The increasing complexity and automation of flight control systems pose a challenge to federal policy regarding aircraft certification and pilot training. Despite significant commercial aviation safety improvements over the past two decades, flight control automation and aircraft complexity have been cited as contributing factors in a number of major airline accidents, including two high-profile crashes overseas involving the recently introduced Boeing 737 Max variant in 2018 and 2019. These crashes have directed attention to Federal Aviation Administration (FAA) oversight of aircraft type certification and pilot training practices for transport category aircraft, particularly as they pertain to complex automated flight control systems. As aircraft systems have evolved over the past three decades to incorporate new technologies, Congress has mandated FAA to streamline certification processes, with the primary motivation being to facilitate the development of new safety-enhancing technologies. Modern commercial aircraft rely on "fly-by-wire" flight control technologies, under which pilots' flight control inputs are sent to computers rather than through direct mechanical linkages to flight control systems. The fly-by-wire software contains flight control laws and logic that, in addition to optimizing performance efficiency, protect the aircraft from commanded actions that could put the airplane in an unsafe state. Automated flight control systems have largely been viewed as having a positive effect on safety, and accident rates have improved considerably over the past two decades. However, the increasing complexity of automated flight systems has sometimes caused confusion and uncertainty, contributing to improper pilot actions during critical phases of flight and in some cases leading pilots to unintentionally place an aircraft in an unsafe condition. Besides designing these systems in a manner that minimizes pilot errors and the consequences of those errors, aircraft designers and operators face challenges regarding maintaining piloting skills for flight crews to be able to take over and manually fly the aircraft safely if critical systems fail. They also face challenges regarding documentation and pilot training effectiveness in building accurate mental models of how these complex systems operate. The primary goals of ongoing efforts to address these challenges are to enhance pilot situation awareness when using automation and reduce the likelihood of mode errors and confusion, while at the same time not overburdening pilots with intricate systems knowledge beyond what is necessary. In the ongoing investigations of two Boeing 737 Max crashes, Lion Air flight 610 and Ethiopian Airlines flight 302, concerns have been raised about the design of an automated feature called the Maneuvering Characteristics Augmentation System (MCAS) and its reliance on a single angle-of-attack sensor even though the aircraft is equipped with two such sensors. These concerns led to the worldwide grounding of all Boeing 737 Max aircraft until the MCAS safety concerns can be resolved, significantly impacting both U.S. and foreign airlines that operate the aircraft. These recent aviation accidents have prompted reviews of the manner in which modern transport category aircraft are certified by FAA and its foreign counterparts, and in particular, the roles of regulators and manufacturers in the certification process. The challenges of certifying increasingly complex aircraft are largely being met by delegating more of FAA's certification functions to aircraft designers and manufacturers. This raises potential conflicts between safety and quality assurance on the one hand and competitive pressures to market and deliver aircraft on the other. Under Organization Designation Authorization (ODA), FAA can designate companies to carry out delegated certification functions on its behalf. Congress has supported the ODA framework and in recent FAA reauthorization legislation ( P.L. 115-254 ) directed FAA to establish performance objectives and metrics for aircraft certification that both streamline the certification process and increase transparency and accountability for both FAA and the aviation industry. However, the Boeing 737 Max grounding has prompted reviews of the certification process to identify potential gaps in oversight. Foreign authorities have also put pressure on FAA to review its certification delegation practices, although similar approaches are used in Europe. The inquiries have led to broader discussions about aircraft certification practices and also about global training, qualification, and currency standards for airline pilots.


The innovative use of technology by insurance companies (insurtech) is growing and offers the potential to improve customer experiences while also lowering insurer costs. Some stakeholders have raised questions about how certain uses of insurtech could create both risks for consumers and challenges for regulators, and whether some challenges might slow technological innovation in the insurance sector. GAO was asked to provide information on insurtech activities in the property/casualty and life insurance sectors. This report (1) identifies new uses of technologies and potential benefits and challenges for insurers and their customers; and (2) discusses what stakeholders identified as key challenges that could affect the adoption of new technologies, and actions taken to address those challenges. GAO reviewed available literature; analyzed relevant laws and regulations; and conducted interviews with more than 35 stakeholders, including federal and state regulators, technology companies, insurers, and consumer groups (selected based on literature reviews and recommendations, and for relevance to the scope of GAO's review). GAO is not making any recommendations in this report. Insurtech companies (recently established companies bringing technology-enabled innovations to the insurance industry) as well as established insurers have begun to use technologies, including artificial intelligence (AI) and mobile applications, in an attempt to improve risk assessment and enhance customer experiences. For example: Consumers can purchase insurance products specifically tailored to their situation and needs, such as renters or auto insurance that can be turned on and off as needed using a mobile app. Some insurers have begun to use nontraditional data (such as from social media) to analyze policyholder risk, and use AI and complex algorithms to reduce costs by automating information gathering and risk assessment. However, implementing these technologies can create potential challenges for insurers and risks for consumers, including the following: The use of AI to create underwriting models for determining premium rates can make it challenging for insurers to ensure that factors prohibited by regulation (such as race) are not used in models. Such models are often developed by data scientists who, unlike actuaries, may not fully understand insurance-specific requirements. Insurer collection and use of consumer data not provided by the consumer raise questions about data accuracy, privacy, and ownership. Some insurtechs sell coverage through nonadmitted insurers. As we have previously reported, nonadmitted insurers—unlike traditional insurers—are not required to be licensed in each state in which they sell insurance, and receive less regulatory oversight of their policies and rates. Also, if nonadmitted insurers became insolvent, state guaranty funds would not be available to help pay policyholder claims. Stakeholders with whom GAO spoke identified challenges they said might affect adoption of innovative technologies. These include paper-based documentation requirements that do not accommodate online insurance transactions, and challenges for regulators in the evaluation of complex rating models. The National Association of Insurance Commissioners (NAIC) and state regulators have initiated a number of actions designed to address such concerns. For example: State insurance regulators, through an NAIC task force, have been examining regulatory areas that may pose obstacles for innovation, such as requirements for paper documentation or signatures. NAIC issued draft best practices for states to use when reviewing complex rating models. NAIC adopted a model law that creates a legal framework for states to use to require insurance companies to operate cybersecurity programs and protect consumer data. Because many of these regulatory initiatives are still in development (or recently developed), the effect on innovation and consumer protection is unknown.


The international financial institutions (IFIs), including the International Monetary Fund (IMF), the World Bank, and regional and specialized multilateral development banks, are mobilizing unprecedented levels of financial resources to support countries responding to the health and economic consequences of the COVID-19 pandemic. More than half of the IMF's membership has requested IMF support, and the IMF has announced it is ready to tap its total lending capacity, about $1 trillion, to support governments responding to COVID-19. The World Bank has committed to mobilizing $160 billion over the next 15 months, and other multilateral development banks have committed to providing $80 billion during that time period. At the urging of the IMF and the World Bank, the G-20 countries in coordination with private creditors have agreed to suspend debt payments for low-income countries through the end of 2020. Policymakers are discussing a number of policy actions to further bolster the IFI response to the COVID-19 pandemic. Examples include changing IFI policies to allow more flexibility in providing financial assistance, pursuing policies at the IMF to increase member states' foreign reserves, and providing debt relief to low-income countries. Congressional Role Congress exercises oversight of U.S. participation of the IFIs and authorizes and appropriates U.S. financial contributions to the IFIs. In response to the overwhelming demand for IFI resources, in March 2020 Congress accelerated authorizations that were under consideration in the FY2021 budget request to increase funding for the IMF, two World Bank lending facilities, and two African Development Bank lending facilities ( P.L. 116-136 ). Some of the policy actions under discussion to bolster the IFI response to the COVID-19 pandemic, such as IMF gold sales, IMF policies to bolster foreign reserves, and additional debt relief for low-income countries, would require congressional legislation. Some Members of Congress may seek to shape or exercise broader oversight of U.S. policy towards IFI policy changes as well as new IFI programs that could exceed $1 trillion.


The lack of reliable data on federal assets is one of the main reasons Federal Real Property Management remains on GAO's high risk list. In 2016, legislation required GSA to publish a single, comprehensive, and descriptive database of federal real property that would be available to the public. The database could be used for research and other potential applications. GAO was asked to study the public database. This report assesses (1) GSA's efforts to improve the reliability of FRPP's data and the public database, (2) the public database's completeness, and (3) the presentation of the data in the public database. GAO reviewed federal laws, documents, and data, including GSA's fiscal years 2017 and 2018 FRPP and public databases. GAO interviewed officials at GSA and from six federal agencies selected in locations with enough questionable data in the public database to analyze, among other things, and studied assets in Washington, D.C., Illinois, and New Mexico. GAO also interviewed selected stakeholders involved in federal real property management, such as real estate brokers. The General Services Administration (GSA) has worked in recent years to improve reliability of the Federal Real Property Profile (FRPP), which tracks federal real property assets. However, numerous errors in the database were carried into the public version. GSA extracted data from the FRPP's 398,000 civilian federal assets to create a public database to be used, for example, by researchers and real estate developers. However, GSA's data verification process did not address key errors. GAO found that 67 percent of the street addresses in the public database were incomplete or incorrectly formatted. For example, the database lists “Greenbelt Road” as the address for over 200 buildings at NASA's Goddard Space Flight Center, but the road stretches over 6.3 miles, thereby reducing a user's ability to locate specific buildings. The public database is not complete because GSA and selected agencies decided not to provide certain useful information. Specifically, GSA withheld assets' information without consulting those agencies managing the assets and allowed agencies to withhold information that is already publicly available. For example, GSA withheld the name “Goddard Space Flight Center” from the public database, but NASA's website lists this name and the Center's location. Unnecessarily withholding information limits the database's utility and undermines analysis. The public database's usefulness is further limited by how GSA presents the information. Because the database does not identify if an asset is part of a secure installation, the public does not know if assets, such as the unnamed buildings at Goddard, are accessible to the public. Unless GSA improves the public database's accuracy, completeness, and usefulness, its benefits may not be realized.


The legislative branch appropriations bill provides funding for the Senate; House of Representatives; Joint Items; Capitol Police; Office of Congressional Workplace Rights (formerly Office of Compliance); Congressional Budget Office (CBO); Architect of the Capitol (AOC); Library of Congress (LOC), including the Congressional Research Service (CRS); Government Publishing Office (GPO); Government Accountability Office (GAO); Open World Leadership Center; and the John C. Stennis Center. The legislative branch budget request was submitted on March 11, 2019. Following hearings in the House and Senate in February, March, and April, the House Appropriations Committee Subcommittee on the Legislative Branch held a markup on May 1, 2019. No amendments were considered, and the bill was ordered reported to the full committee by voice vote. On May 9, 2019, the House Appropriations Committee held a markup of the bill. Two manager's amendments were considered. The first amendment was adopted by voice vote. The second amendment was adopted by voice vote after an amendment to the amendment was not adopted (23-28). The bill was ordered reported ( H.Rept. 116-64 ; H.R. 2779 ). As amended, the bill would have provided $3.972 billion, not including Senate items (+$164.2 million). On June 3, the House Committee on Rules announced its intention to consider and report a resolution that would structure the consideration in the House of H.R. 2740 , the Labor, Health and Human Services, and Education appropriations bill. The committee indicated that the resolution would add the text of four additional appropriations bills to the text of H.R. 2740 , including the text of H.R. 2779 as Division B. Although draft amendments were submitted related to legislative branch appropriations, that division was stricken prior to consideration of H.R. 2740 on the House floor. On September 26, the Senate Appropriations Committee met to mark up its version of the FY2020 legislative branch appropriations bill. It reported the bill on the same day by recorded vote (31-0). S. 2581 ( S.Rept. 116-124 ) would have provided $3.600 billion, not including House items (+$187.6 million). Continuing appropriations resolutions ( P.L. 116-59 and P.L. 116-69 ) provided funding for legislative branch activities until the enactment of P.L. 116-94 on December 20, 2019. Division E provides $5.049 billion (+$202.8 million, or +4.2%, from the FY2019 level). Additional language related to the legislative branch was included in Division P. During consideration of the FY2020 funding levels, Congress also considered $10.0 million in FY2019 supplemental appropriations for GAO for audits and investigations related to storms and disasters ( P.L. 116-20 , enacted June 6, 2019). Previously, over the last decade The FY2019 level of $4.836 billion represented an increase of $136.0 million (+2.9%) from FY2018, not including the FY2019 supplemental. The FY2018 level of $4.700 billion represented an increase of $260.0 million (+5.9%) from FY2017. The FY2017 level of $4.440 billion represented increase of $77.0 million (+1.7%) from FY2016. The FY2016 level of $4.363 billion represented an increase of $63.0 million (+1.5%) from FY2015. The FY2015 level of $4.300 billion represented an increase of $41.7 million (+1.0%) from FY2014. The FY2014 level of $4.259 billion represented an increase of $198 million (+4.9%) from FY2013. The FY2013 level of $4.061 billion represented a decrease of $246 million (-5.6%), including the sequestration and rescission, from FY2012. The FY2012 level of $4.307 billion represented a decrease of $236.9 million (-5.2%) from FY2011. The FY2011 level of $4.543 billion represented a decrease of $125.1 million (-2.7%) from the $4.669 billion provided for FY2010. The smallest of the appropriations bills, the legislative branch bill comprises approximately 0.4% of total discretionary budget authority.


Between 1969 and 1999, almost 3,500 people died as a result of political violence in Northern Ireland, which is one of four component "nations" of the United Kingdom (UK). The conflict, often referred to as "the Troubles," has its origins in the 1921 division of Ireland and has reflected a struggle between different national, cultural, and religious identities. Protestants in Northern Ireland (48% of the population) largely define themselves as British and support remaining part of the UK ( unionists ). Most Catholics in Northern Ireland (45% of the population) consider themselves Irish, and many desire a united Ireland ( nationalists ). Successive U.S. Administrations and many Members of Congress have actively supported the Northern Ireland peace process. For decades, the United States has provided development aid through the International Fund for Ireland (IFI). In recent years, congressional hearings have focused on the peace process, police reforms, human rights, and addressing Northern Ireland's legacy of violence (often termed dealing with the past ). Some Members also are concerned about how the UK's decision to withdraw from the European Union (EU)âknown as Brexit âmight affect Northern Ireland. The Peace Agreement: Progress to Date and Ongoing Challenges In 1998, the UK and Irish governments and key Northern Ireland political parties reached a negotiated political settlement. The resulting Good Friday Agreement, or Belfast Agreement, recognized that a change in Northern Ireland's constitutional status as part of the UK can come about only with the consent of a majority of the people in Northern Ireland (as well as with the consent of a majority in Ireland). The agreement called for devolved governmentâthe transfer of specified powers from London to Belfastâwith a Northern Ireland Assembly and Executive in which unionist and nationalist parties would share power. It also contained provisions on decommissioning (disarmament) of paramilitary weapons, policing, human rights, UK security normalization (demilitarization), and the status of prisoners. Despite a much-improved security situation since 1998, full implementation of the peace agreement has been difficult. For years, decommissioning and police reforms were key sticking points that generated instability in the devolved government. In 2007, the pro-British Democratic Unionist Party (DUP) and Sinn Fein, the nationalist political party traditionally associated with the Irish Republican Army (IRA), reached a landmark power-sharing deal. Tensions and distrust persisted, however, between the unionist and nationalist communities and their respective political parties. Ten years later, the devolved government led by the DUP and Sinn Fein collapsed, prompting snap Assembly elections in March 2017 amid several contentious regional issues and unease in Northern Ireland about Brexit. Negotiations to reestablish the devolved government repeatedly stalled. The DUP and Sinn Fein agreed to form a new devolved government in January 2020, but the long impasse renewed concerns about the stability of the power-sharing institutions and the fragility of community relations. Northern Ireland also faces a number of broad challenges in its search for peace and reconciliation, including reducing sectarian divisions, dealing with the past, addressing lingering concerns about paramilitary and dissident activity, and promoting further economic development. Brexit and Northern Ireland Brexit occurred on January 31, 2020, and may have significant political and economic repercussions for Northern Ireland. In the UK's 2016 public referendum on EU membership, voters in Northern Ireland favored remaining in the EU, 56% to 44% (the UK overall voted in favor of leaving, 52% to 48%). The future of the border between Northern Ireland and Ireland was a central issue in the UK's withdrawal negotiations with the EU. Since 1998, as security checkpoints were dismantled in accordance with the peace agreement and because both the UK and Ireland belonged to the EU single market and customs union, the circuitous 300-mile land border between Northern Ireland and Ireland effectively disappeared. Many on both sides of the sectarian divide viewed this open border as intrinsic to peace and crucial to fostering a dynamic cross-border economy. Preventing a hard border (with customs checks and physical infrastructure) post-Brexit was thus a key imperative and a major stumbling block in the UK-EU withdrawal negotiations. Although concerns about a hard border developing have receded in light of the solution found in the UK-EU withdrawal agreement, Brexit has added to divisions within Northern Ireland and revived questions about the region's constitutional status. Sinn Fein, for example, has called for a border poll , or referendum, on whether Northern Ireland should remain part of the UK. Also see CRS Report R45944, Brexit: Status and Outlook , coordinated by Derek E. Mix.


The legislative response to the global pandemic of Coronavirus Disease 2019 (COVID-19) has included the enactment of laws to provide authorities and supplemental funding to prevent, prepare for, and respond to the pandemic. This report focuses on supplemental FY2020 discretionary appropriations provided to programs and activities traditionally funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. As of the date of this report, LHHS supplemental appropriations for COVID-19 response have been provided in four separate supplemental appropriations measures: Title III, Division A, of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 ( P.L. 116-123 ), enacted on March 6, 2020, provided approximately $6.4 billion in supplemental LHHS funds. Title V, Division A, of the Families First Coronavirus Response Act (FFCRA, P.L. 116-127 ), enacted on March 18, 2020, provided $1.25 billion in supplemental LHHS funds. Title VIII, Division B, of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act, P.L. 116-136 ), enacted on March 27, 2020, provided $172.1 billion in supplemental LHHS funds. Title I, Division B, of the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA, P.L. 116-139 ), enacted on April 24, 2020, provided $100 billion in supplemental LHHS funds. In total, LHHS has received roughly $280 billion in supplemental discretionary appropriations from these COVID-19 response measures. These supplemental funds are in addition to roughly $195 billion in regular FY2020 LHHS discretionary appropriations provided in Division A of P.L. 116-94 , the FY2020 omnibus appropriations act containing full-year LHHS appropriations that was enacted on December 20, 2019. Unlike the annual discretionary appropriations, however, these additional funds were designated as an "emergency requirement" and thus were effectively exempted from otherwise applicable budget enforcement requirements (such as the statutory discretionary spending limits). Overall, the COVID-19 supplemental funds have increased FY2020 LHHS discretionary appropriations by approximately 143%. The Department of Health and Human Services (HHS) received funding in all four COVID-19 supplemental appropriations acts, whereas the Department of Labor (DOL), Department of Education (ED), and entities funded under the "Related Agencies" heading received funding in the third supplemental only. In total, HHS received $248 billion, or 89% of all COVID-19 LHHS supplemental appropriations. ED received the second-largest share at $31 billion, or 11%. DOL and the Related Agencies received approximately 0.1% and 0.2% of the LHHS COVID-19 supplemental funds, respectively.


The majority of veterans utilizing VA health care services receive care in VA-operated medical facilities, including 172 VA medical centers and more than 1,000 outpatient facilities. For nearly 20 years, GAO has reported on the challenges VA medical facilities have faced providing health care services in a timely manner. When veterans face wait times at VA medical facilities, they may be able to receive services from VA's community care programs, which VA estimates will be 19 percent of its $86.5 billion in health care obligations in fiscal year 2020. This testimony focuses on GAO's large body of work on veterans' access to care and the status of VA's efforts to address GAO's recommendations, including those from GAO's June 2018 report on VA's community care programs and from GAO's December 2012 report on VA's scheduling of timely medical appointments that VA has provided information on through July 2019. It also includes preliminary observations on related ongoing work. GAO has issued several reports recommending that the Department of Veterans Affairs (VA) take action to help ensure its facilities provide veterans with timely access to medical care. VA has taken a number of steps to address GAO's recommendations to improve wait-time measurement and its appointment scheduling policy. However, additional actions are needed to fully address most of GAO's recommendations. GAO found in 2012 that outpatient appointment wait times reported by VA were unreliable because VA did not ensure consistency in schedulers' definitions of the dates by which wait times were measured. GAO recommended that VA clarify these definitions. VA concurred and has taken a number of actions in response, including improved oversight through scheduling audits. However, VA's first internal audit in August 2018 was unable to evaluate the accuracy and reliability of its wait-time data due to the lack of business rules for calculating them, indicating that additional efforts are needed to address this issue. GAO also found in 2012 that not all facilities GAO visited used the electronic wait list to track new patients that needed medical appointments, as required by VA's scheduling policy. This put patients at risk for being lost for appointment scheduling. GAO recommended VA ensure consistent implementation of its policy, and that all schedulers complete required training. VA concurred, and with the information VA provided in July 2019 GAO considers VA's actions, including updating its scheduling policy and completing scheduler training, sufficient to fully address the recommendation. While improvements to VA's scheduling policy and processes will help ensure veterans receive timely access to care, there are other factors that may also affect access that are not currently reflected in VA's wait-time data. For example, GAO found instances in which the time it took the agency to initially enroll veterans in VA health care benefits was more than 3 months. GAO has also made recommendations to improve appointment scheduling and ensure timely access to care from non-VA providers in VA's community care programs that remain unimplemented. GAO found in June 2018 that the data VA used to monitor the timeliness of the Veterans Choice Program's appointments captured only a portion of the total appointment scheduling process. Although VA had a wait-time goal of 30 days, VA's timeliness data did not capture certain processes, such as the time taken to prepare veterans' referrals and send them to a third-party administrator. GAO found that if these were accounted for, veterans could potentially wait up to 70 calendar days to see a community care provider. VA officials stated that most recommendations will be addressed with new program tools it plans to implement. For example, VA is implementing a system for referral management and appointment scheduling expected to be available in all VA medical facilities by fiscal year 2021. While technology may be an important tool, VA will also need clear and consistent policies and processes, adequate oversight, and effective training to help avoid past challenges.


The manner in which staff are integrated and utilized within an organization may reflect the missions and priorities of that organization. In Congress, staff work for Members of Congress in personal, committee, and leadership offices, and are involved with every facet of congressional activity. Activities might include supporting a Member's representational, legislative, leadership, or administrative responsibilities as they arise in those settings. House and Senate staff activities may be of particular interest as one Congress comes to a close, and another Congress integrates new Members and staff in support of addressing its constitutional and representational responsibilities. Interest in staff issues may also arise when considering committee funding or appropriations for the legislative branch. CRS has several products about congressional staff, listed below, that provide information about staff roles and data over time about the number of staff, pay levels, and time in specific positions in Member office and committee settings. Congressional clients may contact the authors of the individual reports for additional information.


The market for electrified light-duty vehicles (also called passenger vehicles; including passenger cars, pickup trucks, SUVs, and minivans) has grown since the 1990s. During this decade, the first contemporary hybrid-electric vehicle debuted on the global market, followed by the introduction of other types of electric vehicles (EVs). By 2018, electric vehicles made up 4.2% of the 16.9 million new light-duty vehicles sold in the United States that year. Meanwhile, charging infrastructure grew in response to rising electric vehicle ownership, increasing from 3,394 charging stations in 2011 to 78,301 in 2019. However, many locations have sparse or no public charging infrastructure. Electric motors and traction battery packsâmost commonly made up of lithium-ion battery cellsâset EVs apart from internal combustion engine vehicles (ICEVs). The battery pack provides power to the motor that drives the vehicle. At times, the motor acts as a generator, sending electricity back to the battery. The broad categories of EVs can be identified by whether they have an internal combustion engine (i.e., hybrid vehicles) and whether the battery pack can be charged by external electricity (i.e., plug-in electric vehicles). The numerous vehicle technologies further determine characteristics such as fuel economy rating, driving range, and greenhouse gas emissions. EVs can be separated into three broad categories: Hybrid-electric vehicles (HEVs): The internal combustion engine primarily powers the wheels. The battery pack and electric motor provide supplemental power. Plug-in hybrid-electric vehicles (PHEVs): The battery pack can be charged by an external source of electricity. Depending on the model, primary power to the wheels may be supplied by the battery pack and electric motor, the internal combustion engine, or a combination. All-electric vehicles (AEVs; also called battery-electric vehicles or BEVs): The battery pack must be charged via an external source of electricity. The battery pack and electric motor power the wheels. Current technology offers three levels of charging for plug-in EVs. Level 1 and Level 2 are currently the most widely accessible with standardized vehicle connectors and charge ports that can be set up for at-home charging. Level 3 (also called DC fast charging) offers the fastest charging rates on the market but is not available for at-home installation due to high voltage. Vehicle connectors and corresponding charge ports for Level 3 are also not standardized, with three different systems currently in use by different vehicle manufacturers. Some research has raised concerns regarding the potential impact of fast charging on battery performance, resulting in technology development aimed at addressing potential capacity loss and decreased charging cycles. As an emergent technology area, EVs present a number of issues for consideration. The fuel sources used to generate the electricity to charge PHEVs and AEVs are a major factor in determining EV greenhouse gas emissions relative to ICEVs. Per-mile EV emissions vary geographically and with the time of day and year that charging takes place. Growing demand for lithium-ion batteries also shifts the material requirements of the vehicle market from fuels for combustion to minerals and other materials for battery production. A growing EV market may encourage new strategies around the supply and refining of raw materials, ability to manufacture batteries, and end-of-life management for batteries that are no longer suitable for use in vehicles. Support for EV deployment stems from, among other things, federal and state policies establishing manufacturing rebates, tax credits for purchases, funding for research and development, and standards for fuel economy and emissions. These policies include the Plug-In Electric Vehicle Tax Credit, and the coordinated Corporate Average Fuel Economy (CAFE) standards and emissions standards for vehicles. Over time, some federal incentives and grant programs have expired. Several bills pending in the 116 th Congress would extend or repeal tax credits for EVs, establish highway usage fees on alternative fuel vehicles, fund grants for charging infrastructure, or establish a national zero-emissions vehicle standard.


The military services preposition stocks worth billions of dollars at strategic locations around the world to provide U.S. forces with critical assets before supply chains have been established. In the 2018 National Defense Strategy, DOD emphasized that prepositioned stocks provide key logistical support for the department's missions. For many years, GAO has identified the potential for duplication among the military services' prepositioned stock programs due to a fragmented management approach and limited joint oversight within DOD. In the NDAA for Fiscal Year 2014, Congress required DOD to develop an implementation plan to manage prepositioned stock programs. DOD finalized its plan in August 2017. The act included a provision for GAO to review the plan and report on related issues. GAO assessed the extent to which (1) DOD's implementation plan addresses mandated reporting elements and (2) DOD has made progress in implementing a joint oversight approach for managing the services' prepositioned stock programs. GAO compared the implementation plan and DOD's joint oversight approach with congressional requirements and federal standards for internal control and interviewed DOD officials. The Department of Defense's (DOD) implementation plan for managing the military services' prepositioned stock programs does not fully address four of the seven elements required by the National Defense Authorization Act (NDAA) for Fiscal Year 2014. For example, DOD's plan did not include all information required by the NDAA, such as a complete list of the services' programs, information on how DOD would pursue key initiatives, or the resources required to implement the plan. DOD officials told GAO that they developed a plan without detail to allow the services to determine for themselves how to implement their programs. However, absent an implementation plan that fully addresses NDAA requirements, DOD continues to provide incomplete information to Congress on the department's prepositioned stock programs. Since 2011 when Congress required DOD to take action and since 2005 when GAO first reported on the issue, DOD has not fully implemented a joint oversight approach for managing prepositioned stock programs (see figure). DOD's recent approach for implementing joint oversight has been to update guidance documents and develop other efforts, such as a working group, but the services continue to manage their programs with little joint oversight. Without taking steps to fully implement joint oversight, including providing detailed information on how to achieve this in guidance and reviewing other efforts, DOD's management will continue to be fragmented and it risks duplication and inefficiencies among the services' programs. Moreover, updating Congress on DOD's progress would help assure decision makers that DOD intends to follow their direction in establishing joint oversight of prepositioned stock programs.


The military services' 21 depots maintain the readiness of critical weapon systems such as ships, aircraft, and tanks needed for military operations. The condition of depot facilities and equipment directly affects the timeliness of maintenance and the readiness of the weapon systems they repair. The services have invested over $13 billion in the depots from fiscal year 2007 to fiscal year 2017. Senate Report 115-125 included a provision for GAO to examine the services' investment in and performance of their depots. GAO evaluated (1) the condition of depot facilities and equipment, their relationship to depot performance, and the services' tracking of the relationship to depot performance and (2) the extent to which DOD and the services have developed an approach for guiding depot investments to address key challenges. GAO also provides an overview summary for each depot. GAO reviewed data from fiscal years 2007 through 2017 on depot investment, performance, and the age and condition of facilities and equipment; reviewed agency guidance; and interviewed DOD, service, and depot officials. The condition of facilities at a majority of the Department of Defense's (DOD) depots is poor and the age of equipment is generally past its useful life, but the services do not consistently track the effect that these conditions have on depot performance. Twelve of the 21 depots GAO reviewed––more than half––had “poor” average facility condition ratings (see figure). Some facilities also serve functions for which they were not designed, reducing their efficiency. In addition, the average age of depot equipment exceeded its expected useful life at 15 of the 21 depots. These factors contributed, in part, to a decline in performance over the same period. From 2007 to 2017, performance at the depots generally declined, reducing the availability of the weapon systems repaired for training and operations. Optimizing facilities and equipment at the depots can improve their maintenance efficiency. For example, the Navy estimates that its shipyard optimization effort will save over 325,000 labor days per year, which would allow an additional submarine overhaul annually. However, the services lack data on the effect that facilities and equipment conditions have on maintenance delays, hindering DOD's ability to effectively target investments to the highest priorities. DOD and the services' approach for managing investments to improve the efficiency and effectiveness of its depots lacks elements important to addressing key challenges. The services have efforts underway to complete their plans by February 2019 to address their depots' facility and equipment needs. However, GAO found that these plans are preliminary and will not include key elements, such as analytically-based goals; results-oriented metrics; a full accounting of the resources, risks, and stakeholders; and a process for reporting on progress. Addressing the poor conditions at DOD's 21 depots will cost billions and require sustained management attention over many years. However, the DOD office responsible for depot policy does not monitor or regularly report on depot improvement efforts to DOD decision makers and Congress. Until DOD and the services incorporate these key elements into the management approach for their depot investments, they risk continued deterioration of the depots, hindering their ability to meet the Secretary of Defense's goals for improving readiness and reducing operating and support costs.


The mission of the presidential helicopter fleet is to provide safe, reliable, and timely transportation in support of the President. The Navy plans to acquire a fleet of 23 VH-92A helicopters to replace the current Marine Corps fleet of VH-3D and VH-60N aircraft. Initial delivery of VH-92A presidential helicopters is scheduled to begin in fiscal year 2020 with production ending in fiscal year 2023. The total cost of this acquisition program was originally estimated at almost $5.2 billion. The National Defense Authorization Act of 2014 included a provision for GAO to report on the VH-92A program annually, until the Navy awards the full-rate production contract. This report discusses (1) the extent to which the program is meeting its cost and schedule goals and (2) challenges facing the program in system development. To determine how the program is progressing, GAO analyzed program documents; and spoke with officials from the program office, the Defense Contract Management Agency, contractors, Director, Operational Test and Evaluation, and Department of Defense, Developmental Test and Evaluation. GAO also assessed the program's integrated master schedule against GAO best practices. Acquisition cost estimates for the Presidential Helicopter Replacement Program (also known as the VH-92A) have declined from $5.18 billion to $4.95 billion, for 23 new helicopters, since the program started in April 2014 (see table), and the program remains within its planned schedule. The contractor attributes this cost decrease to several factors: stable requirements, a low number of design changes, and program efficiencies. The program has delayed some program milestones—for example, its low-rate production decision—by 5 months from its original baseline goal. Although this remains within the approved schedule, the program will have less time than planned between the end of development testing and start of operational assessment. Program officials told GAO they expect to have enough information from both the government-led integrated testing and the operational assessment to inform the low-rate production decision. Continuing development challenges concerning performance requirements may affect whether the program can deliver fully capable aircraft on time in the future. These include: VH-92A start procedures: As we reported last year, the VH-92A was pursuing technical improvements related to Sikorsky's S-92A propulsion system, which has yet to meet a VH-92A performance requirement. Program risk for this performance requirement has not changed since our April 2018 report on the program. Landing zone suitability: As GAO found in 2018, the program has not yet met a key system capability requirement for landing the helicopter without damaging the landing zone—for example, the White House South Lawn. According to program officials, Sikorsky plans to have a solution for this performance requirement by November 2020 . Mission communications system: The VH-92A program has experienced problems connecting the aircraft's communication system to secure networks, due to changes in network security requirements, presenting a new risk area for the program. The Navy anticipates having a fix by January 2020. These changes are expected to be incorporated into the four production representative helicopters being built under the development contract in time for the program's initial operational test and evaluation.


The mission of the presidential helicopter fleet is to provide safe, reliable, and timely transportation in support of the President. The Navy plans to acquire a fleet of 23 VH-92A helicopters to replace the current Marine Corps fleet which has been in use for more than 40 years. Delivery of production VH-92A helicopters is scheduled to begin in April 2021 and be completed in January 2023. The National Defense Authorization Act of 2014 included a provision for GAO to report annually on the acquisition of the VH-92A helicopter. This report, GAO's sixth related to the provision, examines (1) the extent to which the program is meeting cost goals and (2) performance and schedule challenges that the program has experienced. To conduct this work, GAO compared the Navy's April 2019 cost estimates for acquiring and maintaining the new helicopters and October 2019 program schedule information to its April 2014 acquisition baseline. GAO reviewed development test results and status reports from the program. GAO also interviewed officials from the program office, Navy test organizations, and the contractor. GAO is not making any recommendations in this report. The Navy estimates the cost to develop, procure, and maintain the VH-92A ® over its 40-year operational life to be just over $20.5 billion, or about 10 percent less than the Navy's 2014 baseline estimate (see table). Navy and contractor officials worked to remain within the program's April 2014 cost baseline estimate, in part, by keeping program requirements stable, limiting design changes, and taking advantage of cost saving initiatives. The Navy also plans to use Navy personnel and facilities to perform depot-level maintenance for the VH-92A fleet, rather than sending the helicopters back to the contractor as is currently done. The program has made progress addressing technical risks and performance challenges GAO discussed in prior reports; however, an April 2019 operational assessment confirmed several other risks that could affect the helicopter's ability to meet its reliability and availability requirements. For example, Navy officials stated that the assessment confirmed known limitations with the mission communications system. Upgraded software intended to address those limitations is to be evaluated during the initial operational test and evaluation scheduled to be conducted between June and September 2020. The results of that testing could impact the Navy's planned January 2021 decision to begin using the helicopters as part of the presidential helicopter fleet.


The misuse of prescription opioid pain relievers and illicit opioids, such as heroin, has contributed to increases in OUD and overdose deaths. Pregnant women with OUD have an increased risk of overdose during the postpartum period. Opioids also caused over half of drug overdose deaths among youth in 2017. Medicaid plays a key role in covering services to treat OUD for low-income women and children. The SUPPORT Act includes a provision for GAO to study Medicaid coverage for pregnant and postpartum women with a substance use disorder, including OUD. The act also includes a provision for GAO to examine children's access to these services, such as through telehealth. This report describes Medicaid coverage of OUD services for (1) pregnant and postpartum women in selected states; (2) children in selected states; and (3) children delivered via telehealth in schools across all states, and utilization of these services. GAO reviewed documentation and interviewed officials from federal agencies within HHS to understand Medicaid coverage of OUD services for pregnant and postpartum women, as well as children. GAO also interviewed officials and reviewed documentation from six states selected for variation in opioid use rates, status of Medicaid expansion, and geographic variation, among other things. GAO also conducted outreach and received responses from 49 of 50 states and the District of Columbia about Medicaid coverage and use of OUD services delivered via telehealth in schools. HHS provided technical comments, which were incorporated as appropriate. All state Medicaid programs are required to provide coverage of health care services to pregnant women with incomes at or below 138 percent of the federal poverty level through 60 days postpartum. With regard to opioid use disorder (OUD), GAO found that six selected state Medicaid programs provide coverage of a range of services for eligible pregnant women with OUD. Specifically, the six states—Alabama, Arkansas, Colorado, Massachusetts, South Dakota, and Texas—covered OUD services, such as screening for opioid use, counseling, and medication-assisted treatment, which combines the use of medications with counseling. In the six selected states, women who are eligible for Medicaid coverage after 60 days postpartum can receive most of the same OUD services that were covered during pregnancy. Furthermore, GAO found that the six selected states also use other sources of funding, such as federal grants, to provide coverage of OUD services for postpartum women who are not eligible for Medicaid. GAO did not review how frequently the OUD services were actually provided to pregnant and postpartum women. GAO found that the state Medicaid programs in all six selected states cover annual screenings for substance use, which includes opioid use, for eligible children. This coverage is provided as part of Medicaid's Early and Periodic Screening, Diagnostic, and Treatment benefit, under which all states are required to cover certain screenings for eligible children under age 21. GAO also found that Medicaid programs in 31 states and the District of Columbia covered OUD services, including screenings, delivered through telehealth in schools. However, state Medicaid officials said they were not aware of any instances of these services being utilized through telehealth in schools. Telehealth can be used to provide clinical care remotely, such as for screening, counseling, and therapy. Such services could be provided, for example, via a video conference on a desktop computer or laptop that connects a student in school with a provider in another location. State officials and experts cited both benefits and challenges with providing OUD services through telehealth in schools. For example, benefits included addressing provider shortages, particularly in rural areas, as well as reducing the amount of time students spend outside of the classroom accessing services. Challenges included lack of needed infrastructure and provider discomfort with using telehealth. Agencies within the Department of Health and Human Services (HHS) have recently issued guidance emphasizing the use of telehealth for OUD services, particularly in schools.


The nation's electric grid—the commercial electric power generation, transmission, and distribution system comprising power lines and other infrastructure—delivers the electricity that is essential for modern life. As a result, the reliability of the grid—its ability to meet consumers' electricity demand at all times—has been of long-standing national interest. GAO was asked to review the cybersecurity of the grid. Among other things, this report (1) describes the cybersecurity risks facing the grid, (2) assesses the extent to which DOE has defined a strategy for addressing grid cybersecurity risks, and (3) assesses the extent to which FERC-approved standards address grid cybersecurity risks. To do so, GAO developed a list of cyber actors that could pose a threat to the grid; identified key vulnerable components and processes that could be exploited; and reviewed studies on the potential impact of cyberattacks on the grid by reviewing prior GAO and industry reports, as well as interviewing representatives from federal and nonfederal entities. GAO also analyzed DOE's approaches to implementing a federal cybersecurity strategy for the energy sector as it relates to the grid and assessed FERC oversight of cybersecurity standards for the grid. The electric grid faces significant cybersecurity risks: Threat actors . Nations, criminal groups, terrorists, and others are increasingly capable of attacking the grid. Vulnerabilities . The grid is becoming more vulnerable to cyberattacks—particularly those involving industrial control systems that support grid operations. (The figure below is a high-level depiction of ways in which an attacker could compromise industrial control systems.) The increasing adoption of high-wattage consumer Internet of Things devices—“smart” devices connected to the internet—and the use of the global positioning system to synchronize grid operations are also vulnerabilities. Impacts . Although cybersecurity incidents reportedly have not resulted in power outages domestically, cyberattacks on industrial control systems have disrupted foreign electric grid operations. In addition, while recent federal assessments indicate that cyberattacks could cause widespread power outages in the United States, the scale of power outages that may result from a cyberattack is uncertain due to limitations in those assessments. Although the Department of Energy (DOE) has developed plans and an assessment to implement a federal strategy for addressing grid cybersecurity risks, these documents do not fully address all of the key characteristics needed for a national strategy. For example, while DOE conducted a risk assessment, that assessment had significant methodological limitations and did not fully analyze grid cybersecurity risks. One such key limitation was that the assessment used a model that covered only a portion of the grid and reflected how that portion existed around 1980. Until DOE has a complete grid cybersecurity plan, the guidance the plan provides decision makers in allocating resources to address those risks will likely be limited. The Federal Energy Regulatory Commission (FERC)—the regulator for the interstate transmission of electricity—has approved mandatory grid cybersecurity standards. However, it has not ensured that those standards fully address leading federal guidance for critical infrastructure cybersecurity—specifically, the National Institute of Standards and Technology (NIST) Cybersecurity Framework. (See table below for an excerpt of GAO's analysis of two of the five framework functions.) Without a full consideration of the framework, there is increased risk that grid entities will not fully implement leading cybersecurity practices. In addition, FERC's approved threshold for which entities must comply with the requirements in the full set of grid cybersecurity standards is based on an analysis that did not evaluate the potential risk of a coordinated cyberattack on geographically distributed targets. Such an attack could target, for example, a combination of geographically dispersed systems that each fall below the threshold for complying with the full set of standards. Responding to such an attack could be more difficult than to a localized event since resources may be geographically distributed rather than concentrated in the same area. Without information on the risk of such an attack, FERC does not have assurance that its approved threshold for mandatory compliance adequately responds to that risk.


Between 2001 and 2007, more than 575,000 members of the reserve components were ordered to active duty in support of ongoing military operations, including major combat operations in Afghanistan (Operation Enduring Freedom), Iraq (Operation Iraqi Freedom). While on active duty, reservists and their family members have access to a wide range of health care services administered by the Department of Defense's (DOD) Military Health System (MHS). However, prior to 2005, chapter 55 of Title 10, U.S. Code, authorized little to no DOD health care services to nonactivated reservists or their family members. In 2005, Congress began examining initial impacts of frequent mobilizations on reservists, their families, and their employers. Soon after, Congress enacted a series of new or expanded health care, transitional, and other personnel benefits to mitigate certain effects associated with reserve mobilizations. Two health care programs tailored for reservists were established: TRICARE Reserve Select (TRS)âa premium-based health plan option available to qualified members of the Selected Reserve and their family members; and TRICARE Retired Reserve (TRR)âa premium-based health plan option available to so-called gray area reservistsâthose who have retired but are too young to draw retired payâand their family members. Section 701 of the Ronald W. Reagan National Defense Authorization (NDAA) Act of Fiscal Year 2005 ( P.L. 108-375 ) established TRS. Initially, TRS eligibility was limited to certain reservists who had served on continuous active duty in support of a contingency operation and signed a military service obligation agreement. Section 706 of the John Warner NDAA for FY2007 ( P.L. 109-364 ) revised TRS by removing certain restrictions and expanding eligibility. The law also added a prohibition on members of the Selected Reserve and their family members from being eligible for TRS if they are also eligible for the Federal Employee Health Benefits (FEHB) program. Section 705 of the NDAA for FY2010 ( P.L. 111-84 ) established TRR, which also prohibits retired reservists and their families from participating, if they are also eligible for the FEHB program. Both reserve plans mirror the benefits and cost sharing requirements established for TRICARE Select, a health plan option available to family members of active duty servicemembers and certain military retirees. Congress has not explicitly addressed why the prohibition on TRS or TRR for FEHB-eligible reservists and their family members was established. Nevertheless, observers have noted several considerations in removing the statutory prohibition, including: potential impacts to the FEHB health insurance risk-pools; potential cost implications to federal mandatory and discretionary spending; and continuity of care for reservists transitioning between active and reserve status. While Congress has considered various proposals to remove the statutory prohibitions on TRS or TRR eligibility, none have been enacted.


The number of nongovernmental hospitals participating in the 340B Program has grown over time. HRSA requires participating hospitals to register and annually recertify their eligibility. HRSA also reviews hospitals' eligibility through audits of a small sample each year. GAO was asked to provide information on 340B-participating hospitals' contracts with state and local governments. This report (1) describes any obligations in selected nongovernmental hospitals' contracts to serve low-income individuals, and (2) examines HRSA's processes to assess nongovernmental hospitals' eligibility. GAO examined contract documentation from all 258 nongovernmental hospitals HRSA reviewed in 2017 and 2018; and HRSA's policies, procedures, and guidance related to 340B hospital eligibility. GAO also interviewed HRSA officials. Under the 340B Drug Pricing Program (340B Program), administered by the U.S. Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA), drug manufacturers provide discounted prices on outpatient drugs to certain hospitals and other entities. About two-thirds of hospitals participating in the 340B Program (approximately 1,700) are nongovernmental hospitals (private, nonprofit hospitals), which qualify for the program, in part, based on having contracts with state or local governments to provide health care services to the 340B-specified low-income population—low-income individuals not eligible for Medicaid or Medicare. GAO's review of contract documentation for 258 nongovernmental hospitals found that most contracts obligated these hospitals to provide health care services to low-income individuals. However, few of the contracts reviewed included details about those obligations, such as the amount or type of care hospitals were required to provide. The statute does not require the contracts to contain such details. GAO found that HRSA's processes do not provide reasonable assurance that participating nongovernmental hospitals meet eligibility requirements. For example, HRSA primarily relies on hospitals' self-attestations to verify the existence of contracts with state and local governments. The agency reviewed contract documentation for less than 10 percent of nongovernmental hospitals per year in 2017 and 2018. GAO also identified several weaknesses in HRSA's review of the nongovernmental hospital contracts: HRSA does not conduct reviews to determine whether the documents submitted by nongovernmental hospitals are actual contracts, namely that they are mutually binding agreements to provide services or supplies in exchange for something of value. GAO found that 18 of the 258 hospitals reviewed submitted documents that did not appear to be contracts, such as descriptions of community programs, yet all of these hospitals were permitted to participate in the program. When audits have identified hospitals that did not have contracts in place throughout the audits' periods of review, HRSA has allowed hospitals to avoid audit findings by, for example, entering into new contracts with retroactive start dates. This practice undermines the integrity of HRSA's audits. HRSA's contract reviews do not always include assessments of whether contracts are consistent with the statutory requirement to provide health care services to the 340B-specified low-income population and HRSA's guidance for conducting such assessments, when required, lacks detailed instructions. As a result, GAO found that contracts for 13 hospitals reviewed did not appear to require hospitals to serve the 340B-specified low-income population. Despite this, these 13 hospitals were permitted to participate in the program. Given these weaknesses, some nongovernmental hospitals that do not appear to meet the statutory requirements for program eligibility are participating in the 340B Program and receiving discounted prices for drugs for which they may not be eligible.


The number of robocalls continues to grow in the United States, and the figures tend to fluctuate based on the introduction of new government and industry attempts to stop them and robocallers' changing tactics to thwart those attempts (see Figure ). In 2019, U.S. consumers received 58.5 billion robocalls, an increase of 22% from the 47.8 billion received in 2018, according to the YouMail Robocall Index. In 2016, the full first year the Robocall Index was tabulated, that figure was 29.1 billion callsâhalf the number of calls in 2019. Further, the Federal Communications Commission (FCC) states that robocalls make up its biggest consumer complaint category, with over 200,000 complaints each yearâaround 60% of all the complaints it receives. A robocall is any telephone call that delivers a pre-recorded message using an automatic (computerized) telephone dialing system. The Telephone Consumer Protection Act of 1991 ( P.L. 102-243 ) regulates robocalls. Legal robocalls are used by legitimate call originators for political, public service, and emergency messages. Illegal robocalls are usually associated with fraudulent telemarketing campaigns. The FCC estimates that eliminating illegal scam robocalls would provide a public benefit of $3 billion annually. A survey by Truecaller, a company that tracks and blocks robocalls, puts that figure as high as $10.5 billion. Figure . Robocalls per Month, April 2019 through March 2020 (in billions) Source: Robocall Index, https://www.robocallindex.com . Over the past three years, the FCC has pursued a multi-part strategy for combatting illegal robocalls. The agency has issued hundreds of millions of dollars in fines for violations of its Truth in Caller ID rules; expanded its rules to reach foreign calls and text messages; enabled voice service providers to block certain clearly unlawful calls before they reach consumers' phones; clarified that voice service providers may offer call-blocking services by default; and called on the industry to "trace back" illegal spoofed calls and text messages to their original sources. Other wide-ranging steps by the FCC to stop illegal robocalls include mandating the implementation of call authentication technologies by the telecommunications industry, creating databases of numbers that should not be called, and establishing a reassigned numbers database. Major recent FCC regulatory actions include a June 2019 FCC Declaratory Ruling and Third Further Notice of Proposed Rulemaking, and a March 2020 FCC Order and Further Notice of Proposed Rulemaking. The FCC was empowered to take many of these actions by the Pallone-Thune Telephone Robocall Abuse Criminal Enforcement and Deterrence Act (TRACED Act) signed into law on December 30, 2019 ( P.L. 116-105 ). Although these steps appear to be having some impact, scammers remain determined to continue their attempts to defraud consumers using robocalls. Historically, decreases in the number of robocalls are sometimes followed shortly thereafter by spikes in those numbers, illustrating how robocallers continue to overcome measures to stop them (e.g., by changing their originating numbers). Most of the tools being used against robocalls have been developed recently, while some are still under development. Therefore, it may take telecommunications providers some time to fully implement them, and it may be some time before a long-term and ongoing decrease in robocall numbers will be realized. The positive impacts of FCC initiatives on fraudulent robocalls, as well as potential negative impacts on the telemarketing industry due to blocking legitimate calls, may be the subject of continued oversight by Congress.


The oil and natural gas produced from wells on federal lands are important to the U.S. energy supply and bring in billions in federal revenue each year. However, when wells are not properly managed, the federal government may end up paying to clean up the wells when they stop producing. Specifically, wells on federal lands that an operator does not reclaim and for which there are no other liable parties fall to BLM to reclaim (restore lands to as close to their original natural states as possible). These wells become orphaned if the operator's bond held by BLM is not sufficient to cover reclamation costs. BLM regulations set minimum bond values at $10,000 for all of an operator's wells on an individual lease, $25,000 for all of an operator's wells in a state, and $150,000 for all of an operator's wells nationwide. GAO was asked to review the status of oil and gas bonding for federal lands. This report (1) describes the value of bonds for oil and gas wells in 2018 compared to 2008, and (2) examines the extent to which BLM's bonds ensure complete and timely reclamation and thus prevent orphaned wells. GAO analyzed agency data on bonds and wells and interviewed BLM officials. The average value of bonds held by the Bureau of Land Management (BLM) for oil and gas wells was slightly lower on a per-well basis in 2018 ($2,122) as compared to 2008 ($2,207), according to GAO's analysis of BLM data. The total value of bonds held by BLM for oil and gas operations increased between these years, as did the number of wells on federal land. Bonds held by BLM have not provided sufficient financial assurance to prevent orphaned oil and gas wells (wells that are not reclaimed by their operators and, among other things, whose bonds were not sufficient to cover remaining reclamation costs, leaving BLM to pay for reclamation). Specifically, BLM identified 89 new orphaned wells between July 2017 and April 2019, and BLM offices identified to GAO about $46 million in estimated potential reclamation costs associated with orphaned wells and with inactive wells that officials deemed to be at risk of becoming orphaned in 2018. In part, bonds have not prevented orphaned wells because bond values may not be high enough to cover the potential reclamation costs for all wells under a bond, as may be needed if they become orphaned. GAO's analysis indicates that most bonds (84 percent) that are linked to wells in BLM data are likely too low to reclaim all the wells they cover. Bonds generally do not reflect reclamation costs because most bonds are set at their regulatory minimum values, and these minimums have not been adjusted since the 1950s and 1960s to account for inflation (see figure). Additionally, these minimums do not account for variables such as number of wells they cover or other characteristics that affect reclamation costs, such as well depth. Without taking steps to adjust bond levels to more closely reflect expected reclamation costs, BLM faces ongoing risks that not all wells will be completely and timely reclaimed, as required by law. It falls to BLM to reclaim orphaned wells, but the bureau does not assess user fees to cover reclamation costs, in part because it believes it does not have authority to do so. Providing such authority and developing a mechanism to obtain funds from operators for such costs could help ensure that BLM can completely and timely reclaim wells.


The outbreak of COVID-19 has called greater attention to the United States' reliance on foreign drug manufacturers and further highlighted the importance of ensuring a safe pharmaceutical supply chain. Much of the manufacturing of drugs for treating COVID-19 occurs overseas, which is also true of the majority of other drugs marketed in the United States. While the volume of drugs manufactured overseas for the U.S. market is not fully known, FDA reports that about 70 percent of establishments manufacturing active ingredients and more than 50 percent of establishments manufacturing finished drugs for the U.S. market were located overseas, as of August 2019. FDA is responsible for overseeing the safety and effectiveness of all drugs marketed in the United States, regardless of where they are produced, and conducts inspections of both foreign and domestic drug manufacturing establishments. GAO has had long-standing concerns about FDA's ability to oversee the increasingly global pharmaceutical supply chain, an issue highlighted in GAO's High Risk Series since 2009. In particular: GAO recommended in 2008 ( GAO-08-970 ) that FDA increase the number of inspections of foreign drug establishments. GAO found in 2010 ( GAO-10-961 ) that FDA continued to conduct relatively few foreign inspections than domestic inspections. GAO found in 2016 ( GAO-17-143 ) that FDA was conducting more of these foreign drug inspections, and GAO closed its 2008 recommendation to conduct more foreign inspections. However, GAO also reported that FDA may have never inspected many foreign establishments manufacturing drugs for the U.S. market. In addition, in the summer of 2018, FDA began announcing recalls of blood pressure medications manufactured overseas that were tainted with a potential carcinogen, raising further questions about FDA’s oversight of foreign-manufactured drugs. This statement is largely based on GAO’s December 2019 testimony ( GAO-20-262T ) and discusses 1. the number of foreign inspections FDA has conducted, 2. inspection staffing levels, and 3. challenges unique to foreign inspections. For that testimony, GAO examined FDA data from fiscal years 2012 through 2018 and interviewed investigators from FDA’s 2019 cadre of investigators (who are based in the United States but exclusively conduct foreign drug inspections) and from FDA’s foreign offices in China and India. In December 2019, GAO found that a growing number of foreign drug manufacturing inspections conducted by the Food and Drug Administration (FDA) were in China and India (43 percent in 2018), where most establishments that manufacture drugs for the United States were located. In fiscal year 2015, FDA, for the first time, conducted more foreign inspections than domestic inspections. However, from fiscal year 2016 through 2018, both foreign and domestic inspections decreased—by about 10 percent and 13 percent, respectively. FDA officials attributed the decline, in part, to vacancies among investigators available to conduct inspections. In March 2020, FDA announced that, due to Coronavirus Disease 2019 (COVID-19), it was postponing almost all inspections of foreign manufacturing establishments. While FDA has indicated it has other tools to ensure the safety of the U.S. drug supply, the lack of foreign inspections removes a critical source of information about the quality of drugs manufactured for the U.S. market. GAO also found that FDA had vacancies among each of the groups of investigators who conduct foreign inspections. FDA had 190 investigators in the United States who conduct the majority of foreign inspections, but an additional 58 positions were vacant. At the time of GAO's December 2019 testimony, FDA was in the process filling 26 of these vacancies, with 32 remaining. However, according to FDA officials, it could be 2 to 3 years before new staff are experienced enough to conduct foreign inspections. FDA also faced persistent vacancies among investigators in its foreign offices. GAO further found in December 2019 that FDA investigators identified persistent challenges conducting foreign inspections, raising questions about the equivalence of foreign to domestic inspections. Specifically, GAO found: While FDA inspections performed in the United States were almost always unannounced, FDA's practice of preannouncing foreign inspections up to 12 weeks in advance may have given manufacturers the opportunity to fix problems ahead of the inspection. Investigators from FDA's China and India offices had conducted some unannounced inspections, but these staff do not perform most of the inspections in these countries (27 percent and 10 percent, respectively). FDA was not generally providing translators on foreign inspections. Rather, FDA continued to rely on translators provided by the foreign establishments being inspected, which investigators said raised questions about the accuracy of information FDA investigators collected. For example, one investigator said there was more risk of conflict of interest if the establishment used its own employees to translate. In addition, the establishment representative providing the translation may be someone who does not have the technical language needed, which can make it harder to communicate with establishment staff and facilitate the inspection. The overseas travel schedule can present challenges for FDA's domestically based investigators, who conduct the majority of foreign inspections. Domestically based investigators told us there is little flexibility for them to extend foreign inspections during an overseas trip. The inspections they conduct on an overseas trip are scheduled back-to-back in 3-week trips and may involve three different countries. Therefore, extending one inspection would limit the amount of time the investigator has to complete their other scheduled inspections. FDA officials said that inspections conducted by investigators based in China or India (and domestic inspections in the United States) are generally scheduled one at a time and can thus more easily be extended if the investigator needs additional time to pursue potential deficiencies. However, these in-country investigators are not involved in the majority of FDA inspections conducted in China or India.


The outbreak of COVID-19 quickly spread around the globe. As of June 17, 2020, the United States had over 2 million reported cases of COVID-19, and over 100,000 reported deaths, according to federal agencies. Parts of the nation have seen severely strained health care systems. The country has also experienced a significant and rapid downturn in the economy. Four relief laws, including the CARES Act, were enacted as of June 2020 to provide appropriations to address the public health and economic threats posed by COVID-19. In addition, the administration created the White House Coronavirus Task Force. The CARES Act includes a provision for GAO to report regularly on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. Yesterday, GAO issued its first report ( GAO-20-625 ). Like the report, this testimony focuses on key actions the federal government has taken to address the COVID-19 pandemic, GAO recommendations for improvement, and evolving lessons learned relevant to the nation’s response to pandemics, among other things. GAO reviewed data and documents from federal agencies about their activities and interviewed federal and state officials as well as industry representatives. GAO also reviewed available economic, health, and budgetary data. In response to the national public health and economic threats caused by COVID-19, four relief laws were enacted as of June 2020 that appropriated $2.6 trillion. This funding provided support to individuals, health care providers, businesses, and state and local government. While complete government-wide data will not be available until July, GAO determined that as of May 31, 2020, a total of about $1.2 trillion of assistance has been provided—close to $700 billion in expenditures and over $500 billion in loan guarantees. Consistent with the urgency of responding to widespread health issues and economic disruptions, agencies have worked hard to give priority to moving swiftly. In moving quickly, however, agencies made trade-offs; thus, only limited progress has been made so far in achieving transparency and accountability goals. GAO also identified challenges with the federal response to the crisis, including: Paycheck Protection Program (PPP). The Small Business Administration (SBA) moved quickly to establish a new nationwide program, but the pace contributed to confusion and questions and raised program integrity concerns. GAO recommends that SBA develop and implement plans to identify and respond to risks in PPP to better ensure program integrity. SBA neither agreed nor disagreed. Implementing GAO’s recommendation is essential. Economic impact payments. The Internal Revenue Service (IRS) and the Department of the Treasury (Treasury) faced difficulties delivering payments to some individuals, and made some payments to ineligible individuals, such as decedents. GAO recommends that IRS should consider cost-effective options for notifying ineligible recipients how to return payments. IRS agreed. Unemployment Insurance (UI). The program could have an unintentional overlap with benefits provided under PPP. GAO recommends that the Department of Labor (DOL) immediately provide help to state unemployment agencies that specifically addresses PPP loans, and the risk of improper payments associated with these loans. DOL is planning additional guidance. Aviation-preparedness plan. In 2015, GAO recommended that the Department of Transportation (DOT) work with federal partners to develop a national aviation-preparedness plan for communicable disease outbreaks. Thus far, no plan exists. GAO recommends Congress require DOT to produce a plan. Full access to death data. It is important to consistently use safeguards when providing assistance to individuals. The Treasury and Bureau of Fiscal Service do not have access to the Social Security Administration’s full set of death records. GAO recommends that the Congress give Treasury that access and require that Treasury consistently use it. Medicaid. GAO previously found that during economic downturns, the Federal Medical Assistance Percentage (FMAP) formula does not reflect current state economic conditions. GAO recommends that, during an economic downturn, Congress use a formula to provide timely and targeted assistance during economic downturns.


The outbreak of Coronavirus Disease 2019 (COVID-19), first in China, and then globally, including in the United States, is drawing attention to the ways in which the U.S. economy depends on manufacturing and supply chains based in China. This report aims to assess current developments and identify immediate and longer range China trade issues for Congress. An area of particular concern to Congress is U.S. shortages in medical suppliesâincluding personal protective equipment (PPE) and pharmaceuticalsâas the United States steps up efforts to contain COVID-19 with limited domestic stockpiles and insufficient U.S. industrial capacity. Because of China's role as a global supplier of PPE, medical devices, antibiotics, and active pharmaceutical ingredients, reduced export from China have led to shortages of critical medical supplies in the United States. Exacerbating the situation, in early February 2020, the Chinese government nationalized control of the production and distribution of medical supplies in Chinaâdirecting all production for domestic useâand directed the bureaucracy and Chinese industry to secure supplies from the global market. Now apparently past the peak of its COVID-19 outbreak, the Chinese government may selectively release some medical supplies for overseas delivery, with designated countries selected, according to political calculations. Congress has enacted legislation to better understand and address U.S. medical supply chain dependencies, including P.L. 116-136 , The Coronavirus Aid, Relief, and Economic Security (CARES) Act, that includes several provisions to expand drug shortage reporting requirements; require certain drug manufacturers to draw up risk management plans; require the U.S. Food and Drug Administration (FDA) to maintain a public list of medical devices that are determined to be in shortage; and direct the National Academies of Science, Engineering, and Medicine to conduct a study of pharmaceutical supply chain security. Other potential considerations for Congress include whether and how to incentivize additional production of health supplies, diversify production, address other supply chain dependencies (e.g., microelectronics), fill information and data gaps, and promote U.S. leadership on global health and trade issues. The crisis that has emerged for the U.S. economy is defined, in large part, by a collapse of critical supply, as well as a sharp downturn in demand, first in China and now in the United States and globally. As China's manufacturing sector recovers, while the United States and other major global markets are grappling with COVID-19, some fear China could overwhelm overseas markets, as it ramps up export-led growth to compensate for the sharp downturn of exports in the first quarter of 2020, secure hard currency, and boost economic growth. China may also seek to make gains in strategic sectorsâsuch as telecommunications, microelectronics, and semiconductorsâin which the government undertook extraordinary measures to sustain research and development and manufacturing during the COVID-19 outbreak in China.


The poor condition of infrastructure at the Navy's four public shipyards—Norfolk Naval Shipyard, Virginia; Portsmouth Naval Shipyard, Maine; Puget Sound Naval Shipyard, Washington; and Pearl Harbor Naval Shipyard, Hawaii—affects the readiness of the aircraft carrier and submarine fleets they are charged with maintaining. In response to congressional direction to create a plan to address the shipyards' infrastructure deficiencies, the Navy developed the Shipyard Infrastructure Optimization Plan , which the Navy estimates will require $21 billion and 20 years to implement. Senate Report 115-262 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2019 included a provision for GAO to review the Shipyard Infrastructure Optimization Plan . GAO evaluated the extent to which the plan (1) addresses deficiencies in the infrastructure needed to support the Navy's projected needs, (2) includes reliable cost estimates to address those deficiencies, and (3) identifies clear roles and responsibilities for implementation. GAO reviewed the Navy's shipyard infrastructure plan and cost estimates; conducted site visits to shipyards selected to provide a variety of operational perspectives; and interviewed Navy and shipyard officials. The Navy's 2018 Shipyard Infrastructure Optimization Plan includes actions to address critical deficiencies at the shipyards, but the extent to which the plan fully addresses those deficiencies remains to be seen as the proposed actions are complex and years away from being implemented. The plan includes steps to address dry dock deficiencies, which the Navy expects willl provide it with the capacity and capability to perform 67 of 68 ship maintenance periods it is currently unable to support through fiscal year 2040. Once area development plans are complete (see figure), the Navy projects it will take at least $21 billion over 20 years to fully implement the plan. The Navy's initial cost estimate for the plan did not use certain best practices in developing the estimate, such as documenting key assumptions, accounting for inflation, and addressing risks that together could add billions to the ultimate cost. Navy officials stated that high-quality cost estimates will not be possible until they complete modeling and simulation in fiscal year 2020 and subsequently identify the most effective shipyard layouts and prioritize projects in fiscal year 2022. However, without fully following best practices in subsequent estimates, the Navy risks requesting inadequate resources to address shipyard deficiencies. The Navy created a program management office in June 2018 to oversee the estimated 20-year-long process of optimizing the shipyards. This program office includes representatives from multiple Navy organizations. However, the office has not formally defined the role of shipyard officials. Navy officials stated that they intend to develop an agreement to address roles and responsibilities, but this has not yet been finalized. Without defining clear shipyard roles and responsibilities, the Navy risks an ineffective implementation of its plan.


The popularity of cryptocurrencies such as Bitcoin and the underlying blockchain technology presents both challenges and opportunities to the energy sector. As interest in Bitcoin and other cryptocurrencies has increased, the energy demand to support cryptocurrency "mining" activities has also increased. The increased energy demandâwhen localizedâcan exceed the available power capacity and increase customers' electricity rates. On the other hand, not all cryptocurrencies require energy-intensive mining operations. Some cryptocurrencies can operate under algorithms that require less energy. In addition, blockchain technologies could present opportunities for the energy sector by facilitating energy and financial transactions on a smart grid. Bitcoin and other cryptocurrencies can be used to make payments without banks or other third-party intermediaries, and are sometimes considered virtual currency. The technology underlying these cryptocurrencies is blockchain. A blockchain is a digital distributed ledger that enables parties who may not otherwise trust one another to agree on the current ownership and distribution of assets in order to conduct new business. New blocks may be added to a blockchain through a variety of methods. In mining blocks, users seek to add the next block to the chain. For Bitcoin, new blocks are added to the blockchain through a proof-of-work (PoW) algorithm. Under PoW, minersâthose seeking to add a block to a blockchainâare presented a difficult computational problem. Once the problem is solved, other users can validate the solution and confirm the block, adding the next block to the chain. In the case of Bitcoin, miners who create and publish new blocks are rewarded with Bitcoin. Less energy intensive, alternative algorithms exist, such as proof of stake and proof of authority. Cryptocurrency mining through PoW requires substantial energy to (1) operate the devices computing the calculations required to maintain the integrity of the blockchain and (2) thermally regulate the devices for optimal operation. Devices have different performance capabilities and have different power requirements. Generally, the device, or a cluster of devices, that can perform more calculations per second will require more energy for powering and cooling the device or devices. Global power requirement estimates for Bitcoin have increased within the last five years. Network power estimates for 2018 range between 2,500 megawatts (MW) and 7,670 MW, which, for comparison, is nearly 1% of U.S. electricity generating capacity. Opinions differ on whether future growth in Bitcoin will significantly impact energy consumption and subsequent carbon dioxide (CO 2 ) emissions. Cryptocurrency mining includes costs associated with equipment, facilities, labor, and electricity. Some users pool computational resources to solve PoW problems faster, and are on a worldwide hunt for cheap, reliable electricity in abundance. While many mining pools are in China, some have been able to utilize closed industrial facilities in the United States that can provide abundant electricity at affordable rates. According to a study in 2017, nearly three-quarters of all major mining pools are based in either China (58%) or in the United States (16%). By some estimates, the state of Washington hosted 15%-30% of all Bitcoin mining operations globally in 2018. Governments are developing various policies in response to growth in energy demand by cryptocurrency mining activities. In some areas, applications from potential mining companies have exceeded the available capacity. Other areas have offered reduced electricity rates to attract miners. In the United States, in addition to efforts at the state and local level, there are potential options that could be adopted by the federal government to improve the energy efficiency of mining operations. Potential federal policy options include minimum energy conservation standards, voluntary energy efficiency standards, and data center energy efficiency standards. In addition to the challenges that cryptocurrency mining presents to the energy sector, there are also opportunities, particularly for blockchain. These may include electric vehicle charging infrastructure and distributed energy resources, among others. The U.S. electricity grid is critical infrastructure and subject to certain regulations to maintain safe and reliable operations. Opinions differ as to a potential role for blockchain technology in the energy sector. The popularity of cryptocurrencies such as Bitcoin and the underlying blockchain technology presents both challenges and opportunities to the energy sector. As interest in Bitcoin and other cryptocurrencies has increased, the energy demand to support cryptocurrency "mining" activities has also increased. The increased energy demandâwhen localizedâcan exceed the available power capacity and increase customers' electricity rates. On the other hand, not all cryptocurrencies require energy-intensive mining operations. Some cryptocurrencies can operate under algorithms that require less energy. In addition, blockchain technologies could present opportunities for the energy sector by facilitating energy and financial transactions on a smart grid. Bitcoin and other cryptocurrencies can be used to make payments without banks or other third-party intermediaries, and are sometimes considered virtual currency. The technology underlying these cryptocurrencies is blockchain. A blockchain is a digital distributed ledger that enables parties who may not otherwise trust one another to agree on the current ownership and distribution of assets in order to conduct new business. New blocks may be added to a blockchain through a variety of methods. In mining blocks, users seek to add the next block to the chain. For Bitcoin, new blocks are added to the blockchain through a proof-of-work (PoW) algorithm. Under PoW, minersâthose seeking to add a block to a blockchainâare presented a difficult computational problem. Once the problem is solved, other users can validate the solution and confirm the block, adding the next block to the chain. In the case of Bitcoin, miners who create and publish new blocks are rewarded with Bitcoin. Less energy intensive, alternative algorithms exist, such as proof of stake and proof of authority. Cryptocurrency mining through PoW requires substantial energy to (1) operate the devices computing the calculations required to maintain the integrity of the blockchain and (2) thermally regulate the devices for optimal operation. Devices have different performance capabilities and have different power requirements. Generally, the device, or a cluster of devices, that can perform more calculations per second will require more energy for powering and cooling the device or devices. Global power requirement estimates for Bitcoin have increased within the last five years. Network power estimates for 2018 range between 2,500 megawatts (MW) and 7,670 MW, which, for comparison, is nearly 1% of U.S. electricity generating capacity. Opinions differ on whether future growth in Bitcoin will significantly impact energy consumption and subsequent carbon dioxide (CO 2 ) emissions. Cryptocurrency mining includes costs associated with equipment, facilities, labor, and electricity. Some users pool computational resources to solve PoW problems faster, and are on a worldwide hunt for cheap, reliable electricity in abundance. While many mining pools are in China, some have been able to utilize closed industrial facilities in the United States that can provide abundant electricity at affordable rates. According to a study in 2017, nearly three-quarters of all major mining pools are based in either China (58%) or in the United States (16%). By some estimates, the state of Washington hosted 15%-30% of all Bitcoin mining operations globally in 2018. Governments are developing various policies in response to growth in energy demand by cryptocurrency mining activities. In some areas, applications from potential mining companies have exceeded the available capacity. Other areas have offered reduced electricity rates to attract miners. In the United States, in addition to efforts at the state and local level, there are potential options that could be adopted by the federal government to improve the energy efficiency of mining operations. Potential federal policy options include minimum energy conservation standards, voluntary energy efficiency standards, and data center energy efficiency standards. In addition to the challenges that cryptocurrency mining presents to the energy sector, there are also opportunities, particularly for blockchain. These may include electric vehicle charging infrastructure and distributed energy resources, among others. The U.S. electricity grid is critical infrastructure and subject to certain regulations to maintain safe and reliable operations. Opinions differ as to a potential role for blockchain technology in the energy sector.