,000 veteran patients collectively using the following three VA telehealth modalities: (1) home telehealth, (2) store-and-forward telehealth, and (3) clinical video telehealth. The VA has developed VA mobile applications (apps), which refer to software programs that run on certain operating systems of mobile devices (e.g., smartphones and tablets) and computers that transmit data over the internet that veterans can access as telehealth applications. Veterans can access VA mobile apps on cellular and mobile devices that operate using either a web-based platform, an iOS platform, or an Android operating platform. VA Telehealth Partnerships and Access According to the VA, it cannot meet the health care demands of veteran patients in-house and therefore, it has established partnerships with private sector vendors to help address veterans' demand for VA care. For example, the VA's partnership with the wireless service provider T-Mobile would allow a veteran who has T-Mobile as a cellular wireless service provider to access the VA Video Connect app without incurring additional charges or reducing plan data allotments. VA Teleconsultations VA providers can use telehealth platforms and applications to consult with one another, which is referred to as a teleconsultation by section 1709A(b) of title 38 of the U.S. Code . The VA has adopted and modified the Project Extension for Community Healthcare Outcomes (Project ECHO) learning model, which the Expanding Capacity for Health Outcomes Act ( P.L. 114-270 ) required the Secretary of the Department of Health and Human Services to examine and report on, to create a Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) learning model. The VA's SCAN-ECHO is a similar approach that aims to connect underproductive providers to assist access-challenged providers, using the hub-and- spoke model , which refers to a structure whereby a central point (referred to as the "hub") disseminates information to different connecting points (referred to as the "spokes"). Topics Covered in This Report This report provides background information on VA telehealth, including veteran eligibility and enrollment criteria, VA telehealth copayment requirements, and VA providers' authority to provide telehealth services anywhere. The report also discusses the components of VA telehealth. It also discusses three issues that Congress could choose to consider: (1) access barriers to in-person VA care, (2) lack of access to the internet, and (3) conflicting guidelines for prescribing controlled substances via telehealth across state lines.