Through the FSS program, VA manages nine healthcare-related schedules—groups of contracts used to order medical supplies and services—under authority delegated by GSA. VA's FSS program management, including the speed with which it adds new contracts, affects VA medical centers' ability to use it to easily obtain goods and services. Further, recent changes in VA's medical procurement have also raised questions about the future role of the program. GAO was asked to examine VA's management and use of its FSS program. This report assesses (1) what is known about VA use of its FSS program for fiscal years 2014-2018; (2) program management challenges faced by NAC; (3) the extent to which NAC awarded FSS contracts to vendors in a timely manner from fiscal years 2014-2018; and (4) the extent to which the FSS and MSPV-NG programs provide overlapping or duplicative offerings. GAO reviewed eight VA schedules, excluding pharmaceutical due to the use of a prime vendor, among other things. GAO also analyzed three of these schedules representing about two-thirds of VA's FSS contracts; analyzed policies, guidance, and processes; and interviewed senior VA procurement, contracting, and supply chain logistics staff at NAC and two medical centers. Over the past 5 years, Department of Veterans Affairs (VA) medical spending increased, but spending on its eight non-pharmaceutical Federal Supply Schedules (FSS) was flat. GAO found the vendor-submitted sales reports to be sufficiently reliable for describing these trends. However, GAO found that VA's National Acquisition Center (NAC)—the VA-wide contracting organization responsible for FSS—lacks controls to ensure the completeness of vendor sales data, which is used to calculate fees that finance the program. The FSS program faces numerous challenges. For instance, NAC FSS guidance and training are not comprehensive, posing a risk of inefficiency and uneven application of requirements by contracting staff. Limited collaboration between FSS leadership at both NAC and the General Services Administration (GSA) also resulted in missed opportunities to share tools and practices. A 3-year FSS leadership gap further exacerbated challenges; these positions are now filled. NAC also failed to meet its 180-day timeliness goal for 75 percent of the non-pharmaceutical FSS contracts it awarded from fiscal years 2014 through 2018 (see figure), though NAC met its goal for contract modifications 80 percent of the time. By assessing timeliness goals and identifying barriers to achieving them, NAC leadership can take steps to better enable its contracting workforce to provide an efficient and reliable means to obtain needed goods and services through FSS. Moreover, VA's procurement leaders have not assessed, and communicated to program managers, whether the duplication between FSS and the Medical Surgical Prime Vendor-Next Generation (MSPV-NG) program is a necessary and effective use of resources. These two programs feature many of the same items, and different contracting staff manage different contracts for the provision of the same or similar medical supplies for VA medical centers. Without assessing duplication between these two programs, VA is at risk of inefficient use of its contracting workforce, and may be unable to fully leverage its buying power.


CBP, within the Department of Homeland Security (DHS), is the lead federal agency charged with a dual mission of facilitating the flow of legitimate travel and trade at the nation's borders while keeping terrorists and their weapons, criminals and their contraband, and inadmissible aliens out of the country. GAO was asked to review CBP's process for inspecting passenger vehicles, pedestrians, and commercial vehicles at land POEs to secure the border. This report examines to what extent CBP (1) has processes and policies for inspections, (2) monitors inspection activities, and (3) has measures to assess its efforts to detect illegal activity of passengers, pedestrians, and commercial vehicles at land POEs. To address these questions, GAO analyzed CBP documents and data related to inbound inspections; interviewed officials; and observed operations at a non-generalizable sample of seven land POEs, selected to reflect a range of traffic volumes and geographic locations, among other things. This is a public version of a sensitive report that GAO issued in June 2019. Information that DHS deemed sensitive has been omitted. U.S. Customs and Border Protection (CBP) has processes for inspecting passenger vehicles, pedestrians, and commercial vehicles at U.S. land ports of entry (POE). These processes include reviewing travel documents, screening against law enforcement databases, and using canines and X-ray equipment (see figure below). However, because CBP has not updated many of its policies—in a few cases for almost 20 years—they do not always reflect changes in technology or processes, such as those for conducting searches and handling fentanyl. By reviewing and updating policies, CBP could help ensure officers have guidance needed to consistently and properly perform inspections. CBP has various mechanisms at the port, field office, and national levels to monitor inspection activities at land POEs, but opportunities exist to enhance analysis of the results from its national level Self-Inspection Program (SIP) and covert operational testing. The SIP is an annual self-assessment that POEs are to conduct to determine compliance with CBP policies. CBP analyzes the results of the SIP annually to identify systemic compliance issues across CBP that year; however, it does not analyze noncompliance at individual POEs over time. By analyzing these data, CBP could better identify and address deficiencies at individual POEs. In addition, CBP has produced three comprehensive assessments, which analyzed aggregated results for certain types of covert tests, such as fraudulent document tests, conducted at land POEs in fiscal years 2013, 2014, and 2018. However, CBP has not done so for other types of tests, such as canine contraband detection tests, conducted from fiscal years 2013 through 2018. By implementing a policy for periodically conducting such analyses, CBP could identify vulnerabilities, trends, and best practices occurring more broadly. CBP uses various sets of measures to assess its efforts to detect illegal activity at land POEs. CBP performance measures generally reflect the key attributes of effective measures, but CBP does not set an ambitious and realistic target for one measure. CBP's target for the land border interception rate—the estimated percentage of major violations in privately-owned vehicles that CBP intercepts out of the projected total number of major violations—is lower than the actual reported rate for fiscal years 2015 through 2018. A more ambitious target for the interception rate would better encourage CBP to review past performance of inspection activities that impact the measure and challenge CBP to identify ways to improve performance .


Throughout U.S. history, Congress has created advisory commissions to assist in the development of public policy. Among other contexts, commissions have been used following crisis situations, including the September 11, 2001, terrorist attacks and the 2008 financial crisis. In such situations, advisory commissions may potentially provide Congress with a high-visibility forum to assemble expertise that might not exist within the legislative environment; allow for the in-depth examination of complex, cross-cutting policy issues; and lend bipartisan credibility to a set of findings and recommendations. Others may determine that the creation of an advisory commission is unnecessary and instead prefer to utilize existing congressional oversight structures, such as standing or select committees. This report provides a comparative analysis of five congressional advisory commissions proposed to date that would investigate various aspects of the COVID-19 outbreak, governmental responses, governmental pandemic preparedness, and the virus's impact on the American economy and society. The overall structures of each of the proposed commissions are similar in many respects, both to each other and to previous independent advisory commissions established by Congress. Specifically, the proposed commissions would (1) exist temporarily; (2) serve in an advisory capacity; and (3) report a work product detailing the commission's findings, conclusions, and recommendations. That said, each proposed commission has unique elements, particularly concerning its membership structure, appointment structure, and time line for reporting to Congress. Specifically, this report compares and discusses the (1) membership structure, (2) appointment structure, (3) rules of procedure and operation, (4) duties and reporting requirements, (5) commission powers, (6) staffing, and (7) funding of the five proposed commission structures. The five proposals are found in H.R. 6429 (the National Commission on COVID-19 Act), H.R. 6431 (the Made in America Emergency Preparedness Act), H.R. 6440 (the Pandemic Rapid Response Act), H.R. 6455 (the COVID-19 Commission Act), and H.R. 6548 (the National Commission on the COVID-19 Pandemic in the United States Act).


Throughout U.S. history, noncitizens have served in the U.S. Armed Forces. Although the Immigration and Nationality Act allows noncitizen service members to acquire citizenship, some veterans may not apply or may not satisfy all eligibility criteria. If the Department of Homeland Security (DHS) determines that a noncitizen veteran is potentially removable, the veteran may be subject to administrative immigration enforcement and removal. ICE, among other things, is responsible for identifying and removing aliens who violate U.S. immigration law. GAO was asked to review issues related to the removal of noncitizen veterans. This report examines (1) the extent to which ICE has developed and implemented policies for handling and tracking cases of potentially removable veterans; (2) how federal agencies facilitate the naturalization of noncitizen service members and veterans, and what is known about the number who have applied for naturalization; and (3) how removal affects veterans' eligibility for and access to VA benefits and services. GAO reviewed documentation, met with agency officials, analyzed available data on veterans placed in removal proceedings, and conducted a review of removed veterans' alien files. GAO also analyzed data on military naturalization applications. U.S. Immigration and Customs Enforcement (ICE) has developed policies for handling cases of noncitizen veterans who may be subject to removal from the United States, but does not consistently adhere to those policies, and does not consistently identify and track such veterans. When ICE agents and officers learn they have encountered a potentially removable veteran, ICE policies require them to take additional steps to proceed with the case. GAO found that ICE did not consistently follow its policies involving veterans who were placed in removal proceedings from fiscal years 2013 through 2018. Consistent implementation of its policies would help ICE better ensure that veterans receive appropriate levels of review before they are placed in removal proceedings. Additionally, ICE has not developed a policy to identify and document all military veterans it encounters during interviews, and in cases when agents and officers do learn they have encountered a veteran, ICE does not maintain complete electronic data. Therefore, ICE does not have reasonable assurance that it is consistently implementing its policies for handling veterans' cases. U.S. Citizenship and Immigration Services (USCIS) and the Department of Defense (DOD) have policies facilitating the naturalization of noncitizen service members and veterans, and provide informational resources to noncitizen service members seeking naturalization. The number of military naturalization applications received by USCIS declined sharply from fiscal years 2017 to 2018, resulting in a decreased number of applications approved in fiscal year 2018. USCIS and DOD officials attributed this decline to several DOD policy changes that reduced the number of noncitizens joining the military . Citizenship status, including removal history, does not affect a veteran's eligibility for Department of Veterans Affairs (VA) benefits and services. However, living abroad affects eligibility for certain VA benefits and services. Veterans living abroad may also experience challenges accessing certain benefits and services, such as slower disability claim processing.


Title IX, the energy title, of the 2018 farm bill (Agriculture Improvement Act of 2018; P.L. 115-334 ) contains authority for the energy programs administered by the U.S. Department of Agriculture (USDA). USDA energy programs incentivize research, development, and adoption of renewable energy projects, including solar, wind, and anaerobic digesters. However, the primary focus of USDA energy programs has been to promote U.S. biofuels production and useâincluding corn starch-based ethanol (the predominant biofuel produced and consumed in the United States), cellulosic biofuels, and soybean-based biodiesel. The USDA energy programs via the farm bill are separate from the Renewable Fuel Standard (RFS) and tax incentives contained in separate energy and tax legislation. Four farm bills have contained an energy title: 2002, 2008, 2014, and 2018. For all four farm bills, the majority of the energy programs expire and lack baseline funding. Many of the energy title programs are authorized to receive both mandatory and discretionary funding. Historically, mandatory funding has been the primary support for these programs, as appropriators have not provided funding for most of the discretionary authorizations. The programs that have received discretionary authorizations under the 2018 farm bill are the Rural Energy for America Program, the Rural Energy Savings Program, and the Sun Grant Program. The 2018 farm bill extended most of the energy provisions of the 2014 farm bill with new funding authority. There are two exceptions, as the 2018 farm bill repealed both the Repowering Assistance Program and the Rural Energy Self-Sufficiency Initiative. Additionally, the 2018 farm bill established one new programâthe Carbon Utilization and Biogas Education Program. The 2018 farm bill contains initiatives that address noncorn feedstocks (e.g., cellulosic feedstocks). The most important programs to this end are the Bioenergy Program for Advanced Biofuels, which pays producers for production of eligible advanced biofuels; the Biorefinery, Renewable Chemical, and Biobased Product Manufacturing Assistance Program (formerly the Biorefinery Assistance Program), which assists in the development of new and emerging technologies for advanced biofuels; and the Renewable Energy for America Program (REAP), which has funded a variety of biofuels-related projects. Over the five-year reauthorization period (FY2019-FY2023), the 2018 farm bill contains a total of $375 million in new mandatory funding and authorizes discretionary funding (i.e., subject to annual appropriations) of $1.7 billion for the various farm bill energy programs. This discretionary total includes discretionary authorizations for the Sun Grant Program and the Rural Energy Savings Program. The mandatory funding provided for the energy programs under the 2018 farm bill is approximately 46% less than what was provided in the 2014 farm bill, which had authorized $694 million in mandatory funding over the five-year period of FY2014-FY2018. Conversely, the 2018 farm bill provides discretionary authorizations that are approximately 13% more than what was provided in the 2014 farm bill ($1.5 billion) for the energy programs (although, as noted above, farm bill energy programs generally have not received discretionary appropriations). At issue for Congress is oversight of the energy programs and the future of annual funding for these programs. This report provides an overview and funding summary of the various energy titles contained in the farm bills from 2002 to the present, and provides a description of the 2018 farm bill energy programs including their funding levels, program implementation status, and any changes made to the programs by the 2018 farm bill.


To encourage greater value in health care, CMS adjusts its Medicare payments to many health care providers based on measures of the quality of care. Therefore, the decisions CMS makes to choose certain quality measures have significant consequences. These decisions may involve selecting specific existing measures for CMS to use, stopping the use of some measures, or identifying new measures to be developed. The Bipartisan Budget Act of 2018 contains a provision for GAO to review CMS's quality measurement activities. For this report, GAO (1) assessed the information CMS maintains on funding of health care quality measurement activities, and (2) described and assessed how CMS makes decisions to develop and to use quality measures. GAO analyzed CMS funding data for 2009 through 2018 and data on CMS quality measurement selections for 2014 through 2018. GAO reviewed CMS documentation related to its decisions on quality measurement and interviewed program and contractor officials. The Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services (HHS), maintains information on the amount of funding for activities to measure the quality of health care provided under Medicare. CMS's information shows it has carried over from each year to the next large amounts of available funding—known as unobligated balances—for quality measurement activities from fiscal years 2010 through 2018 (see figure). CMS officials said they maintained such available funding to ensure there were no gaps in funding for future years. However, CMS officials also told GAO that the information it maintains does not identify all of the funding the agency has obligated for quality measurement activities. Further, it does not identify the extent to which this funding has supported CMS's quality measurement strategic objectives, such as reducing the reporting burden placed on providers by CMS's quality measures. With more complete and detailed information, CMS could better assess how well its funding supports its quality measurement objectives. CMS takes different approaches for deciding which quality measures to develop and to use. However, CMS lacks assurance that the quality measures it chooses address its quality measurement strategic objectives. This is because CMS does not have procedures to ensure systematic assessments of quality measures under consideration against each of its quality measurement strategic objectives, which increases the risk that the quality measures it selects will not help the agency achieve those objectives as effectively as possible. These procedures, such as using a tool or standard methodology to systematically assess each measure under consideration, could help CMS better achieve its objectives. In addition, CMS has not developed or implemented performance indicators for each of its quality measurement strategic objectives. Establishing these indicators and using them to evaluate its progress towards achieving its objectives would enable CMS to determine whether its quality measurement efforts are sufficient or changes are warranted.


To maintain heavy polar icebreaking capability, the Coast Guard, in collaboration with the Navy, plans to acquire up to three new heavy polar icebreakers. The Navy plans to award a contract in 2019 for the polar icebreaker program. GAO has found that before committing resources, successful acquisition programs begin with sound business cases, which include plans for a stable design, mature technologies, a reliable cost estimate, and a realistic schedule. This statement addresses, among other things, the key acquisition risks facing the polar icebreaker program. This statement is primarily based on GAO's April 2018 and September 2018 reports examining the Coast Guard's polar icebreaker acquisition, and also draws from GAO's extensive body of published work examining the Coast Guard's and the Navy's shipbuilding efforts. In its prior work, GAO analyzed Coast Guard and Navy guidance, data, and documentation, and interviewed Coast Guard and Navy officials. The Coast Guard—a component of the Department of Homeland Security (DHS)—did not have a sound business case in March 2018, when it established the cost, schedule, and performance baselines for its heavy polar icebreaker acquisition program, because of risks in four key areas: Design. The Coast Guard set program baselines before conducting a preliminary design review, which puts the program at risk of having an unstable design, thereby increasing the program's cost and schedule risks. While setting baselines without a preliminary design review is consistent with DHS's current acquisition policy, it is inconsistent with acquisition best practices. Based on a prior GAO recommendation, DHS is currently evaluating its policy to better align technical reviews and acquisition decisions. Technology. The Coast Guard intends to use proven technologies for the program, but did not conduct a technology readiness assessment to determine the maturity of key technologies prior to setting baselines. Coast Guard officials indicated such an assessment was not necessary because the technologies the program plans to employ have been proven on other icebreaker ships. However, according to best practices, such technologies can still pose risks when applied to a different program or operational environment, as in this case. Without such an assessment, the program's technical risk is underrepresented. Cost. The lifecycle cost estimate that informed the program's $9.8 billion cost baseline was not fully reliable because it only partially met GAO's best practices for being credible. It did not quantify the range of possible costs over the entire life of the program. As a result, the cost estimate may underestimate the total funding needed for the program. However, the estimate substantially met GAO's best practices for being comprehensive, well-documented, and accurate. Schedule. The Coast Guard's planned delivery dates were not informed by a realistic assessment of shipbuilding activities, but rather driven by the potential gap in icebreaking capabilities once the Coast Guard's only operating heavy polar icebreaker—the Polar Star —reaches the end of its service life (see figure). GAO's analysis of selected lead ships for other shipbuilding programs found the icebreaker program's estimated construction time of 3 years is optimistic. As a result, the Coast Guard is at risk of not delivering the icebreakers when promised and the potential gap in icebreaking capabilities could widen.


To manage the risks posed by some drugs, FDA requires drug companies to establish risk evaluation and mitigation strategies. Companies developing generic drugs generally need samples of the reference standard drug to conduct bioequivalence testing. Generic companies may also have to negotiate a shared system with the reference drug company, when that company's drug is subject to certain REMS requirements. FDA and FTC officials acknowledge that some drug companies have used certain practices that prevent or delay the development of generic drugs. The practices include limiting access to samples of reference standard drugs with and without REMS and delaying negotiations for creating required shared systems. GAO was asked to review drugs subject to REMS and drug companies' experience with these practices. This report describes (1) the drugs subject to REMS, and (2) FDA and FTC's efforts to address these practices, and stakeholders' views on agencies' efforts. GAO analyzed FDA data on the conditions these drugs treat and the REMS requirements that apply to the drugs. GAO also interviewed FDA and FTC officials and representatives from five reference drug companies and four generic drug companies, which GAO selected based on a variety of factors, including the companies' experiences with drugs subject to REMS . GAO also reviewed public comments and related documents from FDA and FTC. HHS and FTC provided technical comments on a draft of this report, which GAO incorporated as appropriate. The Food and Drug Administration (FDA) can require drug companies to establish risk evaluation and mitgation strategies (REMS) for drugs with serious safety concerns to ensure that a drug's benefits outweigh its risks. As of March 18, 2019, FDA approved 74 active REMS that cover 523 drugs that treat various conditions. One hundred forty-three of the drugs are reference standard drugs, which are drugs generic drug companies must use to conduct bioequivalence testing. Of these 143, 64 have at least one approved generic that is also subject to REMS. Ten of the REMS are shared systems that allow health care providers to obtain information from multiple companies on a drug's risks and satisfy other administrative requirements through one REMS system. According to FDA and the Federal Trade Commission (FTC), drugs with and without REMS have been the subject of practices that can delay or prevent generic drug development and marketing. FDA and FTC have taken actions designed to address some of these practices. According to FDA officials, they are more limited in what actions they can take when drugs without REMS are involved. Drug company officials that GAO interviewed had different views on these actions. To address practices that may limit access to samples of reference standard drugs and keep generic drugs from the market: FDA issued draft guidance in 2014 on how generic companies could obtain a letter stating that the agency would not consider it a REMS violation to provide reference standard drug samples to the generic company requesting the letter. Three of the four generic companies GAO interviewed said these letters were not useful because they do not require drug companies to share samples. In contrast, officials from three of five reference drug companies said the letters addressed their safety concerns about providing samples to generic companies. FDA does not issue such letters for drugs without REMS. In February 2019, FDA published a list of drug companies whose reference standard drugs were the subject of access inquires made to FDA by generic drug companies. One of the four generic companies GAO spoke with said FDA's list was helpful, and one reference drug company said it was uncertain why it was included on the list. FTC has reviewed inquiries it received from FDA and generic companies, and has filed amicus briefs in two cases involving drugs with REMS. According to FTC, to date, the agency has not brought a case charging a drug company with violating federal antitrust law for refusing to provide samples to a generic drug company. To address practices that may delay negotiations between reference drug and generic drug companies for creating required shared systems, FDA issued waivers and related guidance that allowed generic companies to develop a separate, but comparable, REMS shared system. One generic drug company said the guidance on waivers was helpful; however, one drug company said the waivers put added burden on health care providers who have to use multiple REMS systems.


To meet operational demands, the Navy has doubled the number of ships based overseas since 2006. Navy ships based abroad represent about 14 percent of the total fleet and are there to provide presence, deter threats, quickly respond to crises, and build partnerships. Effective and timely maintenance is essential to meet strategic objectives, fulfill operational requirements, and ensure ships reach their expected service lives. House Report 115-676 included a provision that GAO assess maintenance for ships based overseas. This report: (1) describes existing maintenance capacity and approaches the Navy uses for surface ships based overseas, (2) assesses the extent to which the Navy completed maintenance periods as scheduled in fiscal years 2014 through 2018 and analyzes factors contributing to any delays, and (3) evaluates the extent to which the Navy has assessed any challenges facing future overseas maintenance efforts. To address these objectives, GAO analyzed Navy policies and maintenance data from fiscal years 2012 through 2018, and interviewed officials, including from Naval Sea Systems Command and overseas fleets and maintenance centers. The Navy maintains the 38 surface ships based in Japan, Spain, and Bahrain through a mix of Navy-operated facilities and private contractors. The Navy uses different maintenance approaches at each location depending on the number and type of ships based there and the Navy and private contractor industrial base available to provide maintenance support. For example, to support the 12 surface ships based in Yokosuka, Japan, the Navy uses both private contractors and its Ship Repair Facility and Japan Regional Maintenance Center, which is subsidized by the government of Japan. In Rota, Spain, the Navy relies on one Spanish contractor to maintain the four ships based at that location. Maintenance on surface ships based overseas took longer than planned for 50 of the 71 maintenance periods—or about 70 percent—started during fiscal years 2014 through 2018. More than half of these maintenance delays lasted a month or longer, which reduced the ships' availability for training and operations. Various factors contribute to delays, such as discovery that unanticipated additional repairs are needed, missed planning milestones, or shortages of key staff. However, the Navy's efforts to understand delays often solely focus on individual maintenance periods and result in steps to improve specific issues related to maintenance timeliness. The Navy has not conducted a comprehensive analysis of maintenance delays to systematically identify and address their root causes. Without such an analysis, the Navy cannot effectively target corrective actions, and risks continuing to underestimate maintenance needs and the time and resources required to address them. The Navy has developed a new maintenance approach for ships in Japan, but has not assessed the risks associated with this approach or analyzed the overseas maintenance requirements for a growing fleet. The new maintenance approach calls for ships to obtain all required maintenance in the United States before and after going overseas, among other things. The Navy decided to implement this approach in Japan based on use of the approach in Spain—where ships have experienced few maintenance delays. However, the Navy has not assessed the risks posed by differences between the operating environments in Spain and Japan, or by shortfalls in maintenance capacity at U.S. facilities. The Navy also plans to replace aging ships in Bahrain as it grows the fleet to 355 ships, but it did not analyze or include overseas maintenance requirements in its long-range plan. Without assessing the risks challenges may pose to the success of its new maintenance approach in Japan or analyzing the requirements of a growing fleet, the Navy could be hindered in its ability to ensure these ships are ready and available for operations.


To protect data that are shared with state government agencies, federal agencies have established cybersecurity requirements and related compliance assessment programs. Specifically, they have numerous cybersecurity requirements for states to follow when accessing, storing, and transmitting federal data. GAO was asked to evaluate federal agencies' cybersecurity requirements and related assessment programs for state agencies. The objectives were to determine the extent to which (1) selected federal agencies' cybersecurity requirements for state agencies varied with each other and federal guidance, and (2) federal agencies had policies for coordinating their assessments of state agencies' cybersecurity. GAO reviewed four federal agencies that shared data with states and had assessment programs: CMS, FBI, IRS, and SSA. GAO compared, among other things, each agency's cybersecurity requirements to federal guidance and to other selected agencies' requirements; and reviewed federal agencies' policies for conducting assessments. In addition, GAO examined OMB's efforts to foster coordination among federal agencies. GAO also surveyed and received responses from chief information security officers in 50 out of 55 U.S. states, territories, and the District of Columbia to obtain their perspectives. Although the Centers for Medicare and Medicaid Services (CMS), Federal Bureau of Investigation (FBI), Internal Revenue Service (IRS), and Social Security Administration (SSA) each established requirements to secure data that states receive, these requirements often had conflicting parameters. Such parameters involve agencies defining specific values like the number of consecutive unsuccessful logon attempts prior to locking out the user. Among the four federal agencies, the percentage of total requirements with conflicting parameters ranged from 49 percent to 79 percent. Regarding variance with National Institute of Standards and Technology guidance, GAO found that the extent to which the four agencies did not fully address guidance varied from 9 percent to 53 percent of total requirements. The variances were due in part to the federal agencies' insufficient coordination in establishing requirements. Although the Office of Management and Budget's (OMB) Circular A-130 requires agencies to coordinate, OMB has not ensured that agencies have done so. Further, while federal agencies' variance among requirements may be justified in some cases because of particular agency mission needs, the resulting impact on states is significant, according to state chief information security officers (see figure). The four federal agencies that GAO reviewed either fully or partially had policies for coordinating assessments with states, but none of them had policies for coordinating assessments with each other. State chief information security officers that GAO surveyed reinforced the need to coordinate assessments by identifying impacts on state agencies' costs, including multiple federal agencies that requested the same documentation. Coordinating with state and federal agencies when assessing state agencies' cybersecurity may help to minimize states' cost and time impacts and reduce associated federal costs. Federal agencies reported spending about $45 million for fiscal years 2016 through 2018 on assessments of state agencies' cybersecurity.


To protect the interests of participants and beneficiaries in pension plans, Congress enacted the Employee Retirement Income Security Act of 1974 (ERISA; P.L. 93-406 ). ERISA specified funding rules for single-employer defined benefit (DB) pension plans, among other provisions. Single-employer DB pension plans are sponsored by one employer for the benefit of its employees. In DB pension plans, participants typically receive regular monthly benefit payments in retirement (which some refer to as a "traditional" pension). ERISA also authorized the creation of the Pension Benefit Guaranty Corporation (PBGC), which is a government corporation that insures private-sector pension benefits up to a specified maximum in the case of plan termination. Single-employer DB funding rules generally require several steps: calculating the value of benefits that a plan will pay in the future; determining how much a plan has set aside to pay those benefits; and determining how much, and the time period over which, an employer must contribute to the plan each year. Since ERISA, Congress has periodically modified funding rules for pension plans. The Pension Protection Act of 2006 (PPA; P.L. 109-280 ) outlined new pension funding standards for single-employer DB plans, among other requirements. PPA required that plans become 100% funded over time and outlined assumptions that pension plans must use to become fully funded. PPA also provided special rules for DB plans sponsored by certain employers, such as some airlines and defense contractors. Since PPA was enacted, legislation has further modified funding rules for single-employer DB plans for various reasons. At times, legislation has applied broadly to most private-sector DB plans; at other times, changes to funding rules have targeted plans sponsored by specific industries or types of employers. At times, legislation has provided funding relief , which are measures that lower employer contributions. In general, funding relief measures allow plans more time to make required payments by (1) modifying assumptions that affect the calculated value of pension benefits or (2) extending the time period to make up for plan losses. The adoption of a funding corridor for interest rates in the Moving Ahead for Progress in the 21 st Century Act (MAP-21; P.L. 112-141 ) marked a significant change to single-employer DB funding rules. DB plans calculate the present value of future benefits that will be owed using certain specified interest rates for discounting. In response to a period of low interest rates, MAP-21 established a process for determining minimum and maximum interest rates for discounting based on 25-year averages of historical corporate bond yields. As originally established, the funding corridor was scheduled to widen eventually, which, when applied to the specified interest rates, would have resulted in the use of lower interest rates to calculate DB pension obligations. Subsequent legislation delayed the date when the funding corridor is to begin widening. Under current law, the widening is scheduled to begin in 2021. Funding relief measures do not directly affect participants' benefits. However, they can result in pension plans having lower funding levels than they otherwise would at a point in time. Thus, funding relief can negatively affect PBGC's finances because it could take over a plan that has fewer assets than the plan otherwise would in the absence of funding relief. Funding relief can also affect PBGC's ability to pay non-guaranteed benefits, such as benefit increases implemented within five years prior to plan termination. On the other hand, funding relief can positively affect PBGC finances because greater DB plan underfunding results in higher variable-rate premiums (premiums based on the amount of plan underfunding) paid to PBGC by employers. This report provides (1) background on single-employer DB pension funding, (2) a discussion of funding rules under PPA, and (3) provisions since PPA that have provided funding relief or otherwise modified single-employer DB pension funding rules.


To provide greater support for caregivers of post-9/11 veterans, Congress and the President enacted legislation requiring VA to establish a program to assist caregivers with the rigors of caring for seriously injured veterans. In May 2011, the Veterans Health Administration (VHA), which operates VA's health care system, established the Family Caregiver Program at each of its VA medical centers across the United States. At that time, the department implemented an IT system, called CAT, to help support the program. Subsequently, the VA MISSION Act was enacted in June 2018, requiring VA to implement an IT system to fully support the Family Caregiver Program by October 1, 2018. Further, VA's Secretary is to certify the system by October 1, 2019. GAO was asked to discuss its September 2014 report that examined how VHA is implementing the Family Caregiver Program. In addition, the statement includes relevant information VA provided on its actions toward addressing GAO's prior recommendation. The statement also discusses critical success factors related to IT acquisitions as identified in GAO's prior work. The reports cited throughout this statement include detailed information on the scope and methodology of GAO's prior reviews. In September 2014, GAO reported on the Department of Veterans Affairs' (VA) Program of Comprehensive Assistance for Family Caregivers (Family Caregiver Program) and found that the program office had limitations with its information technology (IT) system—the Caregiver Application Tracker (CAT). Specifically, the program did not have ready access to workload data that would allow it to monitor the effects of the program on VA medical centers' resources. VA has initiated various projects since 2015 to implement a new system, but has not yet been successful in its efforts. (See figure.) Specifically, in July 2015 VA initiated a project to improve the reliability of CAT's data, called CAT Rescue. However, the department reported in January 2017 that it had identified numerous defects during system testing. The project ended in April 2018 before any new system capabilities were implemented. A companion project was initiated in September 2015 to develop the Caregivers Tool (CareT), a new system intended to replace CAT. The CareT project was expected to use improved data from CAT Rescue, while also adding new system capabilities. However, the user acceptance testing of CareT identified the need for the department to develop more system capabilities than originally planned. Further, VA reported that implementing a system by October 1, 2018, as specified in the Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), was not feasible. Subsequently, VA terminated CareT in February 2019. The department initiated another project in March 2019 to implement a new system, the Caregiver Record Management Application (CARMA). GAO has ongoing work to evaluate the department's efforts to implement an IT system to support the Family Caregiver Program as required by the MISSION Act. GAO's prior work has determined that successfully overcoming IT acquisition challenges can best be achieved when critical success factors are applied. These factors can serve as a model of best practices that VA could apply to enhance the likelihood that the acquisition of a replacement IT system for the Family Caregiver Program will be successfully achieved. Examples of these critical success factors include, maintaining active engagement of program officials with stakeholders, involving end users and stakeholders in the development of requirements, and ensuring participation of end users in testing system functionality prior to formal end user acceptance testing.


A relatively recent series of high-profile crimes where the offenders' actions appeared to be motivated by their bias or animosity towards a particular race, ethnicity, or religion might contribute to a perception that hate crimes are on the rise in the United States. These incidents might also generate interest among policymakers about how the federal government collects data on hate crimes committed in the United States. The Federal Bureau of Investigation (FBI) started its Hate Crime Statistics program pursuant to the requirement in the Hate Crime Statistics Act (HSCA, P.L. 101-275 ) that the Department of Justice (DOJ) collect and report data on crimes that "manifest evidence of prejudice based on race, gender and gender identity, religion, disability, sexual orientation, or ethnicity, including where appropriate the crimes of murder, non-negligent manslaughter; forcible rape; aggravated assault, simple assault, intimidation; arson; and destruction, damage or vandalism of property." In addition to the FBI's Hate Crime Statistics program, DOJ also collects data on hate crime victimizations through the Bureau of Justice Statistics' (BJS') National Crime Victimization Survey (NCVS). The NCVS measures self-reported criminal victimizations including those perceived by victims to be motivated by an offender's bias against them for belonging to or being associated with a group largely identified by the characteristics outlined in the HSCA. Scholars, advocates, and members of the media have pointed out that there is a significant disparity between the number of hate crimes reported by the FBI each year and the number of hate crime victimizations reported by BJS. This has led some to criticize the hate crime data published by the FBI as an undercount of the number of hate crimes committed in the United States each year. However, this statistics gap can be partially explained by the different measures and methodologies utilized by the FBI and BJS to collect these data. For example, the FBI only reports on crimes that have been reported to the police, while BJS collects reports of criminal victimizations that may or may not meet the statutory definition of a hate crime and may or may not have been reported to the police. There are a number of reasons why some victims do not report their victimization to the police, including fear of reprisal, not wanting the offender to get in trouble, believing that police would not or could not do anything to help, and believing the crime to be a personal issue or too trivial to report. There are also several reasons why a hate crime that was reported to the police might not be subsequently reported to the FBI for their Hate Crime Statistics program. Deciding whether a crime meets the statutory definition of a hate crime requires law enforcement agencies to investigate allegations of hate crime motivations before making a final determination. Reporting by law enforcement agencies to the FBI might be hampered by the fact that some law enforcement agencies do not have the training necessary to investigate potential bias-motivated offenses effectively. In addition, differing definitions between the FBI and state statutes as to what constitutes a hate crime generate confusion as to which standard should be used to determine whether a hate crime occurred and should be reported. In 2021, the FBI plans to transition to the National Incident Based Reporting System (NIBRS) and will no longer accept non-NIBRS compliant data from law enforcement agencies. Policymakers might have an interest in how NIBRS differs from the FBI's current hate crime reporting program and whether full participation in NIBRS might improve the quality and completeness of federal hate crime data. However, like the FBI's current crime reporting program, participation in the NIBRS program is voluntary, and policymakers might consider steps Congress could take to promote wide-scale adoption of NIBRS.


CCDF is the primary source of federal funding for child care subsidies. States administering CCDF are subject to requirements that improve the quality of child care for all children, nonsubsidized as well as subsidized. In March 2018, the Consolidated Appropriations Act, 2018 was enacted, which provided $5.2 billion in additional CCDF discretionary funding for fiscal year 2018, approximately twice the amount provided in fiscal year 2017. GAO was asked to review state use of CCDF funds and their potential impact on nonsubsidized children. GAO examined (1) the extent to which states use CCDF funds to support their child care system, (2) the kinds of CCDF–related activities states engage in that affect children who are not receiving CCDF subsidies, and (3) how states plan to use the increase in CCDF funding from the Consolidated Appropriations Act, 2018. GAO collected information from state CCDF administrators through a survey to the 50 states and the District of Columbia (D.C.) and interviews with officials in 15 states, including D.C., selected to reflect diverse characteristics and locations. GAO also reviewed relevant federal laws, regulations, and guidance, and interviewed Department of Health and Human Services officials. GAO makes no recommendations in this report. A majority of states used funding from the Child Care and Development Fund (CCDF) in fiscal year 2017 to entirely or mostly support 7 of 10 major state child care activities GAO identified in its survey of 51 state CCDF programs. These activities, components of which are also required by CCDF, represent diverse aspects of state child care systems and are a key means through which states may choose to improve the quality of their child care. States reported that they relied primarily on CCDF funding for child care resource and referral systems, consumer education, and health and safety standards establishment and training more frequently than for other activities. States reported in GAO's survey that a range of CCDF quality activities affect the care of children not receiving CCDF subsidies (nonsubsidized children), including three activities cited by all states—consumer education, child care licensing, and professional development of the child care workforce. CCDF administrators in most of the 15 states GAO interviewed said they have elected to apply certain requirements for caregivers subsidized under CCDF to all state licensed child care providers. For example, child care providers may be subject to monitoring and professional development requirements, whether or not they care for children receiving subsidies. CCDF administrators also stated that, as a result, all children in the care of licensed providers in these states—including nonsubsidized children—benefit from the enhanced requirements. States most often reported in GAO's survey that they plan to spend new CCDF funds provided in the Consolidated Appropriations Act, 2018, on quality activities that benefit all children in child care including licensing, consumer education, and professional development. For example, officials GAO interviewed in several states described plans to enhance public state child care websites to make them more user-friendly for all families or available in other languages, such as Spanish. However, more than a third of the interviewed states said their spending plans were still in flux, and more than half said they faced challenges making spending decisions because it was unclear whether the new funds would be provided in the future.


Tobacco use causes more than 480,000 deaths each year, according to the Department of Health and Human Services (HHS). To protect the public, the Family Smoking Prevention and Tobacco Control Act granted FDA, an agency within HHS, authority to regulate tobacco products. To fund FDA's tobacco regulation activities—such as those aimed at preventing youth use of tobacco products—the act authorizes FDA to assess and collect a specified total amount of user fees from tobacco manufacturers and importers each fiscal year. The total amount of user fees are to be allocated based on the individual manufacturers' and importers' market share in six FDA-regulated tobacco product classes. GAO was asked to review FDA's tobacco user fees. This report examines FDA's process for the calculation, billing, and collection of these fees. GAO reviewed the relevant law and regulations, as well as FDA policies and procedures, and interviewed FDA officials. In fiscal year 2017, the latest data available at the time of our analysis, the Food and Drug Administration (FDA) assessed about $635 million in user fees to tobacco manufacturers and importers of six classes of FDA-regulated tobacco products—cigarettes, snuff, chewing tobacco, roll-your-own tobacco, pipe tobacco, and cigars. (See figure.) FDA has a process that is designed to ensure accurate calculation, billing, and collection of tobacco user fees. However, the agency has not completed a key step in this process—its year-end reconciliation—since doing so for fiscal year 2015. FDA procedures provide that the agency will conduct this year-end reconciliation annually after receiving necessary data from the Department of the Treasury's Alcohol and Tobacco Tax and Trade Bureau (TTB) and U.S. Customs and Border Protection (CBP). FDA relies on this year-end reconciliation to ensure that its user fee calculations are based on complete and accurate data—that is, that all manufacturers and importers subject to tobacco user fees were assessed fees correctly, based on accurate market share data. Incomplete or inaccurate data for one manufacturer or importer affects the market share—and the user fee amount—for all other manufacturers and importers in its product class. FDA has not completed this year-end reconciliation in recent years because of delays in obtaining the quality data it needs from TTB and CBP. While FDA has reported receiving most of the data for fiscal years 2016 through 2018 and has plans for completing the reconciliation for those years, the agency faces a risk of repeating delays in its reconciliation efforts in the future because it does not have reasonable assurance that it will receive quality data in a timely manner moving forward. Until FDA consults with TTB and CBP to determine and document the procedures and time frames that will allow FDA to obtain the quality data it needs to complete this key step in a timely manner, the agency risks repeating these delays.


Total expenditures for the Medicare Part D drug program exceeded $100 billion in 2016. Part D plan sponsors may use a PBM to provide drug benefit management services for Part D coverage, such as negotiating drug rebates and other price concessions and paying pharmacy claims. Policymakers have sought a better understanding of PBMs' roles in the drug supply chain and plans' and PBMs' efforts to manage Part D drug spending and use. GAO was asked to examine the role of PBMs in the Part D program. This report examines, among other objectives, (1) the extent to which Part D plan sponsors use PBMs, (2) trends in rebates and other price concessions obtained by both PBMs and plan sponsors for Part D drugs, and (3) how PBMs earn revenue for services provided to Part D plans. GAO analyzed Centers for Medicare & Medicaid Services (CMS) data on Part D plan sponsors' use of PBMs in 2016 as well as CMS drug expenditure, pricing, and rebate and other price concession data for all Part D drugs from 2014 through 2016 (the most recent available data at the time of our analysis). GAO reviewed service agreements between Part D plan sponsors and PBMs that were approved by CMS from January 2016 through May 2018 and had the highest enrollment as of June 2018. GAO spoke with CMS officials and 38 stakeholder groups including PBMs, Part D plan sponsors, pharmacy representatives and drug manufacturers. Medicare Part D plan sponsors used pharmacy benefit managers (PBM) to provide 74 percent of drug benefit management services and performed the remaining 26 percent of services themselves in 2016—the most recent year of data at the time of our analysis. Plan sponsors are private entities that operate drug plans; PBMs are organizations that help manage drug benefits. Rebates and other price concessions—discounts generally paid by manufacturers to Part D plan sponsors and PBMs after the sale of a drug at the pharmacy—grew faster than Part D expenditures from 2014 through 2016. Specifically, gross expenditures (the amount paid to pharmacies by plan sponsors, or by the PBM on the sponsor's behalf, and by the beneficiary) increased 20 percent, to $145.1 billion. During this period, rebates and other price concessions increased 66 percent, to $29 billion—20 percent of 2016 gross expenditures. Consequently, net expenditures (gross expenditures less rebates and other price concessions) increased only 13 percent, to $116.1 billion. PBMs primarily earned Part D revenue through a volume-based fee paid by plan sponsors based on PBM-processed claims; a per-member, per-month fee paid by plan sponsors; or a combination of the two. PBMs also earned revenue from the rebates they negotiated with manufacturers for Part D drugs, which accounted for $18 billion of the $26.7 billion in rebates in 2016. PBMs retained less than 1 percent of these rebates, passing the rest to plan sponsors. Plan sponsors in turn may use rebates to help offset the growth in drug costs, helping control premiums for beneficiaries. The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate.


Trauma is a widespread, harmful, and costly public health problem, and its effects are especially detrimental to children. Any frightening, dangerous, or violent event that threatens a child or their loved ones can potentially be traumatic. While not every child who experiences trauma will suffer lasting effects, trauma significantly increases the risk of mental health problems, difficulties with social relationships and behavior, physical illness, and poor school performance. GAO was asked to review selected states' efforts to support children affected by trauma. This report describes (1) the assistance that HHS and Education provide to help state and local agencies support children affected by trauma; (2) how child welfare and education agencies in selected states support these children; and (3) the challenges these agencies have faced in selected states in supporting these children. GAO interviewed state and local officials in six states that were selected based on recommendations from subject-matter experts and federal officials, among other factors; administered a questionnaire to 16 state agencies in the selected states; interviewed federal officials from HHS and Education; and reviewed relevant federal, state, and local agency documents, such as reports and guidance. Although our findings cannot be generalized to all states, they provide insight into government support for children affected by trauma. GAO is not making recommendations in this report. The Department of Health and Human Services (HHS) and the Department of Education (Education) provide grants, disseminate information, and fund training and technical assistance to help state and local agencies support children affected by trauma. HHS's Administration for Children and Families and Substance Abuse and Mental Health Services Administration (SAMHSA) have awarded discretionary grants specifically to address childhood trauma. In addition, state and local officials reported making use of other discretionary grants from HHS and Education—as well as formula funds meant for broad purposes like mental health, substance abuse, child welfare, and education—to support their work with children affected by trauma. In terms of non-financial support, state and local officials in six selected states all referred to the National Child Traumatic Stress Network, which is funded by SAMHSA, as an important resource for information, training, and technical assistance. Both HHS and Education have also made other guidance and informational resources available to states. Officials in child welfare and education agencies in the six selected states reported using a range of approaches to help children affected by trauma, including training staff, screening children, and providing services and support systems. To train child welfare workers, educators, and birth and foster parents to understand trauma and its effects on children, agencies in the six selected states used various approaches, such as learning communities, which include in-person learning and coaching, and online courses. Several state child welfare agencies also used learning communities to train clinicians in trauma-focused therapies. In addition, child welfare and education agencies in five states used screening tools to identify children exposed to and exhibiting symptoms of trauma. Children identified as experiencing trauma are referred for a trauma-informed mental health assessment. Also, to help children affected by trauma, child welfare and education agencies in five of the six states provide support and services. For example, in one state, caseworkers provide specialized services, including weekly visits, to children and families. Officials in the six selected states reported facing various challenges in their efforts to support children affected by trauma, and they emphasized the importance of engaged leadership in establishing and sustaining support for these children. In three states, officials said that a lack of such leadership hindered their efforts, and they described cases that included delayed, incomplete, or unsuccessful implementation of initiatives. Officials in all six states also talked about limitations on their agency's capacity to support children affected by trauma, including: high rates of staff turnover, especially in child welfare; limited staff time to dedicate to trauma initiatives; lack of clinicians trained in trauma-focused therapies; and insufficient funding to support trauma initiatives. Officials in some states reported strategies they have used to help address these challenges, including providing additional support to employees and coordinating with partner agencies to jointly leverage resources, expertise, and data.


Tribal lands hold considerable energy resources—oil, gas, coal, wind, solar, geothermal, and biomass. Tribal energy projects can help tribes fund programs and services that improve tribal members' quality of life. Federal agencies are large consumers of energy in the United States, spending about $6 billion in 2017 on energy for their facilities. Congress has provided a mechanism for agencies to support development and use of tribal energy by authorizing agencies to give preference to majority tribally owned suppliers when purchasing energy. GAO was asked to review federal efforts to use the preference. This report examines, among other objectives, the extent to which GSA, DOD, and DOE have used the tribal energy preference. GAO reviewed available agency information on use of the preference and interviewed federal agency officials to understand how agencies would use the preference when entering into contracts with tribal suppliers. None of the three primary federal agencies with authority to enter into energy contracts—the General Services Administration (GSA) and the Departments of Defense (DOD) and Energy (DOE)—have used the tribal energy preference since it was established in the Energy Policy Act of 2005 (EPACT05). The section of the act that includes the preference provides federal agencies with mechanisms that can support development and use of tribal energy resources. The mechanisms include grants to assist tribes in developing their energy resources and authorization for agencies to give preference to majority tribally owned sources in federal energy purchases, so long as they pay no more than prevailing market prices and obtain no less than prevailing market rate terms and conditions. According to DOE, tribal lands account for 2 percent of U.S. land but contain about 6.5 percent of all utility-scale U.S. renewable energy potential. GSA, DOD, and DOE officials identified five instances in the past when a tribe bid for a federal energy contract, and the agencies did not use the preference in any of those instances. GSA awarded a contract to tribes in two of the instances. In the first instance, the tribe submitted the best bid. In the second, GSA officials attempted to use the preference by limiting the energy contract solicitation solely to tribal sources, according to a stakeholder that worked on the project, but the GSA Administrator expressed concern about limiting competition in that manner. GSA instead used the small business preference authority, through which the tribe ultimately won the contract. DOD and DOE received the other three bids, which did not lead to contracts because either the cost was too high or the bid was not needed by the agency, according to agency officials. Federal officials noted that use of the preference is discretionary. EPACT05, which says agencies “may give preference,” does not require use of the preference, and the Federal Acquisition Regulation does not specifically address the preference. In November 2016, GAO reported that one reason federal agency officials cited for not using the preference was uncertainty about how to do so. GAO recommended that GSA develop guidance to clarify use of the preference across the federal government. GSA agreed that such guidance would be beneficial but stated that the Federal Acquisition Regulatory Council is the regulatory body empowered to address this issue. In April 2017, GSA presented the council with a business case on the issue. However, GSA officials told GAO that the council determined that the preference has limited application government-wide because it mainly affects GSA, DOD, and DOE, and that, accordingly, the council declined to issue regulations and recommended GSA consider nonregulatory paths. GSA then added the preference language to the form it will use if it delegates purchasing authority in the future. In 2018, federal agency officials told GAO they were uncertain how to use the preference. According to GSA and DOD officials, other statutes that authorize agencies to apply preferences for acquisition of goods and services from specific sources include more specific requirements in their statutory language, making them easier to apply. GSA officials noted that the Small Business Act, as amended, contains specific requirements and measurable goals that increase contracts awarded to small businesses. DOD officials stated that the agency might use the tribal energy preference if EPACT05 had similar requirements.


Truck underride crashes are collisions in which a car slides under the body of a truck—such as a tractor-trailer or single-unit truck—due to the height difference between the vehicles. During these crashes, the trailer or truck may intrude into the passenger compartment, leading to severe injuries or fatalities. Current federal regulations require trailers to have rear guards that can withstand the force of a crash, whereas the rear guards required for single-unit trucks do not have to be designed to withstand a crash. There are no federal side or front underride guard requirements. GAO was asked to review data on truck underride crashes and information on underride guards. This report examines (1) the data DOT reports on underride crashes and (2) the development and use of underride guard technologies in the U.S. GAO analyzed DOT's underride crash data for 2008 through 2017; reviewed NHTSA's proposed regulations and research on new guard technologies; and interviewed stakeholders, including DOT officials, industry and safety groups, and state officials selected based on reported underride crash fatalities and other factors. According to crash data collected by police and reported by the Department of Transportation's (DOT) National Highway Traffic Safety Administration (NHTSA), fatalities from “underride” crashes, such as those pictured below, represent a small percentage of all traffic fatalities. From 2008 through 2017, an average of about 219 fatalities from underride crashes involving large trucks were reported annually, representing less than 1 percent of total traffic fatalities over that time frame. However, these fatalities are likely underreported due to variability in state and local data collection. For example, police officers responding to a crash do not use a standard definition of an underride crash and states' crash report forms vary, with some not including a field for collecting underride data. Further, police officers receive limited information on how to identify and record underride crashes. As a result, NHTSA may not have accurate data to support efforts to reduce traffic fatalities. Underride guards are in varying stages of development, and gaps exist in inspection of rear guards in current use and in research efforts for side guards. NHTSA has proposed strengthening rear guard requirements for trailers (the rear unit of a tractor-trailer) and estimates about 95 percent of all newly manufactured trailers already meet the stronger requirements. Although tractor-trailers are inspected, Federal Motor Carrier Safety Administration annual inspection regulations do not require the rear guard to be inspected, so damaged guards that could fail in a crash may be on the roadways. Side underride guards are being developed, but stakeholders GAO interviewed identified challenges to their use, such as the stress on trailer frames due to the additional weight. NHTSA has not determined the effectiveness and cost of these guards, but manufacturers told GAO they are unlikely to move forward with development without such research. Based on a 2009 crash investigation, the National Transportation Safety Board (NTSB) recommended that NHTSA require front guards on tractors. NHTSA officials stated that the agency plans to complete research to respond to this recommendation in 2019. However, stakeholders generally stated that the bumper and lower frame of tractors typically used in the U.S. may mitigate the need for front guards for underride purposes. Regarding single-unit trucks , such as dump trucks, NTSB has recommended that NHTSA develop standards for underride guards for these trucks, but the agency has concluded these standards would not be cost-effective.


Two recent amendments to the Anti-Terrorism Act (ATA, 18 U.S.C. Â§Â§ 2331 et seq. ) have significant implications for U.S. aid to the Palestinians and U.S. courts' ability to exercise jurisdiction over Palestinian entities. They are the Anti-Terrorism Clarification Act of 2018 (ATCA, P.L. 115-253 ) and the Promoting Security and Justice for Victims of Terrorism Act of 2019 (PSJVTA, Â§ 903 of the Further Consolidated Appropriations Act, 2020, P.L. 116-94 ). Congress passed ATCA after a U.S. federal lawsuit (known in various incarnations as Waldman v. PLO and Sokolow v. PLO ) against the Palestinian Authority (PA) and Palestine Liberation Organization (PLO) that an appeals court dismissed in 2016. The trial court had found that the PA and PLO were responsible under ATA (at 18 U.S.C. Â§ 2333) for various terrorist attacks by providing material support to the perpetrators. However, the U.S. Court of Appeals for the Second Circuit ruled that the attacks, "as heinous as they were, were not sufficiently connected to the United States to provide specific personal jurisdiction" in U.S. federal courts. Amendments to ATA . ATCA provided that a defendant consents to personal jurisdiction in U.S. federal court for lawsuits related to international terrorism if the defendant accepts U.S. foreign aid from any of the three accounts from which U.S. bilateral aid to the Palestinians has traditionally flowed. In December 2018, the PA informed the United States that it would not accept aid that subjected it to federal court jurisdiction. Consequently, all bilateral aid ended on January 31, 2019. PSJVTA eliminated a defendant's acceptance of U.S. foreign aid as a trigger of consent to personal jurisdictionâthus partly reversing ATCAâand instead provides that PA/PLO payments related to a terrorist act that kills or injures a U.S. national act as a trigger of consent to personal jurisdiction. The PA/PLO may face strong Palestinian domestic opposition to discontinuing such payments. PSJVTA also directs the State Department to establish a mechanism for resolving and settling plaintiff claims against the PA/PLO. President Trump stated in a signing statement that this provision could interfere with the exercise of his "constitutional authorities to articulate the position of the United States in international negotiations or fora." Implications of stopping U.S. aid and prospects for resumption . It is unclear to what extent the stop to U.S. security assistance for the PA has affected Israel-PA security cooperation and could affect it in the future. The U.S. Security Coordinator for Israel and the Palestinian Authority (USSC) said in December 2019 that the suspension of aid had not significantly affected Israel-PA security cooperation, but that the disruption of initiatives aimed at facilitating cooperation and helping reform the PA security sector had some impact on PA acquiescence to USSC requests aimed at reform and greater professionalization. Even though PSJVTA removed acceptance of U.S. bilateral aid as a trigger for personal jurisdiction, the actual resumption of U.S. aid may depend on political decisions by Congress and the Administration, as well as cooperation from the PA. For FY2020, Congress has appropriated $75 million in PA security assistance for the West Bank and $75 million in economic assistance for the "humanitarian and development needs of the Palestinian people in the West Bank and Gaza." However, the Trump Administration had previously suggested that restarting U.S. aid for Palestinians could depend on a resumption of PA/PLO diplomatic contacts with the Administration, which may be unlikely in the current U.S.-Israel-Palestinian political climate. Additionally, it is possible that the PA might not accept aid if doing so could be perceived domestically as giving in to U.S. political demands on the peace plan, or as tacitly agreeing to the new triggers of potential PA/PLO liability in PSJVTA. Implications for p ersonal jurisdiction . The extent to which Congress can provide by statuteâsuch as through ATAâthat a foreign entity (in this case, the PA/PLO) is deemed to consent to personal jurisdiction appears to be untested in court. The deemed consent provision in ATA may encounter legal challenges on the basis that it could constitute an unconstitutional condition. A condition attached to government benefits is unconstitutional if it forces the recipient to relinquish a constitutional right that is not reasonably related to the purpose of the benefit. If this concept applies to personal jurisdiction, a reviewing court may need to determine whether submission to jurisdiction has a rational relationship with PA/PLO payments or other PA/PLO activities, such as maintenance of facilities in the United States.


U.S airspace system is one of the safest in the world, but incidents and near misses at and around U.S. terminal areas still occur. FAA oversees the safety of runways and taxiways and works with industry partners—including airlines, airports, pilots, and others—to improve safety in these areas. Despite FAA's continued efforts, the number of reported terminal area incidents has increased over time. GAO was asked to review various issues related to runway safety and to update its prior work on airport terminal areas. This report examines: (1) the extent to which FAA uses data to analyze terminal area incidents and (2) efforts FAA and others have implemented to improve terminal area safety, and how FAA assesses their effectiveness. GAO analyzed FAA data; interviewed officials from 10 airports selected based on high runway incident rates in the past 3 years, among other factors; and interviewed federal and industry officials. The Federal Aviation Administration (FAA) uses data to analyze some types of incidents in airport “terminal areas”—runways, taxiways, and ramps. For example, FAA uses data to analyze runway “incursions”—the incorrect presence of an aircraft, vehicle, or person on the runway. According to FAA data, the rate of reported runway incursions nearly doubled from fiscal years 2011 through 2018, with most of this increase due to a rise in reports of less severe incursions, or those without immediate safety consequences. However, GAO found that FAA has not identified or removed all duplicates from its data on runway “excursions”—when an aircraft veers off or overruns a runway—which limits FAA's ability to accurately analyze these incidents. Additionally, FAA does not use data to analyze incidents that occur in ramp areas—the parts of terminal areas where aircraft are prepared for departure and arrival—where injuries to workers and damage to aircraft can occur. Without a process to leverage accurate excursion and ramp incident data, FAA may not be able to assess the risk these incidents pose to passengers, airport staff, and others. FAA, airports, and airlines have implemented multiple efforts to improve terminal area safety, but FAA has not assessed the effectiveness of many of its efforts. For example, FAA has funded multiple technologies to improve runway safety, such as Airport Surface Detection Equipment, Model X (ASDE-X)—a ground surveillance system that enables air traffic controllers to track landing and departing aircraft and alerts controllers of potential collisions. However, FAA has not assessed the effectiveness of ASDE-X. Similarly, FAA has not assessed the effectiveness of its Runway Safety Program, whereby FAA staff, along with local airport stakeholders, provide data and support to local air traffic managers to help identify and manage terminal area safety incidents. FAA has taken steps to evaluate some of its terminal-area safety efforts, such as tracking the number of runway excursions safely stopped by a lightweight, crushable concrete designed to stop or greatly slow an aircraft that overruns the runway. However, without assessing how all of FAA's efforts contribute to its goal of improving runway and taxiway safety, FAA cannot determine the extent to which it is targeting its limited resources to the most effective strategies.


U.S. agricultural production got off to a late start in 2019 due to prolonged cool, wet springtime conditions throughout the major growing regions, particularly in states across the northern plains and eastern Corn Belt. Saturated soils prevented many farmers from planting their intended cropsâsuch acres are referred to as "prevent plant (PPL)" acres. As of November 1, 2019, the U.S. Department of Agriculture (USDA) reported that farmers were unable to plant a record 19.6 million acres in 2019âincluding 11.4 million acres of corn and 4.5 million acres of soybeans. The previous record for total PPL acres was set in 2011, when USDA reported 10.2 million acres of PPL. USDA's Risk Management Agency (RMA) reported on November 15, 2019, that 2019 PPL indemnity payments were over $4.2 billion, with $2.6 billion (60.6%) for corn PPL acres and $1.1 billion (25%) for soybean PPL acres. The 2019 average national PPL payment rate for all crops was $224.04 per acre. Payment rates varied by crop and ranged from a low of $50 per acre for millet to a high of $1,432 per acre for dark air cured tobacco. The unusually wet spring conditions that produced the record PPL acres in 2019 were heavily concentrated in Corn Belt states but were also reported in significant numbers in Arkansas, Texas, Mississippi, Louisiana, North Carolina, Tennessee, New York, and Oklahoma. However, South Dakota's 3.9 million acres of PPL were more than double second-place Ohio's 1.4 million of PPL acres. South Dakota's PPL acres accounted for over 20% of the national total in 2019, while its PPL indemnity payments of over $925 million accounted for 21.9% of national PPL indemnity payments. During the previous 19-year period from 2000 to 2018, national PPL averaged 4.1 million acres annually with average indemnities of $680 million per year. Of these national totals, South Dakota accounted for an average of 10% of PPL acres (406 million acres) and 11.2% of PPL indemnities ($76.4 million). Farmers that were unable to plant a crop during the spring of 2019 due to natural causes were potentially eligible for multiple payments under federal farm programs. First, federal crop insurance provides PPL coverage under a standard policy that covers pre-planting cost and potential revenue loss. Second, the FY2019 supplemental authorized disaster assistance payments for PPL (referred to as "top up") in addition to crop insurance indemnities. Third, the Administration's 2019 MFP payments, although based on planted acres, also included payments for eligible cover crops planted on PPL acres. In addition to the unplanted acres, a sizeable portion of the U.S. corn and soybean crops was planted later than usual. Such late planting meant that initial crop development would be behind normal across much of the major growing regions and that eventual yields would depend on beneficial weather extending late into the fall to achieve full crop maturity. Widespread wet conditions continued into the fall, especially in the northern plains and western Corn Belt. Ultimately, much of the corn crop was harvested under wet conditions with high moisture content that required drying. Due to the high costs of propane for drying, many farmers chose to leave their corn in the field until more beneficial market conditions emerged. As of December 16, 2019, USDA estimated that 8% (or 7.2 million acres) of the U.S. corn crop had yet to be harvested, adding further to the uncertainty of yields and harvested acreage for the 2019 corn crop. Saturated soil conditions heading into the winter months suggests a continuation of wet conditions into the 2020 planting season and the potential for a repeat of planting difficulties in the year ahead. Should wet conditions persist in 2020 and create a situation where farmers are again confronted with delayed or prevented planting, many producers may also bump up against a limit on the continued use of crop insurance PPL. Another looming concern for market watchers and policymakers is that, should wet conditions persist in 2020, they could signal the potential for continued dependence on federal programs to sustain farm incomes in 2020.


U.S. airports are important contributors to the U.S. economy, providing mobility for people and goods, both domestically and internationally. About 3,300 airports in the United States are part of the national airport system and eligible to receive federal AIP grants to fund infrastructure projects. To help fund these projects, certain categories of airports are also authorized by federal law to collect PFCs, which passengers pay when buying tickets. GAO was asked to examine airport- funding sources and planned infrastructure projects. This report examines, among other issues: (1) levels of federal and other funding that U.S. airports received from fiscal years 2013 through 2017 for infrastructure projects, (2) projected costs of planned infrastructure investments at U.S. airports from fiscal years 2019 through 2023, and (3) any challenges selected airports identified in obtaining projects' funding and financing. GAO analyzed airport-funding data for AIP grants, PFCs, airport-generated revenue, and other sources for fiscal years 2013–2017—the most recent years for which data were available—and FAA's and Airports Council – North America's cost estimates of airports' planned infrastructure projects for fiscal years 2019–2023. GAO also interviewed FAA officials; representatives from airline and airport associations, and bond-rating agencies; officials from 19 selected airports representing airports of different sizes and with the highest planned development costs, among other things; and representatives from eight selected airlines, selected based on factors such as passenger traffic. From fiscal years 2013 through 2017, U.S. airports received an average of over $14 billion annually for infrastructure projects. The three largest funding sources are below: Funding from federal Airport Improvement Program (AIP) grants has remained relatively constant, at an annual average of $3.2 billion. Smaller airports (small hub, non-hub, and general aviation) collectively received more AIP funding compared to larger airports (large and medium hub). Revenue from federally authorized passenger-facility charges (PFC), a per-passenger fee charged at the ticket's point of purchase, increased by 9 percent, with an annual average of $3.1 billion. Increases in passengers and PFC revenue at larger airports contributed to this increase. Airport-generated revenue (e.g., concessions and airline landing fees) increased by 18 percent, with an annual average of $7.7 billion. While both larger and smaller airports experienced increases in these revenues, the larger airports made up 92 percent ($7.1 billion) of these revenues. In addition to these sources, some airports obtained financing by issuing bonds, secured by airport revenue or PFCs. According to Federal Aviation Administration (FAA) data, larger airports were able to generate more bond proceeds than smaller airports in part because larger airports are more likely to have a greater, more certain revenue stream to repay debt. Airports' planned infrastructure costs for fiscal years 2019 through 2023 are estimated to average $22 billion annually (in 2017 dollars)—a 19 percent increase over prior estimates for fiscal years 2017 through 2021. These costs are expected to increase in part because airports are planning to invest in more terminal projects. For example, cost estimates for AIP-eligible terminal projects increased about 51 percent when compared to FAA's prior 5-year estimate. FAA and airport association representatives stated that terminal projects can be more expensive than other projects because of the scale of the improvements, which can include renovating terminals to repair aging facilities and accommodate larger aircraft and growth in passengers. Officials from GAO's 19 selected airports cited several challenges to funding infrastructure projects. For example, officials stated that the funding and revenue they receive from combined sources may not be sufficient to cover the costs of planned infrastructure projects. The officials also raised concerns about being able to finance future airport-infrastructure projects because they have already obligated their current and future PFCs to service debt on completed and ongoing infrastructure projects. According to FAA data, in fiscal years 2013 through 2017, airports paid a total of $12 billion—or 78 percent of total PFC revenues collected—for debt service. Bond-rating agencies, however, continue to give airports high or stable ratings, and rating agencies' representatives stated that airports' access to capital markets continues to remain favorable. Some airport officials stated that to address funding challenges, they have deferred some needed infrastructure investments or completed projects in phases, steps that increased construction times and costs.


U.S. international family planning activities stem from a provision of the Foreign Assistance Act of 1961 (Section 104, P.L. 87-195; as amended), which authorized research on family planning issues, among many other things. In 1965, Congress authorized the U.S. Agency for International Development (USAID) to create contraceptive distribution programs. Originally, international family planning programs focused on distributing contraceptives and related commodities. Over time, such programs evolved to also address reproductive health issues, such as female genital mutilation (FGM) and obstetric fistula prevention and care. The United States is the largest donor of international family planning and reproductive health (FP/RH) assistance, supporting programs in 40 countries and providing, in recent years, $575 million annually in bilateral aid for this purpose. USAID administers the majority of this funding, which Congress appropriates primarily through the Global Health Programs account in the annual State, Foreign Operations and Related Programs appropriation. Policy debates about U.S. bilateral foreign assistance for FP/RH activities have focused primarily on whether recipient organizations could repurpose those funds to indirectly support abortion, despite legislation barring the use of U.S. funds for such purposes. Other aspects of FP/RH programs, particularly those related to curbing child marriage and gender-based violence, have generally received broad based support. This report describes the background and history of U.S. bilateral international family planning and reproductive health programs, funding trends, and related policy debates, including the effects of the Mexico City Policy/Protecting Life in Global Health Assistance restrictions and other abortion, and involuntary sterilization related restrictions on voluntary family planning and reproductive health services supported by U.S. bilateral foreign assistance; appropriate funding levels for international family planning and reproductive health programs; the utility of more or less integration of family planning/reproductive health programs and maternal and child health funding and programs; and pending legislation focused on international family planning assistance. This report does not cover family planning assistance channeled through multilateral organizations, such as the U.N. Population Fund (UNFPA). It provides only limited discussion of legislative restrictions and executive branch policies related to international abortion, which are detailed in other CRS products. For information on legislative restrictions, U.S. domestic abortion laws, and U.S. global health assistance, including international family planning, see the following CRS products: CRS In Focus IF11013, Protecting Life in Global Health Assistance Policy , by Tiaji Salaam-Blyther and Sara M. Tharakan. CRS Report R41360, Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Law and Policy , by Luisa Blanchfield. CRS Report RL33467, Abortion: Judicial History and Legislative Response , by Jon O. Shimabukuro. CRS In Focus IF10131, U.S. Global Health Assistance: FY2017-FY2020 Request , by Tiaji Salaam-Blyther.


CHIP is a public insurance program established in 1997 that finances health care for over 9 million low-income children whose household incomes do not qualify them for Medicaid. States have flexibility in structuring their CHIP programs under broad federal requirements, and their income eligibility limits vary. Policymakers have had concerns that some states' inclusion of children from families with higher income levels could result in some families substituting CHIP for private insurance (i.e., crowd-out). Crowd-out may occur when, because of CHIP availability, (1) employers make decisions about offering health insurance; or (2) employees make decisions about enrolling in employer-sponsored health insurance. GAO was asked to examine CHIP crowd-out. This report describes (1) the information on potential indicators of crowd-out reported by states and estimates of crowd-out; and (2) the procedures CMS and states use to address potential crowd-out. GAO reviewed federal laws and guidance and state CHIP documentation, including their 2017 annual reports (the latest available at the time of GAO's review); conducted a literature review of studies published between 2013 and 2018; and interviewed CMS officials, stakeholders from national health policy organizations, and researchers. GAO also interviewed a non-generalizable selection of officials from nine states chosen to obtain variation in CHIP programs, such as income eligibility levels and geography. HHS provided technical comments on a draft of this report, which GAO incorporated as appropriate. Limited information exists about Children's Health Insurance Program (CHIP) crowd-out—that is, substituting CHIP for private health insurance. The Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services (HHS), asked the 42 states that have separate CHIP programs to report on two crowd-out indicators for the 2017 annual reports: (1) the percentage of individuals who are enrolled in CHIP that have access to private health insurance and (2) the percentage of CHIP applicants who cannot be enrolled because they have private health insurance. The 2017 reports showed that: 4 states reported 0.5 percent to 7 percent of CHIP applicants had access to private health insurance; and 21 states reported denying CHIP enrollment to 0 percent to 18 percent of applicants because they had private insurance. Not all of these 42 states reported on these indicators and GAO found that those that do may calculate them differently. CMS officials acknowledged that not all states report on these indicators; however, they noted that states operating separate CHIPs have other processes in place to prevent children with other health insurance from enrolling in CHIP. Further, some states may have other processes for directly measuring CHIP crowd-out. GAO also identified three studies published between 2013 and 2018 that estimated CHIP crowd-out. However, these studies used different methods to calculate crowd-out, and as a result produced varied estimates. For example, one study attributed a portion of increased enrollment in CHIP and other public insurance to crowd-out, while another study found no evidence of crowd-out. According to CMS's 2017 annual reports and other information, the 42 states with separate CHIP programs reported implementing at least one of six types of crowd-out prevention procedures. Source: GAO analysis of information from the Centers for Medicare & Medicaid Services, state Children's Health Insurance Programs (CHIP), and a Kaiser Family Foundation and Georgetown Center for Children and Families survey on Medicaid and CHIP programs. │GA O-20-12


U.S. international food assistance programs provide food, or the means to purchase food, to people around the world at risk of hunger. Congress funds these programs through two appropriations bills: the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Actâalso known as the Agriculture appropriations billâand the Department of State, Foreign Operations, and Related Programs (SFOPS) Appropriations Act. The Agriculture appropriations bill funds the U.S. Department of Agriculture (USDA) except for the Forest Service. The SFOPS appropriations bill funds the U.S. Department of State, U.S. Agency for International Development (USAID), and other non-defense foreign policy agencies. Both bills provide funding for U.S. international food assistance programs. Appropriations for agricultural development programs, such as Feed the Future or international agricultural exchange programs, are not considered part of food assistance spending. For FY2020, the Further Consolidated Appropriations Act, 2020 ( P.L. 116-94 ), provided an estimated $4.091 billion in funding for U.S. international food assistance programs. This was an 11% decrease from the $4.581 billion provided in FY2019. Division B of the act provided $1.945 billion in agriculture appropriations for international food assistance programs, including $1.725 billion for the Food for Peace (FFP) Title II program and $220 million for the McGovern-Dole International Food for Education and Child Nutrition Program. Division G of the act provided an estimated $2.146 billion for international food assistance in SFOPS appropriations. This included $80 million in the Community Development Fund and an estimated $2.066 billion for the Emergency Food Security Program (EFSP). Congress funds EFSP within the International Disaster Assistance (IDA) account but does not designate a specific amount for the program. USAID allocates IDA funds to EFSP and other non-food humanitarian response programs. The estimated FY2020 EFSP appropriation is a CRS calculation based on a five-year average of the percentage of IDA funds allocated to EFSP. In its FY2020 budget request, the Trump Administration proposed to eliminate the FFP Title II, McGovern-Dole, and Food for Progress programs, which Congress funds within Agriculture appropriations. The Administration proposed to consolidate multiple accounts, including accounts within Agriculture and SFOPS appropriations that fund international food assistance and other humanitarian assistance, into a new International Humanitarian Assistance account. Congress did not adopt these proposals. In addition to funding U.S. international food assistance programs, the FY2020 Agriculture appropriations bill included policy-related provisions that directed the executive branch how to carry out certain appropriations. The Explanatory Statement accompanying P.L. 116-94 , as well as committee reports accompanying the House and Senate Agriculture and SFOPS appropriations bills, also included policy provisions related to international food assistance. For example, one provision directed that a certain amount of the funds appropriated for the McGovern-Dole Program be used for local and regional procure ment âfood assistance purchased in the country or region where it is to be distributed rather than purchased in the United States.