In fiscal year 2018, the federal government provided about $30 billion for USDA's child nutrition programs, including the school meals programs, WIC, and SFSP, among others. In that year, the federal government spent almost $14 billion on the largest of these programs, the National School Lunch Program, which supported the provision of meals to about 30 million children. Federal, state, and local entities play important roles in administering the child nutrition programs and ensuring program integrity. For example, USDA annually estimates improper payments in these programs, which are an indicator of program integrity, and states monitor implementation of the programs by local organizations that directly provide food and services to participants. This testimony discusses (1) actions USDA has taken to address GAO's prior recommendations related to program integrity in the child nutrition programs and (2) improper payments in these programs. This testimony is based on prior GAO reports on child nutrition programs issued from 2013 through 2018, recent GAO and USDA reports on improper payments, and updates GAO obtained in March and April 2019 from USDA officials on actions related to GAO's prior recommendations and improper payments in child nutrition programs. The U.S. Department of Agriculture (USDA) has taken steps, or is planning steps, to improve the integrity of the child nutrition programs in response to recommendations from GAO's prior work. For example: School meals. In 2014, GAO identified several opportunities for USDA to improve school meals oversight and integrity. For example, through GAO's survey of states, over three-fourths reported a need for USDA guidance on monitoring the financial management of local entities that provide meals to children in schools—an area we reported states were newly required to review. GAO recommended that USDA assess states' needs for information in this area. USDA did this assessment and provided related guidance and training to states. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). In 2013 and 2014, GAO identified several ways that USDA could improve program integrity and oversight in WIC, which provides food benefits to individuals who are low-income. For example, GAO found that USDA had not used its own monitoring findings on state policies for determining applicants' income eligibility to target assistance to states, and recommended that USDA do so. In response, USDA developed a process for reviewing and acting on its monitoring results. Summer Food Service Program (SFSP). In 2018, GAO identified several opportunities for USDA to improve program integrity in the SFSP, which provides food to children in low-income areas when schools are closed for vacation. For example, GAO found that USDA did not collect reliable data on children's participation in the program and that estimates were calculated inconsistently from state to state and from year to year. GAO recommended that USDA take steps to improve the reliability of these estimates and take additional actions to improve program integrity. USDA recently reported plans to address GAO's recommendations. USDA reported improper payments for four child nutrition programs totaling an estimated $1.8 billion in fiscal year 2018, or just over 1 percent of the $151 billion in improper payments that agencies estimated government-wide. GAO has reported that reducing improper payments—which generally include payments that should not have been made or were made in an incorrect amount—is critical to safeguarding federal funds. Since fiscal year 2013, the school meals programs have consistently reported the highest improper payment rates across the child nutrition programs. Over time, USDA has taken a variety of corrective actions aimed at reducing improper payments in child nutrition programs, yet estimated improper payment rates for these programs remained generally steady until fiscal year 2018. For that year, USDA changed what it considers to be an improper payment in the school meals programs, resulting in improper payment estimates that are substantially lower than those from prior years. The Office of Management and Budget (OMB) provides guidance to federal agencies on measuring and reporting improper payment rates, and USDA reported that it made this change after consultation with OMB.


In fiscal year 2019, CBP reported apprehending more than 527,000 noncitizen family unit members (children under 18 and their parents or legal guardians) at or between U.S. ports of entry along the southwest border—a 227 percent increase over fiscal year 2018. GAO was asked to review issues related to families—including family units—arriving at the southwest border. This report examines the extent to which DHS has identified, collected, documented, and shared information its components need to inform processes for family members apprehended at the border. GAO analyzed DHS documents; interviewed DHS officials; and visited DHS locations in Arizona, California and Texas, where CBP apprehensions of family units increased in 2017. GAO compared the information gathered with leading practices in collaboration to evaluate DHS components' processes for apprehended family members. The Department of Homeland Security's (DHS) processes to identify, collect, document, and share information about family members apprehended at the southwest border are fragmented. DHS's U.S. Customs and Border Protection (CBP) apprehends family members and determines how information about each individual—and his or her relationship to other family members—will be collected and documented. Other DHS components, such as U.S. Immigration and Customs Enforcement (ICE), use information collected at the time of apprehension to inform how those who are members of a family, including children, will proceed through immigration proceedings. Family members apprehended at the border and placed into expedited removal that indicate an intention to apply for asylum, or a fear of persecution or torture or fear of return to their home country, are referred to DHS's U.S. Citizenship and Immigration Services (USCIS) for a credible fear screening. However, DHS has not identified the information its components collectively need about apprehended family members. Each DHS component collects information to meet its own operational needs, and does not consider the information needs of other components. For example, the information about family members that CBP needs differs from the information about family members that USCIS needs. CBP officials told us they would not generally identify spouses and children age 18 to 21 apprehended with a parent as family members, although USCIS's definition of a dependent for credible fear screening purposes includes spouses and unmarried children under age 21. CBP collects information about certain family members for its operational purposes, but does not collect and document information at the time of apprehension that other DHS components may later need. Specifically, CBP collects and documents information about parents and their children under age 18 who are apprehended together. However, consistent with regulation, USCIS policy is to include any dependents who arrived concurrently with the principal applicant, such as a spouse or unmarried child under age 21, on a principal applicant's positive credible fear determination if the dependent wants to be included. According to USCIS and ICE officials, it can be difficult to identify spouses and children age 18 to 21 because CBP does not regularly document such family relationships. DHS does not have a mechanism to link the records of family members apprehended together across its components that need this information. As a result, DHS components may not have access to all the information about family members they need to make effective operational decisions. Because DHS has not identified the information all of its components collectively need to process family members apprehended at the border, collected and documented that information at the time of apprehension, and evaluated options to share that information across components, consistent with leading practices in collaboration, DHS risks removing individuals from the United States who may have been eligible for relief or protection based on their family relationship.


In fiscal year 2019, CBP reported apprehending more than 527,000 noncitizen family unit members at or between U.S. ports of entry along the southwest border—a 227 percent increase over fiscal year 2018. In April 2018, the U.S. Attorney General issued a memo on criminal prosecutions of immigration offenses, which DHS officials said led to an increase in family separations. GAO was asked to review issues related to DHS's processing of family units. This report examines (1) CBP data on apprehended family unit members; the extent to which (2) CBP and (3) ICE developed and implemented policies and procedures for processing family units; and (4) how DHS and HHS share information about UAC. GAO analyzed record-level DHS and HHS data and documents; interviewed DHS and HHS officials; and visited DHS locations in California and Texas where CBP apprehensions of family units increased in 2017. Data from the Department of Homeland Security's (DHS) U.S. Customs and Border Protection (CBP) indicate that apprehensions of family unit members (noncitizen children under 18 and their parents or legal guardians) grew from about 22 percent of total southwest border apprehensions in fiscal year 2016 to about 51 percent of such apprehensions during the first two quarters of fiscal year 2019—the most current data available. During this period, CBP data indicated that most apprehensions of family units—about 76 percent—occurred between ports of entry by the U.S. Border Patrol (Border Patrol). With regard to family separations, from April 2018 through March 2019, CBP data indicate it separated at least 2,700 children from their parents, processing them as unaccompanied alien children (UAC) and transferring them to the Department of Health and Human Services (HHS). CBP developed some policies and procedures for processing family units but does not have sufficient controls to ensure effective implementation. For example, CBP policy requires that Border Patrol agents and officers track apprehended family unit members and, if applicable, subsequent family separations in agency data systems. GAO's analysis of Border Patrol documents and data indicates that its agents have not accurately and consistently recorded family units and separations. Specifically, GAO examined a nongeneralizable sample of 40 HHS records for children involved in family separations between June 2018 and March 2019 and matched them to Border Patrol apprehensions data for these children. GAO found Border Patrol did not initially record 14 of the 40 children as a member of a family unit (linked to a parent's record) per Border Patrol policy, and thus did not record their subsequent family separation. GAO found an additional 10 children among the 40 whose family separations were not documented in Border Patrol's data system as required by CBP policy during this period. Border Patrol officials were unsure of the extent of these problems, and stated that, among other things, data-entry errors may have arisen due to demands on agents as the number of family unit apprehensions increased. Thus, it is unclear the extent to which Border Patrol has accurate records of separated family unit members in its data system. Further, Border Patrol agents inconsistently recorded information about the reasons for and circumstances surrounding family separations on required forms. Developing and implementing additional controls would help Border Patrol maintain complete and accurate information on all family separations. DHS's U.S. Immigration and Customs Enforcement (ICE) is, among other things, responsible for detaining and removing those family units apprehended by CBP. ICE officers are to determine whether to accept or deny a referral of a family unit from CBP for detention in one of ICE's family residential centers, release family unit members into the interior of the United States, or remove family unit members (who are subject to final orders of removal) from the United States. ICE has procedures for processing and releasing family units from ICE custody. However, with regard to family unit separations, ICE relies on a manual process to track separations that occur in ICE custody (generally at one of ICE's family residential centers) and does not systematically record this information in its data system. Without a mechanism to do so, ICE does not have reasonable assurance that parents whom ICE separated from their children and are subject to removal are able to make arrangements for their children, including being removed with them, as provided in ICE's policy for detained parents. In 2018, DHS and HHS developed written interagency agreements regarding UAC. However, DHS and HHS officials stated they have not resolved long-standing differences in opinion about how and what information agencies are to share related to the care and placement of those children, including those referred to HHS after a family separation. GAO found that DHS has not consistently provided information and documents to HHS as specified in interagency agreements. HHS officials also identified additional information they need from DHS, about those adults apprehended with children and later separated, to inform their decisions about placing children with sponsors and reunifying separated families, when necessary. Increased collaboration between DHS and HHS about information sharing would better position HHS to make informed and timely decisions for UAC.


In providing health care and other benefits to veterans and their dependents, VA relies extensively on IT systems and networks to receive, process, and maintain sensitive data, including veterans' medical records and other personally identifiable information. Accordingly, effective security controls based on federal guidance and requirements are essential to ensure that VA's systems and information are adequately protected from loss, unauthorized disclosure, inadvertent or deliberate misuse, or improper modification, and are available when needed. For this testimony, GAO summarized the status of information security across the federal government and particularly at VA. It also discusses the security challenges that VA faces as it modernizes and secures its information systems. To develop this statement, GAO reviewed its prior reports and relevant Office of Management and Budget, IG, and agency reports. , detect , respond , and recover —established by the National Institute of Standards and Technology's cybersecurity framework. VA's ratings were generally consistent with the ratings of other major agencies (see figure) and its information security program was one of 18 agency programs that IGs deemed ineffective. Most major agencies, including VA, had significant security control deficiencies over their financial reporting. For example, for fiscal year 2018, VA's IG reported deficiencies in control areas, such as security management, access control, configuration management, segregation of duties, and contingency planning. Additionally, as of fiscal year 2018, VA reported meeting six of the 10 cybersecurity performance targets set by the administration. VA faces several security challenges as it secures and modernizes its information systems. These challenges pertain to effectively implementing information security controls; mitigating known vulnerabilities; establishing elements of its cybersecurity risk management program; and identifying critical cybersecurity staffing needs. VA also faces the additional challenge of managing IT supply chain risks as the department takes steps to modernize its information systems.


In recent years, financial innovation in capital markets has fostered a new asset classâdigital assetsâand introduced new forms of fundraising and trading. Digital assets , which include crypto - assets , cryptocurrencies , or digital tokens , among others, are digital representations of value made possible by cryptography and distributed ledger technology. Regardless of the terms used to describe these assets, depending on their characteristics, some digital assets are subject to securities laws and regulations. Securities regulation generally applies to all securities, whether they are digital or traditional. The Securities and Exchange Commission (SEC) is the primary regulator overseeing securities offerings, sales, and investment activities. The SEC's mission is to protect investors; maintain fair, orderly, and efficient markets; and facilitate capital formation. The existing securities regulatory regime generally aligns with this mission, and the SEC's digital asset regulation generally follows the same regime. The SEC has used existing authorities to evaluate new product approval, provide individual regulatory relief, and solicit public input for policy solutions more tailored to digital assets. Digital assets have a growing presence in the financial services industry. Their increasing use in capital markets raises policy questions regarding whether changes to existing laws and regulations are warranted and, if so, when such changes should happen, what form they should take, and which agencies should take the lead. The current innovative environment is not the regulatory regime's first encounter with changing technology since its inception in the 1930s. Some technological advancements led to regulatory changes, whereas others were dealt with through the existing regime. The general consensus is that regulatory oversight should be balanced with the need to foster financial innovation, but securities regulation's basic objectives should apply. In addition, some believe that certain digital asset activities that may appear similar to traditional activities nonetheless require adjusted regulatory approaches to account for particular operating models that may amplify risks differently. In general, policymakers contending with major financial innovations have historically focused on addressing risk concerns while tailoring a regulatory framework that was flexible enough to accommodate evolving technology. Current developments that raise policy issues include the following: Initial coin offerings (ICOs) . ICOs as a digital asset fundraising method can be offered in many forms using existing public and private securities offerings channels. Although ICOs may be useful fundraising tools, they raise regulatory oversight and investor protection concerns. Digital asset "exchanges . " Some industry observers perceive digital asset trading platforms as functional equivalents to the SEC-regulated securities exchanges in buying and selling digital assets. But these platforms are not subject to the same level of regulation, suggesting that they may be less transparent and more susceptible to manipulation and fraud. Digital asset custody . Custodians provide safekeeping of financial assets and are important building blocks for the financial services industry. Digital assets present custody-related compliance challenges because custodians face difficulties in recording ownership, recovering lost assets, and providing audits, among other considerations. The SEC is aware of the challenges and is engaging stakeholders to discuss potential issues and solutions. Digital asset exchange-traded funds (ETFs) . ETFs are pooled investment vehicles that gather and invest money from a variety of investors. ETF shares can trade on securities exchanges like a stock. Currently, digital assets themselves are generally not sold on SEC-regulated national exchanges. However, if portfolios of digital assets were made available as ETFs, they may be sold on national exchanges. The SEC has not yet approved any digital asset ETFs because of market manipulation and fraud concerns. Stablecoins in securities markets . Stablecoins are a type of digital asset designed to maintain a stable value by linking its value to another asset or a basket of assets. Issues concerning stablecoins include market integrity, investor protection, payments, financial stability, and illicit activity prevention. Three legislative proposals relating to securities regulation were discussed at a House Committee on Financial Services hearing: the first proposal ( H.R. 5197 ) would subject stablecoins to securities regulation; the second draft proposal would limit public company executives' access to stablecoins; and the third proposal ( H.R. 4813 ) would prevent "Big Tech" firms from offering financial services or issuing digital assets.


In recent years, the airline industry experienced several well-publicized IT system outages to reservation, check-in, flight planning, and other systems. Such outages can result in widespread disruption to air travel, inconveniencing passengers, who may be delayed or face out-of-pocket costs, and can also affect airlines' revenue and operations. Airlines are responsible for operating and maintaining their IT systems. GAO was asked to review airline IT outages. GAO examined: (1) DOT's and FAA's roles related to airline IT outages and (2) what is known about these outages and their effects on passengers. GAO identified relevant federal laws and responsibilities and interviewed DOT and FAA officials. In the absence of DOT and FAA data to identify airline IT outages, GAO identified outages using open source documents for the 12 airlines reporting to BTS from 2015 through 2017 and validated these outages using a multi-step process with publicly available airline information, interviews with airline representatives, and FAA and DOT data. GAO also reviewed airlines' contracts of carriage, which are legally binding contracts between airlines and passengers, to understand how airlines accommodate passengers inconvenienced by IT outages, as well as 140 consumer complaints related to airline IT outages received by DOT from 2015 through June 2018. The Department of Transportation (DOT) and, within it, the Federal Aviation Administration (FAA) have limited roles overseeing or addressing the effects of outages from information technology (IT) systems that airlines rely on to schedule and transport passengers (e.g., reservation or flight planning systems). FAA's operations and oversight. At an airline's request, FAA may halt the operation of all or part of that airline's flights during an outage and work with the airline to reintegrate flights upon recovery. FAA does not directly oversee airline IT systems but works with airlines to ensure that airline data interfaces correctly with FAA's operational systems. DOT's consumer protection. Airline IT outages are not specifically addressed in DOT's consumer protections for passengers, although other protections may apply, such as restrictions on tarmac delays if a passenger is held on a flight during an outage. DOT oversees airlines' adherence to their contracts with passengers. These may include specific provisions such as refund procedures and responsibility for delayed flights, among other things. DOT also receives consumer complaints and uses complaint data to initiate investigations that may result in fines or enforcement actions. DOT's data collection. DOT requires large airlines to report information about on-time performance to the Bureau of Transportation Statistics (BTS), including the causes of flight delays and cancellations in several broad categories (e.g., airline caused, weather, and late-arriving aircraft). Using multiple sources, GAO identified 34 IT outages from 2015 through 2017, affecting 11 of 12 selected airlines. No government data were available to identify IT outages or determine how many flights or passengers were affected by such outages. BTS data provide information to consumers about airline performance broadly but are not designed to identify the effects of individual events, such as the number of flight delays and cancellations resulting from IT outages. According to GAO's validation of multiple sources, however, about 85 percent of the identified outages resulted in some flight delays or cancellations. Because of limited data, information about how passengers have been inconvenienced from outages is largely anecdotal (see figure for examples of inconveniences). Further, airlines vary in what they provide to these passengers (e.g., food, hotel, or rebooking on another airline) when IT outages occur. Consumer complaints stemming from IT outages accounted for less than one percent of all complaints received by DOT from 2015 through June 2018, and according to agency officials, these complaints raised concerns similar to complaints resulting from other causes of flight disruption. Complaints reviewed by GAO included the lack of food, a hotel, or compensation, among other things.


In recent years, the nation's transportation systems facilitated over 5 trillion miles of passenger travel annually while moving billions of tons of cargo. The scale and scope of these systems make them targets for terrorist attacks. Congress directed DHS to work jointly with DOT to develop, revise, and update a biennial National Strategy for Transportation Security that governs federal transportation security efforts. The FAA Reauthorization Act of 2018 includes a provision for GAO to evaluate the extent to which the most recent strategy is reflected in relevant federal transportation security efforts. This report examines the extent to which the 2018 strategy (1) guides relevant federal transportation security efforts, including resource allocation, and (2) incorporates input across transportation modes and risk information, among other things. To conduct this work, GAO reviewed relevant transportation security documentation, interviewed officials within DHS and DOT on the development and use of the strategy, evaluated interagency collaboration during the development of the national strategy, and analyzed the national strategy's incorporation of risk information. The 2018 National Strategy for Transportation Security generally does not guide federal efforts due in part to its unclear alignment with several strategies that also inform federal transportation security efforts. The Department of Homeland Security (DHS)—primarily through the Transportation Security Administration (TSA)—developed the national strategy, consistent with congressional direction, to govern federal transportation security efforts. However, TSA and Department of Transportation (DOT) officials all identified some degree of redundancy or overlap regarding the role of the strategy in light of other transportation security strategies such as the National Strategy for Aviation Security. Agencies reported using the national strategy for reference, context, and general coordination, but not for driving program activities. Agencies instead use separate strategies and plans to guide program and resource decisions. Similarly, agencies in DHS and DOT (key stakeholders of the strategy) use various strategy documents to allocate resources for federal efforts, which the strategy may inform. However, DHS has not communicated how the strategy aligns with related strategies to guide these efforts. By doing so, federal stakeholders would be better positioned use the national strategy as part of a whole-of-government approach to preventing terrorist attacks. TSA effectively incorporated input from stakeholders and considered risk information to develop the 2018 National Strategy for Transportation Security. TSA iteratively updated the biennial strategy by incorporating input across transportation modes and feedback from stakeholders in a manner that generally met GAO's leading practices for collaboration. For example, TSA clearly communicated roles and responsibilities regarding the strategy development process for participating agencies. In addition, the strategy compiles risks identified for each transportation mode in other strategic planning documents. TSA strategy development officials stated that they also included emergent risk information, for example cybersecurity risks. The security risks identified in these risk assessments, in general, aligned with the risk-based priorities highlighted in the strategy.


In response to individuals receiving large, unexpected medical bills for out-of-network care, Congress has recently been considering legislation to address surprise billing. As the term is currently being discussed, s urprise billing typically refers to situations where consumers are unknowingly, and potentially unavoidably, treated by providers outside of the consumers' health insurance plan networks and, as a result, unexpectedly receive larger bills than they would have received if the providers had been in the plan networks. In the 116 th Congress, federal proposals have sought to address surprise billing in the context of two types of situations: (1) where an individual receives emergency services from an out-of-network provider and (2) where an individual receives services from an out-of-network provider that is working at an in-network facility. Although no federal requirements directly address surprise billing, at least half of the states have implemented policies to address surprise billing in some capacity. However, the state laws are limited in application, as certain types of plans, such as self-funded plans offered by employers, are exempt from state insurance regulation. State policies to address surprise billing vary in terms of the types of consumer financial protections provided (e.g., consumer balance billing limitations) and the related requirements on insurers and providers to establish such protections. Among states that offer similar types of consumer protections, policies may vary in their application and may differ according to the types of situations addressed (e.g., emergency services, out-of-network care at an in-network facility), the types of plans addressed (e.g., HMO, PPO), and the methods used to determine insurer payments to providers for such services (e.g., benchmark, arbitration). Similar to many state laws, recent federal legislative proposals related to surprise billing typically seek to address the financial relationships between insurers, providers, and consumers. They do so by establishing new requirements on insurers, providers, or both to create a degree of consumer protection related to reducing patient financial responsibilities with respect to some types of out-of-network care. In addition to including language that limits consumer cost sharing in surprise billing situations, the federal proposals typically include language that specifies the methods by which insurers determine payment to providers for the services being addressed in the bill (since solely reducing consumer financial liability in such situations would reduce the total amount providers receive for their services). When combined with balance billing prohibitions, this type of requirement effectively results in what the insurer and provider recognize as the total payment for out-of-network care. To date, federal proposals are largely aligned in how they would address consumer protections in surprise billing situations. However, the proposals differ in how they would address total payment for specified services furnished by out-of-network providers. Federal proposals generally have focused on at least one of two methods to determine insurers' financial responsibility: (1) selecting a benchmark provider payment rate that serves as the basis for determining specific amounts that insurers must pay providers, net of consumer cost sharing or (2) establishing an alternative dispute resolution process, such as arbitration, with provider payment determined by a neutral third party. This report discusses selected policy issues that Congress may want to consider as it assesses surprise billing proposals. The report concludes by providing an overview of how surprise billing proposals may affect some combination of insurers, providers, and consumers. An Appendix table compares two federal proposals that have gone through committee markup procedures: Title I of S. 1895 (Alexander), which went through a Senate Committee on Health, Education, Labor, and Pensions (HELP) markup session on June 26, 2019, and Title IV of the amendment in the nature of a substitute (ANS) to H.R. 2328 , which went through a markup session held by the House Committee on Energy and Commerce on July 17, 2019.


Almost 70,000 people died from drug overdoses in 2018, according to the latest Centers for Disease Control and Prevention data. The 2018 SUPPORT Act reauthorized ONDCP and imposed new requirements. GAO noted in its March 2019 High Risk report that the federal effort to prevent drug misuse is an emerging issue requiring close attention. Pursuant to 21 U.S.C. § 1708a(b), GAO has periodically assessed ONDCP's programs and operations. This report assesses the extent to which ONDCP (1) met selected statutory requirements related to the National Drug Control Strategy in 2017, 2018, and 2019, and (2) has planned or implemented actions to meet selected new requirements in the SUPPORT Act. GAO assessed the 2019 Strategy and companion documents against four key statutory requirements that were consistent with or similar to ONDCP's ongoing responsibilities under the SUPPORT Act. GAO also assessed ONDCP's progress in addressing seven new SUPPORT Act requirements, and interviewed ONDCP officials. The Office of National Drug Control Policy (ONDCP) is responsible for overseeing and coordinating the development and implementation of U.S. drug control policy across the federal government. However, ONDCP did not issue a National Drug Control Strategy for either 2017 or 2018, as required by statute. ONDCP was also required to assess and certify federal agencies' drug control budgets to determine if they were adequate to meet Strategy goals and objectives. Without a Strategy in 2017 and 2018, ONDCP could not complete this process according to statutory requirements. ONDCP issued a 2019 Strategy and companion documents that addressed some but not all of the selected statutory requirements GAO reviewed. For example, the Strategy and companion documents did not include the required 5-year projection for budget priorities. The October 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) retained some requirements and introduced new ones for ONDCP. ONDCP met some SUPPORT Act requirements GAO reviewed. For example, ONDCP filled all five coordinator positions described in the SUPPORT Act. However, its approach to meeting other requirements does not incorporate key planning elements. For example, the SUPPORT Act requires that future iterations of the Strategy include a description of how each goal will be achieved, performance evaluation plans, and a plan for expanding treatment of substance use disorders. ONDCP could not provide in writing or otherwise describe its planned steps, interim milestones, resource investments, or overall timeframes—all key planning elements—that would provide assurance it can meet these requirements by the deadline for the next Strategy—February 2020. The SUPPORT Act also required ONDCP to publish an online searchable Data Dashboard of drug control data, with information including quantities of drugs and frequency of their use. While ONDCP published (and later updated) a public version of this resource on its website, as of December 2019, it was not complete (e.g., lacked required data on the unmet need for substance use disorder treatment). Further, ONDCP officials had no information on next steps for fully meeting the requirements. Developing, documenting, and implementing key planning elements to meet these requirements—including resource investments, time frames, and any processes, policies, roles, and responsibilities—would be consistent with key principles for achieving an entity's objective and standards for project management. Importantly, doing so would help ONDCP structure its planning efforts and comply with the law.


In response to the COVID-19 outbreak, on March 13, 2020, the Department of Transportation (DOT) issued a national emergency declaration to exempt from the Hours of Service (HOS) rule through April 12, 2020, commercial drivers providing direct assistance in support of relief efforts related to the virus. This includes transport of certain supplies and equipment, as well as personnel. Drivers are still required to have at least 10 consecutive hours off duty (eight hours if transporting passengers) before returning to duty. It has been estimated that up to 20% of bus and large truck crashes in the United States involve fatigued drivers. In order to promote safety by reducing the incidence of fatigue among commercial drivers, federal law limits the number of hours a driver can drive through the HOS rule. Currently the HOS rule allows truck drivers to work up to 14 hours a day, during which time they can drive up to 11 hours, followed by at least 10 hours off duty before coming on duty again; also, within the first 8 hours on duty drivers must take a 30-minute break in order to continue driving beyond 8 hours. Bus drivers transporting passengers have slightly different limits. Approximately 3 million drivers are subject to the federal HOS rule. For decades, drivers recorded their service hours in paper log books. This method made violations of the HOS rule easy to hide. Since many drivers are paid by the mile, some drivers violated the HOS rule in order to drive longer and make more money. Some drivers said they had to violate the rule to meet the schedules imposed on them by dispatchers. There were concerns about the safety impacts of having drivers become even more fatigued by driving longer than the maximum times allowed by the HOS rule. In an effort to improve compliance with the HOS rule, in 2012 Congress mandated that trucks be equipped with electronic logging devices (ELDs), hardware devices that are connected to the truck engine to record driving time and transmit it during roadside inspections. In 2015, the Federal Motor Carrier Safety Administration (FMCSA) finalized regulations to implement that mandate. The mandate took effect in December 2017. FMCSA determined that the mandatory use of ELDs would improve highway safety, and could improve driver health if drivers take advantage of the rest periods mandated under the regulations to get adequate sleep. Since the ELD mandate went into effect, certain sectors of the commercial trucking industry have raised concerns about its impact. Since the ELD mandate did not change the HOS rule, but made it harder to evade the HOS limits without being detected, those concerns suggest that some operators may have routinely been out of compliance with the HOS rule. One sector that has been particularly critical of the improved enforcement of the HOS limits is the livestock hauling industry. The industry's business model has evolved to depend on hauling livestock long distances from around the nation to feedlots and slaughterhouses located mostly in the central states, and each stop along the way poses hazards to the livestock. Congress has repeatedly provided temporary waivers from the ELD mandate for livestock haulers, pending proposed revisions of the HOS rule by FMCSA. Currently the agency is prohibited from using federal funding to enforce the HOS rule against livestock haulers until September 30, 2020. The use of ELDs may help to quantify a challenge faced by drivers: inroads into their driving time caused by delays in loading and unloading their cargo by shippers and receivers. Drivers are typically paid by the mile, and by one estimate this unpaid "driver detention time" costs drivers $1.1 billion to $1.3 billion a year (an average of $1,300 to $1,500 per driver). This detention time is also estimated to increase the risk of crashes due in part to encouraging drivers to speed to make up for mileage that otherwise could not be driven during the allowable work time because of detention time. As the ELD mandate has been in effect for two years now, some impacts are starting to come into focus. An array of ELDs are now offered, some at prices below FMCSA's initial estimates. The impact of improved enforcement on industry activity and truck safety is not yet clear. Legislation is being proposed to help address the shortage of parking spots for truck drivers that can make it difficult to find a safe place to stop when they reach their HOS time limit. FMCSA has proposed a set of relatively minor changes to the HOS rule to, in the agency's words, increase safety while providing flexibility to drivers.


In response to the shortcomings of the Navy's Littoral Combat Ship program and evolving threats, the Navy began the FFG(X) program. With FFG(X), the Navy intends to deliver a multi-mission ship that will provide anti-surface, anti-submarine, and air warfare capabilities. DOD approved FFG(X) requirements in February 2019.The Navy plans for a competitive contract award to support final FFG(X) design and construction. The program is expected to cost over $20 billion for 20 ships. The House report accompanying the National Defense Authorization Act for Fiscal Year 2019 included a provision for GAO to review the FFG(X) program. This report addresses, among other things, the FFG(X) acquisition approach and contracting plans. GAO reviewed requirements, acquisition, design, and cost-related documentation. GAO interviewed Navy and other defense officials, and conducted industry site visits to each shipyard participating in FFG(X) conceptual design activities. GAO also leveraged prior GAO reports and best practices guides. The Navy undertook a conceptual design phase for the FFG(X) Guided Missile Frigate program that enabled industry to inform FFG(X) requirements, identify opportunities for cost savings, and mature different ship designs. The Navy also streamlined the FFG(X) acquisition approach in an effort to accelerate the timeline for delivering the ships to the fleet. As shown in the figure, however, the Navy has requested funding for the FFG(X) lead ship even though it has yet to complete key cost estimation activites, such as an independent cost estimate, to validate the credibility of cost expectations. Department of Defense (DOD) cost estimators told GAO the timeline for completing the independent cost estimate is uncertain. Specifically, they stated that this estimate will not be finalized until the Navy communicates to them which FFG(X) design is expected to receive the contract award. GAO-identified best practices call for requisite cost knowledge to be available to inform resource decisions and contract awards. The Navy plans to use a fixed-price incentive contract for FFG(X) detail design and construction. This is a notable departure from prior Navy surface combatant programs that used higher-risk cost-reimbursement contracts for lead ship construction. The Navy also plans to require that each ship has a minimum guaranty of $5 million to correct shipbuilder-responsible defects identified in the 18 months following ship delivery. However, Navy officials discounted the potential use of a warranty—another mechanism to address the correction of shipbuilder defects—stating that their use could negatively affect shipbuilding cost and reduce competition for the contract award. The Navy provided no analysis to support these claims and has not demonstrated why the use of warranties is not a viable option. The Navy's planned use of guarantees helps ensure the FFG(X) shipbuilder is responsible for correcting defects up to a point, but guarantees generally do not provide the same level of coverage as warranties. GAO found in March 2016 that the use of a guaranty did not help improve cost or quality outcomes for the ships reviewed. GAO also found the use of a warranty in commercial shipbuilding and certain Coast Guard ships improves cost and quality outcomes by requiring the shipbuilders to pay to repair defects. The FFG(X) request for proposal offers the Navy an opportunity to solicit pricing for a warranty to assess the cost-effectiveness of the different mechanisms to address ship defects.


In the Energy Policy Act of 2005 ( P.L. 109-58 ; EPAct05), Congress required the U.S. Environmental Protection Agency (EPA) to implement the Renewable Fuel Standard (RFS)âa mandate that requires U.S. transportation fuel to contain a minimum volume of renewable fuel. Since expansion of the RFS in 2007 under the Energy Independence and Security Act ( P.L. 110-140 ; EISA), Congress has had interest in the RFS for various reasons (e.g., limited cellulosic biofuel production, EPA's use of programmatic waiver authority, and RFS compliance costs). Over the last several months, Congress has expressed repeated interest in small refinery exemptions (SRE) from the RFS. The RFS allows small refineries to receive an exemption from the RFS, if they can prove compliance would subject them to disproportionate economic hardship. There is no statutory definition for disproportionate economic hardship, and a small refinery may apply for an exemption at any time. When deciding whether to grant an exemption, EPA is to consult with the Secretary of Energy. This consultation comes in the form of a recommendation from the Department of Energy (DOE) to EPA. The EPA Administrator has 90 days to act on (i.e., grant or deny) an exemption. A small refinery must apply each year for an exemption from compliance for that year. EPA categorizes the majority of small refinery exemption information as confidential business information (CBI). EPA does make publicly available some exemption information, but only in aggregate (e.g., total number of exemptions granted, total exempted volume of gasoline and diesel); there are no publicly available data on individual SREs. There have been legal challenges about small refinery exemptions. Small refineries can and have challenged EPA's denials of their petitions for SREs in court. Various stakeholders have also challenged EPA's methodology for evaluating small refinery exemption petitions. In 2020, the Tenth Circuit vacated EPA's decision to grant three small refinery exemption petitions. It is unclear how this court decision will affect how EPA evaluates SRE petitions in the future. Congress may be interested in small refinery exemptions for multiple reasons. Foremost, Congress may seek clarification on how EPA is currently evaluating SRE petitions, and whether that has changed over time. Some in Congress have raised concerns over transparency in EPA's decision process on SREs, as there is limited public information on the process. Congress may also value additional information about how SREs are being accounted for in annual rulemakings for the RFS. Each year, EPA issues a final rule for the RFS with the coming year's volume requirements (e.g., EPA is to issue the 2021 volume requirements by November 30, 2020). This final rule contains percentage standards thatâonce obligated parties (e.g., refiners and importers) apply them to their gasoline and diesel salesâare intended to ensure the volumes required are met. The formula for calculating the annual percentage standard includes a variable that accounts for small refinery exemptions granted by the time of the rulemaking. Depending on when the small refinery exemption is grantedâprior to the release of a final rule or afterâthat exemption may or may not be accounted for in the annual percentage standard (to date, most SREs have been granted afterward). In December 2019, EPA announced that it will change how it calculates the annual percentage standard in order to account for volumes of gasoline and diesel that will be exempted from the renewable volume obligations. The impact small refinery exemptions have on the RFS depends on the number of SREs granted, when they are granted, and the amount of gasoline and diesel exempted. Congress may consider several items as it seeks to understand the impact of SREs on the RFS, including transparency, agency discretion, a potential RFS reset, and U.S. gasoline consumption.


In the United States, federal retirement programs typically include cost-of-living adjustments based on a CPI that measures inflation for a subpopulation of workers. This includes Social Security, which provides benefits for more than 60 million older Americans, workers with disabilities, and their families. As the life expectancy of Americans continues to increase, more Americans will be subject to these adjustments, so it is critical for them to be accurate. GAO was asked to review U.S. and international efforts to measure the cost of living for older populations. This report examines (1) key issues that BLS faces in measuring the cost of living for older Americans; and (2) the experiences of other countries that developed alternate methods of adjusting retirement benefits. GAO reviewed pertinent literature; assessed BLS efforts to measure inflation; conducted case studies in three countries—Australia, New Zealand, and the U.K.—with a variety of CPIs, which GAO selected based on expert referral and document review; and interviewed agency officials and experts. The U.S. Bureau of Labor Statistics (BLS) faces accuracy, timeliness, and relevancy challenges developing consumer price indexes (CPI) for subpopulations of blue-collar workers and older Americans. For example, the CPI for these workers is used to adjust federal retirement benefits for inflation, including Social Security. BLS has not evaluated the extent to which its existing data are adequate to produce CPIs that reflect what these subpopulations pay, where they shop, and what they purchase. Officials cite budgetary reasons for not having done this, but there may be cost-efficient methods for evaluating the adequacy of these data. Without an evaluation, federal retirement benefits could be subject to adjustment based on potentially inaccurate information. Additionally, BLS has made limited use of certain data already collected by the federal government—such as National Accounts data on U.S. production and consumption—that could be used to increase the accuracy, timeliness, and relevancy of CPI calculations that reflect the mix of goods and services consumers purchase. Without adequately exploring the potential of using these data, BLS may be missing an opportunity to improve its CPIs. Reports about the retirement systems in the 36 Organisation for Economic Co-operation and Development countries indicate that most use their primary measures of inflation to adjust government retirement benefits. In addition, all three of GAO's case study countries (Australia, New Zealand, and the United Kingdom, or U.K.) have a variety of CPIs, including for subpopulations, and they filled information gaps in their CPIs with National Accounts and other data. For example, Australia and the U.K. use National Accounts data annually to update their calculations of the mix of goods and services consumers buy, thereby making the CPIs more relevant and accurate. All three countries also collaborated with stakeholders—such as other agencies—to implement changes, for example by gathering input on the design of subpopulation CPIs.


In the United States, state, territorial, and local governments are responsible for most aspects of selecting and securing election systems and equipment. Foreign interference during the 2016 election cycleâand widely reported to be an ongoing threatâhas renewed congressional attention to campaign and election security and raised new questions about the nature and extent of the federal government's role in this policy area. This report provides congressional readers with a resource for understanding campaign and election security policy. This includes discussion of the federal government's roles; state or territorial responsibilities for election administration and election security; an overview of potentially relevant federal statutes and agencies; and highlights of recent congressional policy debates. The report summarizes related legislation that has advanced beyond introduction during the 116 th Congress. It also poses questions for consideration as the House and Senate examine whether or how to pursue legislation, oversight, or appropriations. In the 116 th Congress, the FY2020 National Defense Authorization Act (NDAA; S. 1790 ; P.L. 116-92 ), enacted in December 2019, contains several provisions related to campaign and election security. Most provisions involve providing Congress or federal or state agencies with information about election interference. It also requires the Director of National Intelligence, in coordination with several other agencies, to develop a strategy for countering Russian cyberattacks against U.S. elections. In addition, the Consolidated Appropriations Act, 2020 ( P.L. 116-93 ; H.R. 1158 ), also enacted in December 2019, includes $425 million for payments to states, territories, and the District of Columbia to make general improvements to the administration of federal elections, including upgrades to election technology and security. As of this writing, 116 th Congress legislation that has advanced beyond introduction in at least one chamber includes H.R. 1 ; H.R. 753 ; H.R. 1158 ; H.R. 2500 ; H.R. 2722 ; H.R. 3351 ; H.R. 3494 ; H.R. 3501 ; H.R. 4617 ; H.R. 4782 ; H.R. 4990 ; S. 482 ; S. 1060 ; S. 1321 ; S. 1328 ; S. 1589 ; S. 1790 ; S. 1846 ; S. 2065 ; and S. 2524 . Other bills also could have implications for campaign and election security even though they do not specifically reference the topic (e.g., those addressing cybersecurity generally or voter access). Several congressional committees also have held legislative or oversight hearings on the topic. Federal statutesâsuch as the Help America Vote Act (HAVA); Federal Election Campaign Act (FECA); and the Voting Rights Act (VRA)âall contain provisions designed to make campaign finance, elections, or voting more secure. Several federal agencies are directly or indirectly involved in campaign and election security. These include, but are not limited to, the Department of Defense (DOD); Department of Homeland Security (DHS); Department of Justice (DOJ); Election Assistance Commission (EAC); and Federal Election Commission (FEC). Securing federal elections is a complex policy challenge that crosses disciplinary lines. Some of the factors shaping that complexity include divisions of authority between the federal and state (or territorial or local) governments; coordination among federal agencies, and communication with state agencies; funding; changing elections technology; and the different needs of different sectors, such as campaigns, administrators, and vendors. This report does not attempt to resolve ongoing policy debates about what campaign and election security should entail. The report cites other CRS products that contain additional discussion of some of the topics discussed herein. The report does not address constitutional or legal issues.


In the beginning of the 21 st century, natural gas prices were increasing and the United States was viewed as a growing natural gas importer. Multiple liquefied natural gas (LNG) import terminals were built while existing ones were recommissioned and expanded. However, the market conditions also drove domestic producers to innovate. As average U.S. prices peaked in 2008, domestic shale gas production was brought to market. Improvements in technologies such as hydraulic fracturing and horizontal drilling made the development of unconventional natural gas resources such as shale and other lower-permeability rock formations economically possible. Improved efficiency has lowered production costs, making shale gas production competitive at almost any price. The large amount of natural gas brought to market enabled large-scale exports from the United States. Of today's total global trade in natural gas, some 35% takes the form of LNG. As U.S. natural gas production increased and prices fell, U.S. consumption of natural gas grew. The rise in consumption did not keep pace with production, so companies turned to greater exports of natural gas, first by pipeline to Mexico and then as LNG to other parts of the world. The United States started exporting LNG from the lower-48 states in February 2016. The entrance of the United States as an exporter of LNG has caused significant changes to LNG markets. The U.S. natural gas market is one of the few that does not link the price of natural gas to oil, and this has carried in to LNG contracts. Some buyers view U.S. LNG exports as a hedge against oil prices. U.S. exporters do not require destination clauses, although where U.S. LNG exports end up must be reported to the U.S. Department of Energy. The relatively low price of U.S. natural gas has also helped consumers in other regions negotiate better prices for imports from non-U.S. sources. The United States is poised to rise in the export rankings and may have the most LNG export capacity, worldwide, within the next five years. According to projections by the U.S. Energy Information Administration (EIA), U.S. natural gas production, consumption, and exports will continue to grow for decades to come, while U.S. prices are projected to stay relatively low. One aspect of EIA projections is a status quo assumption when it comes to technology, laws and regulations, and markets among other things. As the advent of shale gas has shown, changes to the industry happen and may happen in significant ways and quickly. Natural gas has been and continues to be a topic of interest for Congress. One hundred bills have been introduced in the 116 th Congress related to different aspects of natural gas. Natural gas may play a bigger or smaller role in the U.S. economy depending, in part, upon congressional actions. Nevertheless, natural gas is an integral part of the U.S. and global energy mix. Knowing the major natural gas producing and exporting nations and how natural gas is transported for export are essential to understanding the sector and how U.S. natural gas fits into the global market.


In the context of high denial rates in the PSLF program, Congress appropriated $700 million in 2018 for a temporary expansion to the public service loan forgiveness program for certain borrowers who were not eligible for the original PSLF program. TEPSLF funds are available on a first-come, first-served basis. GAO was asked to review TEPSLF. This report examines (1) the extent to which the process for obtaining TEPSLF is clear to borrowers, (2) what is known about loan forgiveness approvals and denials, and (3) the extent to which Education has conducted TEPSLF outreach. GAO analyzed data from the TEPSLF servicer on loan forgiveness requests from May 2018 through May 2019 (the most recent available at the time of our review); reviewed Education's guidance and instructions for the TEPSLF servicer; assessed Education's outreach activities; interviewed officials from Education, the TEPSLF servicer, and selected groups representing borrowers; and reviewed borrower complaints about TEPSLF submitted to Education. The Department of Education's (Education) process for obtaining Temporary Expanded Public Service Loan Forgiveness (TEPSLF) is not clear to borrowers. Established in 2007, the Public Service Loan Forgiveness (PSLF) program forgives federal student loans for borrowers who work for certain public service employers for at least 10 years while making 120 payments via eligible repayment plans, among other requirements. In 2018, Congress funded TEPSLF to help borrowers who faced barriers obtaining PSLF loan forgiveness because they were on repayment plans that were ineligible for PSLF. Congress also required Education to develop a simple method for borrowers to apply for TEPSLF. Education established a process for borrowers to initiate their TEPSLF requests via e-mail. The agency also required TESPLF applicants to submit a separate PSLF application before it would consider their TEPSLF request. Agency officials said they established this process to quickly implement TEPSLF and obtain the information needed to determine borrower eligibility. However, the process can be confusing for borrowers who do not understand why they must apply separately for PSLF—a program they are ineligible for—to be eligible for TEPSLF. Requiring borrowers to submit a separate PSLF application to pursue TEPSLF, rather than having an integrated request such as by including a checkbox on the PSLF application for interested borrowers, is not aligned with Education's strategic goal to improve customer service to borrowers. As a result, some eligible borrowers may miss the opportunity to have their loans forgiven. As of May 2019, Education had processed about 54,000 requests for TEPSLF loan forgiveness since May 2018, and approved 1 percent of these requests, totaling about $26.9 million in loan forgiveness (see figure). Most denied requests (71 percent) were denied because the borrower had not submitted a PSLF application. Others were denied because the borrower had not yet made 120 qualifying payments (4 percent) or had no qualifying federal loans (3 percent). More than a year after Congress initially funded TEPSLF, some of Education's key online resources for borrowers do not include information on TEPSLF. Education reported that it has conducted a variety of PSLF and TEPSLF outreach activities such as emails to borrowers, social media posts, and new website content. However, Education does not require all federal loan servicers (who may serve borrowers interested in public service loan forgiveness) to include TEPSLF information on their websites. Further, Education's Online Help Tool for borrowers—which provides information on PSLF eligibility—does not include any information on TEPSLF. Requiring all loan servicers to include TEPSLF information on their websites and including TEPSLF information in its online tool for borrowers would increase the likelihood that borrowers are able to obtain the loan forgiveness for which they may qualify.


In the early months of 2020, the federal government began to express concern over the global outbreak of Coronavirus Disease 2019 (COVID-19). COVID-19 is a viral respiratory illness caused by a novel coronavirus. By late January, the Secretary of the U.S. Department of Health and Human Services (HHS) had invoked certain authorities to direct existing funds to respond to the COVID-19 outbreak. The HHS Secretary declared COVID-19 to be a Public Health Emergency, effective January 27, 2020. On February 24, 2020, the Trump Administration submitted an initial emergency supplemental appropriations request to Congress. The Administration requested $1.25 billion in new funds for the HHS Public Health and Social Services Emergency Fund (PHSSEF) to support COVID-19 response efforts. The request included a number of other proposals, mostly related to repurposing existing funds from across the government toward response activities. All told, the Administration estimated needing to allocate about $2.5 billion toward COVID-19 response efforts. On March 4, 2020, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 ( H.R. 6074 ), was introduced in the House. The bill was passed by the House (415-2) on March 4 and by the Senate (96-1) on March 5. The bill was signed into law ( P.L. 116-123 ) on March 6. This supplemental appropriations act is the first such act to be enacted in the aftermath of the COVID-19 outbreak. Any subsequent such actions are beyond the scope of the report. According to the Congressional Budget Office (CBO), Division A of P.L. 116-123 provides roughly $7.8 billion in discretionary supplemental appropriations. (CBO estimates that provisions in Division B will cost roughly $490 million, but those provisions are not the focus of this report.) The funds in Division A of P.L. 116-123 are primarily intended to prevent, prepare for, and respond to the coronavirus. (For purposes of the bill, the term coronavirus refers to SARS-CoV-2, the virus that causes COVID-2019, or another coronavirus with pandemic potential.) The majority of the funds in Division A are appropriated to HHS agencies and accounts. In total, the bill appropriates $6.5 billion to HHS, representing 84% of all funds in the bill. In general, these funds are for health emergency prevention, preparedness, and response activities related to COVID-19. Funds largely support domestic activities, but certain accounts include funds that may be allocated for global health activities. The HHS funds are distributed as follows: The PHSSEF receives almost half of all funds in Division A, with appropriations totaling $3.4 billion when including $300 million in appropriations that are contingent upon future actions by HHS. PHSSEF funds are provided for the development of countermeasures and vaccines, as well as for the purchase of vaccines, therapeutics, diagnostics, necessary medical supplies, medical surge capacity, and administrative activities. The Centers for Disease Control and Prevention (CDC) receives the next-largest share of all funds in the supplemental: $2.8 billion, accounting for more than a quarter of all funds in Division A. In general, these funds are intended to support core public health functions, including surveillance, laboratory capacity, infection control, and other activities. The funds are also for global disease detection and emergency response, as well as for activities carried out using the Infectious Diseases Rapid Response Reserve Fund (IDRRRF). Remaining HHS funds are appropriated to the Food and Drug Administration ($61 million) and the National Institutes of Health ($836 million). In addition to amounts appropriated to HHS, the supplemental provides $20 million in administrative funds for the Disaster Loans Program Account within the Small Business Administration (SBA). The supplemental also includes provisions clarifying that SBA disaster loans and economic injury disaster loans may be made in response to COVID-19. Finally, the supplemental provides nearly $1.3 billion (about 16% of all funds in Division A) to support foreign operations activities across several agencies and funding mechanisms. This includes funding to help the Department of State maintain consular operations, reimburse for evacuation expenses, and support emergency preparedness. Additional funds are provided for global health, international disaster assistance, economic support, and certain oversight activities.


In the past three decades, debt has grown substantially among older Americans. The increase in debt among older Americans has raised concerns about financial security for people near or during retirement, not only because Americans aged 65 and older represent a large and growing proportion of the U.S. population, but also because increases in household debt might require retirees to devote a larger share of their fixed income from Social Security, pensions, or government subsidies toward paying debt. Older people also tend to have limited ability to adjust their labor supply to offset higher monthly debt obligations. Excessive debt payments may put more seniors, especially those living on limited incomes, at greater risk of financial insecurity. According to the Survey of Consumer Finances (SCF), the percentage of elderly households (i.e., those headed by individuals aged 65 and older) who held any debt increased from 37.8% in 1989 to 61.1% in 2016. During the same time, the median debt among elderly households with debt increased from $7,463 to $31,050 (in 2016 dollars), and the real average debt increased from $29,918 to $86,797 (in 2016 dollars). The median debt lies at the middle of the debt distribution, and the average debt is generally higher than the median debt because a relatively small percentage of people have very high debt. Between 1989 and 2016, growth in average household debt among elderly households with any debt largely resulted from mortgages, including growth in average debt secured by a residence (from $12,970 to $57,943 in 2016 dollars) and average debt for other residential properties (from $2,970 to $11,446 in 2016 dollars). Some researchers speculate that much of the growth in debt among elderly households through 2007 might have resulted from the increased availability of mortgage credit, whereas others argue that tightening underwriting standards on mortgage debt in the wake of the financial crisis have slowed mortgage originations among young borrowers, which consequently resulted in a shift of new mortgage originations toward older borrowers. Residential loans are usually considered to be long-term wealth builders, as the residence's market value may increase over time, and some researchers find that they are much less stressful to older people than other debt, such as credit card debt. However, some others also argue that households headed by individuals aged 65 and older held historically high levels of housing debt in 2016, which might expose them to greater vulnerability to housing market shocks than elderly households in previous cohorts. The change in debt among elderly households from 1989 to 2016 varied by age groups and asset levels. For example, the largest growth in the share of elderly households who have any debt was for those headed by individuals aged 75 and older. In terms of asset levels, households in the middle of the total asset distribution had the largest growth in the holding of any debt. Much of the change in debt among elderly households on average was well balanced by their assets. To measure the extent to which a household is burdened by debt, researchers and policymakers usually refer to the debt payments-to-income ratio and the total debt-to-asset ratio. Among elderly households with debt, the debt payment-to-income ratio increased from 8.7% in 1989 to 12.4% in 2016, and the debt-to-asset ratio increased from 5.1% to 9.0% during the same time. Both ratios peaked in 2010, the year after the recent economic recession, and then decreased from 2010 to 2016. The debt burden increased more rapidly for certain types of elderly households between 1989 and 2016. The debt-to-asset ratio among households headed by individuals aged 80 and older increased by 5 percentage points during this time. Likewise, the ratio among elderly households in the middle of the total asset distribution increased by more than 10 percentage points during the same time.


In the wake of 9/11, terrorists continue to target aircraft and airports, underscoring the ongoing threat to civil aviation and the need for effective security measures. FAMS deploys air marshals on selected flights to address such threats and is a key component of TSA's approach to aviation security. However, longstanding challenges faced by FAMS's workforce could impact its ability to carry out its mission. GAO was asked to review FAMS workforce issues. This report addresses (1) the extent to which FAMS has taken steps to address air marshals' health concerns, (2) the extent to which FAMS has taken steps to address air marshals' concerns about their work schedules, and (3) the number of discrimination complaints FAMS employees have reported and the extent to which FAMS has taken steps to prevent discrimination. GAO analyzed TSA and FAMS policies; documentation of efforts to address air marshals' quality of life issues; and FAMS data on missions, schedules, and discrimination complaints. GAO also interviewed TSA and FAMS officials, including FAMS management and air marshals in a non-generalizable sample of six FAMS field offices selected to capture a breadth of perspectives. Air marshals continue to express concerns about their health, but the Federal Air Marshal Service (FAMS) has not comprehensively assessed the health of its workforce. Air marshals in all six field offices we visited noted health issues, such as sleep deprivation, as a key quality of life concern. FAMS has taken steps to assess air marshals' individual health, such as requiring medical exams, but has not comprehensively assessed the overall health of its workforce and has not developed a plan to do so. FAMS officials stated that it would be difficult to analyze air marshals' medical records because they are not stored electronically, though they are researching options to do so. FAMS could develop and implement a plan to analyze the employee health data it already collects to identify workforce trends, and use this information to better promote employee welfare consistent with Transportation Security Administration (TSA) leadership principles. FAMS has taken some steps to address air marshals' concerns about their work schedules. In March 2018, FAMS revised its deployment strategy to expand coverage of certain high risk missions that it typically learns of 72 hours in advance. Following this, changes to air marshals' schedules to accommodate these missions more than doubled. In response, FAMS altered how it staffs these missions and reports that these modifications have reduced schedule changes. FAMS also maintains shift length and rest period guidelines intended to balance mission needs with air marshals' quality of life. However, FAMS does not monitor the extent to which air marshals' actual work hours are consistent with guidelines because it has not identified a need to do so. As a result, it cannot determine how frequently air marshals work beyond guidelines and is not well-positioned to manage risks associated with long work hours. From fiscal years 2016 through 2018, FAMS employees filed 230 discrimination complaints with TSA's Civil Rights Division, though employees may have reported additional discrimination complaints through other means. In 2012, FAMS adopted an action plan to address discrimination and has taken some steps called for in the plan, such as sustaining a FAMS Ombudsman position. However, due to a loss of management focus on the plan, FAMS has not fully implemented other planned efforts, such as holding diversity focus groups. Taking steps to reaffirm its efforts to prevent discrimination would demonstrate leadership commitment to reducing concerns of discrimination within FAMS.


Almost 70,000 people died from drug overdoses in 2018, an estimated 69 percent of which involved opioids. Medicaid, a joint federal-state health care program for low-income and medically needy individuals, is one of the largest sources of coverage for individuals undergoing treatment for opioid use disorder. Congress included a provision in statute for GAO to review access barriers to MAT medications, including the distribution methods. This report describes policies that can restrict Medicaid beneficiaries' access to MAT medications, including any related to the distribution methods. To do this work, GAO reviewed relevant laws, policies, and documents, as well as studies describing access barriers and the benefits and challenges of the distribution methods. GAO also interviewed federal officials; stakeholders representing state Medicaid directors, health care providers, patients, and pharmacies; and state officials and health care providers from Minnesota, North Carolina, and Ohio, as well as the District of Columbia. GAO selected these three states and the District of Columbia based on their Medicaid programs' coverage of the MAT medications, their programs' spending for the treatment of opioid use disorder, and other criteria. Medication-assisted treatment (MAT)—which combines behavioral therapy and the use of certain medications, such as buprenorphine—has been shown to be effective at reducing the misuse of or addiction to opioids and increasing treatment retention. The federal government has identified expanding access to MAT as important for reducing opioid use disorders and overdoses, and has taken action to increase access. However, GAO found that some state and federal policies can restrict Medicaid beneficiaries' access to MAT medications. Some of these policies, and three selected states' and the District of Columbia's efforts to address potential access barriers, include the following: MAT medication coverage. A 2018 study found that about 40 percent of states may not provide Medicaid coverage for some formats of MAT medications, such as injectable and implantable formats, as required by federal law; however, the Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, has not determined the extent to which states are in compliance with the federal requirements to cover MAT medications. Prior authorization requirements. Some MAT medications and formats are subject to prior authorization, which requires these medications to be pre-approved before being covered by Medicaid. While these requirements are generally used to reduce expenditures, unnecessary utilization, and improper payments, stakeholders told GAO the requirements may cause life-threatening delays in the case of MAT medications. Some states, including three states and the District of Columbia that GAO reviewed, have taken steps to remove prior authorization requirements for MAT medications. Distribution methods. States may mandate the ways MAT medications can be distributed. For example, Minnesota's fee-for-service plan requires the use of the buy-and-bill distribution method for all injectable and implantable medications. This method requires providers, such as physicians, to purchase and store these medications until administered to the patient, allowing immediate access to the MAT medication for Medicaid beneficiaries. However, for expensive injectable medications, which can cost $1,200 per treatment, this method places providers at financial risk if the medication is not used or the reimbursement is less than the providers' costs, requiring resources some providers may lack, according to providers in the selected states and District of Columbia. As a result, some states have removed such restrictions to maximize beneficiary access. Federal waiver for prescribing buprenorphine. According to stakeholders GAO interviewed, some providers are unwilling to obtain the federal waiver necessary to prescribe or administer buprenorphine for opioid use disorder—due to reasons such as the hours of training associated with the waiver—which can restrict beneficiary access to this MAT medication. In addition, while nurse practitioners and physician assistants are eligible for these waivers, some state laws require them to be supervised by a physician. Stakeholders told GAO that some nurse practitioners may find it difficult to identify a qualified physician, which may affect patient access to MAT.


In the wake of increasing concerns in the 1970s about human health and environmental risks posed by inactive uranium mill tailings, Congress enacted the Uranium Mill Tailings Radiation Control Act of 1978 (UMTRCA). Uranium milling operations generate uranium concentrate, also known as "yellowcake" uranium, and waste material, called tailings , which can harbor and liberate radioactive and non-radioactive constituents. Title I of UMTRCA authorized a remedial action program for uranium mill tailings sites that were inactive prior to 1978, which produced uranium concentrate under federal procurement contracts primarily for nuclear weapons and other defense purposes. Title II of UMTRCA authorized the regulation of uranium mills and tailings sites that were operating on or after the law's enactment, which largely produced uranium concentrate for civilian nuclear power plants. UMTRCA does not provide regulatory authority over uranium mining (the physical removal of uranium ore from the earth), waste material produced from uranium mining, or remediation of inactive uranium mine sites. The Department of Energy (DOE) is the federal agency responsible for implementing the remedial action program and administering long-term federal management of the tailings. The site remediation costs have exceeded costs originally envisioned by Congress, the agencies, and the licensees due to an evolving understanding of the complexities and risks posed by unintended releases of contaminants from uranium mill tailings. As part of the remediation action, the uranium mill tailings are enclosed in engineered repositories, located at disposal sites, which are designed to prevent unintended release of potentially hazardous constituents for hundreds of years. DOE's authority to perform surface remediation at Title I sites expired on September 30, 1998. Groundwater contamination has compounded the technical complexity and timeline of remedial actions at certain sites. Congress amended UMTRCA in 1988 to authorize DOE to perform groundwater remediation without expiration under the Uranium Mill Tailings Remedial Action Amendments Act (UMTRA). UMTRCA requires the transfer of both Title I and Title II disposal sites to long-term federal management. As of FY2019, the Department of Energy, Office of Legacy Management (DOE-LM) administers long-term federal management at 31 Title I sites, excluding the site at Moab, UT. Title II sites are regulated by the U.S. Nuclear Regulatory Commission (NRC) or an NRC agreement state and transferred to DOE-LM for long-term federal management when NRC, or the state, determines that applicable standards have been met. As of FY2019, six of 29 Title II sites have transferred to DOE-LM, and 23 Title II sites remain privately owned under an NRC or an agreement state license. DOE-LM expects to take long-term management responsibilities of the 23 remaining Title II sites by 2048. Under UMTRCA, Congress established that the federal government pay for long-term monitoring and maintenance costs at Title I sites, subject to annual appropriations to DOE-LM. For Title II sites, Congress intended that the licensee would pay for any long-term management costs with a one-time long-term surveillance charge (LTSC). In the event that the LTSCs are not sufficient to cover annual monitoring and maintenance costs, DOE-LM would be responsible to carry out long-term management responsibilities, subject to availability of annual appropriations. The long-term management efforts to stabilize tailings and monitor groundwater have proven more challenging, and expensive, than originally expected. The federal government will be responsible for long-term management of all UMTRCA sites once transferred to DOE-LM. Potential oversight issues for Congress may include understanding the decommissioning and transfer status of the remaining Title II sites, the adequacy of funding to complete decommissioning at certain sites if the licensee is unable to fulfill its obligations, and the adequacy of LTSCs to meet future management needs.


In total, 162 African Americans have served in Congress. This total includes 152 African Americans (146 Representatives and 6 Delegates) elected only to the House of Representatives; 9 African Americans elected or appointed only to the Senate; and 1 African American who has served in both chambers. The first African American Members, Senator Hiram Revels of Mississippi and Representative Joseph Rainey of South Carolina, both took the oath of office in 1870. These first two Members were among the 22 African American Members (2 in the Senate, 20 in the House) who began their service in the period of time after the Civil War but prior to the start of the 20 th century. After these first 22, the presence of African Americans in the membership of Congress was not continuous, and there were subsequent periods in both chambers with no African American Members. Most recently, the 116 th Congress began with the highest number of African American Members ever at the start of a Congress: 57 (52 Representatives, 2 Delegates, and 3 Senators). Other information in this report includes the following: Numbers of African Americans who have served in Congress by party and type of service; Numbers of African Americans who have served in each Congress since 1870; Numbers of African Americans who have served in the House and Senate by state, district, or territory; Means of entry to Congress, including regular elections, special elections, and appointments; Brief background and selected data on the Congressional Black Caucus (CBC); Lists of selected "firsts" for African Americans in Congress; Lists of the African Americans who have served in leadership; Records for length of service in the House and Senate; and Lists of the African American women in the 116 th Congress.


Income and wealth inequality in the United States have increased over the last several decades. At the same time, life expectancy has been rising, although not uniformly across the U.S. population. Taken together, these trends may have significant effects on Americans' financial security in retirement. GAO was asked to examine the distribution of income and wealth among older Americans, as well as its association with longevity, and identify the implication that these trends may have on retirement security. This report examines (1) the distributions of income and wealth among all older Americans over time; (2) the association between income, wealth, and longevity among older Americans; and (3) how the distributions of income and wealth changed over time for a cohort of individuals as they aged. To conduct this work, GAO analyzed data from two nationally representative surveys: the SCF, using data from 1989 through 2016, and the HRS. GAO used 1992 through 2014 HRS data linked to earnings records from the Social Security Administration. While preliminary 2016 HRS data are available, GAO used 2014 data, which contain more complete information for GAO's analysis. GAO also reviewed studies and interviewed researchers to further analyze the relationships between income, wealth, longevity, and retirement security. Disparities in income and wealth among older households have become greater over the past 3 decades, according to GAO's analysis of Survey of Consumer Finances (SCF) data. GAO divided older households into five groups (quintiles) based on their income and wealth. Each year of data in the analysis, and, thus, each quintile, included different sets of households over time. Average income and wealth was generally higher over time (see fig. 1 for average income), disproportionately so for the top quintile (top 20 percent). For example, in 2016, households in the top quintile had estimated average income of $398,000, compared to about $53,000 for the middle quintile and about $14,000 for the bottom quintile. GAO also found that for quintiles with lower wealth, future income from Social Security and defined benefit pensions provide a relatively significant portion of resources in retirement for those who expect such income. A substantial number of older Americans born from 1931 through 1941 lived at least into their 70s or early 80s, according to GAO's analysis of data from the Health and Retirement Study (HRS), a nationally representive survey which follows the same individuals over time. GAO divided individuals born from 1931 through 1941 into quintiles based on their mid-career household earnings using records from the Social Security Administration. GAO's analysis, as well as that of other researchers, shows that differences in income, wealth, and demographic characteristics were associated with disparities in longevity. However, even with these disparities, we found a substantial number of people in the sample were alive in 2014, including those with characteristics associated with reduced average longevity, such as low earnings (see fig. 2) and low educational attainment. Taken all together, individuals may live a long time, even individuals with factors associated with lower longevity, such as low income or education. Those with fewer resources in retirement who live a long time may have to rely primarily on Social Security or safety net programs. GAO's analysis of HRS data also found that disparities in household income decreased while disparities in wealth persisted as a cohort of older Americans aged from approximately their 50s into their 70s or early 80s. Income disparities decreased between higher- and lower-earning households because higher-earning households saw larger drops in income over time, indicating the possible transition from working to retirement. For example, we estimated median income for the top mid-career earnings group decreased by 53 percent while estimated median income for the bottom earnings group decreased by 36 percent over the same period. Wealth remained relatively steady for households in the bottom three earnings groups over the time period GAO examined, while households in the top two earnings groups experienced larger fluctuations in wealth. GAO estimated that median retirement account balances and median home equity increased across earnings groups for households that had these assets. However, the continued wealth disparities may be due to significant differences in the median value of retirement accounts and home equity between higher- and lower-earning households. GAO also found that white households in the bottom two earnings groups had higher estimated median incomes, and white households in all earnings groups generally had greater estimated median wealth, than racial minority households in those earnings groups. In addition, within each earnings group, households headed by someone with at least some college education generally had higher median incomes and wealth than households headed by someone who did not attend college.


India, a federal republic and the world's most populous democracy, held elections to seat a new lower house of parliament in April and May of 2019. Estimates suggest that more than two-thirds of the country's nearly 900 million eligible voters participated. The 545-seat Lok Sabha (People's House) is seated every five years, and the results saw a return to power of the Bharatiya Janata Party (BJP) led by Prime Minister Narendra Modi, who was chief minister of the west Indian state of Gujarat from 2001 to 2014. Modi's party won decisivelyâit now holds 56% of Lok Sabha seats and Modi became the first Indian leader to win consecutive majorities since Indira Gandhi in 1971. The United States and India have been pursuing an expansive strategic partnership since 2005. The Trump Administration and many in the U.S. Congress welcomed Modi's return to power for another five-year term. Successive U.S. Presidents have deemed India's growing power and influence a boon to U.S. interests in Asia and globally, not least in the context of balancing against China's increasing assertiveness. India is often called a preeminent actor in the Trump Administration's strategy for a "free and open Indo-Pacific." Yet there are potential stumbling blocks to continued development of the partnership. In 2019, differences over trade have become more prominent, and India's long-standing (and mostly commercial) ties to Russia and Iran may run afoul of U.S. sanctions laws. Additionally, India maintains a wariness of U.S. engagement with Pakistan and intentions in Afghanistan, with Islamabad presently facilitating a U.S.-Taliban dialogue and India counseling against a precipitous U.S. withdrawal from Afghanistan. Prime Minister Modi's return to power promises broad continuity, even with some notable changes to the federal cabinet. By many accounts, Modi's record as an economic reformer and liberalizer is mixed, and his reputation as a nationalist "watchman" has not always translated into effective foreign policy, according to some analysts. It is unclear if Modi will use his renewed domestic political mandate to pursue more assertiveness internationally, possibly in ways that challenge U.S. preferences. Still, most analysts contend that Modi and the BJP have been and will continue to be more open to aligning with U.S. regional strategy and more energetic in pursuing U.S.-favored economic reforms than would have been any alternative Indian leadership. The BJP is a Hindu nationalist party, born in 1980 of a larger social movement, and Narendra Modi is a self-avowed Hindu nationalist (India is roughly 79% Hindu and 14% Muslim). The 2019 Modi-BJP campaign was widely criticized for divisiveness, and nationalist fervor following a February India-Pakistan crisis may have benefitted the BJP at the polls. India's minority communities and the country's civil society are widely reported to be under increasing threats emanating from Hindu majoritarian policies and sentiment. These threats can take violent and repressive forms, at times with the involvement of Indian officials or political figures, as reported by the U.S. State Department and independent human rights watchdogs, and as criticized by some Members of Congress. This report reviews the recent Indian election process and results, the country's national political stage, and possible implications for U.S. interests in the areas of bilateral economic and trade relations, defense and security ties, India's other foreign relations, and human rights concerns.