House Report 117-7 — Union Calendar No. 1, 117th Congress
Summary
House Report 117–7, Union Calendar No. 1, is the report of the Committee on the Budget of the House of Representatives to accompany H.R. 1319, the American Rescue Plan Act of 2021, with minority views, ordered to be printed February 24, 2021. After the title page it lists the Committee members, with John A. Yarmuth as Chairman, and a contents page that begins with an Introduction by the Committee on the Budget at page 2. The contents then list Title I from the Committee on Agriculture at page 7 and following titles prepared by other committees. The text read is only front matter and the contents list.
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“House Report 117-7 — Union Calendar No. 1, 117th Congress.”
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1
Union Calendar No. 1
117TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
1st Session 117–7
AMERICAN RESCUE PLAN ACT OF 2021
R E P O R T
OF THE
COMMITTEE ON THE BUDGET
HOUSE OF REPRESENTATIVES
TO ACCOMPANY
H.R. 1319
together with
MINORITY VIEWS
FEBRUARY 24, 2021.—Committed to the Committee of the Whole House
on the State of the Union and ordered to be printed
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AMERICAN RESCUE PLAN ACT OF 2021
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1
Union Calendar No. 1
117TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
1st Session 117–7
AMERICAN RESCUE PLAN ACT OF 2021
R E P O R T
OF THE
COMMITTEE ON THE BUDGET
HOUSE OF REPRESENTATIVES
TO ACCOMPANY
H.R. 1319
together with
MINORITY VIEWS
FEBRUARY 24, 2021.—Committed to the Committee of the Whole House
on the State of the Union and ordered to be printed
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U.S. GOVERNMENT PUBLISHING OFFICE
43–504 WASHINGTON : 2021
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COMMITTEE ON THE BUDGET
JOHN A. YARMUTH, Kentucky, Chairman
HAKEEM S. JEFFRIES, New York JASON SMITH, Missouri,
BRIAN HIGGINS, New York Ranking Member
BRENDAN F. BOYLE, Pennsylvania, TRENT KELLY, Mississippi
Vice Chairman TOM McCLINTOCK, California
LLOYD DOGGETT, Texas GLENN GROTHMAN, Wisconsin
DAVID E. PRICE, North Carolina LLOYD SMUCKER, Pennsylvania
JANICE D. SCHAKOWSKY, Illinois CHRIS JACOBS, New York
DANIEL T. KILDEE, Michigan MICHAEL BURGESS, Texas
JOSEPH D. MORELLE, New York BUDDY CARTER, Georgia
STEVEN HORSFORD, Nevada BEN CLINE, Virginia
BARBARA LEE, California LAUREN BOEBERT, Colorado
JUDY CHU, California BYRON DONALDS, Florida
STACEY E. PLASKETT, Virgin Islands RANDY FEENSTRA, Iowa
JENNIFER WEXTON, Virginia BOB GOOD, Virginia
ROBERT C. ‘‘BOBBY’’ SCOTT, Virginia ASHLEY HINSON, Iowa
SHEILA JACKSON LEE, Texas JAY OBERNOLTE, California
JIM COOPER, Tennessee
ALBIO SIRES, New Jersey
SCOTT H. PETERS, California
SETH MOULTON, Massachusetts
PRAMILA JAYAPAL, Washington
PROFESSIONAL STAFF
ELLEN BALIS, Staff Director
MARK ROMAN, Minority Staff Director
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CONTENTS
Page
Introduction by the Committee on the Budget ...................................................... 2
Title I—Committee on Agriculture ......................................................................... 7
Title II—Committee on Education and Labor ....................................................... 47
Title III—Committee on Energy and Commerce ................................................... 130
Title IV—Committee on Financial Services .......................................................... 360
Title V—Committee on Oversight and Reform ..................................................... 400
Title VI—Committee on Small Business ............................................................... 456
Title VII—Committee on Transportation and Infrastructure .............................. 486
Title VIII—Committee on Veterans’ Affairs .......................................................... 532
Title IX—Committee on Ways and Means ............................................................ 561
Committee on the Budget:
Votes of the Committee on the Budget ........................................................... 899
Other House Report Requirements ................................................................. 915
Views of Committee Members ......................................................................... 920
American Rescue Plan Act of 2021 (legislative text) ............................................ 925
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Union Calendar No. 1
117TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
1st Session 117–7
AMERICAN RESCUE PLAN ACT OF 2021
FEBRUARY 24, 2021.—Committed to the Committee of the Whole House on the State
of the union and ordered to be printed
Mr. YARMUTH, from the Committee on the Budget,
submitted the following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 1319]
[Including cost estimate of the Congressional Budget Office]
The Committee on the Budget, to whom reconciliation rec-
ommendations were submitted pursuant to title II of S. Con. Res.
5, the concurrent resolution on the budget for fiscal year 2021, hav-
ing considered the same, report favorably thereon without amend-
ment and recommend that the bill do pass.
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INTRODUCTION BY THE COMMITTEE ON THE BUDGET
It has been roughly one year since the first COVID-19 case was diagnosed in the United States. Our
nation is struggling to endure the unrelenting devastation spawned by the pandemic and corresponding
economic fallout. The need for bold, compassionate, and aggressive action remains unparalleled and
undeniable.
THE CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2021
PAVED THE WAY FOR THE AMERICAN RESCUE PLAN
The 2021 budget resolution (S. Con. Res. 5) laid the groundwork for bold action by providing the option
of using the budget reconciliation process to deliver crucial relief to the American people and achieve
the goals of President Biden's American Rescue Plan. This reconciliation bill is the next step toward
implementing the plan.
Budget reconciliation has been used by Democrats and Republicans over the past four decades for a
variety of purposes, including reducing the deficit, expanding access to health coverage, restricting
eligibility and benefits in safety-net programs, and handing out deficit-increasing GOP tax cuts heavily
weighted to the wealthy. There is nothing inherently partisan about using budget reconciliation to move
legislation forward. Many past budget reconciliation bills had bipartisan support; some did not. Using
the reconciliation process does not preclude reaching a bipartisan agreement on a COVID-19 relief
package, but it doesn't require it either. This process can help ensure that Congress can move forward
and meet the country's needs. Without reconciliation, the bold action outlined by the President could
languish indefinitely in the Senate, putting the health and well-being of millions of American families at
risk. This is not an acceptable option.
Congress must act expeditiously to enact the American Rescue Plan Act and help workers, families,
communities, and small businesses survive these crises.
LIVES AND LIVELIHOODS ARE AT STAKE
The coronavirus pandemic and economic crisis are destroying lives and livelihoods across the country.
Tens of millions of Americans have been infected and nearly half a million have died-with almost one-
fifth of deaths occurring last month alone. Our economy has faced lows unseen since the Great
Depression. And our most vulnerable communities are forced to bear the brunt of these twin crises as
underlying health and economic inequities grow worse.
This recovery is sputtering, painful, and the most unequal on record. Already, there are two stories of
recovery in America right now as underlying racial, wealth, social, and gender disparities are
exacerbated by the pandemic, increasing the divergence between wealthier and poorer Americans. In
fact, workers making over $60,000 a year have seen their employment rates increase by nearly 3
percent since February 2020, while employment rates for workers making less than $27,000 have
decreased by more than 20 percent. The American people cannot afford any more delays. Millions of
Americans remain out of work, forced to leave their careers as entire industries crumble. Women -
especially mothers and women of color - are exiting the workforce at alarming rates, eight out of ten
minority-owned businesses are on the brink of closure, and without intervention, vital unemployment
benefits are set to expire for more than 11.4 million workers in just a few short weeks.
(1)
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In homes across America, food insecurity is climbing. Nearly 24 million Americans are going hungry and
as many as 12 million children live in a household without enough food. Widespread school closures
threaten to derail our children's education, with students of color experiencing learning loss at a higher
rate than their white peers. And 30 to 40 million Americans are living under the threat of eviction
because they cannot afford to pay their rent.
The public health and economic crises are inextricably tied. We cannot rescue our economy without first
containing the virus. Congress passed bipartisan legislation that provided help. But these short-term
measures have not been enough to respond to a pandemic that has been ongoing for a year. Additional
humanitarian relief and economic support are needed, and the American people cannot afford delay.
Absent additional government assistance, the economic and public health crises will worsen in the
months ahead; schools will not be able to safely reopen; vaccination rates will remain far too low; and
more Americans will needlessly suffer.
THE AMERICAN RESCUE PLAN ACT OF 2021
President Biden's American Rescue Plan takes a multipronged approach to tackle the public health and
economic crises resulting from the COVID-19 pandemic. This ambitious $1.9 trillion plan provides the
resources needed to change the direction of the pandemic and spur an inclusive and strong economic
recovery. With the American Rescue Plan Act, we will:
Beat the virus and safely reopen schools. The plan will mount a national vaccination program that
includes setting up community vaccination sites nationwide. It will also take complementary measures
to combat the virus, including scaling up testing and tracing, addressing shortages of personal protective
equipment and other critical supplies, investing in high-quality treatments, and addressing health care
disparities. The plan will also make the investments necessary to safely reopen schools.
Deliver immediate relief to working families bearing the brunt of the crisis. The plan will increase direct
assistance to households in need across America by $1,400 per person, bringing the total (including the
$600 down payment enacted in December) to $2,000. The plan will also provide direct housing and
nutrition assistance to families struggling to get by, expand access to safe and reliable child care and
affordable health care, extend and expand unemployment insurance so American workers can pay their
bills, and give families with children as well as childless workers a boost through enhanced tax credits.
The plan will also give 27 million workers a raise by increasing the federal minimum wage. These
measures will not only ensure working families can make ends meet now but will also help to generate
an inclusive economic recovery, rather than a recovery that leaves behind millions of Americans.
Support communities struggling with the economic fallout. The plan will provide crucial support for the
hardest-hit small businesses, especially those owned by entrepreneurs who have experienced systemic
discrimination, with Economic Injury Disaster Loan (EIDL) grants, expanded Paycheck Protection
Program (PPP) eligibility, and more. The plan also provides crucial resources to protect the jobs of first
responders, frontline public health workers, teachers, transit workers, and other essential workers that
all Americans depend on.
WEAK SUPPORT Will SOW A WEAK RECOVERY
Responses to past crises have made it clear that doing too little will cost us far more. Recessions can
lead to permanent economic losses and reduced opportunity, and our economy still bears scars from
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insufficient support during the Great Recession. The relief Congress has provided to date has been
instrumental in staving off an even more destructive downturn. However, because of the one-two
punch of an economic crisis fueled by a health crisis, more must be done to safeguard Americans' health
and economic security through this prolonged downturn. Our nation and our economy cannot wait for
the aggressive, bold relief included in the American Rescue Plan Act.
Without the American Rescue Plan Act, CBO estimates real GDP will not recover to its pre-pandemic
projection until 2025. That is four years of the economy operating below its potential, and years of
needless human suffering. The American Rescue Plan Act will get the economy back on track much
faster, with real GDP reaching CBO's pre-pandemic projection by the end of this year.
Far too many Americans are finding themselves out of work through no fault of their own. Many are
being forced to choose between their health and a paycheck. Not only does prolonged unemployment
lead to lost income, it has consequences for mental and physical health. Without the American Rescue
Plan Act, CBO estimates it will take at least three years before employment returns to pre-pandemic
levels. But with this vital support, economists estimate that we can bring the economy back to near full
employment in a little over 12 months.
WE MUST LEARN FROM PAST CRISES AND PAST MISTAKES
Unfounded fears of the federal debt, rather than any real economic constraint, hobbled the response ta
the Great Recession from the outset, producing a fiscal response that was too small and was withdrawn
tao soon ta fully match the depth of the downturn. As a result, the U.S. economy experienced a slow
and painful recovery, and it took nearly a decade far unemployment rates to recover. Years of forced
austerity and chronic underinvestment in public health, infrastructure, education, and more have left
the United States less safe, less resilient, and less able ta effectively respond to crises a reality the
pandemic has magnified.
Fortunately, economists across the ideological spectrum agree that the United States has ample fiscal
space to provide the resources necessary ta end the pandemic, mitigate its economic damage, and
rebuild a stranger and mare equitable economy. Interest rates and inflation are at historic laws - lower
today than before the pandemic - and consequently, returns an smart investments in the economy have
never been higher. In fact, economists warn that failing ta deliver the relief in the American Rescue Plan
Act and squandering this opportunity will lead ta a weak, prolonged, and unequal recovery, posing more
severe risks to our economic and budget outlooks than any deficits we might incur.
The quicker we act the more lives can be saved and the faster our economy will recover. Multiple
variant strains of the navel caranavirus are now infecting Americans across the United States, and our
vaccine rallout and efforts to contain the virus are in desperate need of resources. We are in a race
against time, and aggressive, bold action is needed before our communities are permanently scarred by
the human and economic costs of inaction.
THE BUDGET COMMITTEE'S ROLE IN DELIVERING THE AMERICAN RESCUE PLAN ACT
The major steps in the reconciliation process, as provided far under Section 310 of the Budget Act, and
haw they apply in this instance, are the following:
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The Budget Resolution. Reconciliation can be triggered only by the adoption of a budget resolution.
Therefore, the fiscal year 2021 budget resolution {S. Con. Res. 5), passed in early February, carried
reconciliation instructions for 12 committees that have jurisdiction over some portion of the American
Rescue Plan Act.
The resolution's budget reconciliation framework sets a budgetary target of up to $1.9 trillion -the
estimated cost of President Biden's American Rescue Plan.
Figure l
RECONCILIATION INSTRUCTIONS TO HOUSE COMMITTEES
Deficit increase (2021-2030), billions of dollars
COMMITTEE AMOUNT
Agriculture 16
Education and Labor 358
Energy and Commerce 188
Financial services 75
Foreign Affairs 10
Natural Resources 1
Oversight and Reform 351
Science, Space, and Technology 1
Small Business 50
Transportation and Infrastructure 96
Veterans' Affairs 17
Ways and Means 941
Subtotal 2103
Remove overlap 215
TOTAL 1,889
Authorizing Committees. Nine authorizing committees marked up legislative provisions pursuant to their
instructions and transmitted them to the Committee on the Budget. This report incorporates the
detailed descriptions of the provisions provided in the committees' submissions to the Budget
Committee, summarized below. Three authorizing committees did not submit recommendations to the
Budget Committee in response to the reconciliation instruction.
• The Agriculture Committee: Provisions help families put food on the table by extending
enhanced SNAP benefits, providing funds to alleviate backlogs and respond to pandemic
impacts in our food supply chains, and supporting debt relief and other financial and technical
assistance to Black farmers and other farmers of color.
• The Education and Labor Committee: Provides critical funding to help K-12 schools safely
reopen and address lost time in the classroom, as well as provisions to increase workers' income
by raising the federal minimum wage and expanding grants to make child care safer and more
affordable for families.
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The Energy and Commerce Committee Provisions provide critical funding and resources to
increase COVID-19 vaccinations across the country and to test, treat and protect all Americans,
including communities of color.
• The Financial Services Committee Provisions include funds to protect renters and homeowners,
prevent homelessness, and procure essential medical supplies and equipment through the
Defense Production Act.
• The Committee on Oversight and Reform Provisions provide urgent funding to help
communities across the country battle the coronavirus, restore critical services to struggling
families, and help save the jobs of our heroes - health care workers, first responders, sanitation
and transportation workers, and teachers - in states, localities, tribes, and territories.
• The Small Business Committee Provisions help small businesses get back on track with
additional funding for EIDL and restaurant grants, expanded PPP eligibility for nonprofits, and
support for shuttered and struggling live venues.
• The Veterans' Affairs Committee Provisions will provide critical funds to help the VA meet the
health and economic needs of our nation's veterans, including funds to waive copays for
treatment and help the VA reduce claims and appeals backlogs caused by COVID.
• The Transportation and Infrastructure Committee Provisions provide key funding for transit,
airports, and FEMA's disaster relief fund that help put people back to work.
• The Ways and Means Committee: Provisions include additional direct payments, extended
pandemic-related unemployment benefits, financial assistance for individuals to retain health
coverage through the Affordable Care Act, and funding for enhancements to refundable tax
credits like the Child Tax Credit and the Earned Income Tax Credit designed to help low-
income Americans and combat child poverty.
The Budget Committee. Having received the submissions, the Committee on the Budget, as provided for
under Section 310 of the Budget Act, has bound the provisions together, without substantive change,
into a single measure-a reconciliation bill-and met to report the measure to the House for floor
consideration.
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It.&. A)oust of l\tprt1mtattbes
Commttttt on ~griculturt
111$bington, l)C 20515
February 16, 2021
The Honorable John A. Yarmuth
Chaim1an
Committee on the Budget
204-E Cannon House Office Building
Washington, D.C. 20515
Dear Chainnan Yannuth,
Pursuant to section 2001 of the Concurrent Resolution on the Budget, I hereby transmit these
recommendations which have been approved by vote of the Committee on Agriculture and the
appropriate accompanying material including additional and minority views, to the House
Committee on the Budget. This submission is in order to comply with reconciliation directives
included in S. Con. Res. 5, the fiscal year 2021 budget resolution, and is consistent with section
310 of the Congressional Budget and fmpoundment Control Act of 1974.
Sincerely,
David Scott
Chainnan
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TITLE I-COMMITTEE ON AGRICULTURE
TABLE OF CONTENTS
TABLE OF CONTENTS .....
TITLE I COMMITTEE ON AGRICULTURE ................................................................ '~
SUBTITLE A-AGRICULTURE... . .
SUBTJTLE B-NUTRITION
BRIEF EXPLANATION .. . .................................... 20
PURPOSE ANTI NEED .... . ....... .20
SECTION-BY-SECTION DESCRIPTION. ................................................................ .26
COMMITTEE CONSIDERATION .. .... 29
TRANSMITTING THE MEASURE ..... . ........... J]
ROLL CALL VOTES ........................................................................ 31
CONGRESSIONAL BUDGET ACT COMPLIANCE ..... .. ..................... ..40
CONGRESSIONAL BUDGET OFFICE (CBO) ESTIMATE AND COMPARISONS ....... ..41
CONSTITUTIONAL AUTHORITY STATEMENT.. ....... ..47
PERFORMANCE GOALS AND OBJECTIVES .................................................................. ..47
COlVl1HTTEE OVERSIGHT FINDINGS .... ..... 47
ADVISORY COMMITTEE STATEMENT .. .. .... .47
APPLICABILITY TO THE LEGISLATIVE BRANCH .......................................................... ..47
FEDERAL MANDATES STATEMENT.. ... .......... .47
EARJ\1ARK STATEMENT .. ................................................................ ..48
DUPL!CA TION OF FEDER..A.L PROGRAMS ........................................................................... .48
CHANGES IN EXISTING LAW .. ..48
ADDITIONAL VIEWS
2
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TITLE I-COlVllvHTTEE ON AGRICUL TORE
BRIEF EXPLANATION
The provisions passed by the Committee increase spending within the jurisdiction of the
Committee on Agriculture, as instructed by S. Con. Res. 5, establishing the congressional budget
for the United States Government for Fiscal Year 2021 and setting forth the appropriate
budgetary levels for fiscal years 2022 through 2030, as passed by the House of Representatives
on February 5, 202 l.
PURPOSE AND NEED
The Senate Concurrent Resolution, S. Con. Res. 5, included budget reconciliation instructions
directing the Committee on Agriculture to report changes in laws within its jurisdiction that
result in increases to the deficit by not more than $16,112,000,000 for fiscal years 2021 through
2030. The Committee on Agriculture reported provisions out of Committee that meet those
instructions and are intended to address the ongoing crises across our country.
The United States faces unprecedented crises of a pandemic because of a zoonotic virus,
recession, joblessness, poverty, and hunger. The pandemic has exposed structural inadequacies
of the food supply chain, highlighting the need for improved resiliency from fa1m to fork.
The COVID-19 pandemic has claimed the lives of at least 484,000 Americans and sickened over
27 million Americans to date, with nearly 62,000 Americans lost in January 2021 alone. The
impact of the virus on Americans has been uneven, with communities of color more likely to
contract the virus, more likely to be hospitalized because of the virus, and more likely to die
from the virus according to statistics from the Centers for Disease Control. Additionally, as
compared to urban and suburban communities, rural communities often had less access to
intensive care hospital resources needed to survive this disease, with 17 rural hospitals closing in
2020 alone.
This ongoing pandemic has led to an economic recession, with significant unemployment,
hunger, and economic wellbeing impacts to Americans and families across the country. In April
2020, the unemployment rate of the United States rose to a level not seen since the data has been
collected. Both the Federal Reserve and the Congressional Budget Office project that the country
will have unemployment rates over 6 percent for the next three years. In February 2021, the
Bureau of Labor Statistics found that nearly 40 percent of the total of unemployed Americans
have been without a job for at least 27 weeks. Another 7 million Americans want a job but are
not current! y in the labor force.
Not surplisingly, the poverty and hunger rates of families, children, seniors, and working age
Americans have increased in the past year. Before the pandemic, the Census Bureau reported an
overall poverty rate of 10.5 percent, with significant differences across races. In 2019, the
poverty rate for black Ame1icans was l 8.8 percent, Hispanic Americans was 15.7 percent, and
American Indian and Alaska Natives was 18.5 percent. Poverty in America in 2020 is defined as
having an annual income of approximately $12,760 for an individual, $17,240 for a family of
20
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TITLE I---COMl'vHTTEE ON AGRICULTURE
two, and $26,200 for a family of four. In 2019, those guidelines were $12,490; $16,910; and
$25,750. Even before the pandemic, one in ten Ame1ican households and one in eight American
households with children experienced food insecurity. Rural households also experienced these
high rates of food insecurity and poverty. While Congress has provided some relief for
households suffering from food insecurity by providing crncial waivers for state agencies
administering the Supplemental Nutrition Assistance Program (SNAP) to efficiently process
significant increases in their caseloads and by providing emergency allotments under the
Families First Corona.vims Response Act to SNAP households, as determined by the Secretary,
the rates of food insecurity and poverty due to the pandemic remain high.
Across the country, more than 420 Republican and Democratic mayors from states including
Arizona, Florida, California, Ohio, Oklahoma, Kentucky, and Minnesota have exhorted Congress
to provide critical assistance for their cities and states, including assistance contained in this
measure. In a Febrnary 2021 article in the FVashington Post, Mayor Jeny Dyer of Fresno,
California stated that Federal aid for cities and states, including to help care for the hungry, "[is]
not a Republican issue or a Democrat issue .... lt's a public health issue. It's an economic
issue. And it's a public safety issue."
Food Supply Chain and Agriculture Pandemic Response
The impacts of the COVID-l 9 pandemic have been acutely experienced by food and
farmworkers. News reports estimate nearly 90,000 food processing plant workers located across
nearly 1,400 facilities have had confinned cases of COVID-19. Economists at Purdue University
estimate nearly 500,000 agriculture and farmworkers have contracted the disease. These essential
employees have continued to perfrnm despite challenges in acquiring adequate personal
protective equipment, difficulty with socially distancing while working, and the lack of culturally
appropriate literature on COVID-19 in workers' preferred language. In December 2020, the
National Academy of Sciences published an article titled "Livestock plants and COVID-19
transmission" that "suggests that, among essential industries, livestock processing poses a
particular public health risk extending far beyond meatpacking companies and their employees."
An article published in the CDC journal Emerging Irifectious Diseases titled "Coronavims
Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces"
highlighted how the COVID-19 pandemic has affected food and farmworkers, particularly racial
minorities within the sector. Of the states reporting race and ethnicity data, 36. 5 percent of food
and fann workers were Hispanic or Latino, but these workers accounted for 72.8 percent of
workers with COVID-19.
Acknowledging these needs, forty-three groups representing specialty crop growers and
processors wrote to the Secretary of Agriculture requesting that at least $1,000,000,000 be
prioritized specifically for the procurement and distribution of worker protective equipment.
The negative impacts of COVID-19 on food and farmworkers, as well as the simultaneous
shutdown of the food service sector in the initial days of the pandemic, crippled agricultural
supply chains that were heavily dependent on human labor and "just in time" processing and
21
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TITLE I-COl\,1J\,1ITTEE ON AGRICULTURE
delivery of products to retailers and consumers. According to the United States Depaiiment of
Agriculture (USDA), consumers typically spend 54 percent of all food and drink dollars on
products that are purchased and consumed outside of the home. As restaurants, bars, and other
food se1vice institutions such as schools and universities quickly closed in response to the
pandemic, agricultural processors and distributors were forced to pivot to other available
chaimels of trade such as retail grocery outlets.
Challenges with safe processing capacity, product packaging, and shelf-life led to the backup of
supply chains, causing increases in food costs and bare grocery store shelves, while on-farm
prices dropped and necessitated the destruction oflivestock and agriculture products that could
not be timely rerouted or repurposed. Some livestock and poultry producer groups forecast that
on-fann losses for hog fanners alone total $5,000,000,000.
The destruction of these products was happening as more and more Americans faced
unemployment and hunger. Food and agricultural supply chain security needs will persist as
pandemic recovery continues and understanding of SARS-CoV-2 continues to evolve.
To meet these critical needs, section 1001 of the Committee Print invests $4 billion in the United
States food supply chain and agriculture pandemic response. $3.6 billion of these funds are
intended to purchase food and agricultural commodities; purchase and distribute agricultural
commodities to Americans in need; make grants and loans to eligible organizations to respond to
COVID-19; and, make loans and grants and other assistance to improve the resiliency of the food
and agricultural supply chain.
This virus is of zoonotic origin, has demonstrated the ability to cross species boundaries and
mutate in multiple species, and may have unknown reservoir host or hosts. Cases have been
documented and tracked by the World Organization for Animal Health (OIE) in multiple genera
of the Felidae family; mustelids; primates; dogs; and more. To fully respond to the threat of
SARS CoV-2 and protect public health, a one health approach to surveillance must be adopted
and fully implemented. On November 12, 2020, the OIE issued a statement on COVID-19 and
mink. The statement observed that "[t]he risk of susceptible animals ... becoming a SARS-CoV-2
reservoir generates worldwide concern, as it could pose a continued public health risk and lead to
future spillover events to humans." The OIE went on to assert that "a global One Health
approach is needed" and that "actions should be taken to ... monitor susceptible animals." An
OIE guidance document on November 16, 2020 notes that "[tJransmission from infected minks
to humans was demonstrated in the Netherlands" and that "in high mink density areas there is a
risk of establishing a reservoir of SARS-CoV-2." With these recommendations and observations
from the international organization supporting global animal welfare and disease, the Committee
invests $300 million in monitoring and surveillance of SARS CoV-2 in susceptible animals.
In 2020, the meat and poultry supply chain in America was significantly disrupted by COVID-
19. Temporary actions to protect public health resulted in a supply chain backlog, mismatch of
product availability and accessible markets, and the euthanasia of animals. Very small and small
meat and poultry plants across the country are still working to reduce the backlog from that time
pe1iod. The Committee invests $100 million to defray the costs of overtime fees for Federal
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TITLE !---COMMITTEE ON AGRICULTURE
inspectors at small and very small Federally inspected meat and poultry facilities. These funds
will support resiliency and capacity in the domestic meat and poultry supply chains.
Emergency Grants for Rural Health Care
As stated earlier, rural communities may have less access to health care providers and
infrastructure, and some rural communities are also impacted by persistent pove1ty and hunger.
Even ,vith Federal assistance earlier investments to combat COVID-19, mral communities have
been hit hard by COVlD- l 9 as the pandemic has spread across the country, with the USDA
Economic Research Service noting that "non-metro death rates from COVlD-19 surpassed metro
rates starting in late August". Accordingly, the Committee provides the Department funds for
emergency grants to entities eligible under the USDA Community Facilities Grant Program to
maintain and increase health care and nutritional assistance capacity related to COVlD-19.
Socially Disadvantaged Farmers, Ranchers, Forest Land Owners and Operators, and Groups
The USDA spends billions of dollars annually to provide crncial support to American
agricultural producers. Black farmers and other agricultural producers belonging to racial or
ethnic minority groups have received a disproportionately small share of the farm loans and
payments administered by USDA as a result of the longstanding and widespread discrimination
against these groups. Despite multiple lawsuits, numerous government reports, and the limited
programs created by Congress since the J 980s attempting to address the disproportionately low
rates of agricultural spending on socially disadvantaged groups, USDA farm loan and payment
programs continue to disproportionately benefit farmers who are not racial or ethnic minorities.
Consequently, the Committee has agreed to achieve its directed spending target by using a
tailored approach to increase spending to address these longstanding inequities.
For this purpose, the Committee provides funds for payment or modification of existing
Department of Agriculture Farm Service Agency loans and Commodity Credit Corporation Farm
Storage Facility Loans held by socially disadvantaged farmers or ranchers. The Committee also
ensures that these payments do not affect the eligibility of farmers or ranchers for future farm
loans.
For the same purpose, the Committee provides $1.01 billion for assistance to socially
disadvantaged farmers, ranchers, forest landowners, and groups who have historically faced
discrimination on the basis of race or ethnicity by USDA. These funds will support outreach,
financial training, cooperative development and capacity building, and other technical assistance
to socially disadvantaged groups. These funds will also support the development of agricultural
legal centers and ag1icultural credit institutions to serve socially disadvantaged groups, including
other financing institutions funded by the Fann Credit System. These funds will support pilot
projects to provide technical and financial assistance to socially disadvantaged groups focused on
land acquisition, financial planning, technical assistance, and access to credit The funds will also
support grants and loans to improve land access, including heirs' property issues, and aid former
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TITLE I-COMMITTEE ON AGRICULTURE
farm loan borrowers that suffered adverse actions or past discrimination or bias. These funds will
support the activities of equity commissions. These funds will also support research, education,
and extension activities at minority serving institutions, including scholarships, internships, and
pathways to Federal employment for students; eligible institutions include 1890 Land-Grnnt
Institutions, 1994 Tribal Land-Grant Colleges and Universities, Alaska Native/Native Hawaiian
Serving Institutions, Hispanic-Serving Institutions, and Insular Area Institutions.
Food Assistance
To ease food and agricultural supply chain disruptions and address increased hunger due to
COVID-19, the Committee provides an additional $800 million in necessary funds to facilitate
delivery of U.S. commodities abroad via Title II grants of the Food for Peace Act, most recently
reauthorized in the Agriculture Improvement Act of2018 (P.L. 115-334).
Domestic Hunger and Nutrition
As stated earlier in this repo1t, the crisis of hunger in this country has been exacerbated by the
ongoing pandemic. News story after news story has highlighted the impact of this in
communities across the country.
Subtitle B of the Committee Print is intended to reduce this real threat of hunger to American
families. The Committee extends for 3 additional months, through September 30, 2021, the
requirement that the value of SNAP benefits be calculated using 115 percent of the June 2020
value of the thrifty food plan. This temporary increase to SNAP benefits is necessary because of
the significant increase in food insecurity and rise in food prices during the COVID-19
pandemic. The Committee provides additional funds to states to administer the program, as
caseloads are expected to remain high through the fiscal year due to the economic indicators. The
Committee also provides funds to the Nutrition Assistance Programs for Puerto Rico, American
Samoa, and the Commonwealth of the Northern Mariana Islands. In order to achieve greater
equity in the distribution of Federal resources to the underserved, minority community in the
Commonwealth of the No11hern Mariana Islands, the Committee encourages the Secretaiy of
Agriculture to collaborate with leadership of the N011hern Ma1iana Islands to better meet the
nutrition and anti-hunger needs of communities across the islands.
The Committee also provides funds to support improvements for online purchases using SNAP,
modernize the electronic benefit transfer system, and support mobile payment technologies. And,
the Committee provides additional funding for the Commodity Supplemental Food Program to
ensure sufficient inventory of food and to provide flexibility for increased caseload of low-
income seniors for this critical program.
Program Administration aud Oversight
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TITLE !--COMMITTEE ON AGR ICULTURE
The Committee designates $47.5 million for administration of the programs and policies in
Subtitle A of this title.
Over the past 12 months, the United States Department of Agriculture has received an additional
$111 billion to respond to the impacts of COVID-19. Congress and the public have an interest in
ensming that all funds used to implement projects and activities have followed appropriate laws
and regulations. The Committee provides $2.5 million to the USDA Office of the Inspector
General for such purposes.
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TITLE I-COlvlMITTEE ON AGRICULTURE
SECTION-BY-SECTION DESCRIPTION
SUBTITLE A-AGRICULTlJRE
Section 1001. Foodsupp(v chain and agriculture pandemic response
Section !001 provides $4,000,000,000 to the Secretary of Agriculture, $3,600,000,000 of
which is to support the food supply chain, including purchasing food and agricultural
commodities; making grants and loans for small to mid-sized processors, seafood processing
facilities, farmers markets, producers and other organizations to respond to COVID-19;
providing assistance to maintain and improve food and agricultural supply chain resiliency; and
making payments for necessary expenses related to losses of crops (including losses due to
derechos) pursuant to the Wildfire Hurricane Indemnity Program Plus.
The section requires the Secretary to use $300,000,000 of the $4,000,000,000 made
available, to conduct animal surveillance related to COVID-19.
The section requires that Secretary use $100,000,000 of the $4,000,000,000 made
available, to reduce the amount of overtime inspection costs borne by federally-inspected small
and very small meat, poultry, and egg processors.
Section 1002. Rmergency grantsfbr rural health care
Section 1002 provides $500,000,000 for the Secretary of Agriculture to award emergency
grants for rural health care costs related to COVID-19, including increasing capacity for vaccine
distribution, constmcting temporary or permanent stmctures to provide vaccine administration or
testing, and supporting staffing needs for vaccine administration or testing. Grants awarded
under this section may be used to reimburse for costs incurred prior to the issuance of the grant.
The funds provided to carry out this section shall remain available until September 30,
2023. Not more than three percent of the funds may be used by the Secretary for administrative
purposes and not more than two percent may be used by the Secretary for technical assistance.
Section 1003. Pandemic program administrationfimd5
Section 1003 provides $47,500,000 for necessary administrative expenses associated with
carrying out this subtitle.
Section 1004. Fundingfor the USDA Office ofInspector Genera/for oversight ,>{COT7D-l 9-
related programs
Section 1004 provides $2,500,000 for the USDA Office of the Inspector General to audit,
investigate, and conduct other oversight activities of projects and activities carried out with funds
made available to the Department of Agriculture related to the COVID-19 pandemic. These
funds remain available until September 30, 2022.
Section 1005. Farm loan assistancefiJr socially disadvantagedfarmers and ranchers
Section 1005 requires the Secretary of Agriculture to make payments of 120 percent of
any outstanding farm loan indebtedness, as of Januaiy I, 2021, to pay off such loan debt for each
socially disadvantaged farmer or rancher. A payment under this section shall not affect the
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TITLE !---COMMITTEE ON AGRICULTURE
eligibility of the affected socially disadvantaged farmer or rancher for a farm loan after the date
on which the payment under this section is made.
Section 1006. Assistance and support.for socially disadvantaged.firrmers, ranchers, forest land
owners and operators, and groups
Section 1006 provides $1,010,000,000 forthe Secretary of Agriculture to provide
assistance and support for socially disadvantaged fanners, ranchers, and forest land owners and
operators, and socially disadvantaged groups, including providing technical assistance,
cooperative development training and support, and other activities to support socially
disadvantaged groups; providing grants and loans to improve land access for socially
disadvantaged farmers, ranchers, or forest land owners or operators, including issues related to
heirs' property; supporting the development of agricultural credit institutions that are designed to
serve socially disadvantaged groups; to support the activities of one or more equity commissions;
to support and supplement research, education, and extension, as well as scholarships and
programs that provide internships and pathways to Federal employment, at 1890 institutions,
1994 institutions, Alaska Native, Native Hawaiian, and Hispanic-serving institutions, and insular
area institutions of higher education.
Section 1007. Fundingjbr Food for Peace Title 11 grants
Section 1007 provides $800,000,000 for Food for Peace Title II grants. These funds
remain available until September 30, 2022.
SUBTITLE B- NUTRITION
Section l O11. Supplemental nutrition assistance program
Section IO 11 extends from June 30, 2021 to September 30, 202 l, the requirement that the
value of supplemental nutrition assistance program benefits be calculated using l 15 percent of
the June 2020 value of the thrifty food plan.
This section also provides $1,150,000,000 to the Secretary of Agriculture,
$1,135,000,000 of which shall be for the Secretary to make grants for each of fiscal years 2021
through 2023 to each State agency for the costs of State administrative expenses associated with
the supplemental nutrition assistance program. The remaining $15,000,000 is made available to
the Secretary of Agriculture for necessary expenses for management and oversight of the
supplemental nutrition assistance program.
Section 1012. Additional assistance.fi.ir SNAP 011/ine purchasing and technology improvements
Section l 0 12 provides $25,000,000 for the Secretary of Ag1iculture to make
technological improvements to online purchasing in the supplemental nutrition assistance
progran1, to modernize electronic benefit transfer technology, to support the use of mobile
technologies, and to provide technical assistance to educate retailers on such technologies. These
funds remain available until September 30, 2026.
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TITLE !---COMMITTEE ON AGRICULTURE
Section 1013. Additional.fimdingjor nutrition assistance programs
Section 1013 provides $1,000,000,000 to remain available until September 30, 2027 for
the Secretary of Agriculture to provide grants for nutrition assistance to Puerto Rico, American
Samoa, and the Commonwealth ofNorthern Mariana Islands. $30,000,000 of the total funding
shall be made available to the Commonwealth of Northern Mariana Islands.
Section 1014. Commodizv supplemental food program
Section 1014 provides $37,000,000 for the Commodity Supplemental Food Program, to
remain available until September 30, 2022.
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TITLE I---COMl\i!ITTEE ON AGRICULTURE
COMMITTEE CONSIDERATION
The Committee on Agriculture met, pursuant to notice, with a quorum present, on
Wednesday, February 10, 2021, to consider the Committee on Agriculture Committee Print
pursuant to the budget reconciliation instructions provided in the fiscal year 2021 budget
resolution, S. Con. Res. 5.
Chairman David Scott offered an opening statement as did Ranking Member Glenn 'GT'
Thompson. Without objection the Committee on Agriculture Committee Print was placed before
the Committee for consideration and the first reading of the measure was waived. The measure
was open for amendment on a section by section basis and subsequently for amendment at any
point.
The Committee engaged in discussion of specific sections and of the Committee Print in
general. Fourteen amendments were offered, all by the Minority.
Ranking Member Thompson offered an amendment to the Committee Print that would
have reduced by half each dollar amount specified in any section of the measure, excluding
sections 1005 and l 006. The amendment would have provided payments through the Renewable
Fuel Reimbursement Program and would have provided funding for certain broadband programs,
rural utility bridge loans, and rural hospitals and other community facilities. Mr. Thompson
called for a recorded vote and it failed by a vote of 23 yeas to 24 nays.
Mr. Feenstra offered an amendment to section 1001 of the Committee Print that ,vould
provide payments for necessary expenses related to crop losses, including losses due to high
winds or derechos, pursuant to the Wildfire Hurricane Indemnity Program Plus. Mr. Feenstra
called for a recorded vote and the amendment was adopted by a vote of24 yeas to 23 nays.
Mr. Feenstra offered an amendment to section !001 of the Committee Print that would
have prioritized small and medium-sized processors and distributors, where available, for
purchases and distribution of agricultural commodities under section 100l(b)(2). Mr. Thompson
called for recorded vote and it failed by a vote of23 yeas to 24 nays.
Mr. Davis offered an amendment to section 100 I of the Committee Print that would have
provided payments to biofuels producers for unexpected market losses due to COVID-19. Mr.
Thompson called for a recorded vote and it failed by a vote of23 yeas to 25 nays.
Mr. LaMalfa offered an amendment to section 1001 of the Committee Print that would
have reduced funding for COVID-19 animal surveillance by $200 million and increased funding
for grants and loans for measures to protect workers against COVID-19 by $200 million. Mr.
LaMalfa withdrew his amendment.
Mr. Johnson offered an amendment to section 1001 of the Committee Print that would
have allowed funds for COVID-19 animal monitoring and surveillance to be used to conduct
animal research and vaccination. Mr. Johnson withdrew his amendment.
Mr. Hagedorn offered an amendment to the Committee Print that would have prevented
any funds provided under this measure from being allocated until 80 percent of the funds made
available under the Coronavirus Aid, Relief, and Economic Security Act and the Consolidated
Appropriations Act, 2021 have been obligated. Mr. Hagedorn called for a recorded vote and it
failed by a vote of 23 yeas to 25 nays.
Mr. Feenstra offered an amendment to section 1005 of the Committee Print that would
have reduced farm loan assistance to socially disadvantaged farmers and ranchers to I 00 percent
oftl1e outstanding farm loan indebtedness of each such fa1mer or rancher. Mr. Thompson called
for recorded vote and it failed by a vote of 23 yeas to 24 nays.
Mrs. Hartzler offered an amendment to section l 005 of the Committee Print that would
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TITLE I--COlvIMITTEE ON AGRICULTURE
have limited fann loan assistance to socially disadvantaged farmers and ranchers to farm loan
debt incurred as a direct result of the COVJD-19 pandemic. Mr. Thompson called for a recorded
vote and it failed by a vote of 23 yeas to 25 nays.
Mr. Davis offered an amendment to section l 006 of the Committee Print that would have
expanded section l006(b)(6) of the measure to include any entities eligible to receive funds
under a capacity and infrastrncture program under the Department of Agriculture Reorganization
Act of 1994. Mr. Davis withdrew his amendment.
Mrs. Cammack offered an amendment to section 10 l l of the Committee Print that would
have eliminated the 3-month extension of the temporary increase in Supplemental Nutrition
Assistance Program benefits and provided $3 billion for employment and training programs. Mr.
Thompson called for a recorded vote and it failed by a vote of23 yeas to 25 nays.
Mr. Bacon offered an amendment to the Committee Print that would have provided a
$380 million increase in agricultural research and cooperative extension and education programs.
Mr. Thompson called for a recorded vote and it failed by a vote of23 yeas to 25 nays.
Mr. Feenstra offered an amendment to the Committee Print that would have rescinded the
unobligated balance of each amount made available without fiscal year limitation by the Act, as
of September 22, 2022. Mr. Thompson called for recorded vote and it failed by a vote of23 yeas
to 25 nays.
Mr. Baird offered an amendment to the Committee Print that would withhold all funds
made available under this measure until the Secretary of Agriculture reinstated the processing of
payments under the program under part 9 of title 7, Code of Federal Regulations. Mr. Thompson
called for a recorded vote and it failed by a vote of 22 yeas to 25 nays.
Hearing no further debate or amendments, Vice Chair Alma Adams moved that the
Committee transmit the Committee Print, with amendment, to the Committee on the Budget.
Ranking Member Thompson called for a recorded vote and it passed by a vote of25 yeas to 23
nays.
Ranking Member Thompson reserved the right for Minority views to be included with
the Committee Report.
Chainnan David Scott advised Members that, consistent with Committee and House
rules, Members would have until the end of the day on Sunday, February 14, 2021 to file such
views with the Committee. Without objection, staff were given the authority to make any
necessary clerical, technical, or conforming changes to the Committee Report reflect the intent of
the Committee. Chairman David Scott thanked the Members and the Committee meeting was
adjourned.
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TITLE I--COMMITTEE ON AGRICULTURE
TRANSMITTING THE MEASURE
On a motion by Vice Chair Adams, the Committee voted to transmit the Agriculture and
Nutrition title Committee Print, with amendment, to the Committee on the Budget, by a vote of
25 yeas to 23 nays.
ROLL CALL VOTES
In compliance with clause 3(b) of rule XIII of the House of Representatives, the
Committee sets forth the record of the following roll call votes taken with respect to the
Agriculture and Nutrition title Committee Print.
Rollcall No. I
Summary: An amendment that would have reduced by half each dollar amount specified
in any section of the measure, excluding sections 1005 and 1006. The amendment would have
provided payments through the Renewable Fuel Reimbursement Program and would have
provided funding for certain broadband programs, rural utility bridge loans, and rural hospitals
and other community facilities.
Offered by: Mr. Thompson
Result: Failed
23 yeas, 24 nays, 1 not voting
YEAS
1. Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mr. Feenstra
2. Mr. Austin Scott 8. Mr. Allen 14. Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais 10. Mr.Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Mann
NAYS
1. Mr. David Scott 7. Mrs. Hayes 13. Mrs. Bustos 19. Mr. Correa
2. Mr. Costa 8. Mr. Delgado 14. Mr. Maloney 20. Ms. Craig
3. Mr. McGovern 9. Mr. Rush 15. Mr. O'Halleran 2 l. Mr. Harder
4. Mr. Vela 10. Ms. Pingree 16. Mr. Carbajal 22. Mrs. Axne
5. Ms. Adams 11. Mr. Sablan 17. Mr. Khanna 23. Ms. Schrier
6. Ms. Spanberger 12. Ms. Kuster 18. Mr. Lawson 24. Mr. Panetta
NOT VOTING
1. Ms. Plaskett
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TITLE I---COJvfMITTEE ON AGRICULTURE
Rollcall No. 2
Summary: An amendment to section 1001 that would provide payments for necessary
expenses related to crop losses, including losses due to high winds or derechos, pursuant to the
Wildfire Hurricane Indemnity Program Plus.
Offered by: Mr. Feenstra
Result: Passed
24 yeas, 23 nays, I not voting
YEAS
L Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mr. Feenstra
2. Mr. Austin Scott 8. Mr. Allen 14. Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais JO.Mr.Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Mann 24. Mrs. Alme
NAYS
1. Mr. David Scott 7. Mrs. Hayes 13. Mrs. Bustos 19. Mr. Correa
2. Mr. Costa 8. Mr. Delgado 14. Mr. Maloney 20. Ms. Craig
3. Mr. McGovern 9. Mr. Rush 15. Mr. O'Halleran 21. Mr. Harder
4. Mr. Vela I 0. Ms. Pingree 16. Mr. Carbajal 22. Ms. Schrier
5. Ms. Adams l l. Mr. Sablan 17. Mr. Khanna 23. Mr. Panetta
6. Ms. Spanberger 12. Ms. Kuster 18. Mr. Lawson
NOT VOTING
l. Ms. Plaskett
Roltcall No. 3
Summary: An amendment to section 100 l that would have prioritized small and
medium-sized processors and distributors, where available, for purchases and distribution of
agricultural commodities under section 100l(b)(2).
Offered by: Mr. Feenstra.
Result: Failed
23 yeas, 24 nays, 1 not voting
YEAS
L Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mr. Feenstra
2. Mr. Austin Scott 8. Mr. Allen 14. Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais 10. Mr. Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler ll. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
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TITLE I-COMMITTEE ON AGRfCULTURE
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Mann
NAYS
l. Mr. David Scott 7. Mrs. Hayes 13. Mrs. Bustos 19. Mr. Correa
2. Mr. Costa 8. Mr. Delgado 14. Mr. Maloney 20. Ms. Craig
3. Mr. McGovern 9. Mr. Rush 15. Mr. O'Halleran 21. Mr. Harder
4. Mr. Vela 10. Ms. Pin1,,>ree l 6. Mr. Carbajal 22. Mrs. Axne
5. Ms. Adams 11. Mr. Sablan 17. Mr. Khanna 23. Ms. Schrier
6. Ms. Spanberger 12. Ms. Kuster 18. Mr. Lawson 24. Mr. Panetta
NOT VOTING
l. Ms. Plaskett
Rollcall No. 6
Summary: An amendment to section 1001 that would have provided payments to
biofuels producers for unexpected market losses due to COVID-19.
Offered by: Mr. Davis
Result: Failed
23 yeas, 25 nays
YEAS
l. Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mr. Feenstra
2. Mr. Austin Scott 8. Mr. Allen 14. Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais 10. Mr. Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Mann
NAYS
l. Mr. David Scott 8. Mr. Delgado 15. Ms. Plaskett 22. Mr. Harder
2. Mr. Costa 9. Mr. Rush 16. Mr. O'Halleran 23. Mrs. Axne
3. Mr. McGovern 10. Ms. Pingree 17. Mr. Carbajal 24. Ms. Schrier
4. Mr. Vela 11. Mr. Sablan 18. Mr. Khanna 25. Mr. Panetta
5. Ms. Adams 12. Ms. Kuster 19. Mr. Lawson
6. Ms. Spanberger 13. Mrs. Bustos 20. Mr. Correa
7. Mrs. Hayes 14. Mr. Maloney 21. Ms. Craig
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TITLE I-COMMITTEE ON AGRICULTURE
Rollcall No. 7
Summary: An amendment to the measure that ·would have prevented any funds provided
under this measure from being allocated until 80 percent of the funds made available under the
Coronavirus Aid, Relief and Economic Security Act and the Consolidated Appropriations Act,
2021 have been obligated.
Offered by: Mr. Hagedorn
Result: Failed
23 yeas, 25 nays
YEAS
I. Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mr. Feenstra
2. Mr. Austin Scott 8. Mr. Allen l4. Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais 10. Mr. Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Mann
NAYS
1. Mr. David Scott 8. Mr. Delgado 15. Ms. Plaskett 22. Mr. Harder
2. Mr. Costa 9. Mr. Rush 16. Mr. O'Halleran 23. Mrs. Axne
3. Mr. McGovern 10. Ms. Pingree 17. Mr. Carbajal 24. Ms. Schrier
4. Mr. Vela 11. Mr. Sablan 18. Mr. Khanna 25. Mr. Panetta
5. Ms. Adams 12. Ms. Kuster 19. Mr. Lawson
6. Ms. Spanberger 13. Mrs. Bustos 20. Mr. Correa
7. Mrs. Hayes 14. Mr. Maloney 21. Ms. Craig
Rollcall No. 8
Summaiy: An amendment to section 1005 that would have reduced farm loan assistance
to socially disadvantaged fanners and ranchers to 100 percent of the outstanding farm loan
indebtedness of each such fanner or rancher.
Offered by: Mr. Feenstra
Result: Failed
23 yeas, 24 nays, l not voting
YEAS
l. Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19> Mr. Feenstra
2. Mr. Austin Scott 8. Mr. Allen 14. Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais 10. Mr.Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. LaMalfa 12. Mr. Johnson 18.Mr.Mann
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TITLE I--COM!VIITTEE ON AGRICULTlJRE
NAYS
l . Mr. David Scott 8. Mr. Delgado 15. Ms. Plaskett 22. Mrs. Axne
2. Mr. Costa 9. Mr. Rush 16. Mr. O'Halleran 23. Ms. Schrier
3. Mr. McGovern 10. Ms. Pingree 17. Mr. Carbajal 24. Mr. Panetta
4. Mr. Vela 11. Mr. Sablan 18. Mr. Lawson
5. Ms. Adams l2. Ms. Kuster 19. Mr. Correa
6. Ms. Spanberger 13. Mrs. Bustos 20. Ms. Craig
7. Mrs. Hayes 14 Mr. Maloney 21 Mr.Harder
NOTVOTTNG
1. Mr. Khanna
Rollcall No. 9
Summary: An amendment to section l 005 that would have limited farm loan assistance
to socially disadvantaged farmers and ranchers to fann loan debt incmred as a direct result of the
COVID-19 pandemic.
Offered by: Mrs. Hartzler
Result: Failed
23 yeas, 25 nays
YEAS
1. Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mr. Feenstra
2. Mr. Austin Scott 8. Mr. Allen 14. Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer l 5. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais 10. Mr. Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Mann
NAYS
1. Mr. David Scott 8. Mr. Delgado 15. Ms. Plaskett 22. Mr. Harder
2. Mr. Costa 9. Mr. Rush 16. Mr. O'Halleran 23. Mrs. Axne
3. Mr. McGovern 10. Ms. Pingree 17. Mr. Carbajal 24. Ms. Schrier
4. Mr. Vela 11. Mr. Sablan 18. Mr. Khanna 25. Mr. Panetta
5. Ms. Adams 12. Ms. Kuster 19. Mr. Lawson
6. Ms. Spanberger 13. Mrs. Bustos 20. Mr. Correa
7. Mrs. Hayes 14. Mr. Maloney 21. Ms. Craig
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TITLE !---COMMITTEE ON AGRICULTITRE
Rollcall No. JO
Summary: An amendment to section l 011 that would have eliminated the 3-month
extension of the temporary increase in Supplemental Nutrition Assistance Program benefits and
provided $3 billion for employment and training programs.
Offered by: Mrs. Cammack
Result: Failed
23 yeas, 25 nays
YEAS
1. Mr. Thompson 7. Mr. Davis 13. Mr. Baird [9. Mr. Feenstra
2. Mr. Austin Scott 8. Mr. Allen 14. Mr. Hagedorn 20. lVlrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais JO.Mr.Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Mann
NAYS
1. Mr. David Scott 8. Mr. Delgado 15. Ms. Plaskett 22. Mr. Harder
2. Mr. Costa 9. Mr. Rush 16. Mr. O'Halleran 23. Mrs. Axne
3. Mr. McGovern JO. Ms. Pingree 17. Mr. Carbajal 24. Ms. Schrier
4. Mr. Vela 11. Mr. Sablan 18. Mr. Khanna 25. Mr. Panetta
5. Ms. Adams 12. Ms. Kuster 19. Mr. Lawson
6. Ms. Spanberger 13. Mrs. Bustos 20. Mr. Correa
7. Mrs. Hayes 14. Mr. Maloney 21. Ms. Craig
Rollcall No. 11
Summary: An amendment to the measure that would have provided a $380 million
increase in agricultural research and cooperative extension and education programs.
Offered by: Mr. Bacon
Result: Failed
23 yeas, 25 nays
YEAS
1. Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mr. Feenstra
2. Mr. Austin Scott 8. Mr. Allen 14. Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais 10. Mr.Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Mann
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TITLE I--COMM1TTEE ON AGRICULTURE
NAYS
l . Mr. David Scott 8. Mr. Delgado 15. Ms. Plaskett 22. Mr. Harder
2. Mr. Costa 9. Mr. Rush 16. Mr. O'Halleran 23. Mrs. Axne
3. Mr. McGovern IO Ms. Pingree 17. Mr. Carbajal 24. Ms. Schrier
4. Mr. Vela 11. Mr. Sablan 18. Mr. Khanna 25. Mr. Panetta
5. Ms. Adams 12. Ms. Kuster 19. Mr. Lawson
6. Ms. Spanberger 13. Mrs. Bustos 20. Mr. Correa
7. Mrs. Hayes 14. Mr. Maloney 21. Ms. Craig
Rollcall No. 12
Summary: An amendment to the measure that would have rescinded the unobligated
balance of each amount made available without fiscal year limitation by the Act, as of September
22, 2022.
Offered by: Mr. Feenstra
Result: Failed
23 yeas, 25 nays
YEAS
1. Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mr. Feenstra
2. Mr. Austin Scott 8. Mr.Allen 14 ..Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais 10. Mr. Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 1 l. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Mann
NAYS
l. Mr. David Scott 8. Mr. Delgado 15. Ms. Plaskett 22. Mr. Harder
2. Mr. Costa 9. Mr. Rush 16. Mr. O'Halleran 23. Mrs. Axne
3. Mr. McGovern IO. Ms. Pingree 17. Mr. Carbajal 24. Ms. Schrier
4. Mr. Vela 11. Mr. Sablan 18. Mr. Khanna 25. Mr. Panetta
5. Ms. Adams 12. Ms. Kuster 19. Mr. Lawson
6. Ms. Spanberger 13. Mrs. Bustos 20. Mr. Correa
7. Mrs. Hayes 14. Mr. 1\!laloney 21. Ms. Craig
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TITLE I---COMMITTEE ON AGRICULTURE
Rol!call Nu. 13
Summary: An amendment to the measure that would vvithhold all funds made available
under this measure until the Secretary of Agriculture reinstated the processing of payments under
the program under part 9 of title 7, Code of Federal Regulations.
Offered by: Mr. Baird
Result: Failed
22 yeas, 25 nays, l not voting
YEAS
1. Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mrs. Miller
2. Mr. Austin Scott 8. Mr. Allen 14. Mr. Jacobs 20. Mr. Moore
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Balderson 21. Mrs. Cammack
4. Mr. DesJarlais 10. Mr. Kelly 16. Mr. Cloud 22. Mrs. Fischbach
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Mann
6. Mr. LaMalfa 12. Mr. Johnson 18. Mr. Feenstra
NAYS
I. Mr. David Scott 8. Mr. Delgado 15. Ms. Plaskett 22. Mr. Harder
2. Mr. Costa 9. Mr. Rush 16. Mr. O'Halleran 23. Mrs. Axne
3. Mr. McGovern 10. Ms. Pingree 17. Mr. Carbajal 24. Ms. Schrier
4. Mr. Vela 11. Mr. Sablan 18. Mr. Khanna 25. Mr. Panetta
5. Ms. Adams 12. Ms. Kuster 19. Mr. Lawson
6. Ms. Spanberger 13. Mrs. Bustos 20. Mr. Correa
7. Mrs. Hayes 14. Mr. Maloney 21. Ms. Craig
NOT VOTING
l. Mr. Hagedorn
Rollcall No. 13
Summary: Motion to transmit the measure, as amended, to the Committee on the Budget
Offered by: Vice Chair Adams
Result: Passed
YEAS
l. Mr. David Scott 8. Mr. Delgado 15. Ms. Plaskett 22. Mr. Harder
2. Mr. Costa 9. Mr. Rush 16. Mr. O'Ha!leran 23. Mrs. Axne
3. Mr. McGovern 10. Ms. Pingree 17. Mr. Carbajal 24. Ms. Schrier
4. Mr. Vela 11. Mr. Sablan 18. Mr. Khanna 25. Mr. Panetta
5. Ms. Adams 12. Ms. Kuster 19. Mr. Lawson
6. Ms. Spanberger 13. Mrs. Bustos 20. Mr. Correa
7. Mrs. Hayes 14. Mr. Maloney 21. Ms. Craig
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TITLE 1--COMMITTEE ON AGRICULTURE
NAYS
I. Mr. Thompson 7. Mr. Davis 13. Mr. Baird 19. Mr. Feenstra
2. Mr Austin Scott 8. Mr. Allen !4. Mr. Hagedorn 20. Mrs. Miller
3. Mr. Crawford 9. Mr. Rouzer 15. Mr. Jacobs 21. Mr. Moore
4. Mr. DesJarlais 10. Mr. Kelly 16. Mr. Balderson 22. Mrs. Cammack
5. Mrs. Hartzler 11. Mr. Bacon 17. Mr. Cloud 23. Mrs. Fischbach
6. Mr. Lal'vlalfa 12. Mr. Johnson 18. Mr. Mann
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29
TITLE !---COMMITTEE ON AGRICULTURE
BUDGET ACT COMPLIANCE (SECTIONS 308, 402, AND 423)
The provisions of clause 3(c)(2) ofmle XIU of the House of Representatives and section
308(a)(l) of the Congressional Budget Act of 1974 (relating to estimates of new budget
authority, new spending authority, new credit authority, or increased or decreased revenues or
tax expenditures) are not considered applicable. The estimate and comparison required to be
prepared by the Director of the Congressional Budget Office under clause 3(c)(3) ofmle XIII of
the House of Representatives and sections 402 and 423 of the Congressional Budget Act of 1974
submitted to the Committee prior to the filing of the report are as follows ( on the subsequent
pages):
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Congressional Budget Office February 13, 2021
Cost Estimate
.. . .•. ~~~t~~8:':'~~·:.::,c~r;;:~?:·.~~~~~*~'i\~b
Recon.ciliatlon Recommendations of the Hou.a& Committee on Agrtcultur:e
A• ordere~ repotad on l'•bruary 10, 2021 ·
By Fiscal Year, Millions of Oollu• 2021 2021-2030 2021-2031
---·--·--~-·--
Direc! Spending (Outlays) 13,018 16,072 16,072
Revenues 0 0 0
Increase or Decrease(-)
in the Deficit 13,018 16,072 16,072
The bill would
• Appropriate funds to address the effects of COVID-19, the disease caused by coronavirus, on the food supply
chain, including the purchase and distribution of agricultural commodities to people in need
• Appropriate funds to aid in vaccine administration and expand health care capacity in rural areas
• Provide debt relief to socially disadvantaged farmers and ranchers
• Fund new programs to increase the participation of socially disadvantaged groups in agriculture
• Extend the period for increased benefits under the Supplemental Nutrition Assistance Program (SNAP)
• Provide funds for SNAP and other nutrition programs
Estimated budgetary effects would mainly stem from
• Debt relief for socially disadvantaged farmers and ranchers
• Purchase and distribution of agricultural commodities
• Support for the food supply chain
• New programs to support socially disadvantaged groups in agriculture
• Extended higher funding for SNAP
• Increased spending from additional funding provided for nutrition programs
Areas of uncertainty include
• Estimating the cost of debt relief for socially disadvantaged farmers and ranchers
• Estimating the cost of extending the period for increased SNAP benefits
Detailed estimate begins on the next page,
See a!so CBO's Cost Estimates £:qi81h8d, www.cbo,gov/pub!ication/54437;
How CBO Prepares Cost Estimates, 1N'-f,N,(.cbo.gov/publication/53519: and Glo!!8ry, vvvvw cbo.gov/pubiication/42904.4 l
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Bill Summary
S. Con. Res. 5, the Conctment Resolution on the Budget for Fiscal Year 2021,
instructed several committees of the House of Representatives to recommend legislative
changes that would increase deficits up to a specified amount over the 202 l-2030
pe1iod. As pait of this reconciliation process, tl1e House Committee on Agriculture
approved legislation on Febma1y 10, 2021, with a number of provisions that would
increase deficits.
Subtitle A would appropriate an estimated $10.4 billion for measures intended to
strengthen the food supply chain, purchase and distribute agricultural commodities,
increase health care capacity in lower-income mral areas and other effmts to address
the pandemic. Also included are provisions that would provide debt relief for socially
disadvantaged fanners and ranchers and establish new programs to support socially
disadvantaged groups in agriculture.
Subtitle B would extend increased SNAP benefits through September 30, 202 l, a!ld
provides administrative and technology support for SNAP, as well as increased funding
to other nuuition programs.
Estimated Federal Cost
The estimated budgeta1y effects of the Reconciliation Recommendations of the House
Committee on Agriculture are shown in Table l. The costs of the legislation fall within
budget functions 150 (international affairs), 350 (ag1iculture), 450 (community and regional
development), 550 (health), and 600 (income security).
Basis of Estimate
For this estimate, CBO assumes that the Reconciliation Recommendations of the House
Committee on Agriculture will be enacted by the end of March 2021. CBO estimates that
enacting the legislation would increase direct spending by $16. l billion over the 2021-2030
period.
As required by the Federal Credit Refonn Act of 1990 (FCRA), CBO estimates most costs of
USDA loan programs on a net-present-value basis. A present value is a single number that
expresses a flow of current and future payments in tenns of an equivalent lnmp snm received
or paid at a specific time. Under credit reform, the present value of all loan-related cash
flows is calculated by discounting those expected cash flows to the year of disbursement,
using the rates for comparable maturities on Treasury securities. (For example, the cash flow
for a one-year loan is discounted using the rate for a one-yeai·, zero-coupon Treasmy note.)
As required by FCRA, changes to the estimated costs of outstanding direct loans are shown
in the year of enactment. CBO's estimated cost of $4 billion to pay off certain USDA loans
represents the net-present-value of the chaJtge in cash flows resulting from the loan
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32
forgiveness. That $4 billion comprises the cost of the loan forgiveness and an additional cash
payment to those borrowers equal to 20 percent of their outstanding indebtedness, as directed
in the legislation.
Direct Spending
Subtitle A of the legislation would provide funds to US DA and other agencies to respond to
the pandemic by appropriating:
• $3. 7 billion to purchase and distribute agricultural products to persons in need; to provide
loans and grants for small- and mid-sized food processors and distributors, including
seafood processors, farmers markets, producers, or other organizations to improve supply
chain resiliency; to reduce fees charged to small and very small meat, poultry, and egg
processing facilities for overtime inspection costs; and to compensate producers for
losses in crop year 2020 due to natural disasters, including high winds or derechos;
• $300 million for monitoring animals like mink and domesticated cats that are susceptible
to the viral strain that ca.uses COVID-19 in humans;
• $500 million to make grants to hospitals and clinics located in rural communities to
provide testing and vaccination services related to COVID-19, increase health care
capacity, and engage in other efforts critical to addressing the pandemic;
• $50 million for USDA administrative expenses and oversight of COVID-19-related
programs;
• An estimated $4 billion to pay off farm ownership, opera.ting, emergency, m1d farm
storage facility loans for fa.nners and ranchers who are members of socially
disadvantaged groups, and to provide, as directed by the legislation, an additional cash
payment equal to 20 percent of the outstanding indebtedness of those producers;
• $1 .01 billion to develop programs that provide assistm1ce to socially disadvantaged
farmers, ranchers, forest land owners and operators, and to provide additional funding for
institutions of higher education dedicated to suppo11ing socially disadvantaged groups;
and
• $800 million in additional funding for donations of U.S. food assistance to meet
emergency and nonemergency food needs around the world, including support for food
security goals.
In total, enacting those provisions would cost $10.3 billion over the 2021-2030 period, CBO
estimates.
The Consolidated Appropriations Act, 2021, increased SNAP benefits through June 2021.
Subtitle B would extend the period for those increased SNAP benefits through September 30,
2021, at an estimated cost of$3.54 billion. lt also would provide:
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• $1.15 billion for SNAP state administrative expenses;
• $25 million for SNAP online purchasing and technology improvements;
• $1 billion for nutrition assistance programs in the Commonwealth of the N01ihern
Mariana Islands, Pue1io Rico, and American Samoa; and
• $37 million for the Commodity Supplemental Food Program.
In total, enacting those provisions would cost $5.8 billion over the 2021-2030 period, CBO
estimates.
Uncertainty
Uncetiainty in the estimate of the cost of debt relief for socially disadvantaged farmers and
ranchers mises from incomplete data on the actual indebtedness of those producers. If the
number of affected producers and the net-present-value of future interest on the loans is
higher or lower than our estimate, then the cost ofloan forgiveness and the additional
pay1nent would increase or decrease accordingly.
Additionally, the cost of extending increased SNAP benefits depends on the level of
participation in that program and the average benefits for pa1iicipants. Uncertainty in the
estimate arises around both of those factors. For example, if SNAP participation is higher or
lower than CBO forecasts, costs for extending increased benefits would be higher or lower.
Pay-As-You-Go Considerations:
The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement
procedmes for legislation affecting direct spending or revenues. The net changes in outlays
that are subject to those pay-as-you-go procedures are shown in Table l.
Increases On-Budget Deficits in any Year after 2030: None.
Mandates: None.
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Estimate Prepared By
Federal Costs:
Tiffany Arthur for agriculture
Susan Yeh Beyer for nutrition programs
Jennifer Gray for SNAP and nutrition programs
Etaf Khan for international development
Erik O'Donoghue for agriculture
Jon Sperl for rural development
Ellen Werble for food safety
Mandates: Lilia Ledezma
Estimate Reviewed By
Sheila Dacey
Chief, Income Security and Education Cost Estimates Unit
Susan Willie
Chief, Natural and Physical Resources Cost Estimates Unit
H. Samuel Papenfuss
Deputy Director of Budget Analysis
Theresa Gullo
Director of Budget Analysis
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table!,
E'sfiJ1laied:,_sudg~ta.rY f ~ ~fR~t1d~t~1?n ~~?J:l~endait,;~ ~f~h~ ,H:o«il~ f?,~tteil! Oli:4grimilture'
2021
See, 1001- Food Sup1>lyChaln and Agriculture PimdemiC Response
0 0 4,000
108 55 4,000
See. 1002 • Emergency Grants for Rllraf Healthcare
500 0 500
200 150 100 50 500
Sec. 1003- Pandemk Program Administration Funds
47 47
41 47
Sec. 1004, Offke of the inspector General
Sec, 1005 - Farm loan Assistance for Sodal~ Olsatlvantaged farmers and Ranchers.
0
Sec. 1006 - Assistance and Support for Socially Disadvantaged Farmers, Ranchers,
forest li!nd Ownern and Operators, irnd Grnups
Budgs>tAl-1thority 11 010 1,010
Estirnated01.1tlays 296 25 25 25 25
Sec, 1007 - Food for Peace Tille II Grants
800 0 800
128 440 120 4S 16 760
Sec, 1011- SNAP Value of Benefits
Estimated BuflgetAuthorlty
Estimated Outlays
SNAP Administrative Expenses
Budget Authority 1.15G 1,150
tst1mat.edOtJtlays 345 1,150
Sec, 1012- Additional Assistance-for SNAP Online Puri::hasing and Techn,;logy Improvements.
SudgetAuthocity O O 0
Estimated Outlays 0 25
Sec. 1013- Additional Funding for Nutrition Assistance Programs
8uOgetAmhorlty 1,000 0
500 500 1,000
Sec. 1014- commodity Supplemental Food Program
37 37
11
Total Din,ct Spending
Estimated Budget Authority 16,112 0 16,112
n,01a 1,993 70!)
Estimated Outlays 165
" 36 29 29 29 16,072
Corr,ponents may r:ot sum to tot;i!s because of rot1nding; SNAP"- Suppiernt>ntal Nutrition Assistance Program; ""' between ,$500/JOO and $500,000.
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TITLE !--~COMMITTEE ON AGRICULTURE
CONSTITUTIONAL AUTHORITY STATEMENT
The Committee finds the Constitutional authority for this legislation in A1ticle I, section 8, clause
t 8, that grants Congress the power to make all laws necessary and proper for carrying out the
powers vested by Congress in the consideration of the United States or in any department or
officer thereof The Committee further finds the Constitutional authority for this legislation in
Article I, section 8, clause 1, that grants Congress the power to provide for the general welfare of
the United States.
PERFORMANCE GOALS AND OBJECTIVES
Pursuant to clause 3(c)(4) of rule XIU of the House of Representatives, the performance goals
and objectives of this measure are to increase spending through changes in laws within the
jurisdiction of the Committee on Agriculture as required by S. Con. Res. 5, the fiscal year 2021
budget resolution.
COMMITTEE OVERSIGHT FINDINGS
Pursuant to clause 3(c)(l) of rule X!II of the House of Representatives, the Committee on
Agriculture's oversight findings and recommendations are reflected in the body of this report.
ADVISORY COMMITTEE STATEMENT
No advisory committee within the meaning of section S(b) of the Federal Advisory Committee
Act was created by this measure.
APPLICABILITY TO THE LEGISLATIVE BRANCH
The Committee finds that the measure does not relate to the terms and conditions of employment
or access to public services or accommodations within the meaning of section 102(b)(3) of the
Congressional Accountability Act (Public Law 104- l).
FEDERAL MANDATES STATEMENT
The Committee adopted as its own the estimate of Federal mandates prepared by the Director of
the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Refonn Act
(Public Law 104-4).
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TITLE 1--COl\llMITTEE ON AGRICULTlJRE
EARi\iARK STATEMENT
This measure does not contain any congressional earmarks, limited tax benefits, or limited tariff
henefits as defined in clause 9( e), 9(t), or 9(g) of rnle XXI of the House of Representatives.
DUPLICATION OF FEDERAL PROGRAMS
This measure does not establish or reauthorize a program of the Federal Government known to
be duplicative of another Federal program, a program that was included in any report from the
Government Accountability Office to Congress pursuant to section 21 of Public Law l l l-139, or
a program related to a program in the most recent Catalog of Federal Domestic Assistance.
CHANGES TN EXISTING LAW
At the time of transmission to the Committee on the Budget, a comparative print (Ramseyer)
showing changes in existing law was not available to the Committee.
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TITLE I--COMM!TTEE ON AGR!CULTURE
Minority Views on Committee Print, as reported by the Committee on Agriculture,
required by S. Con. Res. 5
Summary
S. Con. Res. 5 provides reconciliation instructions to certain Committees of the House. For its
part, the Agriculture Committee is responsible for producing legislation that achieves $16.112
billion in new spending. The Committee Print to accompany this legislation is a partisan
exercise, developed behind closed doors with zero input from the Minority, and the measure
fails to meet the needs of mral America while exploding the deficit to fund programs including
those just funded two months ago, programs with a tenuous connection to the pandemic, and
priorities that manage to ignore most farmers and ranchers.
This partisan approach is particularly galling in the context of the Agriculture Committee, which
has long prided itself on being the most bipartisan Committee in the House. In addition, the
Agriculture Committee has never before been utilized in a reconciliation process for the sole
purpose of increasing deficit spending without any provisions to create mandatory savings. All
told, this exercise will saddle future generations with $ J. 9 trillion in additional debt while more
than $1 trillion in already enacted coronavirus relief funds remain unspent.
The United States Department of Agriculture (USDA) has only obligated 62 percent of the
monies provided by Congress to date.
In order to highlight just a few of the priorities missing from the bill, Republican Leader Glenn
"GT' Thompson (R-PA) offered an amendment that would haveredirected23 percent of
spending under the bill - holding harmless provisions for socially disadvantaged producers and
Supplemental Nutrition Assistance Program benefits - to support critical needs for rural families,
businesses, and communities. The amendment would have provided critical investments in
biofuels, needed assistance for rural communities through distance learning and telemedicine
grants, broadband infrastructure improvements, and aid for rural hospitals, community facilities,
rural utility providers, and rural businesses.
During the markup, the Majority universally praised the proposals offered in the amendment and
professed that they shared the same priorities yet labeled them as "poison pills" that would derail
the entire process. The amendment failed 24-23 alongpa1tisan lines.
Additionally, an amendment offered by Representative Jim Baird (R-IN) was rejected on a party
line vote, The amendment would have required the Bi den Administration to unfreeze funding for
the Coronavirus Food Assistance Program (CFAP) - for which sign up has already begun - prior
to moving forward with additional spending under this bill. If the impact of the COVID-19 crisis
is so acute it necessitates moving additional aid through Congress in this hmTied partisan
manner, it would make eminent sense not to hold up critical assistance ready to be delivered in a
matter of days, rather than delaying help for weeks or months on an arbitrary review process.
Subtitle A
Sec. 1001 Food Supply Chain and Agriculture Pandemic Response
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TITLE !--COMMITTEE ON AGRICULTURE
Section l 00 l provides $3 ,6 billion in funding for the Secretary to purchase food and agricultural
commodities, distribute commodities to individuals in need, make 1:,>rants and loans to processors
and distributors for measures to protect workers againstCOVID-19, and provide assistance
available to improve agricultural supply chain resiliency, While all important provisions, the
Minority would note that these are all authorities that were provided to the Secretary in the
Consolidated Appropriations Act, 2021 (PL 116-260) along with $1 l billion in funding that has
yet to be obligated by USDA Additionally, the original text of the legislation completely ignored
the needs of production agriculture and did not contain any provision that would provide direct
support to producers,
An amendment offered by Representative Randy Feenstra (R-IA), which makes disaster relief
for 2020 losses (including losses by high winds or derechos) eligible for funding under the
section, was adopted by a 24-23 margin with one Democrat joining all members of the Minority
in supporting All other amendments offered by the lV!inority were defeated along partisan lines,
including an amendment offered by Representative Jim Hagedorn (R-MN) to require that 80
percent of previous funding made available to USDA forCOVID-19 reliefbe expended before
any new funds under the bill could be obligated,
Additionally, this section makes $300million available to the Secretary to carry out monitoring
and surveillance of susceptible animals for incidence of SARS-Co V-2 despite USDA and
Centers for Disease Control (CDC) guidance advising against such testing
Sec. 1002-Emergency Grants for Rural Health Care
Section 1002 provides $500 million in funding for the Secretary to make grants to entities
eligible for the Community Facilities Program in order to assist eligible entities in meeting the
healthcare needs of rural residents.
Almost one year and $3, 5 trillion into this pandemic, the Majority's belated recognition of the
needs of rural health providers and the unique challenges that they face is welcome.Yet, this
program is poorly targeted, badly designed, and insufficient for the crisis facing rural hospitals
and other essential service providers in rural communities.
The Majority's legislation excludes hospitals and health facilities wbich are ineligible for the
Community Facilities program. In many communities this blanket prohibition excludes the sole
hospital or healthcare provider. We do not believe that essential assistance to battle the pandemic
should be limited to health providers who meet the limited requirements of the Community
Facilities program.
Similarly, the Majority's further restrictions on the usage of grant funds, the complex limitations
on median household income, and wage mandates, all further conspire to make this program
needlessly complicated and treat similar situated communities unequally.
Finally, the $500 million in funds is woefully insufficient for the scope of this crisis. Last
Conb,ress, Subcommittee Ranking Member Austin Scott (R-GA) offered a more robust proposal
which would have addressed the concerns the Minority raised with the Majority and provided $4
billion in funding,
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TITLE 1--COMMITTEE ON AGR!CULTURE
Ranking Member Glenn "GT" Thompson's (R-PA) amendment included a program which was
modeled on Subcommittee Ranking Member Austin Scott's (R-GA) legislation. It would have
provided a more flexible, responsive program for USDA to meet the needs of rnral hospitals,
educational institutions, and public safety facilities. Unfortunately, it was rejected out of hand by
the Majority_
In doing so, the Majority suggested the amendment would costs lives and hinder vaccine
deployment, while failing to note that under Republican Leader Glenn "GT" Thompson's
amendment, $150 million more would have been made available for rnral healthcare needs.
Sec. 1005- Farm Loan Assistance for Socially Disadvantaged Farmers and Ranchers and
Assistance and Sec. 1006 -Assistance and Support for Socially Disadvantaged -Farmers,
Ranchers, Forest Land Owners and Operators, and Groups
The Minority believes that issues of social justice and addressing historical racial inequities in
USDA programs is a worthy and important endeavor for the Committee. These issues certainly
deserve thorough review, thoughtful analysis, and a deliberative process to determine the best
policy solutions to address the problems faced by socially disadvantaged farmers. The Chairman
of the Committee highlighted his intentions to hold a hearing on the matter. However, the
Minority believes it is prndent to hold such a hearing prior to enacting unvetted legislation that
could have unintended impacts, including for the very producers who are the intended
beneficiaries.
The Majority was unable to answer simple questions such as those regarding what specific
producers ,vould be eligible under these sections, if women would be eligible for these programs,
or even if there was a nexus between the pmpose of the program and the COVID-19 pandemic.
The Majority's inability to articulate responses makes it clear that if these provisions are to have
coherent purpose, further discussions of these provisions are necessary before they become law.
Subtitle B
Section 1011. Supplemental Nutrition Assistance Program
Section 10 l l both extends a 15 percent increase to Supplemental Nutrition Assistance Proi,>ram
(SNAP) benefits from June 30, 2021 to September 30, 2021 and provides $1.15 billion to States
for administrative-related expenses.
The Supplemental Nutrition Assistance Proi,>ram currently provides nutrition assistance to 43
million individuals, providing an average benefit of $183 per person, up from $122 in October
2019, the last full fiscal year of data made available. Total SNAP-related spending in FY 2020
was $78.9 billion, which includes benefits, administration, nutrition education, employment and
training, and program integrity. Total benefits provided to households in FY 2020 totaled $74.2
billion.
The COVID-19 pandemic impacted households in need in unprecedented ways, and the
Congressional response to hunger remains colossal. By way of the Families First Corona virus
Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (CARES), and
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TITLE !--COMMITTEE ON AGRICULTURE
the Consolidated Appropriations Act, 2021, more 1han $37<8 billion has been approp1iated to
respond to the nutrition needs of our nation's vulnerable< This magnificent response is also in
addition to the more than $7< 7 billion per month in standard SNAP benefits< Beyond direct
funding from Congress, over 3,000 administrative waivers have been provided to all States; these
waivers impact operations related to program eligibility, distribution of benefits, employment and
training, etc<
Like other Committees, this Committee has found itself victim to an Administration and a
Majority who have repeatedly failed to take into consideration the plight of the American
worker, the worker who has fallen victim to shuttered businesses, job-killing shutdowns, and
canceled classes and training
Rather than perpetuate our Nation's second largest expansion of welfare entitlements, and
continue down a pathway ofnever-endingwork disincentives and prolonged dependency,
Representative Kat Cammack (FL-03) introduced a commonsense amendment that would have
taken $3 billion from an extension of an (arbitrary) benefit increase and injected it directly into
SNAP Employment and Training (E& T)< These funds would have provided a lifeline to
individuals staring at a post-pandemic economy unlike one ever seen<
Instead of entertaining the amendment, the Majority immediately launched into a tirade against
it, also calling into question Republicans' commitment to the Congressional response to hunger.
Unfortunately, a few facts were left out of this response, including the fact that the SNAP benefit
formula assumes households will spend at least 30 percent of their net income on food; SN AP
makes up the difference between that contribution and the cost of the Thirty Food Plan< To claim
that SNAP is the only means of purchasing food is disingenuous at best The Majority relies on a
half-truth- that anyone on SNAP who can work, does -which begs the question, which is it? ls
SNAP the only means to food access, or do working households spend some amount of money
on food 9 Worse, the Majority acknowledged that "many people lost their jobs because of the
pandemic<" The ensuing rant against using the benefit increase, not the benefit itself, for
employment and training further proved the Majority has no interest in helping the very
unemployed workers they rely on for political messaging to regain employment, an income, and
independence, particularly as this pandemic begins to recede<
Additionally, the Majority continues to rely on (anecdotal) evidence related to the Fanners to
Families Food Box Program< The Majority fails to acknowledge that this program has open
eligibility, making certain anyone and eveiyone in need, regardless of status, income, household
size, has access to nutritious foods that run the gamut from fruits and vegetables to meat and
dairy< This program has provided over 136 million boxes to households across the nation< And
with this program, fanners were able to redirect their products, American workers were able to
sustain their employment or join new ventures, and most importantly, a vast selection of foods
that would have otherwise been wasted found their way into the homes of millions<
Section l 012. Additional Assistance for SNAP Online Purchasing and Technology
lmpi·ovements
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TITLE !--COMMITTEE ON AGRICULTURE
This section provides an additional $25 million, to remain available until September 30, 2026, to
make technological improvements to improve SNAP online purchasing, to modernize electronic
benefit transfer (EBT) technology, to support mobile technologies demonstration projects, and
for technical assistance purposes. This appropriation is in addition to the $5 million provided in
the Consolidated Appropriations Act,2021, of which it is unknown what has been obligated as of
February 12, 2021.
Section 1013. Additional Funding for Nutrition Assistance Programs
Section 1013 provided an additional $1 billion to remain available until September 30, 2027, for
nutrition assistance grants to be provided to the Commonwealth of the Northern Mariana Islands,
Puerto Rico, and American Samoa, of which $30 million is guaranteed forthe Commonwealth of
the Northern Mariana Islands. This appropriation is in addition to the $614 million provided in
the Consolidated AppropriationsAct,2021, of which to date, zero has been obligated. This calls
into question the need, and the desire of the Majority to circumvent the annual appropriations
process without a clear understanding of the needs of these communities.
Section 1014. Commodity Supplemental Food Program
This section appropriates $37 million to the Commodity Supplemental Food Program, a program
geared toward seniors in need. lt is important to note that the Speaker of the House was the sole
arbiter of every policy related to nut1ition since the beginning of the pandemic, and yet never
once acknowledged the needs of our Nation's seniors. Until the Consolidated Appropriations
Act,2021, where the Minority reflected on the need based on data from USDA, the Majo1ity had
no proposal to fund this important program. Instead, the Majority has spent eleven months
advocating for various legislative proposals aimed at pausing program integrity measures,
allowing SNAP benefits to be used for diapers and sundries, expanding SNAP to be accepted in
restaurants, and earmarking millions of dollars to further bloat multi-billion dollar nonprofits.
Grants for Distance Learning and Telemedicine Needs
Perhaps there is no more urgent need than additional funds for the Distance Learning and
Telemedicine (DL T) program, which helps hospitals, health clinics, schools, and libraries
purchase the equipment needed to help rural residents see doctors and teachers safely during this
pandemic.
USDA has indicated that this program is dramatically oversubscribed, 'With over $200 million
worth of application requests that have sat unfulfilled since the pandemic began. Republican
Leader Glenn "GT' Thompson's (R-PA) amendment would have addressed this backlog by
providing an immediate infusion of$200 million into the DL T program. Unfortunately, it was
unanimously rejected by the Majority on the grounds that providing funds for broadband
programs would" derail the bill."
Distance learning and telemedicine tools require broadband access and this pandemic has laid
bare the stark divide between those with broadband access and those without broadband access.
The Minority agrees with the concerns of the Majority, that construction of broadband
infrastructure is a long-term investment and will not he solved overnight. However, the Minority
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TITLE !--COMMITTEE ON AGRICULTURE
strongly believes that this amendment is the right way to continue to make investments in those
programs.
Assistance for Rural Families and Essential Rural Utility Providers
Many families have been forced to make difficult financial choices over the past year and at
times, that has understandably included skipping utility bills. Rural utility operators - like
electric cooperatives, local telephone companies, municipal water systems, and waste disposal
services - are facing crippling drops in revenue from bills their subscribers cannot pay and lost
demand due to idled businesses. These costs have been mounting month after month for rural
utility operators, who nevertheless continue to provide their essential services to the families and
communities who rely on them.
Unlike large, diversified utility companies, many utility companies serving isolated rural
communities are small, independent, and lack access to the capital markets and financial services
that might enable them to better withstand these temporary dismptions.
The Minority does not believe that this situation is sustainable, which is why Republican Leader
Glenn "GT" Thompson's (R-PA)amenclment included an important provision - based on
legislation introduced by Representative Rick Crawford (R-AR) - to provide bridge loans to
rural utility operators to see them through this time of dismption, and provide them with the
necessary breathing room until economic conditions return to normal. The legislation would
encourage operators to work with their customers to provide flexible repayment options,
extended repayment periods, and even debt forgiveness for those who are in need.
Assistance for Rural Businesses
The Minority notes with concern the lack of parity between the treatment of business lending
programs at the Small Business Administration (SBA) and the Rural Business Service (BRS) of
USDA. In the CARES Act and again in the Consolidated Approp1iations Act, 2021, borrowers in
loan programs operated by SBA were provided with significant temporary assistance with their
loan and interest payments. No such similar assistance was extended to borrowers in similar loan
programs operated by RBS. Bipartisan legislation was introduced by Representatives Cynthia
Axne (D-IA) and Troy Balderson (R-OH) which would have addressed this inequity.
The Minority strongly believes this is an oversight in need of correction, which is why the
amendment included a provision which would have rectified this oversight.
In Closing
As we have detailed in these views, we believe the Majority's proposal fails to fully address the
myriad of problems facing rural communities. It doubles down on assistance where it is
unnecessary while ignoring proposals that would alleviate tangible, immediate problems.
Perhaps more concerning was the Majority's continued and inexplicable insistence that any
alterations to the plan - devised in secret by their Leadership -would result in delays to the
passage of this relief bill. We are incredulous at such claims and would not find them worthy of
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TITLE !--COMMITTEE ON AGR!CULTURE
discussion, if they were not the sole reason the Majority could offer for their indestructible
blockade of common sense.
There is no plausible or rational argument that can be made that adopting an amendment during a
markup delays the legislative process. Perhaps the Majority was simply seeking to save time for
the Leadership staft~ who would have had to find and delete any text added during markup, so as
to preserve their legislation, in its perfect inception. If that is the concern, it makes one wonder
why we bothered with this charade to begin with.
Yet, we need not stretch for hypotheticals in this argument The Majority surprised itself by
adopting Representative Randy Feenstra's (R-IA) amendment We shall see if its inclusion
delays or derails the Budget and Rules Committees as they prepare this Reconciliation Package.
The Minority suspects that it will not, whether the Majority keeps the provision or takes the time
to carefully strike it from the text
To say that members of the Minority were frustrated with this process would be an
understatement We take the Chairman at his word thatthis process will not be the process we
undertake in future Committee business. We look forward to the many opportunities for hearings
and oversight and fruitful participation in the work of this Committee in the months to come.
Rcprcsentatin~ Glenn 'GT' Thompson (PA-15)
.Ja$£iu 5co.f:t
Representative Austin Scott(GA-08)
Republican Leader
House Commitlce on Agriculture
Representative DaYid Rouzer (NC-07) scntatiYe Don Bacon (NE-02)
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TITLE f--COMMITIEE ON AGRICULTURE
.t-'7£,UI LL /~Vtfv\
l'lusty Johnson (SD-AL)
Representative Randy Fee stra (lA-04)
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TITLE !--COMMITTEE ON AGRICULTURE
Additional Views of Mr. O'Halleran
As a Representative of a cotton producing district, the economic stability of the U.S cotton
industry is important to me. The United States is the top cotton exporting country in the world.
and our ability to remain competitive in the global marketplace is crucial to the livelihoods of
every cotton fam1er in my district.
The COVID pandemic has created challenges to the entire US. cotton supply chain, including
the merchandiser-shippers who are the crucial link connecting the U.S. supply chain to the global
marketplace. For nearly a year, business shutdowns and disruptions throughout the transportation
network have caused, widespread delays and cancellations of shipments of US. cotton. These
cancellations and delays have imposed onerous carrying and logistical costs associated with
destination displacement, which have been borne on the entire industry. While there has been
some recent recovery in demand and shipments, port congestion and lack of container
availability at major US. ,vest coast ports, which handle the majority of US. exports, continue to
squeeze supply chain capacity, adding more costs and risks to U.S. cotton exporters. Industry
estimates indicate that COVJD-related losses and added costs already total at least $700 million
for US. cotton merchandisers.
I am pleased to support this bill that will provide the funding the Secretary of Agriculture needs
to respond to the food and agricultural supply chain challenges brought by COVTD, including
challenges in the cotton supply chain. 1 look forward to working with the Chaim1an and with
incoming Secretary Vi!sack to ensure the Secretary uses this authority to assist cotton
merchandisers as this legislation is implemented in the coming weeks.
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R08E:RTC ·sose-rscoTT,VIRGINIA 1/IRG/NI/\FOXX."IORTHCAROll'-JA
Ct,i,<msra R.iWklnt/M&ml><1<"
COMMITTEE ON
EDUCATION AND LABOR
U.S HOUSE OF REPRESENTATIVES
2176 RAYBURN HOUSE OFFICE BUILDING
WASHINGTON, DC 20515-6100
February 16, 2021
The Honorable John Yannuth
Chaim,an
Committee on the Budget
204-E Cannon House Office Building
Washington, DC 205 l 5
Dear Chairman Yarmuth:
Pursuant to section 2001 of the Concurrent Resolution on the Budget for Fiscal Year 2021, S.
Con. Res. 5, [ hereby transmit these recommendations that have been approved by vote of the
Committee on Education and Labor, and the appropriate accompanying material including
Minority Views, to the House Committee on the Budget. This submission is in order to comply
with reconciliation directives included in the Concurrent Resolution on the Budget for Fiscal
Year 2021, S. Con. Res. 5, and is consistent with section 3 JO of the Co11gre,1:siona/ Budge/ and
Jmpmmdment Control Act of 197./.
Sincerely,
Robert C "Bobby" Scott
Chairman
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Table of Contents
Purpose and Summary
Committee Action
Committee Views
Section-by-Section Analysis
Explanation of Amendments
Application of Law to the Legislative Branch
Unfunded Mandate Statement
Eannark Statement
Roll Call Votes
Statement of Perfonnance Goals and Objectives
Duplication of Federal Programs
Hearings
Statement of Oversight Findings and Recommendations of the Committee
New Budget Authority and CBO Cost Estimate
Committee Cost Estimate
Changes in Existing Law Made by the Bill, as Reported
Advisory Committee Statement
Minority Views
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PURPOSE AND SUMMARY
The purpose of the Committee Print is to respond to the needs of students, workers, and
communities as the country continues to grapple with the COVID-19 pandemic and to comply
with the reconciliation directive given to the Committee on Education and Labor (Committee)
included in section 200l(b) of the Concurrent Resolution on the Budget for Fiscal Year 2021,
S.Con.Res. 5. As ofFebruary 2021, the public health crisis has sickened more than 27 million
people and left over 470,000 dead in the United States alone, 1 with the nation's most vulnerable
populations-in particular communities of color, low-income families, and older Americans-
bearing the brunt of the harm. While Congress has previously acted to provide relief during the
pandemic, the Committee Print will provide continued and urgent relief to struggling workers,
students, and families.
COMMITTEE ACTION
117 th Congress
On February 9, 2021, the Committee began consideration of the Committee Print, and on
February JO, 2021, the Committee concluded its consideration and voted to transmit the
Committee Print, as amended, to the Committee on the Budget by a vote of 27 ayes and 21 nays.
The Committee considered and adopted the following amendments to the Committee Print:
• Chainnan Robert C. "Bobby" Scott (D-VA-03) offered an Amendment in the Nature of a
Substitute (ANS) that made one technical edit to the Committee Print. The amendment
was adopted by voice vote.
• Rep. Joe Courtney (D-CT-02) offered a manager's amendment that made technical and
clarifying edits to the ANS, clarified the uses offunding in section 2201, provided $10
million to carry out the long-term care ombudsman program under title VU of the Older
Americans Act (OAA) of 1965, 2 and reduced funding to carry out Part B of Title JU of
OAA from $480 million to $470 million. The amendment was adopted by voice vote.
The Committee also considered the following amendments:
• Rep. Rick Allen (R-AL-12) offered an amendment to deny Elementary and Seconclaiy
School Emergency Relief (ESSER) funds to school districts that do not offer the option
of in-person instruction to all students. The amendment was defeated by a recorded vote
of21 ayes and 27 nays.
• Rep. Greg Murphy (R-NC-03) offered an amendment to deny ESSER funds unless in-
person instruction is available to subgroups of students. The amendment was defeated by
a recorded vote of 21 ayes and 2 7 nays.
'Coronavirus in the US: Latest Map and Case Count. N.Y. TIMES (Feb. 10, 2021),
lu.tttdL\nrry.m·timcs:.(,;:om/iutcr~tlvc/2()20/ns/cnronm-irns-us-casc~.ht1n.!.
2
42 U.S C §§ 300l-3058ff.
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• Rep. Michelle Steel (R-CA-48) offered an amendment to deny ESSER funds unless in-
person instruction is available and all teachers have had access to the COVID-19 vaccine.
The amendment was defeated by a recorded vote of21 ayes and 26 nays.
• Rep. Mary Miller (R-IL-15) offered an amendment to deny ESSER funds unless
instruction is entirely in-person and require each state that receives ESSER funds to open
an Education Savings Account to divert fonding from away public schools and to p1ivate
school vouchers. The amendment was defeated by a recorded vote of2 l ayes and 27
nays.
• Rep. Bob Good (R-VA-05) offered an amendment to require school districts that accept
ESSER funds to document in writing and make public all negotiations regarding
reopening between the school district and the teacher's union. The amendment was
defeated by a recorded vote of 21 ayes and 27 nays.
• Ranking Member Foxx (R-NC-05) offered an amendment to strike sections 2103 and
2104 of the Committee Print. Section 2103 expands eligibility under the Federal
Employees' Compensation Act for workers' compensation benefits for federal employees
diagnosed with COVID-19, 3 and Section 2104 expands eligibility under the Longshore
and Harbor Workers' Compensation Act for workers' compensation benefits for
maritime ,vorkers diagnosed with COVID-19. 4 The amendment was defeated by a
recorded vote of2l ayes and 27 nays as part ofen bloc 1.
• Reps. Burgess Owens (R-lJT-04) and Veronica Spartz (R-IN-05) offered an amendment
to prohibit any ESSER funds from being used on the assessments required under section
1111 of the Elementmy and Secondary Education Act. 5 The amendment was defeated by
a recorded vote of 21 ayes and 27 nays.
• Rep. Fred Keller (R-PA-12) offered an amendment to exempt certain small businesses
from provisions of section 2101 of the Committee Print that raises the federal minimum
wage. The amendment was defeated by a recorded vote of21 ayes and 27 nays.
• Rep. Madison Cawthorn (R-NC-11) offered an amendment to exempt certain
geographical areas from section 2101 of the Committee Print, which raises the federal
minimum wage. The amendment was defeated by a recorded vote of 21 ayes and 27
nays.
• Rep. Steel offered an amendment to prohibit the implementation of the increase of the
minimum wage in section 2101 of the Committee Print if the U.S. Government
Accountability Office determines that at least 200,000 jobs will be lost due to automation
from implementation of section 210 l. The amendment was defeated by a recorded vote
of 21 ayes and 27 nays.
• Rep. Owens offered an amendment to condition the minimum wage increase in section
210 l of the Committee Print on various employment statistics. The amendment was
defeated by a recorded vote of 21 ayes and 27 nays.
• Rep. Murphy offered an amendment to strike section 2101 of the Committee Print, which
raises the federal minimum wage. The amendment was defeated by a recorded vote of 21
ayes and 27 nays as part of en bloc 1.
3
5 U.S.C. § 8101 et seq.
_, 33 USC§ 901 et seq.
·' 20 U.SC. § 6311,
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• Rep. Glenn Grothman (R-WI-06) offered an amendment to strike the language in Section
2101 phasing out the 14(c) subminimum wage certificates for individuals with
disabilities. The amendment was defeated by a recorded vote of2l ayes and 27 nays.
• Ranking Member Foxx offered an amendment to strike the provisions closing the Higher
Education Act :5° 90/10 loophole and instead exclude veterans' education benefits from
the calculation entirely. The amendment was defeated by a recorded vote of2l ayes and
27 nays.
• Rep. Keller offered an amendment to increase the share of Higher Education Emergency
Relief (HEER) funds that flow to students at for-profit colleges. The amendment was
defeated by a recorded vote of 21 ayes and 27 nays as part of en bloc 1.
• Rep. Jim Banks (R-IN-03) offered an amendment to exclude workers from receiving
premium assistance if their health plan provides coverage of abortion care. The
amendment was defeated by a recorded vote of21 ayes and 27 nays.
• Rep. Spartz offered an amendment to provide $1 billion to entities receiving funding
under Title l[ of the.Juvenile .Justice and Delinquency Prevention A<.:t <?/ 1974. 7 The
amendment was defeated by a recorded vote of 21 ayes and 27 nays.
• Rep. Tim Walberg (R-MI-07) offered an amendment to allocate $20 million for the
Office of Labor-Management Standards from U.S. Department of Labor (DOL)
appropriations. The amendment was defeated by a recorded vote of 21 ayes and 27 nays
as pat1 of en bloc 1.
• Rep. Elise Stefanik (R-NY-21) offered an amendment to add $4.58 billion in funding to
the Workforce Innovation and Opportunity Act and require that 75 percent of such funds
be spent on skills development and education. s The amendment was defeated by a
recorded vote of 2 l ayes and 27 nays.
• Rep. Stefanik offered an amendment to deny HEER funds to institutions of higher
education that have partnerships with entities owned or controlled by China. The
amendment was defeated by a recorded vote of20 ayes and 27 nays.
• Rep. Stefanik offered an amendment to reserve a ve1y low percentage of funds from the
child care stabilization fund for rural care child care providers. The amendment was
defeated by a recorded vote of 21 ayes and 27 nays as part of en bloc 1.
• Rep. Mariannette Miller-Meeks (R-IA-02) offered an amendment to dive11 two percent of
ESSER and HEER funds to multi-year competitive grants for mental health services. The
amendment was defeated by a recorded vote of20 ayes and 28 nays.
• Rep. Stefanik offered an amendment to cut funding and limit allowable uses for
institutions of higher education subject to the excise tax on endowments. The
amendment was defeated by a recorded vote of21 ayes and 27 nays.
• Rep. Good offered an amendment to deny emergency aid under HEER to tmdocumented
students. The amendment was defeated by a recorded vote of21 ayes and 27 nays as part
of en bloc 2.
• Rep. Russ Fulcher (R-ID-01) offered an amendment to exclude workers from premium
assistance unless they provide a social security number. The amendment was defeated by
a recorded vote of21 ayes and 27 nays as part of en bloc 2.
6
20 U.S.C. § 1001 et seq.
7
34 use.§ 1110! et seq.
8
29U.S.C.§3101 et seq.
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• Rep. Cavv1hom offered an amendment to add $2 billion to ESSER for competitive grants
to mral schools to use for education technology. The amendment was defeated by a
recorded vote of 19 ayes and 29 nays.
• Rep. Good offered an amendment to eliminate the $270 million appropriation to the
National Endowment for the Arts and the National Endowment for the Humanities and
redirect that funding to the Rural Education Achievement Program. The amendment was
defeated by a recorded vote of 20 ayes and 28 nays.
• Rep. Miller-Meeks offered an amendment to appropriate an additional $30 million to the
Occupational Safety and Health Administration (OSHA) to carry out compliance
assistance activities related to COVID-19. The amendment was defeated by a recorded
vote of 21 ayes and 27 nays.
• Rep. Spartz offered an amendment to require the U.S. Department of Health and Human
Services (HHS) to prioritize foster care services with funding appropriated to assist
programs under the Administration for Children and Families. The amendment was
defeated by a recorded vote of21 ayes and 27 nays.
• Rep. Spartz offered an amendment to require the Inspector General of HHS to issue a
report to Congress on fraud, performance, and compliance audits related to emergency
funding provided under the Committee Print for Older Americans Act programs. The
amendment was defeated by a recorded vote of 21 ayes and 27 nays as part of en bloc 3,
• Rep. Spartz offered an amendment to prohibit ESSER funds from going to a state
educational agency unless the governor and state and local legislatures are notified of the
maintenance of effort and maintenance of equity conditions, which the governor and
legislature must approve if required by law. The amendment was defeated by a recorded
vote of 2 l ayes and 27 nays as part of en bloc 3,
• Rep. Spartz offered an amendment to require the Inspector Generals of the U.S.
Department of Education (ED) and the Corporation for National and Community Service
(CNCS) to transmit rep011s to the auth01izing committees regarding audits and oversight
of activities funded by the Committee Print. The amendment was defeated by a recorded
vote of2l ayes and 27 nays as part of en bloc 3.
COMMITTEE VIEWS
Background
The COVID-19 pandemic has impacted every aspect of daily life, It has forced early childhood
care and education programs, schools, and institutions of higher education across the nation to
close and operate remotely, leading to an unprecedented disruption in learning and exacerbating
pre-existing educational disparities faced by tens of millions of vulnerable students. 9 At the
same time, the vims' s effects have upended the U.S. economy and labor market; economic
output shrank by 3 .5 percent in 2020, the largest decline since the end of World War IJ. 10 The
"Map: Coronavirus and School Closures, EDl.'C. WK., (Sept 16. 2020), lt!Jll_;;)/www.cd,vccls.QU;L).£J1.i!Q.!]~
coronavims-and-SQilllQ.l-closurc,-in-20 l 9-2020/2020/(13: ( 'allege Crisis Initiative ·,;c Davidson Colkge. (Sept. 9,
2020), ~ ~ h b o a r d / ,
10
News Release. U.S. Bureau of Econ. Analysis, Gross Domestic Product 4th Quarter and Year 2020 (Advance
Estimate) (Jan. 28, 2021), hllJ)5J)J, W)Lbea.~oy/i1c\\ s/2021/wss.,domcslili:J;!roduct::Wl::IJllarler-and-year-2020-
adYancc~cs1ima1e.
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53
United States lost an estimated 22 million payroll jobs in a two-month period-nearly 10 million
of which have not yet been recovered-while initial weekly claims for unemployment benefits
have exceeded their historical high-point for 47 consecutive weeks and counting. 11
Throughout the course of the COVTD-19 pandemic, systemic and structural inequities in access
to quality, affordable, and effective health care, education, housing, and community support
services have contributed to disproportionately high rates of COVID-19-related death among
patients of color. 12 Low-wage essential workers of color (many of whom are women) often
serve in environments that increase their risk for COVID-19 exposure ( e.g., hospitals and meat-
processing facilities), have limited access to personal protective equipment (PPE) and COVID-
19 testing, live in areas with few opportunities for social distancing, and Jack telehealth access to
manage chronic conditions that can cause life-threatening COVID-19 symptoms. 13 COVTD-19
hospitalization rates for Native American, Latino, and Black patients are currently 4.0 times
higher, 4.1 times higher, and 3. 7 times higher than rates for non-Hispanic White patients
respectively. 14 Families have reported that bias, discrimination, and limited access to translation
services were barriers to COVlD-19 testing and treatment for symptomatic patients of color who
died from COVID-19 while seeking medical care. 15 Against this backdrop, Congress must do
more to address the ways in which COVID-19 has exacerbated these barriers and the underlying
causes of these inequities.
Congressional action to date, including policy advanced by the Committee, has been critical in
securing relief for schools and institutions of higher education, providing workers with access to
paid leave, protecting workplace safety and health, making sure school-age children have enough
11
As of the week ending February 6, 2021. seasonally adjusted initial claims for Unemployment Tnsurnnce (Ul) had
exceeded the previous high of 695.000 (October 1982) for 46 weeks in a row. U.S. Dep't of Lab., ''Unemployment
lnsurnnce Weekly Claims," .hlUl:J/.l:l" ,, .dol.£Q.l:/ni/data 12'J.[(last visited Feb. l L 202 n.
"Kristen Azar ct. aL /)isparities In Outcomes Among COVID-19 Patient, In A large lfealth Care Svslem In
California, HEAU1-l AFF. (May 2020), ~alth@ffai.~oi/10. D77/hlthaff2020 00598. According to
the Centers for Disease Control and Prevention and the World Health Organization (WHO), the tem1 "health
inequity" refers to the presence of health disparities in controllable or remediable aspects of health and health care
access, World Health Organization, Health Systems: Equity (2021),
!lt1J2:,.i:Kll."1L.Yd100 111Ul1Q..:ilil1,e.ustcmsitQl)j£:;lCQ.l!il.i:frn1: Jamila Taylor. Racism, Inequality, and Health Care.for
African Americans, THE CENTI 'RY Fcll'ND. (Dec. 19, 2019), l!fil1.~lilllrnl1JSl!Qil/rncism~!l:
carc-africa1H1mcrica1ts/,
13
Katy O'Donnell, Black co1111111111ity bracesfor next threat: ,Hass eviclio11s, POLITICO (Jun. 12, 2020).
~ c o mine" s/2020/06/l 2/mass,c,·iclions-3 1-1699: Blair LeYin, COl· 1D-19 pro,,es we need to
con/11111, upgrading America's broadband i11/rastruct11re, BROOKINGS ]>.;ST. (Mar. 30, 2020),
ht!.QS;!N 'ff1,- .brooki~'Ll'b~wcnuci2020/0 3/30/co0d:19:illQl..-cs-wc-n~cd-to::eonti~~mcricas-
b roag!:>;md-infrast111c1 mc/; Chris Geary, Vincent Palacios, and Laura Tatum, Who :Ire Ecs·ential Workers? The U.S
!economy Depend, 011 Women, People of Color, & lm111igra11t Workers, Georgetown Center on Poverty and
Inequality, Georgetown University Law Center (Jul. 20, 2020), !JLJWDDY~9~}1JJJlQVCt1v.QU!.!1,c12:
<;mllcntLIJlllQ1!ds/2(_1)(1/07/GCPI-ES0[-Esscn!ial•\VorkC'rs-Juh 2~1.
"CentcIS for Disease Control and Prevention, Infographic: COVID-19 Cases, Hospitalization, and Death by
Race/Ethnicity (Dec. 10, 2020), ~:fl\\"" .cdc.wjcoronavirns/2019-ncov/comtnnni1yllIC~mciai-
ctlmi~-qj,spasitics/i.u&i.rapJiic-cascs~hosoitali1atiou-deatltlltti1i.
15
John Eligon and Audra Burch, Questions C!( Bias in COViD-19 Treatment ,·!dd to the J,fourningjor Black
fallmilies, N.Y. Times (Mav 20, 2020), l:rtt:Qs:Mn...-w.nvtin1cs.com/2(l20/(15/10/us/coronayims..africa1N1mcricans-
bias.hlml.
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54
to eat, supporting access to health care, and more. 16 However, further action is needed, as the
nation's economic policy leaders, including Federal Reserve Chairman Jerome Powell and
Treasrny Secretary Janet Yellen, have repeatedly advised Congress. 17
On January 20, 2021, President Joseph R. Eiden, Jr., laid out the American Rescue Plan, the first
step ofan aggressive, two-step plan for rescue from the depths of the COVID-19 pandemic. 18
The Committee's consideration of the Committee Print is in response to the budget resolution
adopted by Congress that instructed the Committee to "submit changes in laws within its
jurisdiction to increase the deficit by not more than $357,926,000,000 for the period of Fiscal
Years 2021 through 2030." 19
More than a year after the first case of COVID-19 was confirmed in the United States, the need
to help our constituents overcome this pandemic has only grown. Over 470,000 people in this
country have died from the virus; students across the country are falling further behind; milli ans
of workers remain unemployed, and the latest research predicts that 7 million of the jobs lost will
not come back; and an unprecedented number of children and families are facing hunger and
homelessness. The Committee on Education and Labor's piece of the budget reconciliation
measure will provide our communities with the immediate relief they need and deserve..
SECTION-BY-SECTION ANALYSIS
Subtitle A: Education Matters
Part 1 - Department of Education
Section 2001. Elementary and Secondary School Emergency ReliefFnnd
Provides $128,554,800,000 for grants to state educational agencies (SEAs), with 90 percent
allocated to local educational agencies (LEAs), to be made in accordance with the same terms
and conditions applicable to funds provided in Fiscal Year 202 l for the Elementary and
Secondary School Emergency Relief Fund (ESSERF) of the Education Stabilization Fund.
SEAs are required to reserve at least 5 percent of new ES SERF allocations to carry out activities
to address learning loss. LEAs must reserve at least 20 percent of newly allocated ES SERF
subgrants to address learning loss. The LEA reservation for learning loss is the only provision
subject to equitable services. LEAs are required to provide equitable services to students and
teachers in non-public schools in the same manner as Section 1117 of the Elementary and
16
lncluding the Families First Coronavirus Response .-1cr (FFCRA) (Pub. L. No. 116-127), the Coronavirus Aid,
Relief; and Economic Secuntv (CARES) Act (Pub. L. No. 116-136), aud the Consolidated Appropriations Act, 2021
(Pub. L. No. 116-260).
,- Erica Werner and Jeff Stein, .. Janet Yellen tells lawmakers it's •critically importantto act now' on economic relief
plan, .. WASH. POST. (Jan.19.2021), .IJllm.:1/mn, waslungt!Lm,o$COlu!u~-vJ)iiQ@21/0l/191,cllen--conlirmation-
.l!illi!1!J&llil!.!lill!S.i: .. Transcript of Chair Powctr s Press Conference
January 27. 2021:' :/ " ~ ' , ·, r/"il F I\ nf20 !Ol 7
" The White House, President Bi den Announces American Rescue Plan, (Jan. 20, 2021 ),
!)_~,;" ."hiJs.h.~o, l ~ s l a t i o u / 2 0 2 L1l ~ s i d e rn-bidcn-a11no11nccs-amcric~n-rcscuc:
i.ilim/.
19
S.Con.Res. 5, !17th Cong.~ 2001(b)(2021).
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Secondary Education Act, as determined in consultation with representatives of non-public
schools.
Section 2002. Higher Education Emergency Relief Fund
Provides $39,584,570,000 for grants to institutions of higher education to be made in accordance
with the same terms and conditions applicable to funds provided in Fiscal Year 202 l for the
Higher Education Emergency Relief Fund (HEERF) of the Education Stabilization Fund. Public
and private non-profit institutions receiving new HEERF allocations will be required to spend at
least 50 percent of such allocations on emergency financial aid grants to students, while for-
profit institutions receiving allocations and institutions receiving allocations due to the
enrollment of students enrolled exclusively online will have to spend ! 00 percent of such
allocations on student aid. Institutions will be solely responsible for detennining which students
receive emergency financial aid grants. Institutions are required to use a portion of the
institutional share of new allocations to implement evidence-based practices to mitigate COVID-
19 and conduct outreach to students regarding the opportunity to receive a financial aid
adjustment due to the recent unemployment of a family member or other changes in financial
circumstances. Restrictions that were applied exclusively to institutions subject to the
endowment tax in the previous Higher Education Emergency Relief Fund will not apply to new
allocations under this section. The share of funds for for-profit institutions is reduced from 3
percent to l percent, with the difference reinvested in funds for institutions as defined in section
l OI of the Higher Education Act. The share of funds for Historically Black Colleges and
Universities, Tribal Colleges and Oniversities, Minority-Serving Institutions, and other under-
resourced institutions is unchanged at 7.5 percent. Similarly, the share of funds for institutions
with the greatest unmet needs related to coronavirus is unchanged at .5 percent.
Section 2003. Maintenance of Effort and Maintenance of Equity
Requires each state receiving funds under the Elementary and Secondary School Emergency
Relief Fund to maintain spending in Fiscal Years 2022 and 2023 on both elementary and
secondary education and higher education, at least at the proportionate levels of the state's
spending on those categories relative to the state's overall spending, averaged over Fiscal Years
2017, 2018, and 2019. The Secretary of Education may waive maintenance of effort
requirements for the purpose of relieving fiscal burdens incun-ed by states in preventing,
preparing for, and responding to the coronavirus. This section also includes fiscal equity
guardrails to prevent state budget cuts from disproportionately impacting high-poverty school
districts and low-income students. This section prohibits state educational agencies (SEAs) from
cutting per-pupil spending on high-poverty local education agencies (LEAs) at a rate steeper than
overall cuts in per-pupil spending across all local education agencies. SEAs are further
prohibited from reducing funding for the 20 percent of LEAs with the highest percentage of
economically disadvantaged students below the level of funding provided to those LEAs in
Fiscal Year 2019. Lastly, LEAs are prohibited from cutting per-pupil spending on any high-
poverty school at a rate steeper than overall cuts in per-pupil spending across all schools served
by the LEA, and from reducing per-pupil staffing in any high-poverty school at a rate steeper
than overall cuts in per-pupil staffing across all schools served by the LEA.
Section 2004. Outlying Areas
Provides $850,000,000 for grants to the outlying areas.
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Section 2005. Bureau of Indian Education
Provides $850,000,000 for grants to Bureau of Indian Education-operated and funded elementary
and secondaiy schools and Tribal Colleges or Universities.
Section 2006. Gallaudet University
Provides $19,250,000 for the Kendall Demonstration Elementary School, the Model Secondary
School for the Deaf, and Gallaudet University.
Section 2007. Student Aid Administration
Provides $9 l, 130,000 for Student Aid Administration within the Department of Education to
prevent, prepare for, and respond to coronavirus, domestically and internationally, including
direct outreach to students and borrowers about financial aid, economic impact payments,
means-tested benefits, and ta'C benefits for which they may be eligible.
Section 2008. Howard University
Provides $35,000,000 for Howard University.
Section 2009. National Technical Institute for the Deaf
Provides $19,250,000 for the National Technical Institute for the Deaf.
Section 2010. Institute of Education Sciences
Provides $100,000,000 for the Institute ofEducation Sciences to study learning loss and
disseminate findings to SEAs, LEAs, and other approptiate entities.
Section 2011. Program Administration
Provides$ 15,000,000 for Program Administration within the Department of Education to
prevent, prepare for, and respond to coronavirus, domestically and internationally, and for
salaries and expenses necessary to implement this part.
Section 2012. Office oflnspector General
Provides $5,000,000 for the Office of the 1nspector General of the Department of Education.
Section 2013. Modification of Revenue Requirements for Proprietary Institutions of
Higher Education
Modifies the requirement in Sec. 487 of the Higher Education Act to require proprietary
institutions to derive not less than ten percent of revenue from funds other than federal education
assistance funds, including from the GI Bill.
Part 2 Miscellaneous
Section 2021. National Endowment for the Arts
Provides $135,000,000 for the National Endowment for the Arts, with forty percent of funds
reserved for grants to state art agencies and regional art organizations, and sixty percent of funds
reserved for direct grants that suppo1t organizations' programming and general operating
expenses.
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Section 2022. National Endowment for the Humanities
Provides $135,000,000 for the National Endowment for the Humanities, with forty percent of
funds reserved for grants to state humanities councils, and sixty percent of funds reserved for
direct grants that support humanities organizations' programming and general operating
expenses.
Section 2023. Institute of Museum and Library Services
Provides $200,000,000 to carry out the Librwy Service and Technology Act as authorized under
Subtitle B of the Museum and Library Services Act with a minimum allocation of$2,000,000 for
each state.
Section 2024. COVID-19 Response Resources for the Preservation and Maintenance of
Native American Languages
Provides $10,000,000 for emergency grants to support Native American language preservation
and maintenance. Funding will mitigate COVID-19-related disruptions or threats to Native
American languages and the continued vitality of Native American languages during and after
the COVID-19 public health emergency.
Subtitle B: Labor .Matters
Section 2101. Raising the Federal Minimum Wage
Increases the federal minimum wage ("6(a)(J) wage") for employees from $7.25 per hour to $15
per hour by 2025 ($9.50 in 2021; $11.00 in 2022; $12.50 in 2023; $14.00 in 2024; and $15.00 in
2025). Thereafter, annual increases in the 6(a)(1) wage are indexed to the percentage increase, if
any, in the median hourly wages of all employees.
Increases the tipped minimum wage from $2.13 to $4.95 in 2021. For each succeeding year, the
tipped minimum wage increases by the lesser of either $2.00 or the difference between the tipped
minimum wage and the 6(a)(l) wage. Once the tipped minimum wage reaches the 6(a)(l) wage
(2027), the tipped minimum wage is eliminated by stipulating that the tipped minimum wage
will be the 6(a)(l) wage.
Increases the youth subminimum wage, which employers may currently pay to individuals under
20 years of age for the first 90 calendar days of employment, from $4.25 to $6.00 in 2021. Each
subsequent year, the youth subminimum wage increases by the lesser of either $1.75 or the
difference between the youth sub minimum wage and the 6(a)(J) wage. Once the youth
minimum wage reaches the 6(a)(1) wage (in 2027), the youth subminimum wage is eliminated
by stipulating that the youth minimum wage will be the 6(a)(l) wage.
Discontinues the issuance of new 14(c) certificates, which permit the payment of subminimum
wages to workers with disabilities, while allowing existing 14(c) certificate holders to continue
using their subminimum wage certificates for five years after enactment. Sets the hourly wage
paid to 14(c) covered employees to at least $5. 00 in 202 l (or, if greater, the wage that was paid
to the employee before enactment). Each subsequent year, the 14(c) subminimum wage
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increases by $2.50. In 2025, the subminimum wage paid to 14(c) covered employees must be
the same as the 6(a)(l) wage and remaining 14(c) certificates will have no legal effect.
Unless otherwise specified, these amendments to the Fair Labor Standards Act take effect on the
first day of the third month that begins after the date of enactment. The effective date for the
Commonwealth of the Northern Mariana Islands is 18 months after this general effective date.
Section 2102. Funding for U.S. Department of Labor Worker Protection Activities
Provides $150,000,000 for the Secretary of Labor to implement COVlD-19 worker protection
activities across the Department, with not less than $75,000,000 allocated to the Occupational
Safety and Health Administration (OSHA), and within this allocation funds are reserved for
OSHA enforcement in high risk sectors (such as meat processing, corrections, and health care)
and the Susan Harwood Training Grant Program. As part of the $150,000,000, $12,500,000 is
provided for the DOL Inspector General.
Section 2103. COVID-19 Presumption of Eligibility for Federal and Postal Employees
Under the Federal Employees' Compensation Act
Provides that federal and postal employees who (1) came into contact with patients, the public,
or co-workers in the course of their duties, and (2) were diagnosed with COVlD-19 between
January 27, 2020, and January 30, 2023, will receive a presumption that COVlD-19 is a work-
related illness for purposes of eligibility under the Federal l,)np/oyees' Compensation Ac1
(FECA). FECA provides wage loss compensation for temporary or total disability, medical
costs, and death benefits to survivors. Funds are appropriated to the Employees' Compensation
Fund to pay benefit costs through September 30, 2030.
Section 2104. COVID-19 Presumption of Eligibility for Maritime Workers Under the
Longshore and Harbor Workers' Compensation Act
Provides that employees who were engaged in maritime employment between January 27, 2020,
and January 27, 2023, and were diagnosed with COVID- J9, or were ordered to quarantine, shall
receive a conclusive presumption that such illness or quarantine was work related for purposes of
workers' compensation benefits under the Longshore and Harbor Workers' Compensation Act
(LHWCA) The LHWCA provides medical benefits, wage loss compensation for disability,
funeral expenses, and survivors benefits. Self-insured employers and insurance carriers shall be
reimbursed for the cost of such claims from the Employees' Compensation Fund in the U.S.
Treasury, provided the employer is in compliance with any safety and health guidelines and
standards related to COVID-19, including those issued by the OSHA, a state OSHA plan, or
applicable public health authority. Funds are appropriated from the Treasury to the Employees'
Compensation Fund through September 30, 2030, to cover the cost of such reimbursements.
Subtitle C: Human Services and Community Supports
Section 2201. Additional Funding for Aging and Disability Services Programs
Provides a total of $276,000,000 in funding for the Elder Justice Act for Fiscal Years 2021 and
2022; ensures that Adult Protective Services (APS) funding may be used to serve all adults.
Section 2202. Supporting Older Americans and Their Families
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Provides $1,444,000,000 in funding for programs authorized under the Older Americans Act
(OAA)
• $740,000,000 to support nutrition programs for older Americans;
• $25,000,000 for services, including nutrition, for Native American communities;
• $470,000,000 to support home-and community-based support services programs,
including support for COVID-19 vaccination outreach and coordination and addressing
social isolation;
• $44,000,000 for evidence-based health promotion and disease prevention;
• $145,000,000 for the National Family Caregiver Support Program; and
• $10,000,000 for the long-term care ombudsman program.
Section 2203. Child Care and Development Block Grant Program
Provides $14,990,000,000 for the Child Care and Development Block Grant (CCDBG) program.
Lead agencies may obligate funds during the current fiscal year and succeeding two fiscal years.
Lead agencies may use such funds to provide child care assistance to essential workers without
regard to such workers' income.
Provides an additional $23,975,000,000 to be used for child care stabilization as described in
section 2204 and in accordance with the requirements of the Child Care and Development Block
Grant Act except for requirements in subparagraphs (C) through (E) of section 658E(c)(3) and
section 658G of such Act.
Provides an additional $35,000,000 for federal administrative costs, including technical
assistance and research, to carry out child care stabilization and implement the additional fi.mding
forCCDBG.
Section 2204. Child Care Stabilization
Establishes child care stabilization grants to be awarded to each lead agency in accordance with
allocation requirements under the Child Care and Development Block Gran/ Act. A lead agency
may reserve up to l O percent of grant funds for administrative and technical assistance costs and
must use the remainder of funds to award subgrants to qualified child care providers that were,
on the date of submission of the application for the subgrant, either open and available to provide
child care services or closed for reasons related to the COVID-l 9 public health emergency. The
subgrant amount must be based on the child care provider's stated current operating expenses.
The Committee Print specifies the allowable uses of funds for sub grants, which include but are
not limited to personnel expenses, cleaning supplies and personal protective equipment, and
mental health supports. Sub grant funds may be used for sums obligated or expended prior to the
date of enactment of this Act
A child care provider that receives funds must certify that for the duration of the subgrant, the
child care provider will: implement practices in line with guidance from state, Tribal, and local
authorities, and to the greatest extent possible, guidance from the Centers for Disease Control
and Prevention; pay no less than the full compensation the provider was paying each employee
on the date of submission of the application for the subgrant; and provide relief from copayments
and tuition payments to families enrolled in the provider's program, to the greatest extent
possible, and prioritize such relief for families struggling to make either type of payment. The
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60
lead agency shall notify the Secretary of Health and Human Services if the lead agency is unable
to obligate at least 50 percent of funds awarded to carry out this section within nine months of
the date of the enactment of this Act.
Section 2205. Head Start
Provides $1,000,000,000 for Head Start programs, to be allocated to each Head Start agency
according to the number of children enrolled in that agency as compared to the total number of
children enrolled in all Head Start agencies. Such funding shall not be included in the
calculation of base grants in subsequent fiscal years and shall not be subject to allocation
requirements in section 640(a) of the Head Start Act.
Section 2206. Programs for Survivors
Provides a total of $450,000,000, which shall not be subject to matching requirements for the
duration of the COVlD-19 pandemic, for Fami(v Violence Prevention and Services Act (FVPSA)
programs and related programs:
• $180,000,000 to support FVPSA formula grants;
• $18,000,000 for grants for Indian tribes;
• $2,000,000 for the national domestic violence hotline, of which $1,000,000 is directed to
support Tribal communities;
• $49,500,000 for grants to support culturally-specific populations;
• $198,000,000 for grants to support survivors of sexual assault; and
• $2,500,000 for the federal administrative costs of implementing grants to support
culturally-specific populations and grants to support survivors of sexual assault.
Section 2207. Child Abuse Prevention and Treatment
Provides $250,000,000 for child abuse and neglect prevention programs as authorized under
Title ll of the Child Abuse Prevention and Treatment Act (CAPT A), except that such funds shall
not be subject to state match requirements and shall be distributed to each state in an amount that
bears the same proportion to such amount appropriated for all states as the number of children
under the age of 18 residing in the state bears to the total number of children under the age of 18
residing in all states.
Provides $100,000,000 for the child abuse and neglect treatment and response state grant
program authorized under section 106 of CAPTA, which shall be allocated without regard to the
discretionary activity allocation requirements under section l 12(a)(2) ofCAPTA.
Section 2208. UHEAP
Provides $4,500,000,000 for the Low Income Home Energy Assistance Program (LIHEAP) to
help families afford home heating and cooling costs, to remain available through September 30,
2022.
Section 2209. Department of Health and Human Services
Provides $425,000,000 to the Secretary of Health and Human Services for increased costs
associated with the COVID-19 pandemic in any programs administered under the Administration
for Children and Families that provide direct program services to children.
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Section 2210. Corporation for National and Commnnity Service and the National Service
Trust
Provides $1,000,000,000 to the Corporation for National and Community Service and the
National Service Tmst to support an increase in AmeriCorps volunteers to respond to
communities impacted by COVID-19 such as helping schools safely reopen and tackling the
growing hunger crisis, Grants will be prioritized based on grantees located in and recruiting
from communities disproportionately impacted by COVID-19 and taking into account the
diversity of communities and participants served by such entities, including racial, ethnic,
socioeconomic, linguistic, or geographic diversity.
Subtitle D: Chi!tl Nutrition & Related Programs
Section 2301. Improvements to WIC Benefits
Provides the Secretary of Agriculture with authority and funding to temporarily boost the value
of the Cash Value Voucher (CVV) in the Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC) up to $35 per month for women and children for a four-month
period during the COVID-19 pandemic.
Section 2302. WIC Program Modernization
Provides $390 million for outreach, innovation, and program modernization efforts to improve
participation and benefit redemption in the WIC program.
Section 2303. Meals and Supplementals Reimbursements for Individuals who Have Not
Attained the Age of25
Temporarily expands the age of eligibility for the Child and Adult Care Food Program (CACFP)
at emergency homeless shelters from 18 to 25 for the duration of the COVID-19 pandemic.
Section 2304. Pandemic EBT Program
Allows the Pandemic Electronic Benefit Transfer (P-EBT) program to be implemented for any
school year in which the COVID-19 public health emergency designation is in effect and allows
for P-EBT benefits to be extended through the summer.
Subtitle E: COBRA Continuation Coverage
Section 2401. Preserving Health Benefits for Workers
Provides subsidies to support workers who are eligible for continuation coverage under the
Consolidated Omnibus Reconciliation Act ()f 1985 (COBRA) due to involuntary termination or
reduction in hours. Eighty-five percent premium assistance will be available beginning the first
month following the date of enactment and will remain available through September 30, 202 l.
Provides for an extended election period to allow individuals who previously experienced a
quali(ying event to enroll in subsidized coverage. Requires clear and understandable written
notices and establishes an expedited review process for workers who are denied premium
assistance. Provides a refundable payroll tax credit to allow employers and health plans to be
reimbursed for the full amount of COBRA premiums.
Provides $IO million to the Secretary of Labor to support implementation by the Employee
Benefits Security Administration (EBSA).
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62
EXPLANATION OF AMENDMENTS
The Committee Print to comply with the reconciliation directive included in section 200l(b) of
the Concurrent Resolution on the Budget for Fiscal Year 2021, S.Con.Res. 5, as amended,
including the amendment in the nature of a substitute, are explained in the descriptive po1iions of
this report.
APPLICATION OF LAW TO THE LEGISLATIVE BRANCH
Pursuant to section l02(b )(3) of the Congressional Accountability Act, Pub. L. No. 104-1,
Section 2103 of this Committee Print to comply with the reconciliation directive included in
section 200l(b) of the Concurrent Resolution on the Budget for Fiscal Year 2021, S.Con.Res. 5,
as amended, applies to terms and conditions of employment within the legislative branch by
expanding access to benefits under the federal Employees' Compensation Act (5 U.S.C. 8101 et
seq.) for civilian federal employees who are diagnosed with COVID-l 9.
UNFUNDED MANDATE STATEMENT
Pursuant to Section 423 of the Congressional Budget and lmpoundment Control Act (as amended
by Section 101(a)(2) of the Unjundedlvfandates Reform Act, Pub. L. No. 104-4), the Committee
adopts as its own the estimate of federal mandates regarding the Committee Print, as amended,
prepared by the Director of the Congressional Budget Office.
EARMARK STATEMENT
In accordance with clause 9 of Rule XXI of the Rules of the House of Representatives, the
Committee Print to comply with the reconciliation directive included in section 200 l (b) of the
Concurrent Resolution on the Budget for Fiscal Year 2021, S.Con.Res. 5, as amended, does not
contain any congressional earmarks, limited tax benefits, or limited tariff benefits as described in
clauses 9(e), 9(f), and 9(g) of Rule XXI.
ROLL CALL VOTES
ln compliance vvith clause 3(b) of Rule XIII of the Rules of the House of Representatives, the
Committee advises that the following roll call votes occurred during the Committee's
consideration of the Committee Print to comply with the reconciliation directive included in
section 200l(b) of the Concurrent Resolution on the Budget for Fiscal Year 2021, S.Con.Res. 5,
as amended:
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Date: 02/09/2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:1 Bill:H.R. Cmte Print Amendment Number: 3
Disposition: Defeated by a vote of 21-27
Sponsor/1\mcndmcnt: Allen/ RAMO_ 11.xml
v'.;;;;, '\"an.e&St:itt, V~t~;,
Mr. SCOTT (VA) (Chairman) X Mrs. FOXX (NC) (Ranking) X
Mr. GR!JALVA(AZ) X Mr WTLSON (SC) X
Mr. COURNTFY (CT) X Mr. THOJ\1PSON (!'A) X
Mr SABLAN (lVJl') X Mr. GROTHM/\N ( Vv1) X
Ms. \VJLSON (FL) X Ms. STEFANIK (NY) X
Ms. BONAM!Cl (OR) X Mr. ALLEN (GA) X
Mr. TA.KANO (CA) X Mr BANKS (lN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
Mr DESAULNlER (CA) X Mr. FULCHER (ID) X
rvlr. NORCROSS (NJ) X Mr. KELLER (PJ\) X
Ms. JJ\YAPJ\L (WA) X Mr. MURPHY (NC) X
Mr. MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. W1LD(PA) X Mr O\\TNS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCl ,/\IN (Ml) X
Mr. LEVIN (Ml) X Mrs. HARS! !BARGER (TN) X
Ms. OMAR (MN) X Mrs. MILLER (lLl X
Ms. STEVENS (Ml) X Mrs. SPARTZ (JN) X
Ms. LEO ER FER.NANDEZ tNM) X Mr. FITZGER/\LD(Wl1 X
Mr JONES (NY) X Mr. CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (lNl X f~acanc:v
Mr. BOWMAN (NY) X fracanc:v
Mr. POCAN (Wl) X
Mr. CASTRO (TX) X
Ms. SHERRILL (NJ) X
Mr. Y/\RMUT!l(KY) X
Mr. ESPAILLAT (NY) X
l, ·acanc::v
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
Total:53/ Quorum: / Report:
(29 D-24 R)
"Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
''Although not present for the recorded vote, Member expressed he/she would have voted NO if present at Ume of vote.
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64
Dale: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:2 Bill: H.R. Cmte Print An:10ndmcnt Number: 4
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: Murphy/RAMO_12,xml
'\c,
,':',~, ,;;;;,
Mr, SCOTT (VJ\) (Chainnan) x- Mrs. FOXX (NC) (Ranking) X
Mr. GR!J;\L VJ\ (I\Z) X !v!r, WILSON (SC) X
Mr COURNTEY (CT) X Mr THOMPSON (Pi\) X
Mr SABLAN (MP) X Mr GROTHMAN ( Wl) X
Ms. W1LSON (FL) X Ms. STEFANIK \NY) X
Ms, HONAMICl (OR) X Mr. ALLEN (GA) X
Mr, TAKANO(CA) X Mr. BANKS (lN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
Mr, DFSAULNJER (CA) X Mr, FULCHER (ID) X
Mr, NORCROSS (NJ) X Mr. KELLER(PA) X
Ms. JAYAPAL(WA) X Mr, MURJ'H Y (NC) X
Mr. MORELLE (NY) X Ms. lvl!LLER-MEEKS (IA) X
Ms, WILD (PA) X Mr. OWENS (UT) X
Mrs MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCLAIN (Ml) X
Mr. LEVIN (Nill X Mrs, llNlS!fllARGER (TN) X
Ms, OMAR (MN) X Mrs. MILLER ([L) X
Ms, STEVENS (Ml) X Mm. SPARTZ (IN) X
Ms, LEGER FERNANDEZ (NM) X Mr. FITZGERALD (Wll X
Mr. JONES (NY) X Mr, CA WTIIORN (NC) X
Ms, MANNING (NC) X Mrs, STEEl, (CA) X
Mr. MRVAN(TN) X T'acancy
Mr, 130\VMAN (NY) X Vacancy
Mr. POC/\N (Wl) X
Mr. CASTRO (TX) X
Ms, SHERRIL!, (NJ) X
Mr. YARMliTH (KY) X
Mr. ESPAILLAT (NY) X
Vacancy
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
Total:53/ Quorum: /Report:
(29D-24 R)
'Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote,
"Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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65
Date: Feb 9, 2021
COMMITTEE ON EDU CA TlON AND LABOR RECORD OF COMMJTT}:E VOTE
Roll Call:3 Bill: H.R. Cmte Print Amendment Number: 5
Disposition: Defeated by a vote of 21-26
Sponsor/Amendment: Steel/RAMD_ 13.xml
,;';:,;;,, 1\ye v;,';;,
Mr. SCOTT (VA) (Chaim1an) X Mrs. FOXX (NC) (Ranking) X
Mr. GRTJALVA (AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. Tll01'1PSON (PA) X
Mr. SABLAN (Ml') X lvlr. GROTHMAN (Wl) X
Ms. WILSON (FL) X Ms. STEFANIK (NY) X
Ms. BONAMICI (OR) X Mr. ALLEN (GA) X
Mr. TA KANO (CA) X Mr. BANKS (IN) X
Ms. ADAMS (NC) X Mr. COlvfER (KY) X
Mr. DESAULNJER (CA) X Mr. FULCHER (ll)) X
Mr. NORCROSS (NJ) X Mr. KELLER (PA) X
Ms. JAYAPAL (WA) X Mr. MURPHY (NC) X
Mr. MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. WlLD(PJ\l X Mr. O\v'ENS (UT) X
Mrs MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCLA[N (Ml) X
Mr. LEVIN (Ml) X Mrs. !IARSilBARGER (TN) X
Ms. OMAR (MN) X Mrs. MILLER (lL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEZ (NM) X Mr. FffZ<mRALD ( WI) X
Mr. JONES (NY) X Mr. CA WTI·IORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN ([N) X f'acmzcy
Mr. BOWMAN (NY) X /'(1can1..."'_1,'
Mr. P()CAN (Wl) X
Mr CASTRO (l'Xl X
Ms. SHERRILL (NJ) X
Mr YARMUTH(KY) X
Mr ESPAILLAT (NY) X
T'acanc.y
TOT AI.S: Ayes: 21 N0s:26 Not Voting: 3
Total:53/ Quorum.: /Report:
(29D-24 R)
AAlthough not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at tlme of vote.
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66
Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:4 Bill: H.R. Cmte Print Amendment Nurn.bor: 6
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: Miller/RAMO_14.xml
v:'.,;;~ :'.:\{,
v~;;,;g
Mr. SCOTT (VA) ( Chaimrnn) X Mrs. FOXX (NC) (Ranking) X
Mr. GRIJALVA (AZ) X Mr. 'NILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr. SABLAN (MP> X Mr. GROTH.MAN (Wl) X
Ms. W1LSON (FL) X Ms. STEFANIK(NYJ X
Ms. BONA,WCI (OR) X Mr. ALLEN (GA) X
Mr. TAK ANO (CA) X Mr. BANKS (IN) X
Ms. ADAMS (NC) X Mr. COMiiR (KY) X
Mr. DESAULNJER (CA) X Mr FULCHER ([Dl X
Mr. NORCROSS (NJ) X Mr. KELLER(PAl X
Ms.JAYAPAL(WA) X Mr. MURPHY (NC) X
Mr. MORELLE (NY) X Ms. lvl!LLER-MEEKS (!Al X
Ms. WILD (PA) X Mr. OWENS (UT) X
Mrs. MCBATfl (GA) X Mr. GOOD (VA) X
Mrs. HA Yf'S (CTI X Mrs. MCCLAlN (Ml) X
Mr. LEVIN (MI) X Mrs. llARSIJBARGER (rN) X
Ms. OMAR (MN) X Mrs. MILLER (IL) X
Ms. STEVENS (MI) X lvfrs. SPARTZ. (IN) X
Ms. LEGER FERNANDEZ (NM) X Mr FJTzc;ERALD (WI) X
Mr. JONES (NY) X Mr. CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (lN) X r:,..,cancy
Mr. BOWlv!AN (NY) X iacancy
Mr.POCAN(WD X
Mr. CASTRO (TX) X
Ms. SllERRll.L (NJ) X
Mr. YARMUTll (KY) X
Mr. ESPAILL/\T(NY) X
racancy
TOTl\l.S: Ayes: 21 Nns:27 Nol Voling: 2
Total: 53 / Quonuu: / Repor1:
(29 D-24 R)
'Although not present for the recorded vote, Member expressed heishe would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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67
Date: Feb 9, 2021
COMMITTEE ON EDUC.\ TION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:5 BiB:H.R. Cmte Print Amendment Number: 7
Disposition: Defeated by a vote of 21-27
Sponsor/ Amendment: Good/RAMD _ 15,xml
v::, v~i,;,
lvk SCOTT (VA)\ Chainnan) X Mrs, FOXX (NC) (Ranking) X
Mr, GRIJALVA (J\Z) X Mr, WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr. SABLAN (Ml') X Mr. GROTIJMI\N (Wl) X
Ms. WILSON (FL) X Ms. STbFANIK (NY) X
Ms. BONAMICI (OR) X Mr ALLEN (GA) X
Mr. TAKANO(CA) X Mr. BANKS (lN) X
Ms. ADAMS (NC) X Mr. COMER (K Yl X
Mr. DESAULNJER (CA) X Mr. FULCHER (lD) X
Mr. NORCROSS (NJ) X Mr. KELLER(PA) X
Ms. JAYAPAL(WA) X Mr MURPHY (NC) X
M.r MORELLE (NY) X Ms. lvllLLER-lvIBEKS (IA) X
Ms. WlLD(PA) X Mr. OWENS (UT) X
Mrs. MCBATH (GA) X Mr GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCLAIN (Ml) X
Mr. LEVIN (IV[]) X Mrs. llARSlIBARGER (TN) X
Ms. OMAR (lvlN) X Mrs. lv!ILLER (II.) X
Ms. STEVENS (M!) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDl:2 (NM) X Mr. FITZGERALD(Wli X
ML JONES (NY) X Mr. CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (IN) X VOcanc_v
Mr. BOWMAN (NY) X Vacancy
Mr. POCAN ( WI) X
Mr. CASTRO (TX) X i
Ms. SHERRILL (N.Ti X
Mr. YARMUTH (KY) X
Mr. ESPA!LLAT(NY) X
f (wan('.1'
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
Total:53/ Quorum: /Report:
(29 D-24 R)
'Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
""Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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68
Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:6 Bill: H.R. Cmte Print Amendment Number: 9
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: Owens/RAMD_21.xml
v:'.,'.;, v;;~;s
Mr. SCOTT (VA) (Chairman) X Mrs. FOXX (NC) (Ranking) X
Mr. GRIJALVA(AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr. SABLAN (MP, X Mr GR.OTHMAN ( WI) X
Ms. \NILSON (FL) X Ms. STEFANIK (NY) X
Ms. BON AMICI (OR) X Mr. ALLEN (GA) X
Mr. TAK ANO (CA) X Mr. BANKS (IN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
Mr. DESAULNIER(CAl X Mr. FULCI-IER (ID) X
Mr. NORCROSS (NJ) X Mr. KELLER l PAl X
Ms. JAYAPAL(WA) X Mr. MURPHY (NC) X
Mr. MORELLE (NY) X Ms. M[LLER-MI'EKS (!A) X
Ms. WILD (PM X Mr. OWENS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X Mrs MCCLAIN (Ml) X
Mr. LEVIN (Mll X Mrs. HARSllBARGER (TN) X
Ms. OMAR (MN) X Mrs. MILLER (IL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEZ (NM) X Mr. FJ'I /:GERALD ( WlJ X
Mr. JONES (NY) X Mr. CA \v7"!10RN (NC) X
Ms. MANNING (NC) X iVlrs. STEEL ,CA) X
Mr. MRVAN(TNJ X T1ncanc_v
Mr. HO\'/]VJAN (NY) X f(1ccmcy
Mr. POCAN (Wil X
Mr CASTRO (!Xl X
Ms. SHERRILL (N.I) X
Mr. YARMUT!l(KY) X
Mr. ESPAILLAT (NY) X
Vacmu.)'
TOTALS: Ayes: 21 Nos:27 Not Voting:2
Tutal:53/ Quorum: /Report:
(29 D-24 R)
"Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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69
Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:? Bill:H.R. Crnte Print Amendment Number: 10
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: Keller/SMALLBUSINESS_01.xml
v~t~,, v;,'.~
--
Mr. SCOTT (VA)(Chainnan) X Mrs. FOXX (NC') (Ranking) X
Mr. GRIJALVA (AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (C'T) X Mr. THOMFSON (PA) X
Mr. SAllLAN (MP1 X Mr. GROTl !MAN ( Wl) X
Ms WILSON (FL) X Ms STEFANTK (NY) X
Ms. BONAMICI (OR) X Mr ALLEN (GA) X
Mr. TAKANO(CA) X Mr. BANKS (IN) X
Ms ADAMS (NC) X Mr. COMER (KY) X
Mr. DESAULNJER (CA) X Mr. FULCHER (JD) X
Mr. NORCROSS (NJ) X l'vlr. KELLER (PA) X
Ms. JAYAPAL(W/\) X Mr. MURPJ IY (NC) X
Mr. MORELLE (NY) X Ms. MILLER-MEEKS (!A) X
Ms. \¼1LD (PA) X Mr. OWENS (UT) X
Mrs. MCBATH (GA) X MrGOUD(VA) X
Mrs HA YES (CT) X Mrs. MCCLAIN (Ml) X
Mr LEVIN (MJ) X Mrs. IlARSllBARGER (TNJ X
Ms. Ol'v!AR (MN) X Mrs. MILLER (!L) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (!Nl X
Ms. LEGER FERNANDliZ (NM) X Mr. FlTZGERAl.l) ( Wl J X
Mr. JONES (NY) X Mr. CA WTITORN (NC) X
.Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (IN) X Cacanc:v
Mr. BOWMAN (NY) X f'acancy
lvlr. POCAN (WI) X
Mr. CASTRO (TX I X
Ms. srn-:RRfLL (NJ) X
Mr. YARMUTH (KY) X
Mr. ESPAILLAT (NY) X
/·Tacarlly
TOTALS: Aves: 21 Nos:27 Not Voting: 2
Total:53/ Quorum: /Report:
(29 D-24 R)
"Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote,
"Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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70
Date: Feb 9, 2021
COMMTTTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:8 Bill: H. R. Cmte Print Amendment Number: 11
Disposition: Defeated by a vote of 21-27
SponsotfAmendment: CAWTHORNIRURALEXCEPTION_01.xml
~l't
"\.t>
V<Jhn._g v~~',,s
Mr. SCOTT (VA) (Chainnan) X Mrs. FOXX (NC) (Ranking) X
Mr. GRLTAL VA (AZ\ X Mr. WILSON (SC) X
Mr. COURNTRY (CT) X Mr. THOMPSON \PAl X
Mr SABLAN (MP) X Mr. GROTHMAN (WI) X
Ms. WlLSON (YLJ X Nls. STEFANIK (NY) X
Ms. BON AMICI (OR) X Mr. ALLEN (GA) X
Mr. TAKANO (CA) X Mr. BANKS(IN) X
Ms. ADAMS (NC) X Mr. COMER (KYI X
Mr. DESAULNJER (CA) X Mr. FULCHER([])) X
Mr. NORCROSS (NJ) X Mr. KELLER (PA) X
Ms. JA YAPAL (WA) X Mr MURPHY (NC) X
Mr MORELLE (NY) X Ms. M!LLER-!vlEEKS (!Al X
Ms. WHD(PA) X Mr. OViENS(UT) X
Mrs MCBATH (GA) X Mr. GOOD\VA) X
Mrs. HA YES (CT) X Mrs. MCCLATN (MI) X
Mr. LEVIN (Mll X M.rs.1IARS!!l3ARGER(TNJ X
Ms. OMAR (lV!N) X Mrs. tvrrLLER (!Li X
Ms. STEVENS (Ml) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEZ (NM) X !vlr. l-"JTZGERAI .D (WI) X
Mr. JONES tNYl X Mr CAWTflORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (IN) X Facanc_v
Mr. BOWMAN (NY) X Vacanq.'
Mr. POCAN (WI, X
Mr. CASTRO (TX) X
Ms. Sl!ERRJLL (NJ) X
Mr. YARMUTH(KY) X
Mr. ESPAILLJ\T (NY) X
V(1cancy
TOTALS: Aves: 21 Ncs:27 Not Voting: 2
Total:53/ Quorum: /Re-port:
(29 D-24 R)
"Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote,
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71
Dale: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:9 Bill:H.R. Cmte Print A.mcndmcntNumber: 12
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: STEEUJOBLOSSAUTO_01.xml
v;;;;;, -;;~;,
Mr. SCOTT (VA) (Chairman) X Mrs. FOXX (NC) (Ranking) X
Mr. GRIJALVA (AZ) X Mr. WlLSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr. SABLAN (Ml'> X Mr. UH.OTHMAN ( WI) X
Ms. WILSON (FL) X Ms. STE!-i\NJK (NY) X
Ms. HONAMTC! (OR) X Mr ALLEN (GA) X
Mr TAKANO (CA) X Mr BANKS (IN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
·Mr. DESAULNJER(CA) X Mr. FULCHFR (ID) X
Mr. NORCROSS (NJ) X Mr. Kl'L.LLR (l'A) X
Ms. JAYAPAL (WA) X Mr. MURPHY (NC) X
Mr. MORELLE (NY) X Ms. MlLLER-MiiEKS (IA) X
Ms. WILD (PA) X Mr. O'h'ENS (UT) X
Mrs MCBATH (GA) X Mr. GOOD(VA) X
Mrs. HA YES (CT) X lv!rs MCCLAIN (lvfl) X
Mr. LEVIN (MI) X Mrs. JlARSllBARGER (TNJ X
Ms. OMAR (lvlN) X Mrs. MILLER ([L) X
Ms. RTEVENS (Ml) X Mrs. SPARTZ (lN) X
Ms. LEGER FERNANDEZ (NM) X Mr. F!TZ(<ERALD ( Wl) X
Mr. JONES (NY) X Mr. CAw~rnoRN (NC) X
Ms. l'v1ANNING (NC) X Mrs. STEEL (CAl X
Mr.MRVAN(!N) X T,'acanc;·
Mr. BOW!v1AN (NY) X 11acancy
Mr. POCAN (WI) X
Mr. Cf\STRO (TXJ X
Ms. Sl!ERRTLL (NJ) X i
Mr. YARMUTH (KY) X
Mr. ESPAILLAT (NY) X
Vacanc:r
TOTALS: Ayes: 21 Nos:27 Nol Voting: 2
Total:53/ Quonun: /Report:
(29D-24 R)
AAlthough not present for the recorded vote, Member expressed he/she would have voted AYE If present at time of vote,
*Although not present for the recorded vote, Member expressed he/she vvou!d have voted NO if present at time of vote.
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72
Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call: 10 Bill:H.R. Cmte Print Amendment Number: 13
Disposition: Defeated by a vote of 21-27
Sponsor/ Amendment: OWENS/JOBLOSSTRIGGER_01.xml
,;;;;, :'.'-.J,:,t
Votuig
--- --- ·-
Mr. SCOTT (VA) (Chaimrnn) X Mrs. FOXX (NC) (Ranking) X
Mr. GRI.fALVJ\ (AZ) X Mr. WlLSON (SC) X
Mr. COURNTEY (CT) X Mr THOMPSON (PA) X
Mr SAllLAN (MP) X 1v1r. GROTHMAN ( wn X
Ms. W!LSON(FL) X Ms STEFANIK (NY) X
Ms. BONAM!Cl(OR) X Mr. ALLEN (GA) X
Mr. TAKJ\NO (CA) X Mr BANKS (TN) X
Ms. ADAMS (NC) X Mr. COMEiR (KY) X
Mr. DESAULNJER(CA) X Mr. T'IJLCHER (ID) X
Mr. NORCROSS (NJ) X Mr, KELLER (PA) X
Ms. J!\YAPAL (WA\ X Mr. MURPHY (NC) X
Mr. MORELLE (NY) X Ms, tvllLLER-MEEKS (IA) X
Ms, WILD (PA) X Mr OViENS (UT) X
Mrs, MCBATH (GA) X Mr.GOOD(VJ\) X
Mrs. HA YES (CT) X Mrs MCCLAIN (Ml) X
Mr. LEVIN (MI) X Mrs. HARSllBARGER (rN) X
Ms. OMAR (lv1N) X Mrs. lv!ILLER (TL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (TN) X
Ms. LEGER FERNANDEZ (NM) X Mr. FITZGERALD ( Wl) X
Mr. JONES (NY) X Mr. CAWTHORN (NC) X
Ms, MANNING (NC) X i\1rs STEEL (CA) X
Mr. MRVAN (TN) X VacancJ'
Mr. BOWMAN (NY) X Vacanc~1·
Mr.POCAN(Wl) X
Mr. CASTRO (TX) X
Ms. SllERRlLL (NJ) X
Mr, YARi'v!UTH (KY) X
Mr. ESPA!LLAT (NY) X
Vacanc:v
TOTALS: Aves: 21 Nos:27 Not Voting: 2
Total:53/ Qunrum: /Rcporl:
(29 D-24 R)
Although not present/or the recorded vote, Member expressed he/she would have voted AYE if present attime of vote,
A
"Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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73
Date: Feb 9, 2021
COMMITTEE ON EDUC,\ TION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:11 BiH:H.R. Cmte Print Amendment Number: 15
Disposition: Defeated by a vote of 21-27
Sponsor/ Amendment: GROTHMANiGROTWI_004.xml
,';;;., \~~~
Mr. scorT (VA) (Chairman) X Mn FOXX (NC) (Ranking) X
i'v!r. GRIJN,VA (AZ) X Mr, WILSON (SC) X
Mr. COURNTEY (CT) X ML THOMPSON (PA) X
Mr. SABLAN (MP) X !vlr. GROTHMAN \ Wl) X
Ms. WILSON (FLJ X Ms. STEFANIK (NY) X
Ms. HON AMICI (OR) X Mr. ALLEN (GA) X
Mr. TAKI\NO(C/\) X Mr. BA.1"JKS (IN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
Mr. DESAULNJER(CA) X Mr. FULCHER (ID) X
Mr. NORCROSS (NJ) X Mr. KELLER(PA) X
Ms. Ji\YAPAL(WA) X Mr. MURPHY (NC) X
Mr MORELLE (NY) X Ms. MILLER-tv!EEKS (Ji\) X
Ms. WILD (PA) X Mr. OWENS (UT) X
Mrs. MCBATH (GA) X Mr. OOOD(VA) X
Mrs. HA YES (CT) X lVfrs MCCLAIN (Ml) X
Mr. LEVIN (Ml) X Mrs. HARSHBARGER (TN) X
Ms. OMAR (MN) X Mrs. MILLER (TL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEZ (NM) X Mr. FITZUERALD (WI) X
Mr. JONES (NY) X Mr. CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. (CA) X
Mr. MRVAN (lN) X Vacanc_v
Mr. BOWMAN (NY) X VacmK)'
Mr. POC AN \ WI) X
MrCASTRO(TX) X
Ms. SHERRILL (NJ) X
Mr. YARlv!lJTll (KY) X
Mr. ESPAILLAT(NY) X
Vi:uw-1('.v
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
Total:53/ Quorum: /Report:
(29D-24 R)
A Although not present for the recorded vote. Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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74
Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:12 Bill:H.R. Cmte Print Amendment Number: 16
Disposi1ion: Defeated by a vote of 21-27
Sp,msor/Amendment: FOXXIRAMD2.xml
1\rune&i'>'!atc v~'.;, !(,, -;;,~;,
Mr. SCOTT (VA) (Chairman) X Mrs. FOXX (NC) (Ranking) X
Mr. GRIJALVA (AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr SABI.AN (MP) X Mr GROTHMAN (WI) X
Ms. Wll.SON(FL) X Ms. STEFANIK (NY) X
Ms. BONAMICI (OR) X Mr. ALLEN (GA) X
Mr. TAKANO (CA) X Mr. BANKSON) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
Mr. DESAULNIER (CA) X Mr. FULCHER (ID) X
Mr. NORCROSS (NJ) X Mr. KELLER (PA) X
Ms. JAYAPAL(WA) X Mr. MURPHY (NC) X
l'v!r. MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. W!LD(PA) X Mr. OViENS (UT) X
Mrs.MCBATH (GA) X Mr.GOOD(VA) X
Mrs HA YES (CT) X Mrs. MCCLAIN (Ml) X
Mr. LEVIN (Ml) X Mrs. HARSHBARGER (TN) X
Ms. OMAR (MN) X Mrs. MILLER (IL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEZ (NM) X Mr FJTZGERALD ( WJ J X
Mr. JONES (NY) X Mr. CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (IN) X Vacancy
Mr. BOWMAN (NY) X T'acanc_v
Mr. POCAN (Wl) X
Mr. CASTRO (TX) X
Ms. SHERR!Ll, (NJ) X
Mr. YARMUTH (KY) X
Mr ESPA!LLAT(NY) X
racancy
TOTALS: Ayes: 21 Nos: 27 Not Voting: 2
Total:53/ Quorum: /Report:
(29D-24 R)
A Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
"Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote,
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Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:13 Bill:H.R. Cmte Print Amendment Number: 18
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: BANKSIFC-AMD-PROLIFE-CVGE-PROT_ 01 .xml
N;,mc &St;,tc ~\y.:; ,;,'.;,, :\amt&.SMc v::~,,
Mr. SCOTT (VA) (Chairrnan) X Mrs. FOXX (NC) (Ranking) X
Mr. GRI.Ti\LVA(AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr SAili.AN (MP) X Mr. GROTHMAN (Wl) X
Ms. WILSON (FL) X Ms. STEFANIK (NYJ X
Ms. BONAMICI (OR) X Mr ALLEN (GA) X
Mr. TAKANO (CA) X Mr BANKS (IN) X
Ms. ADAMS (NC) X Mr COMER (KY) X
.Mr. DESAULNJER (CA) X Mr FULCHER (!DJ X
Mr NORCROSS (NJ) X Mr. KELLER(PA) X
Ms. JAYAf'AL (WA) X Mr. MURPHY (NC) X
l'vfr. MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. WILD (PA) X Mr. OWENS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCLAIN (Ml) X
Mr. LEVIN (MI) X Mrs. HARSHBARGER (TN) X
Ms. OMAR (lv!Nl X Mrs. l'v1ILLER (lL) X
Ms. STEVENS (Ml) X Mrs. SPART7 (TN) X
Ms. LEGER FERNANDEZ (NMl X Mr. FITZGERALD (WI) X
Mr. JONES (NY) X Mr CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs STEEL (CA) X
Mr. MRVAN (!N) X 1,~acan(V
Mr. BOWMAN (NY) X Tracancy
Mr. POCAN (WI) X
Mr CASTRO (TX) X
Ms. SHERRIL!. (NJ) X
Mr. YARMUT!l(KY) X
Mr. ESPAILLAT (NY) X
Vi'.ICarl(V
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
Total:53/ Quomm: /Report:
(29 D-24 R)
'Although not present for the recorded vote, Member expressed he/she would have voted AYE if present attime of vote.
"Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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76
Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:14 BiH:H.R. Cmte Print Amendment Number: 19
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: SPARTZISPARTZ_001.xml
v~'.;,, v;~;,
Mr. SCOTT (VA) (C:hainnan) X Mrs. fOXX (NC) (Ranking) X
Mr. GRI.IAL VA (AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr SABI.AN (MP) X Mr GROTHMAN ( Wl) X
Ms. WILSON (FL) X Ms. STEFANIK (NY) X
Ms. RONAM[CI (OR) X Mr. ALLEN (GA) X
Mr. TAKANO (CA) X Mr BANKS (IN) X
Ms. ADAMS (NC) X Mr COMER (KY) X
Mr DESAULNIER(CA) X Mr. FULCHER ([D) X
Mr. NORCROSS (NJ) X Mr. KELLER(PA) X
Ms. JAYAPAL(WA) X i'vlr. MURI'Il Y (NC) X
Mr. MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. WILD (PA) X Mr. OVlENS (lff) X
Mrs MCBATfl (GA) X Mr. GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCLAIN (Ml) X
Mr LEVIN (Ml) X Mrs. IJARSUGARGER (TN) X
Ms. OMAR (MN) X Mrs. MILLER (IL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEZ (NM) X 1v!:r FJTZOERALD ( Wl J X
Mr JONES (NY) X Mr. CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (IN) X 1,'acanc_v
Mr. BOWMAN (NY) X T'acamy
Mr. POCAN ( Wl) X
Mr CASTRO (TX) X
Ms. SHliRR!LJ, (NJ) X
Mr. YARMU1TI (KY) X
Mr ESPAILLAT(NY) X
Vi:1cam:v
TOTALS: Ayes: 21 Nos:27 N0t Voting: 2
Tot.al:53/ Quorum: /Report:
(29 D-24 R)
AAlthough not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
""'Although not present for the recorded vote, Member expressed he/she wou!d have voted NO if present at time of vote.
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Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:15 Bill:H.R. Cmte Print AmendmcntNumbcr:21
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: STEFANIK/AMD18.xml
?-farn~&St&t:;
:,..:f(,t
Voting ;;;,:,;,
Mr. SC(Yl'T (VA) (Chaimian) X Mrs. FOXX (NC) (Ranking) X
Mr. GRIJALVA (AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr SABLAN \MP) X !vlr. GROTl!MAN (Wl) X
Ms. WILSON (FL) X Ms. STEFANIK (NY) X
Ms. BONAMICI (OR) X Mr. ALLEN (GA) X
Mr. TAKANO (CA) X Mr. BANKS (lN) X
Ms. ADAMS (NC) X Mr COMER (KY) X
Mr. DESAULN!ER (CA) X Mr. FULCHER ([D) X
Mr. NORCROSS (NJ) X Mr. KELLER (PA) X
Ms. JAYAPAL (WA) X Mr. MlJRPJ 1Y (NC) X
Mr. MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. WILD (PA) X Mr. O\VENS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YRS (CT) X Mrs. MCCLAIN (M]) X
Mr. LEVIN (Ml) X Mrs. llARS!IBARClER \TN) X
Ms. OMAR (MN) X Mrs. l'vl!LLER (lL) X
Ms. STEVENS (lv!l) X Mrs. SPARTZ (lN) X
Ms. LEGER FERNANDEZ (NM) X Mr. FIT/.GERAL!) ( W[) X
Mr. JONES (NY) X Mr. CAWTBORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr.MRVAN(IN) X Facanc:,r
Mr. BOWMAN (NY) X Vacancy
Jvlr. POCAN (Wf) X
Mr. CASTRO (TX) X
Ms. SHERRJLL (NJ) X
Mr. YARMUTH (KY) X
Mr. ESPAILLAT (NY) X
Vi'.U.'Grtl)'
TOT /\LS: Ayes: 21 Nos:27 Not Vnting:2
Total:53/ Quorum: /Report:
(29 D-24 R)
'Although not present for the recorded vote. Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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78
Date: Feb 9, 2021
COMMITTF,E ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:16 Bill:H.R. Cmte Print AmcndmcntNumbor:22
Disposition: Defeated by a vote of 20-27
Sponsor/Amendment: STEFANIK/RAMO_04.xml
v':.~ Ayt v:'.~;s
Mr. SCOTT (VA) (Chairman) x-· Mrs. FOXX (NC) (Ranking) X
Mr. GRIJALVA (AZ) X Mr. WlLSON (SC) X
Mr COURNTEY (CT) X Mr THOMPSON(PA) X
Mr. SABLAN (MP) X Mr GROTHMAN (WI) X
Ms. WILSON(FL) X Ms. STEFANIK (NY) X
Ms. BONAMI Cf (OR) X Mr. ALLEN (GA) X
Mr TAKANO (CA) X Mr. BANKS (IN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
Mr. DESAULNJER (CA) X Mr. FULCHER (ll)) X
Ml. NORCROSS (NJ) X Mr. KELLER(PA) X
Ms. JAYAPAL (WA) X Mr. MURPJ IY (NC) X
Ml MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. WlLD (Pi\) X Ml. O\VENS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCLAIN (Mil X
Mr.LEVIN(Ml) X Mrs, HARS!ll3AROER (TN) X
Ms. OMAR (MN) X Mrs. tv1ILLER (IL) X
Ms. STEVENS (Ml) X Mrs. SPART7e (IN) X
Ms. LEGER FERNANDEL (NM) X Mr. FJTZGERALD ( WIJ X
Mr. JONES (NY) X MrCAWJ"flORN(NC) X
Ms. tvl/\NNING (NCl X Mrs. STEEL (CA l X
Mr MRVAN (IN) X racancy
Mr. BOWMAN (NY) X Vacancy
Mr.POCAN(Wll X
Mr. CASTRO (TX) X
Ms. SHERRILL (NJ) X
Mr YARMUTH (KY) X
Mr. ESPAILLAT (NY) X
r·acancy
TOTALS: Ayes: 20 Not Voting: 3
Total:53/ Quorum.: /Report:
(29 D-24 R)
AAlthough not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
"Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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79
Dale: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:17 Bill:H.R. Cmte Print AmondmcntNumber:24
Disposition: Defeated by a vote of 20-28
Sponsor/Amendment: MILLER-MEEKS/RAMD_05"xml
;\ame&SMt: >k, ,~::, ,;';:~;,
Mr SCOTT(VA)(Chainnan) X Mrs" FOXX (NC) (Ranking) X
Mr. GRIJALVA(AZ) X Mr. WILSON (SC) X
Mr COURNTEY (CT) X Mr TllOMFSON (PA) X
Mr SABLAN \Ml') X lvlr" GROTl!MAN \ Wl) X
Ms" WILSON (FL) X Ms" STEFANIK (NY) X
Ms" BONAMJCI (OR) X Mr" ALLEN (GA) X
Mr TAKANO (CA) X Mr" BANKS (IN) X
Ms" ADAMS (NC) X Mr COMER \KY) X
Mr" DESAULNIER(CA) X Mr. FULCHER (lD) X
Mr NORCROSS \NJ) X Mr" KELLER(PA) X
Ms" JAYAPAL(WA) X Mr MURPHY (NC) X
Mr" MORELLE \NY) X Ms" lvITLLER-MEEKS (IA) X
Ms" \VJLD (PA) X Mr 0\/iENS \UT) X
Mrs" MCBATH (GA) X Mr" GOOD (VA) X
Mrs" HA YES (CT) X Mrs" MCCLAIN (Ml) X
Mr. LEVIN \lvli) X Mrs" llARSHBARGER (TN) X
Ms" OMAR(MN) X IV!rs" MILLER (IL) X
Ms" STEVENS (Ml) X Mrs" SPART/, \IN) X
Ms" LEGER FERNANDEZ \NM) X Mr. FITZGERALD\ WI) X
Mr JONES (NY) X Mr CAWTHORN (NC) X
Ms" MAN1'<1NG (NC) X Mrs" STEEL (CA) X
Mr MRVAN (TN) X 1,'accmcy
Mr. !301/v'MAN (NY) X vacancy
Mr.POCAN(Wl) X
Mr CASTRO (TX) X
Ms" SHERRlLL (NJ) X
Mr YARMUT!l (KY) X
Mc ESPAILLAT (NY) X
Vacancy
TOTALS: Ayes: 20 Nos:28 Not Voting: 2
Total:53/ Quorum: /Report:
(29 D-24 R)
'Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote"
""'Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:18 Bill: H.R. Cmte Print Amendment Number: 25
Disposiiion: Defeated by a vote of 21-27
Sponsor/Amendmeni: STEFANIK/RAMD_08.xml
,~,'.;,, ,.;;,~;,
Mr. SCOTT (VA) (Chainuan) X Mrs. FOXX (NC) (Ranking) X
ivlr. GRIJALVA (AZ) X Mr. WILSON (SC) X
Mr COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr SABLAN (MPl X Mr GROTHMAN (WI) X
Ms. \NILSON (FL) X Ms. STEFANIK (NY) X
Ms. BONA!'v!ICI (OR) X Mr. ALLEN (GA) X
Mr TAKANO(CAJ X Mr BANKS (fN) X
Ms. ADAMS (NC) X MrCOMER(KY) X
Mr DESAULN!ER (CA) X Mr. FULCHER (!Dl X
Mr. NORCROSS (NJ) X Mr. KELLER(PA) X
Ms. JAYAPAL(WA) X Mr. MURPHY (NC) X
Mr MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. W[LD(l'Al X Mr OWENS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCLAIN (Ml) X
Mr.LEVIN(Mll X Mrs. llARSl!BARGER (TN) X
Ms. OMAR (MN) X lv!rs. MILLER (TL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (TN) X
Ms. LEGER FERNANDEZ (NM) X Mr. FJTZGERALD ( WI) X
Mr. JONES (NY) X Mr. CAWlllORN (NC) X
Ms. MANNJNG (NC) X Mrs. STEEL (CA) X
Mr.MRVAN (TN) X FQcancy
Mr. BOWMAN (NY) X vacancy
Mr. POCAN (WI) X
Mr CASTRO (lX) X
Ms. SHERRILL (NJ) X
Mr Y ARMUTH (KY) X
Mr. ESPAILLAT (NY) X
Vacamy
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
Total:53/ Quonun: /Report:
(29 D-24 R)
'Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at Ume of vote,
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Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:19 Bi11:H.R. Cmte Print Amcnchncnt Number: 28
Disposition: Defeated by a vote of 19-29
Sponsor/Amendment: CAWTHORN/RAMD_16.xml
v~,'.~ v~;;~
Mr. SCOTT (VA) (Chaimrnn) X Mrs. FOXX \NC) (Ranking) X
Mr. GRIJALVA(AZ) X lvlr. WILSON (SC) X
Mr. COlJRNTEY (CT) X Mr. THOMPSON (PA) X
Mr SAlsLAN (MP) X Mr GROTHMAN (Wl) X
Ms. WlLSON (FL) X Ms. STEFANIK (NY) X
Ms. BONAMICI (ORl X Mr. ALLEN (GA) X
Mr TAKANO (CA) X Mr. BANKS (!N) X
Ms. ADAMS (NC) X Mr COMER (KY) X
Mr DESAULNJER(CA) X Mr. FULCHER (ID) X
Mr. NORCROSS (NJ) X Mr.KELLER(PA) X
Ms. JAYAPAL (WA) X Mr MURPHY (NC) X
Mr MORELLE (NY) X Ms. lvllLLER-MEEKS (IA) X
Ms. WlLD(l'M X Mr. O\VENS (UTl X
Mrs. MCBATH (GA) X MrGOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCLAIN (MI) X
Mr. LEVIN (Mll X Mrs. llARSJIBARGER (TN) X
Ms. OMAR (MN) X Mrs. MILLER (IL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ{!N) X
Ms. LEGER FERNANDEZ (NMJ X Mr. FITZGERALD (WIJ X
Mr JONES (NY) X Mr. CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (IN) X Facmic_v
Mr. BOWMAN (NY) X t'acancy
MrPOCAN(Wl) X
Mr CASTRO (IX) X
Ms. Sl!ERRfLL (NJ) X
Mr Y ARMUTH (KY) X
Mr ESPAILLAT(NY) X
I'llcancy
TOTALS: Aves: 19 Nos:29 Not Voting: 2
Total: 53/ Quorum: /R"-port:
(29D-24 R)
A Although not presentfor the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
"'Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTE!i: VOTE
Roll Call:20 Bill:H.R. Cmte Print Amendment Number: 29
Disposition: Defeated by a vote of 20-28
Sponsor/Amendment: GOOD/GOOD_01 0.xml
N&mc&Stnk v';;,'.;, N1)l
Votu1g-
Mr SCOTT (VA) (Chairman) X Mrs. FOXX (NC) (Ranking) X
lv!r. GRIJALVA (AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr SAHl,AN(MP) X Mr UROTHMAN (Wl) X
Ms. WILSON (FL) X Ms. STEFANIK (NYJ X
Ms. 130NAMICI (OR) X Mr. ALLEN (GAl X
Mr TAKANO (CJ\) X Mr. BANKS(IN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
Mr. DESAULNIER (CA) X Mr. FULCHER (1D) X
Mr. NORCROSS (NJ) X !vlr. KEUER (PJ\) X
Ms. JAYAPAL (WA) X Mr. MURPHY (NC) X
Mr. MOREL! ,E (NY) X Ms. MILLER-MEEKS (IJ\) X
Ms. Vi1LD(PA) X l\llr. OWENS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCLAlN (MI) X
Mr. LEVIN (MI) X Mrs. l!ARSHBA.RGER (TN) X
Ms. OMAR (MN) X Mrs. lv!ILLER (IL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEZ (NMJ X Mr. YITZGt•:RALD ( Wl) X
Mr. JONES (NY) X Mr. CAWTHORN (NC) X
Ms. MANNINO (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (!NJ X Vacanc.v
Mr. BOWMAN (NY) X vacam~v
Mr. POCJ\N ( WI) X
Mr. CASTRO (JX) X
Ms. SHERRiLL (NJ) X
Mr YARMUTll(KY) X
Mr ESPAILLAT (NY) X
Vacanc:v
TOTALS: Ayes: 20 Nos:28 Not Voting: 2
Total:53/ Quorum: /Report:
(29 D-24 R)
'Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
"Although not present for the recorded vote, Member expressed he/she wou!d have voted NO if present at time of vote.
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COMMITTEE ON EDUCATION A ND LABOR RECORD OF COMMITTEE VOTE
Roll Call:21 Bill: H.R. Cmte Print Amendment Number: 30
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: MILLER-MEEKS/DOLFUND2.xml
:\am~&Stak Aye: ,;;·~ .
Xo v:::,
Mr SCOTT (VA) (Chainnan) X Mrs. FOXX (NC) (Ranking) X
Mr. GRlJALVA(AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr THOMPSON (PA) X
Mr SAl,LAN (MPl X Mr GROTHMAN (Wll X
Ms. WILSON (FL) X Ms. STEFANIK (NY) X
Ms. BONJ\lvUCJ (OR) X Mr ALLEN (GA) X
Mr. TAKANO(CA) X Mr. BANKS(lN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
tv!r. DESAULNJER (CA) X Mr. FULCHER (ID) X
Mr. NORCROSS (NJ) X Mr. KELLER (PA) X
Ms. JAYAPAL(WA) X Mr. MURPHY (NC) X
Mr. MORELLE (NYl X Ms. MILLER-MEEKS (IA) X
Ms. WILD(PA) X Mr. OWENS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X Mrs. MCCJ.AlN (Ml) X
Mr. LEVIN (Ml) X Mrs. JIARSllBARGER (TN) X
Ms. OMAR (MN) X Mrs. lVI.ILLER (IL) X
Ms. STEVENS (MI) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEZ (NM) X Mr. FITZGl~RALD ( Wl J X
Mr. JONES (NY) X Mr CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEEI, (CA) X
Mr. MRVAN (IN) X 1/0cancy
Mr. BOWMAN (NY) X T'acancy
Mr. POCAN (Wl) X
Mr. CASTRO (TX) X
Ms. SHERRILL (NJ) X
Mr YARMUTH(KY) X
Mr. ESPAILLAT (NY) X
T'acanc:r
TOTALS: Ayes: 21 Nos:27 Not. Voting: 2
Total:5.3/ Quornm: /Report:
(29 D-24 R)
'Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote,
*Although not present for the recorded vote, Member expressed he/she wou!d have voted NO if present at time of vote.
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Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:22 Bill:H.R. Cmte Print Amendment Numbcr:31
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: SPARTZ/SPARTZ_06.xml
i',o
Xo-t
VQUng ,;~;,
Mr. SCOTT (VA) (Chaim1an) X Mrs. FOXX (NC) (Ranking) X
Mr. GRIJALVA (AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr SABLAN (MP) X Mr. GROTHMAN (Wll X
Ms. Vv1LSON (FL) X Ms. sn,FAN!K (NY) X
Ms. BONJ\MICI (OR) X Mr. ALLEN (GA) X
Mr. TAKANO (CA) X Mr. BANKS (IN) X
Ms. ADAMS (NC) X Mr. COMEH (KY) X
Mr. DESAULN!ER (CA) X Mr. FULCHER (1D) X
Mr. NORCROSS (NJ) X Mr. KELLER (PA) X
Ms. JAYJ\PAL (WA) X Mr. MURPHY (NC) X
Mr MORELLE (NY) X Ms. MILLER-MEEKS (Ii\) X
Ms. WILD (PA) X Mr. OWTINS (UT) X
Mrs. MCBATH (GA) X Mr. GOOD(VA) X
Mrs HA YES (CT) X Mrs. MCCLAIN (Ml) X
Mr. LEVIN (MI) X Mrs. l!ARSIIBARGER (TN) X
Ms. OMAR (MN) X Mrs. MILLER (IL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (TN) X
Ms. LEGER FERNANDEZ (NM) X Mr. FJT1/.GERALD ( W[) X
Mr. JONES (NY) X Mr. CJ\ WTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN (TN) X T-"acancy
Mr. BO\/'lMAN (NY) X Tllcancy
Mr. POCAN ( WI) X
Mr CASTRO (TX) X
Ms. Sl lERRlLL (NJ) X
Mr. YARMUTTI(KY) X
Mr. ESPAILLAT (NY) X
l'"acanc_v
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
Total:53/ Quorum: /Report:
(29D-24 R)
AAJthough not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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Date: Feb 9, 2021
COMMITTEE ON EDU CATJON AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:23 Bil!: H.R. Cmte Print Amendment Number: 8, 14, 17,20,23 en bloc
Disposition: Defeated by a vote of21-27
Sponsor/Amendment: FOXX (amend #8), Murphy (amend #14), Keller (amend #17),
Walberg (amend #20), Stefanik (amend #23)
Nt'n
Voting ,t;::,
----
Mr. SCOTT (VA) (Chainnnn) X Mrs. FOXX (NC) (Ranking) X
Mr. GRIJALVA (AZ) X Mr. WfLSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr. SABLAN (MP) X Mr. GR.OTHMAN (WI) X
Ms. WILSON (FL) X Ms. STEFANIK (NY) X
Ms. BONAM.TC! (OR) X Mr ALLEN (GA) X
Mr. TAKANO(CA) X Mr. BANKS (lN) X
Ms. ADAMS (NC) X Mr.COMER(KY) X
Mr. DESAULNIFR (CA) X Mr. FULCHER (!Dl X
l'v!r. NORCROSS (NJ) X Mr. KELLER(PA) X
Ms. JA YAPAL (WA) X Mr. MURPHY (NC) X
Mr. MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. WILD (PA) X Mr. OWENS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VM X
Mrs. HA YES (CT) X Mrs. MCCLAfN (Ml) X
Mr. LEVIN (Ml) X Mrs. I-JARSl!BARGER(TN) X
Ms. OMAR (MN) X Mrs. MILLER (IL) X
Ms. STEVENS (Mil X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEL (NM) X Mr. FIT;,GERALl) ( WI) X
Mr JONES (NY) X Mr. CAWTHORN (NC) X
Ms. MANNINO (NC) X Mrs. STEEL (CA) X
Mr. MRVAN(lN) X fOcanc._v
Mr. BOWMAN (NY) X f'Clcancy
Mr. !'()CAN (WI) X
Mr. CASTRO (TX) X
Ms. SHERRILL (NJ) X
Mr. YARMUT!-1 (KY) X
Mr. ESPAILLAT (NY) X
f'acan('.v
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
Total:5J/ Quorum: /Report:
(29D-24 R)
'Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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Date: Feb 9, 2021
COMMITTEE ON EDUCATION AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:24 Bill:HR Cmte Print AmcndmentNnmbcr:26, 27 en bloc
Disposition: Defeated by a vote of21-27
Sponsor/Amendment: Good (amend #26), Fulcher (amend #27)
,~.~~
:-io!
Aye V\'tnig
Karne&Staie
Mr. SCOTT (VA) (Chaimrnn) X Mrs. FOXX (NC) (Ranking) X
lv!r GRIJALVA (AZ) X Mr. WILSON (SC) X
JI.Ir COURNTEY (CT) X Mr. THOMPSON(PA) X
Mr. SABLAN (MP) X Mr GROTllMAN (WI) X
Ms. WILSON (FL) X Ms. STEFANIK (NY) X
Ms. BONi\iviTCJ (OR) X Mr. ALLEN (GA) X
Mr. TAKI\NO (CA) X Mr. BANKS (TN) X
Ms. ADAMS (NC) X MrCOMER(KY) X
Mr DESAULNJER (CA) X Mr. FULCHER ([D) X
Mr NORCROSS (NJ) X Nlr. KELLER(PA) X
Ms. JAYAPAL (WA) X Mr. MURPHY (NC) X
Mr MORELLE (NY) X Ms. MILLER-JV!FEKS (li\) X
Ms. WILD(PA) X Mr. OWENS (UT) X
Mrs. MCBATH (GA) X Mr.GOOD(VA) X
Mrs. HA YES (CT) X lv!rs MCCLAIN (Ml) X
Mr LEVIN (Ml) X Mrs. HARSHBARGER (TNJ X
Ms. OMAR (MN) X Mrs. MILLER (IL) X
Ms. STEVENS (Mll X Mrs. SPARI7,(JN) X
Ms. LEGER FERNANDl::Z (NM) X M.r. FITZGERALD ( WJ) X
Mr. JONES (NYJ X Mr CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEEL (CA) X
Mr. MRVAN ([N) X Vacan~v
Mr. BOWMAN (NY) X vacancy
Mr. POCAN (Wl) X
Mr. CASTRO (TX) X
Ms. SHERRILL (NJ1 X
Mr YARMUTH (KY) X
Mr. ESPAILLAT (NY) X
Vltcanc:v
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
Total:53/ Quorum: /Report:
(29 D-24 R)
'Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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COMMITTEE ON EDU CA TlON AND LABOR RECORD OF COMMITTEE VOTE
Roll Cull:25 Bill:H.R. Cmte Print Amendment Number: 32,33,34 en bloc
Disposition: Defeated by a vote of 21-27
Sponsor/Amendment: Spartz (amends#32, 33, 34)
,~;;,g Nmne&Stmc: ;;.~~
-
Mr. SCCYrT (VA) (Chainnan) X Mrs FOXX (NC) (Ranking) X
Mr. GRLlJ\L VA (AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
tvlr. SABLAN (MP) X Mr. GR.OTHMAN ( Wl) X
Ms. WILSON (FL) X Ms. STEFANIK (NY) X
Ms. BONAMICI (OR) X Mr. ALLEN (GA) X
Mr. TAKANO (CA) X Mr. BANKS (IN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
Mr. DESAULNIER (CA) X Mr FULCHER (ID) X
Mr. NORCROSS (NJ) X Mr.KELLER(PA) X
Ms. JAYAPAL (WA) X Mr. MURPIIY (NC) X
Mr. MORELLE (NY) X Ms. MrLLER-MEEKS (IA) X
Ms. WILD(PA) X Mr.OWENS(lJr) X
Mrs. MCBATH (GA) X Mr GOOD(VA) X
Mrs. HA YES (CT) X lv!rs MCCLAIN (Ml) X
Mr. LEVIN (Ml) X Mrs. llARSllBARGER (TN) X
Ms. OMAR (lvfN) X Mrs. MILLER (IL) X
Ms. STEVENS (Ml) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNANDEZ (NM) X Mr. FlTZGERALD (WIJ X
Mr. JONES (NY) X Mr. CAWJ'lJORN (NC) X
Ms. MANNfNG (NC) X l'vfrs. STEEL (CA) X
Mr.MRVAN (IN) X Vacancy
Mr BOWMAN (NY) X Facm1(~V
Mr. POCAN (WI) X
Mr CASTRO (TX) X
Ms. SHhRRILL (NJ) X
Mr. YARMUT!l (KY) X
Mr. ESPA!LLAT (NY) X
FQcancv
TOTALS: Ayes: 21 Nos:27 Not Voting: 2
TotaJ:53/ Quorum: /Report:
(29D-24 R)
A Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
*Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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Date: 0210912021
COMMITTEE ON EDU CA T!ON AND LABOR RECORD OF COMMITTEE VOTE
Roll Call:26 Bill: Committee Print Amendment Number: (Reconciliation)
Disposition: Agreed to by a vote of 27 -21
Sponsor/Amendment: Scotti Motion to transmit the Committee Print (Reconciliation), as
amended, with recommendations to the Hcuse Committee on the Budget
\Tun-ie&.Stal.~ 'No ,~,;~ Aye Ko ,~,'::.,
Mr. SCOTT (VA) (Chmmrnn) X Mrs. FOXX (NC) (Ranking) X
Mr. GRIJALVA (AZ) X Mr. WILSON (SC) X
Mr. COURNTEY (CT) X Mr. THOMPSON (PA) X
Mr. SABLAN (MPl X Mr GROTHMAN (W1) X
Ms. WILSON (FL) X Ms. STEFANIK (NY) X
Ms. BONAMICI (OR) X Mr. ALLEN (GA) X
Mr. TAKANO (CA) X Mr. BANKS (lN) X
Ms. ADAMS (NC) X Mr. COMER (KY) X
Mr. DESAUl.NlER (CA) X Mr. FULCHER (ID) X
Mr. NORCROSS (NJ) X Mr. KELLER(PA) X
Ms.JAYAP/\L(WA) X Mr. MURPIIY (NC) X
Mr. MORELLE (NY) X Ms. MILLER-MEEKS (IA) X
Ms. W1LD (PA) X Mr. OWENS (UT) X
Mrs. MCBATH (GA) X Mr. G(X)D (VA) X
Mrs. HA YES (CT) X Mrs. MCCLAIN (Ml) X
Mr. LEVIN (Ml) X Mrs. HARSHBARGER (TN) X
Ms. OMAR (MN) X Mrs. MILLER (IL) X
Ms. STEVENS (Jl,1l) X Mrs. SPARTZ (IN) X
Ms. LEGER FERNAN DEL (NM) X Mr. FITZGERALD\ Wi) X
Mr. JONES (NY) X Mr CAWTHORN (NC) X
Ms. MANNING (NC) X Mrs. STEFL (CA l X
Mr. MRVAN (IN) X va·canc:,i,'
Mr. BOW'MAN (NY) X f'acancy
Mr. POCAN (WI) X
Mr. CASTRO (TX) X
Ms. SHERRILL (NJ) X
Mr YARMUTH (KY) X
Mr. ESPAILLAT (NYl X
F'acuncy
TOTAI.S: Ayes: 27 Nos:21 Not Voting: 2
Total: 53 I Quorum: 271 Report: 27
(29 D-24 R)
"Although not present for the recorded vote, Member expressed he/she would have voted AYE if present at time of vote.
"Although not present for the recorded vote, Member expressed he/she would have voted NO if present at time of vote.
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STATEMENT OF PERFORMANCE GOALS AND OBJECTIVES
Pursuant to clause (3)(c) of Rule XIU of the Rules of the House of Representatives, the goals of
the Committee Print are to provide urgent and needed relief to struggling students, workers, and
families and to comply with the reconciliation directive included in section 200l(b) of the
Concurrent Resolution on the Budget for Fiscal Year 2021, S.Con.Res. 5.
DUPLICATlON OF FEDERAL PROGRAMS
Pursuant to clause 3(c)(5) ofRule XIII of the Rules of the House of Representatives, the
Committee states that no provision of the Committee Print to comply with the reconciliation
directive included in section 2001(b) of the Concurrent Resolution on the Budget for Fiscal Year
2021, S.Con.Res. 5, establishes or reauthorizes a program of the Federal Government known to
be duplicative of another federal program, a program that was included in any report from the
Government Accountability Office to Congress pursuant to section 21 of Pub. L. No. 111-139, or
a program related to a program identified in the most recent Catalog of Federal Domestic
Assistance.
HEARINGS
Pursuant to Section 3(u) ofH.Res. 8, Adopting the Rules of the House of Representatives of the
One Hundred Seventeenth Congress, and for other purposes, which passed the House of
Representatives on January 4, 2021, the Committee is not required to conduct hearings on
legislation reported or transmitted from the Committee before April 1, 2021.
STATEMENT OF OVERSIGHT FINDINGS AND RECOMMENDATIONS OF THE
COMMITTEE
In compliance with clause 3(c)(l) of Rule XHI and clause 2(b)(l) of Rule X of the Rules of the
House of Representatives, the Committee's oversight findings and recommendations are
reflected in the descriptive portions of this report.
NEW BUDGET AUTHORITY AND CBO COST ESTIMATE
Pursuant to clause 3(c)(2) of Rule XIII of the Rules of the House of Representatives and section
308(a) of the Congressional Budget Act of 1974, and pursuant to clause 3(c)(3) of Rule XIII of
the Rules of the House of Representatives and section 402 of the Congressional Budget Act of
1974, the Committee has received the following estimate for the Committee Print to comply with
the reconciliation directive included in section 200l(b) of the ConcmTent Resolution on the
Budget for Fiscal Year 2021, S.Con.Res. 5, as amended, from the Director of the Congressional
Budget Office. Pursuant to clause 3(v) ofH.Res. 8, Adopting the Rules of the House of
Representatives of the One Hundred Seventeenth Congress, and for other purposes, which passed
the House of Representatives on January 4, 2021, the chair of the Committee on the Budget may
adjust an estimate under clause 4 of Rule XXIX of the Rules of the House of Representatives to
"exempt the budgetary effects of measures to prevent, prepare for, or respond to economic or
public health consequences resulting from the COVID-19 pandemic."
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CONGRESSIONAL BUDGET OFFICE Phillip L. Swagel, Director
U.S. Congress
Washington, DC 20515
Februaiy 15, 2021
Honorable Robert C. (Bobby) Scott
Chairman
Committee on Education and Labor
U.S. House of Representatives
Washington, DC 20515
Dear Mr. Chairman:
The Congressional Budget Office has prepared the enclosed cost estimate for
Reconciliation Recommendations of the House Committee on Education and
Labor.
If you wish further details on this estimate, we will be pleased to provide them.
The CBO staff contact is Leah Koestner.
Sincerely,
Phillip L. Swagel
Enclosure
cc: Honorable Virginia Foxx
Ranking Member
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Congressional Budget Office February 15, 2021
Cost Estimate
ReconcUiation Rec~mme.nc:latrCirts. e>ftheHouse Cblnmifteeori
l:duc;aticm and Lal>or ·• ...... , .· . · ·
A": ord~!•H,trepqrted oo Febr1Jary s; 202.1 ·
·_c
By Fiscal Year, Millions of Dollars 2021 2021-2030 2021-2031
--~----·--"-"
Direct Spending (Outlays) 22,849 280,073 293,784
Revenues -11,986 -1,261 3,786
Increase or Decrease(-)
in !he Defie it 34,835 281,334 289,998
The legislation would
• Appropriate funds for education-related programs, labor-related programs, child care, human services and
community support programs. and nutrition programs
Increase the federal minimum wage to $15 per hour by 2025, which would affect the federal budget and
impose intergovernmental and private-sector mandates
Expand eligibilny for federally funded workers' compensation benefrts to certain federal employees and
maritime workers affected by the coronavirus
Subsidize premiums for coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) at
85 percent for people enrolled in that coverage through September 2021
Estimated budgetary effects would mainly stem from
• Increased federal spending on education and child care programs
• Increased federal spending resulting from changes in employment, prices, and the distribution of income
caused by a higher minimum wage
• Federal subsidies for COBRA premiums
Areas of significant uncertainty include
• Projecting the rate at which various entities would spend new budget authority
• Projecting the duration of school closures related to the coronavirus pandemic
• Estimating the behavior of businesses and individuals in response to a higher minimum wage and how those
responses would affect federal spending and revenues
Detailed estimate begins on the next page,
See also CBO's Cost Estimates Explsined, www.cbo.gov/publicatlon/54437;
How CBO Prepares Cost Estimates, www.cbo.gov/pubHcetfon/535-J9; and Gfossery, wvVvv.cbo.gov/publicatlon/42904.
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Legislation Summary
S. Con. Res. 5, the Concurrent Resolution on the Budget for Fiscal Year 2021, instructed
several committees of the House of Representatives to recommend legislative changes that
would increase deficits up to a specified amount over the 2021-2030 period. As part of the
reconciliation process, the House Committee on Education and Labor approved legislation
on Febmaiy 9, 2021, that contains provisions that CBO estimates would, on net, increase
deficits over that period by $281.3 billion.
The legislation would appropriate specified amounts totaling $220. I billion for education-
related programs, labor-related programs, child cai·e, human services and community support
prograllls, and nutrition programs.
The reconciliation recommendations also would make the following changes:
• Modify the 90il0 rule for proprietary postsecondaiy education institutions to include all
federal education benefits in the formula for aid eligibility (a decrease in direct spending
of$124 million over the 2021-2030 period);
• Amend the Fair Labor Standards Act (FLSA) to increase the federal minimum wage to
$ 15 per hour by 2025 (an increase in direct spending of $60.1 billion and an increase in
revenues of $14.7 billion over the 2021-2030 period);
• Expand eligibility for federally funded workers' compensation benefits to federal
employees and maritime workers affected by the coronavirus (an increase in direct
spending of $103 million and $224 million, respectively, over the 2021-2030 period);
• Expand eligibility for certain nutrition programs (a11 increase in direct spending of
$5.74 billion over the 2021-2030 pe1iod); and
• Provide a subsidy, in the fmm of a tax credit, for 85 percent of premiums for continuation
coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA) to
people enrolled in such coverage from the first of the month following the date of
enactment through September 30, 2021 (an increase in the deficit of $9.9 billion over the
2021-2030 period).
Estimated Federal Cost
The estimated budgetaiy effect of the Committee's reconciliation recommendations is shown
in Table l. The changes in outlays from the legislation fall within budget functions 370
(commerce and housing credit), 400 (transportation), 500 (education, training, employment,
and social services), 550 (health), 570 (Medicare), 600 (income security), 650 (Social
Security), and 700 (veterans benefits and services).
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Basis of Estimate
For this estimate, CBO assumes that the reconciliation legislation will be enacted at the end
of March 2021. Outlay estimates are based on historical spending patterns for affected
programs and on information from affected agencies about implementation.
Direct Spending and Revenues
CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting the
Committee's reconciliation recommendations would increase direct spending by
$280.1 billion and reduce federal revenues by $1.3 billion over the 2021-2030 period, for a
net effect on the deficit of $28 L3 billion.
Subtitle A: Education Matters. Subtitle A would appropriate $170.6 billion mostly for
education grants to respond to the coronavirns pandemic; the legislation also would amend
the 90/10 rule, which would reduce spending by about $0. 1 billion. Thus, CBO estimates that
enacting subtitle A would cost $170.5 billion over the 2021-2030 period.
Part }~Department of Education The legislation would appropriate $170.1 billion for the
Department of Education mostly to make grants to states, local education agencies, and
postsecondary education institutions, which would result in outlays totaling $ l 70. l billion
over the 2021-2030 period, CBO estimates. The Congress previously provided nearly
$31 billion for education stabilization in the Coronavirus Aid, Relief, and Economic Security
(CARES) Act, enacted on March 27, 2020, and another $82 billion for this purpose in the
Consolidated Appropriations Act, 2021, enacted on December 27, 2020. Because most of
those funds remain to be spent, CBO anticipates that the bulk of spending of funds provided
in the reconciliation recommendations would occnr after 202 L Specifically, the legislation
would appropriate:
• $128.6 billion for the Elementa1y and Secondary School Emergency Relief Fund for
preparation for, prevention of, and response to the coronavirus pandemic or for other uses
allowed by other federal education programs;
• $39.6 billion to the Higher Education Emergency Relief Fund to provide grants to
students or to defray institutional expenses related to the pandemic; and
• $2.0 billion for other education programs, including $850 million for the Bureau of
Indian Education, $850 million for Outlying Areas (American Samoa, the
Commonwealth of the Notihem Maiiana Islands, Gnam, and the U.S. Virgin Islands),
$100 million for the Institute of Education Sciences, and $91 million for student aid
administration.
Section 2013 would modify the 90/10 rule, under which proprietary institutions that receive
more than 90 percent of their overall revenue from student aid programs autl1orized under
title IV of the Higher Education Act (including Pell grants and federal student loans) are
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ineligible to participate in the federal aid programs. The legislation would expand the
definition of federal aid to include additional non-title-IV programs, such as veterans'
education benefits. CBO expects that amending the 90/10 rule would reduce the number of
students enrolled in proprietary schools, resulting in an estimated savings of $124 million
over the 2021-2030 period. Those savings would stem from a reduction in mandato1y
spending for Pell grants ($78 million), student loans ($25 million), and veterans' education
benefits ($21 million).
Part 2--Miscel/aneous. The legislation would appropriate $480 million for grants to fund
activities related to the aits, huma11ities, libraries and museums, and Native American
language preservation and maintenance. CBO estimates outlays for those activities would
total $479 million over tlle 2021-2030 period.
Subtitle B: Labor Matters. Subtitle B would increase the federal minimum wage, provide
funding to the Department of Labor (DOL) for activities to help protect workers from
contracting CO YID- 19 ( the disease caused by the coronavims), and expand the eligibility of
federal employees and maritime workers who contract COVID-19 for federally funded
workers' compensation benefits. CBO estimates that enacting subtitle B would increase
outlays by $60.6 billion over the 2021-2030 period.
Raising the Federal Minimum Wage. Section 2101 would amend the FLSA to increase the
federal minimum wage in annual increments from $7.25 per hour to $15 per hour in 2025
(shortly after enactment, the minimum wage would be $9.50 per hour). After 2025, the
minimum wage would rise by the annual percentage increase, if any, in the median hourly
wage of all employees. The legislation also would repeal the separate minimum wage for
tipped workers, teenagers, and disabled workers.
CBO estimates that enacting the higher minimum wage would increase the cmnulative
budget deficit by $45.4 billion over the 2021-2030 period (and by $54.1 billion over the
2021-2031 peiiod). The $45.4 billion increase over the 2021-2030 period is the net effect of
a $60.1 billion increase in direct spending and a $14.7 billion increase in revenues. (This
provision would affect both on- and off-budget spending and revenues. The increase in the
on-budget deficit would be $66.7 billion over the 2021-2030 perio~ CBO estimates,
consisting of a $48.8 billion increase in on-budget mandat01y spending and a reduction in
on-budget revenues of $17 .9 billion.) 1
Increasing the minimum wage would induce a number of behaviors alllong businesses and
people that would result in changes in piices, the distribntion of income, employment, and
I. Off-budget effects arc designated by law as excluded from budget totals. The revenues and outlays of the two Social
Security trust funds (the Old-Age and Survivors Insurance Tmst Fund and the Disability lnsnrance Tmst Fund) and
the transactions of the Postal Service are ofl"budgct.
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other economic factors, CBO estimates. 2 Those changes in tum would produce budgetary
effects in revenues and in a broad set of federal programs, including the major health care
programs, unemployment compensation, Social Security, nutrition programs, student loans,
and retirement programs.
CBO estimates that the higher wages of some workers would lead to higher prices for goods
and services, which would contribute to increases in spending for some federal programs.
For example, CBO estimates that higher prices for long-term services and supports and
medical services would increase costs to Medicaid. Changes in employment and in the
distribution of income would increase spending for some programs ( such as unemployment
compensation) and reduce spending for others (such as nutrition programs).
Changes in employment ru1d the distribution of income also would affect revenues. On net,
revenues would increase under the provision, but those changes would result from a number
of factors that worked in opposite directions. Revenues from payroll taxes for Social Security
(which are categorized as off-budget) would increase. Other revenues would decline, on net,
in part because income would shift toward lower-income people ru1d away from higher-
income people 1IDder the legislation, and lower-income people face lower tax rates, on
average, thru1 higher-income people do.
The basis of this estimate is described in significantly greater detail in CBO's analysis of the
budgetary effects of S. 53, the Raise the Wage Act of 2021, published on
February 8, 2021. 3
Other Provisions. Sections 2102-2 l 04 would make additional changes to labor programs;
CBO estimates enacting those sections would increase outlays by $477 million over the
2021-2030 period.
Section 2102 would provide $150 million to DOL for activities to help protect workers from
contracting COVID-19. Much of the funding would be spent by the Occupational Safety and
Health Administration on enforcement of workplace safety standards.
Section 2103 would expand through 2030 the number of federal employees with COVID-19
who are eligible for medical, wage replacement, and death benefits under the Federal
Employees' Compensation Act (FECA), under an assumption that those workers had
contracted the illness on the job. FECA benefits are treated as direct spending; however,
2. Consistent with CBO's cmwentional approach to estimating the costs of legislation. these estimates incorporate the
assumption that nominal gross domestic product would be unchanged. As a result, total income is roughly unchanged.
Even so. the set of effects incorporated in this estimate is more eA1cnsive than the set incorporated in most cost
estimates. That is because the eJTccts on economic behavior that would affect the fcdeml budget would be broader for
increases in the minimum ,wage than for most policies that CBO examines,
3. See Congressional Budget Office. The Budgetary Effects of the Raise the Wage Act of202 / (Fcbrumy 2021),
"\Y\\ w.cbo.gm"/pnhikation/56975.
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employing agencies ultimately bear the cost of federal workers' compensation claims.
Because FECA costs are charged back to a claimant's employing agency by DOL, the
ultimate costs are borne by those agencies' accounts for salaries and expenses. CBO
estimates enacting this provision would cost $103 million over the 2021-2030 period.
Section 2104 would establish the presumption that maritime workers with COVID-19 have
contracted the illness on the job, making them eligible for medical, wage replacement, and
death benefits under the Longshore and Harbor Workers' Compensation Act. Employers or
the employers' insmance carriers would be reimbursed for the cost of those benefits through
the end of fiscal year 2030. CBO estimates enacting this provision would increase outlays by
$224 million over the 2021-2030 period.
Subtitle C: Human Services and Community Supports. Subtitle C would appropriate
$48.4 billion for child care and other human service and community support programs,
which CBO estimates would result in outlays of $48.4 billion over the 2021-2030 period.
Specifically, the legislation would appropriate the following amounts:
• $276 million for programs autho1ized by the Elder Justice Act;
• $1.4 billion for programs authorized by the Older Americans Act;
• $39.0 billion for the Child Care and Development Block Grant program (including
$24. 0 billion for the new Child Care Stabilization Fund to provide assistance to
providers):
• $ l. O billion for Head Stait;
• $450 million for programs authorized by the Family Violence Prevention and Services
Act and other programs to support survivors of sexual assault and domestic violence;
• $350 million for programs authorized by the Child Abuse Prevention and Treatment Act;
• $4.5 billion for the Low Income Home Ener6ry Assistance Program;
• $425 million for the Department of Health and Human Services to allow for pandemic-
related cost increases in programs of the Administration for Children and Families that
provide direct services to children, which CBO interprets as funding that would support
care provided by the Office of Refugee Resettlement to unaccompanied alien children;
and
• $1.0 billion for the Corporation for National and Community Service, primarily to make
new grants to community service programs and to increase the living allowances of
AmeriCorps volunteers.
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Subtitle D: Child Nutrition and Related Programs. Subtitle D would amend and provide
funds for nutrition programs; CBO estimates enacting subtitle D would increase outlays by
$6.6 billion over the 2021-2030 period.
Sections 2301 and 2302 would appropriate $490 million to fund an increase in certain
benefits under the Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC) and an additional $390 million for activities to increase patticipation in
\VIC. Enacting those provisions would cost $880 million over the 2021-2030 petiod, CBO
estimates.
Section 2303 would raise the age of eligibility from 18 to 25 for the Child and Adult Care
Food Program at emergency homeless shelters for the duration of the public health
emergency, which CBO estimates will end in July 2022. CBO estimates that enacting this
provision would cost $180 million over the 202 l-2030 period.
Section 2304 would expand the Pandemic Electronic Benefit Transfer (P-EBT) program by
providing benefits in the summer months after a period during which schools are closed for
at least five consecutive days, and expand eligibility to children under the age of 6 in
households that receive Nutrition Assistance Program benefits in Puerto Rico, tlte
Commonwealth of the North Mariana Islands, and American Samoa. CBO estimates that
enacting this provision would cost $5.6 billion over the 2021-2030 period. Section 2304
would also extend P-EBT for the duration of the public health emergency. However, CBO
anticipates that all schools will return to in-person instruction for school year 2021-2022, so
CBO estimates that the extension would result in an insignificant cost in 2022.
Subtitle E: COBRA Continuation Coverage. Under current law, people who lose their job
or experience another qualifying event that results in a termination of their employment-
based health insurance are eligible to continue healtlt insurance coverage through the
Consolidated Omnibus Budget Reconciliation Act (COBRA). If an individual chooses to
enroll in COBRA coverage, he or she may be required to pay up to l 02 percent of the total
premium and can maintain the coverage for 18 montlts. Under section 2401, qualifying
COBRA enrollees would be required to pay 15 percent of the totaJ COBRA premium from
the first of the month following the date of enactment through September 30, 202 l. The
federal goverurnent would provide a subsidy on behalf of the individual for the remainder.
People would be eligible for premiums to be paid on their behalf if they are enrolled in, or
are eligible to enroll in, COBRA coverage because of an involuntaiy termination or
reduction of hours at the time of enactment. Section 2401 would pem1it eligible people who
did not previously elect COBRA coverage and eligible people who discontinued COBRA
coverage prior to enactment to enroll within 60 days of being notified about the availability
of these subsidies.
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CBO and JCT estimate that enacting section 2401 would increase federal deficits by
$9.9 billion over the 2021-2030 period. That increase in deficits would consist of a decrease
in direct spending of $6. l billion and a decrease in revenues of $16.0 billion over the period.
Those effects would primarily stem from federal subsidies for COBRA premiums, partially
offset by a reduction in federal subsidies for other sources of health insurance coverage.
Under current law, CBO and JCT project that about 1.3 million people would be enrolled in
COBRA coverage on a full year equivalent basis (FYE), representing less than l O percent of
the eligible population. The estimated take-up of COBRA coverage is low because premiums
are not typically subsidized by employers as they are when people are actively employed.
The remaining estimated 11.4 million eligible people who do not enroll in COBRA coverage
would enroll in another form of insmance coverage or be uninsured.
In response to the availability of those subsidies, CBO and JCT estimate that an additional
2.2 million people, on a FYE basis, would enroll in COBRA coverage, resulting in a total of
about 3 .5 milliou FYE COBRA enrollees in 2021. In total, the agencies estimate that
subsidies for COBRA-for existing and new enrollees-would increase deficits by $16.3
billion over the 2021-2030 period.
CBO and JCT estimate there would be offsetting effects as people who would newly emoll
in COBRA coverage would no longer enroll in other sources of health insurance coverage
that are subsidized by the federal government. Of the 2.2 million FYEs that CBO and JCT
estimate would newly enroll in COBRA coverage, an estimated 1.1 million would have
otherwise been enrolled in Medicaid or CHIP and about 600,000 would have forgone
insurance coverage and been uninsured. About 200,000 FYEs would otherwise have enrolled
in subsidized nongroup coverage and about 100,000 would have enrolled in nongroup
coverage without subsidies. The remainder, about 200,000, would have been enrolled in
employment-based coverage. CBO and JCT estimate that those changes in health insurance
coverage would offset the cost of the new COBRA subsidy by $6.4 billion over the 2021-
2030 period. On net, the COBRA provisions in the legislation would increase deficits by
$9.9 billion over the 2021-2030 period.
Uncertainty
The Committee's reconciliation recommendations would appropriate $220 billion in bndget
authority to new and existing programs--a substantial increase in funding for those
activities. For example, funding to help K-12 and higher education institutions respond to the
coronavirus pandemic and funding for the Child Care and Development Block Grant
program would increase significantly. As a result, CBO's estimates of the rate at which
federal agencies, states, local education agencies, and other entities would spend those new
funds are subject to considerable uncertainty, as is the question of whether those entities
could spend the new funds within the allotted time.
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CBO's estimates are subject to other significant areas of uncertainty:
• Projecting the behavior of businesses and individuals in response to a higher minimum
wage and how those responses would affect federal spending and revenues;
• Anticipating effects among proprietary postsecondary education institutions in response
to a change in the 90/10 rule; and
• Projecting the duration of school closures related to the coronavirus pandemic.
Pay-As-You-Go Considerations
The Statutory Pay-As-You-Go Act of 2010 establishes budget-repo1ting and enforcement
procedures for legislation affecting direct spending or revenues. The net changes in outlays
and revenues that are subject to those pay-as-you-go procedures are shown in Table I.
Increase in Long-Term Deficits
CBO estimates that enacting the Committee's reconciliation recommendations would
increase on-budget deficits in eve1y year after 2030. Those increases would total more than
$5 billion in each of the four consecutive I0-year periods beginning in 2031.
Mandates
The Committee's reconciliation recommendations would impose intergovernmental and
private-sector mandates as defined in the Unftmded Mandates Reform Act (UMRA) by
requiring employers to pay a higher minimum wage to workers who are covered under the
Fair Labor Standards Act. Among that group are workers who receive tips, teenage workers,
and workers with disabilities. The legislation also would impose mandates by requiring
group health insurance plans to provide notifications to beneficiaries related to continuation
of coverage under COBRA.
CBO estimates that the aggregate additional amount paid to workers to meet the new
minimum wage requirements would significantly exceed the thresholds established in
UMRA for private-sector and intergovernmental entities in each year beginning in 2021 and
2022, respectively. In 2021, the intergovernmental threshold under UMRA is $85 million
and the private-sector tl1reshold is $170 million; both are adjusted annually for inflation.
CBO estimates that by 2025-when the minimum wage reaches $15 per hour-state, local,
and tribal employers would be required to pay covered workers approximately $4 billion in
additional wages annually. The additional annual cost to private-sector employers would be
$45 billion. Those amounts do not account for employers' possible responses to the higher
minimum wage, whieh could include reducing hiring, altering the composition of the
minimum-wage and non-minimum-wage workforce, or purchasing equipment that would
substitute for workers.
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If employers reduce hiring, CBO estimates that in 2025, public-sector employers would be
required to pay covered workers $3 billion in additional wages. The additional cost to
private-sector employers in that year would be $32.5 billion. CBO did not estimate the
changes in costs to employers associated with other possible responses.
CBO estimated the cost of the mandates using monthly data from the Census Bureau's
Ciment Population Smvey to estimate the distribution of workers' homly wages under
cun-ent law. In projecting hourly wages, CBO accounted for prospective increases in some
states' minimUJU wage rates, including those coming into effect under cun-ent and future
state law.
CBO then identified the subset of workers covered under the FLSA whose hourly wages, in
CBO's projections, would fall below the schedule of minimum wages set by the legislation.
For this analysis, CBO excluded workers who are not covered under the FLSA (including
those in most small businesses and in occupations that generally are exempt from the FLSA)
and workers whose estimated wages would be more than $15 per hour in 2025.
Employers would be expected to incur additional costs to increase the wages of workers who
are not directly covered under this legislation, but that increase would not result from the
employers' compliance with the mandate.
The legislation also would impose a piivate-sector mandate by requiring group health
insurance plans to include additional information about COBRA eligibility and premium
assistance in notifications to beneficiaries. Because group plans routinely provide
information to beneficiaries, CBO estimates that the additional cost of the mandate would be
small.
Estimate Pre1mred By
Federal Costs:
Susan Yeh Beyer (child nutrition programs), Meredith Decker (unemployment insurance and
labor programs), Jennifer Gray (hmnan services programs and the Special Supplemental
Nutiition Program for Women, Infants, and Children), Sofia Guo (workplace safety
programs), Jared Hirschfield (Consolidated Omnibus Budget Reconciliation Act), Paul B.A.
Holland (veterans' benefits), Justin Humphrey (education programs), Arin Kerstein (child
care programs), Leah Koestner (education programs), Justin Latus (longshore workers'
programs, aging programs, and disability programs), Susanne Mehlman (Low Income
Energy Assistance Program), Carolyn Ugolino (Consolidated Omnibus Budget
Reconciliation Act), and Emily Vreeland (Consolidated Omnibus Budget Reconciliation
Act)
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Effects of the Minimum-Wage Increase:
Nabeel Alsalam, Susan Yeh Beyer, William Can-ington, Yiqun Gloria Chen, Chad Chirico,
Sheila Dacey, Meredith Decker, Devrim Demirel, Justin Falk, Nathaniel Frentz, Edward
Gamber, Jennifer Gray, Cornelia Hall, Edward Hanis, Julia Heinze!, Lori Housman,
Justin Humphrey, Nadia Karamcheva, Brian Klein-Qiu, Leah Koestner, Jamease Kowalczyk
(formerly of CBO), Justin Latus, Junghoon Lee, Avi Lerner, Sarnh Masi, Noah Meyerson,
Alexandra Minicozzi, Eamon Molloy, Hudson Osgood, Jan1es Otterson, Brooks Pierce,
Allison Percy, Jeffrey Peny, Stephen Rabent, Dan Ready, Sarah Sajewski, Jeffrey Schafer,
Kutt Seibert, John Seliski, Joshua Shakin, Naveen Singha!, Emily Stern, Robert Stewart,
Carolyn Ugolino, and Emily Vreeland
Mandates:
Lilia Ledezma, Andrew Laughlin
Estimate Reviewed By
Chad Chirico
Chief, Low-Income Health Programs and Prescription Drugs Cost Estimates Unit
Sheila Dacey
Chief, Income Security and Education Cost Estimates Unit
Kathleen FitzGerald
Chief, Public and Private Mandates Unit
Sarah Masi
Senior Adviser, Budget Analysis Division
David Newman
Chief, Defense, International Affairs, and Veterans' Affairs Cost Estimates Unit
Leo Lex
Deputy Director of Budget Analysis
H. Samuel Papenfuss
Deputy Director of Budget Analysis
John McClelland
Director of Tax Analysis
Theresa Gullo
Director of Budget Analysis
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Page 12
‘Sp Fiscat Year, Simtions of Boltars
2024 2022 7023 2028 2025. 2028 2007, 2028. 2028. 2030 2024-2034
increases or Decreases (4 in Direct Spending
‘Subtitle A. Ectucation Matters
Part - Department of Education
Sec, 2004
Budget Authority: 128.555, o ° a eo e a 9 a 8 428,555
Eslimated Outlays on ee a a 128.558
Bee, 2002 Higher Education Emergency Reef Fund
Budget Authority 38.588 8 a 3 a o a @ 6 8 a5 99,588
Estimated Cutiays 3.038 AT8SS. sa 5838 ‘3958 1979 133 38 a a a 34.585
Sec, — 20R4 Outlying Areas
Badget Authority 850 i a e a A e a a a 850
Eximaied Cutays Fy a2 22 179 12 0 v 8 iS o : 850
See, 2005 Bureau of indian Edueation
Budget Authority BBD o e e 8 3 a e o a 850
Estimated Outlays 43 183 153 183 153 A2e 42 cod a e 850
Sex, 2006 Gaitaudet University
‘Sudgat Authority 42 a 3 3 3 . o 8 e ° i 49
Ewimated Cutays 1 a 7 3 o a 3 a 8 G 1a
See. 2007 Student Aid Administration
Budget Authority at ® ° 8 ® ° ) 6 6 a a
Estimated Outlays 9 33 6 o 3 ° a 0 cy 3 at
See, 2008 Howard University
Budget Authority 38 o a a 2 a eo e 3 o 38
Estimates Cutiays 2 6 ary 5 ° 3 a a a e Mw
2009 National Technical institute fer the Deaf
Sudget Authority 9 Q e) 8 9 a a ® 8 a 18
Estimated Outlays 1 8 7 3 ° 8 8 6 6 8 J w
‘Sev, 2010 Institute of Education Sciences
Budget Authority 108 5 6 8 a ° a 5 6 4 oes 400
Estimated Outlays 1 6 18 » 30 a o a Fa ° CES OR, 100
$¥o, 2011 Program Administration A
Budget Authority aid o 8 ° 8 e Ly o 0 a 16
Estimated Cvtlays 4 3 3 3 2 8 8 Q a 0 ie
See, 2012 Office of inspeator Ceneral i
Budget Authority % a t) ° 9 8 . v 8 a oy 5
Estimated Outlays ‘ y 2 1 ‘ a o o a o ‘I at ‘ 3
Seo, 2043 Modteation of op tor x 3
Estimated Budget Authorty ° 3 40 43 416 48 at 9 8 0 ranean 8 188
Estenated Cutays ° 2 6 a 18 18 a7 19 “19 49 Ee ad “44
Pat ecto co
Sec, 202 National Endowment for the Arts SeSOaN 4
Budget Authority 435 a f) fl 0 a ° . 0 8 ak 138
Batinated Outlays Es) 6a M ? 9 ° e a o 6 Bs 138
See. 2022 National Endowment for the Humanities. OF
Budget Authority 138 9 ° a a ° ° 8 ° 8 Ra 438
Estimated Outays 30 84 “ ? 9 0 o ® o 9 as 435
Sea, 2028 Insate of Museum and Livary Services on
Budget Authority 200 a 3 a o 0 a a a a EN 200
Estimated Outlays 48 102 ez 3 8 9 a 6 Q 8 199
Seo. 20m te ayes
Budget Authority 10 o a a o 6 eo o a o 10
Estimated Outiays . 8 2 a e a ® ° 0 8 10
‘Subtotal, Subtitled
Estinvated Budget Authority 470,604 3 10 3 6 18 ar to 8 id 170,454
Estimated Outlays 12,543 46,684 (38.643 42,042, 23.885 11189 4.196 1.695 ot) a8 170,454
‘Sublite B. Labor store
See, 2101 Raising the Federal Minimum Wage"*
Estimated Budget Authorty 599 3,964 (2.807 a0 4,983 6.483 8198 B55S Bas? 10.030 87,387,
Estinsated Cutlays 408 2.975 3413 44a 5815 7348 8.800 aar2 8.367 14,008 79,868
Estimated Budget Autharty ~ On-budget ae 4,958 2873 ‘3508 4364 $305 650F 6515 5835 6,922 2,228
Estimated Outlays ~ On-budget 95 2084 ‘307 3938 4990 5937 7.283 Aiea 6843 7aaT 58,710
Estimated Budget Authority ~ Olf-budget * & 34 208 625 Ae 4587 2080 2a2e 38 15,450
Estimated Ouliays - ORbuayet . & 38 208 a a en 15,198
‘Seo, 2402 Funding for Department of Labor Wesker Protection Activities:
Budget Authority a a a a a 2 9 8 a 130
Estimated Outlays e 8 3 8 2 a ° 0 oO a 460
103
Page 13
‘By Fiscat Year, Millions of Getfars
200 2022, 2023, 2924 2035, 2026 2027 2028 2029 2000 20st: 2b: 2028-2051
See. 2403 Eighty tor Workers"
Estimated Boriget Authorty Kg Ww is 3 e 8 $ 3 4 4 ct 403
Estimated Outlays oF are ais a 6 6 a & 4 é 8: f03
‘See, Paid i ke
Estimated Budget Authority 12 eS ? € s 5 a a 4 4 Bes f; 224
Estimated Outlays: 120 BS 7 s 3 & 4 4 4 a 0: pec
‘Subbots!, SubtitieR
Estimated Budget Authority 288 28 3728 5.000 6204 8203 8564 R485 40.638. $2.68: 87 884
Estimated Outlays 339 ae 438 5.628 F178 8.895 B42t 9.375 14S AB 732) 74348
‘Subtitle ©. Human Serdces and Community Supports
See, 2201 ing for Aging
Budget Authority 88 188 a a B as 3 o 8 a o. 276
Estinated Ootiays: 40 120 Be 3 2 ° o o a e oe 278
See, 2202 Supporting Oider Americans and Their Families
Budget Authority sae 8 8 9 8 . . ° 8 a 8 14a
Estimated Outlays 748 7 cA ° 9 . 8 3 a a 9. 1s
Sev, 2203 Child Care and Development Block Grant Program
Budget Authority 44,999 . a ° 5 a a 9 a 9 o. 14,090
Estimated Outisys: 2.998 A297 4597 2.998 a 6 8 a o e 9: 14,990
Chil Care Stablization
Budget Authority (23,875 8 3 9 . a 8 a a o o 23.878
Estimated Outlays 4,568 12.467 bats 480 a o 8 9 % 9 we 7 23,075
Chitd Care Acsinistration
Budget Authority B a 8 8 8 8 2 8 0 ° 8 38
Estimated Outtays: 4 a aie ? 2 ~ & 0 i a a
See, 2205 Head Stat
Budget aurnority +000 a a a 0 0 o ° o ° ot 1000
Estimated Cutiays 200 780 80 a a a ° s ° a a 4,000
Bee. 2206 Programs for Survivors.
Bulger Authority 450 ° 9 ° a . 8 ° 8 6 ‘ 450
Estimated Quilays 68 2S a3 2 2 8 e ° a 8 one 490
‘
Sec, 2207 Child Abuse Prevention ans Treatment :
Budget Autherty 350 ° 0 8 a a e 8 a 8 i 280
Estimates Outlays 83 575 88 9 8 . o 8 8 a CC 350
Seo. 2208 LIHEAP
Budget Authority 4.509 8 9 8 ° a ° 0 a a ae 4,500
Estimates Outlays 1,808 tro? et azn $98 163 a ® 6 9 on o 4.509
aN
See, 2209 Department of Haaith and Human Services & :
Budget Avthority 425 8 8 . S Ld Ly o & 9 425
Estimated Outays 43 7 8 8 oe 70 e st 4 ° aS 228
See, 2210 Com aoe Trost
Bodget Authority 1.000 8 ° ° 8 ® 2 0 a Seope) 4,000
Estimated Outlays 200 AS ww cd ced 5O » 0 eo 9 4,000
Subtotal, Subtitle ©
Budiget Authority 48.257 188 a 8 o o a o a a 48.405
Entimated Outlay 1938 NSM Tes 438 78 308 4 sf 4 e . AB
‘Buble. Child Nuteition & Related Programe
2, 2301 Improvements to WIC: Benefits
Budget Autmority 490 8 o 2 6 a ° o a o : 400
Eetimated Oalays 490 a 8 3 ° a a ® 9 6 oF 480
See, 2302 WIC Prograrn Modemization
Budget Authority: 0 0 a 8 a o a ° cf 8 300
Estimated Outlays: 58 186 437 3B a a o o e o 0
See, 2303 Ateals and 25
Estimated Budget Authority * 90 a « a 8 e 4 8 * 180
Esthnated Outlays we 140 a . o 6 o 9 o o 480
Seo. (2304 Pandemic EBT Program:
Estimated Budget Authonty 5860 * 8 o 8 a a . a e 5.860
Estimated Outays 5.560 . a a 9 a a o a o s 8.580
‘Subtotal, Subtite D
Estimated Budget Authority 9.510 49 a a a g a o a a #620
Estimated Outlays e178 268 i3F 3 8 a a o a 2 6620
104
Page 14
‘By Fiscal Year, Hions of Dollars
2024 202 2023 2078 2005 2028 2027, 2628 2039 2059 1202-2098
Increases or Decreases {+} in Direct Spending,
‘Sublive €. COBRA Continuation Coverage
See. 2801 Preserving Hoalth Benefis for Workers"*
Estisated Bodger Autorty 5.98 ant 8 2 o e 8 c ° 8 6,088
Estimated Cedlays 5.918 168 8 ° 8 a a 8 8 8 6,088
Tota} inerease in Dicect Spending (on- and off-herige®
Estimated Budget Autianly oo eS 207,206
Eatinated Outlays 22849 «SOL S3SES O37 SSS 18SG} 13,8 ET 8380 ALONE 283,784
Tots! ineroase in Ditect Spending fon bucket)
Estinated Budget Authorty 219170 «2488 28BF ROSS] 5500 BBS RS 592768 298.135
Estimated Outlays 2A889 «70.285 SRE GIT PERSE | ITATS «TEND RT ASE 7.88E 278825
‘Total incvease in Direct Spending (ftbaxtget}
Estinated Bueiget Authority , & 3s 206 e248 ST 2H BER 3.108. 15,158
Ertimated Outlays . @ Mt 208 625 1784208108 $5,959
Increases or Decteases (:) in Reveruies
‘Sublide B. Labor Hatters
‘See. 2101 Raising tne Federal Néimum Wwage™”
“Total Revenues 4 6 22 280-2319 4990238782 ,R 508 19,740
On-budget Revenues n “NF ABST SBE 4.880 637 324 18,984
Ottbodiget Revenues 8 BS 4085 UT BOE MBS gS? 833558 97,930
‘Subltio €. COBRA Coninustion Coverage
Sec, 2401 Preserving Heath Benelit for Workers
‘Total Revenues 3891 4 a a 9 ° a a D 18.983
Onbudget Reverses “4992 @ ° ° e a o ° ° 15368
‘Off-hudlget Revenues 1 g @ ° e @ ° ° e 5
Reventies
Total Reverses A4985 340 222 cS 3786
Onpudget Revenues 12088 = 4305-4283 HT GTS B38 089 -1.9590 7 -32f 194,489
Offbudget Revenues 62 337 a a cS a LD 97,985
Net Increase or Decrease (-}in the Deficit
From Changes in Direct Spending and Revenues:
Enimated Changes tn te Deficit 34895 74289 83,905 40,8 4.872— 17,803 10,490 TAS AEE 8.898 249,998
OmBudgot Darict 34997 7460054807 «42.869 MSHS MOTEY —ISETZ HOTT. SRR 207 9,778
Off Bueiget Deriet 62 -35t | AG2T ROSY 2978 328F 3ST SNR RENE RSI 22,776
‘Campanents may natsum to totals because of rounding
Estimates relative to CBO's February 2021 baseline.
LIHEAP » Low Income Home Energy Assistance Program; Pandemic EBT = Pandemic Electronic Benefits Transfer Program; WIC » Special Supplemental Nutrition Program for Women, Infants
and Chidreny n.a. © not applicable; * « between -$500,000 and $500,000.
Off-b i id by | from budget totals, The revenues and outlays of the two Social Security trust funds (the Old-Age and Survivors Insurance
Trust Fund and the Disability insurance Trust Fund) and the transactions of the Postal Service are off-budget. All affects in this table are on-budget unless otherwise nated,
a. For more detail, see C Budget Office, igatary Effects of the Raise the Wage Act of 2021 (February 2021}, www.cho,gov/publicatian/S6975.
b, These sections would affect direct spending and revenues, which are shown separately.
c. Tha estimated budgetary effects shown here differ from the estimated effects of the same provision that was included in the Reconciliation Recommendations of the House
nn Ways and Means, The estimated the provision in the Ways & Means legislation accounted for interactions with sections 966 and $863 in subtitle
G of that legisiatian, which would i thsidies for certain individuals, whereas this
105
COMMITTEE COST ESTIMATE
Clause 3(d)(l) of Rule XIII of the Rules of the House of Representatives requires an estimate
and a comparison of the costs that would be incurred in carrying out the Committee Print to
comply with the reconciliation directive included in section 200 l (b) of the Concurrent
Resolution on the Budget for Fiscal Year 2021, S.Con.Res. 5, as amended. However, clause
3(d)(2)(B) of that rule provides that this requirement does not apply when the committee has
included in its report a timely submitted cost estimate of the Committee Print prepared by the
Director of the Congressional Budget Office under section 402 of the Congressional Budget Act
of 1974.
CHANGES IN EXISTING LAW MADE BY THE COMMITTEE PRINT, AS
REPORTED
Pursuant to clause 3(e) of Rule XIII of the Rules of the House of Representatives, a comparative
print of changes in existing law made by the Committee Print, as reported, has been requested
but not received.
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ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b) of the Federal Advisory Committee
Act were created by this Committee Print.
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SUMMARY OF THE RECONCILIATION MEASURE
The purpose of the Committee Print is to respond to the needs of students, workers, and
communities as the count1y continues to grapple with the COVID-19 pandemic and to comply
with the reconciliation directive given to the Committee on Education and Labor included in
section 2001(b) of the Concurrent Resolution on the Budget for Fiscal Year 2021, S.Con.Res. 5.
As of February 2021, the public health crisis has sickened more than 27 million people and left
over 470,000 dead in the United States alone, 1 with the nation's most vulnerable populations-in
particular communities of color, low-income families, and older Americans-bearing the brunt
of the hann. While Congress has previously acted to provide relief during the pandemic, the
Committee Print will provide continued and urgent relief to struggling workers, students, and
families.
Count, N.Y. TIMES (Feb. lO, 2021 ),
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Minority Views on S. Con. Res. 5
Introduction
At a time when hardworking American families need Congress to eome together to find
responsible, bipartisan solutions and provide critical COVID-19 relief, Democrats are ignoring
those needs and using a sham process to ram left wing priorities through this Committee. The
legislation the Democrats are reporting to the Committee on Budget is a socialist policy wish list
disguised as pandemic relief Rather than considering this partisan measure, we should have
worked together to convene hearings to examine where relief was needed, identified any gaps in
previous relief packages, and then negotiated a bipatiisan relief package as Congress did under
the Trump administration. Instead of advancing proposals that help schools safely reopen, get
Americans the skills they need to reenter the workforce, and allow our economy to return to its
pre-pandemic prosperity, the Democrats included radical provisions to mandate a $15 national
minimum wage and allow an extreme and flawed expansion of certain workers' compensation
programs. Committee Democrats then blocked amendments that would have achieved legitimate
and effective bipartisan goals.
Furthermore, Democrats labeled themselves experts, deciding that the pandemic only impacts
their chosen groups. COVID-19 doesn't pick winners and losers. The public health emergency
we currently face has disrupted our nation's school systems across the country. The way this
legislation cherry picks which students and schools receive assistance is wildly insulting.
Democrats are operating under the assumption that only some schools and some students need
relief. We need all schools to reopen safely so future generations do not fall further behind.
While Democrats may have an unfounded bias against K-12 private schools, those students do
not deserve to be left behind while Democrats play partisan politics. Additionally, their
nonsensical approach to determining who is worthy of aid extends into higher education.
Democrats decided that students who attend for-profit colleges and universities are not as worthy
of financial relief because the Democrats do not approve of the institutions they enrolled in. This
is wrong. Those students are just as impacted as other students by the pandemic, and they
desperately need financial relief.
Process
Only twenty-six hours after first sharing legislative text, the Chairman gaveled in the markup on
how to allocate the funding this Committee was instructed to spend. Congressional Democrats
seem to never let a crisis go to waste, so it's no surpiise they used this process as an opportunity
to create wasteful, permanent prograins and expand the power of Washington bureaucrats to the
detriment of students, workers, and job creators.
The first thing Democrats did under the jurisdiction of this Committee was move a bill on an
important issue, apprenticeships, that silenced half of the Committee by sidestepping any
committee processes. Then, less than a week later, the Committee marked up a supposed COVID
relief bill that was written completely in secret by the Democrats. The majority provided the text
almost exactly one day before the markup was to begin. Committee Republicans were expected
to analyze and assess the bill's policy and spending piioiities and then carefully and thoughtfully
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craft our position in one day. This was not a small, five-page bill with a narrow scope and
impact. This bill includes hundreds of billions of dollars and covers broad, complex policy
provisions.
Congress and this Committee are supposed to be better. There are times every committee pursues
partisan measures, but a relief package for the American people facing a once in a century
pandemic is not the time to play politics. This is an issue that impacts all our districts and
constituents, but the Democrats' process left half of the country without a voice, at a time when
families are desperate to reopen their small businesses, get their kids back to school, and get the
vaccine. lt ,vould be surprising to learn even Democrats had time to review the legislation.
Americans have seen what happens when weeks of work is crammed into 24 hours - it's never
good.
Missed Opportunities for Needed CO'VID Relief
Despite the cost and scope of this partisan bill, Democrats fail to help mitigate the challenges
faced by so many American families. Parents and students have relayed heartbreaking stories
about the failures of their schools' transition to online learning while teachers' unions continue
the push for remote learning. Students are falling behind, and mental health issues are on the rise.
Democrats aren't listening, opting to pursue the interests of their political allies rather than the
interests of American families.
We know the costs of keeping schools closed are high. So why are schools still closed, especially
when so many private schools are open? The science tells us schools can reopen safely. The
Biden administration's own experts have said this. In a piece in the Journal of the American
Medical Association, Centers for Disease Control and Prevention (CDC) researchers wrote, "the
preponderance of available evidence from the fall school semester has been reassuring ... " 1 They
went on to say, "there has been little evidence that schools have contributed meaningfuJly to
increased community transmission." A second CDC report found, "with proper mitigation
strategies, K-12 schools might be capable of opening for in-person learning with minimal in-
school transmission of SARS-CoV-2." 2
Democrats claim that schools cannot reopen without significantly more federal spending, but this
claim does not hold up to scrutiny. The CDC has estimated that implementing its recommended
mitigation strategies in pre-K through 12th grade schools should cost between $55 and $442 per
student. 3 There are approximately 51 million public school students4 and another approximately
6 million private school students. 5 Using the top of the per-pupil range, the total cost of
implementing the CDC's recommended mitigation strategies is approximately $25 billion.
So far, Congress has appropriated nearly $70 billion in dedicated K-12 funding for coronavirus
relief That does not include additional funds provided to governors, much of which has also
been spent on K-12 schools. In other words, Congress has already provided significantly more
l~ . ) ~
2 :// \V.\ 1 V l \ - /\· - \ j
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funding than the CDC says is necessary. Even if some of the federal school aid is also meant to
offset lost state and local operating revenue, and some is meant to support interventions in the
months and years ahead to support learning loss recovery, the argument that Congress has
shortchanged schools as they cope with COVID-19 is false.
Finally, some Democrats argue that schools cannot reopen until teachers are vaccinated. To be
clear, We believe that teachers should be prioritized for vaccines and should be vaccinated as
quickly as possible. We owe that to our educators, many of whom are above reopening politics
and are eager to serve their students and communities.
Do the experts agree that schools should not reopen until teachers have been vaccinated? The
answer is no. Just last week, the Biden administration's CDC director, Dr. Rochelle Walensky,
said, "vaccination of teachers is not a prerequisite for safe reopening of schools." 6 However, the
next day, the White House press secretary inexplicably tried to walk that statement back, saying
that Dr. Walensky, "spoke to this in her personal capacity," despite the fact that Dr. Walensky
made those comments at an official White House coronavirus briefing. 7 In a particularly surreal
moment, Democrats said during the markup that President Bi den would never politicize the
CDC, apparently unaware his White House has been busy doing exactly that.
During the markup, Republicans offered commonsense solutions to these challenges.
Unfortunately, Democrats rejected each of these. Specifically, Democrats voted against the
following amendments:
• Rep. Rick Allen's (R-GA) amendment requiring K-12 school districts offer in-person
instruction in order to receive most of the COVID relief funds appropriated under the bill.
• Rep. Gregory F. Murphy's (R-NC) amendment requiring schools reopen to serve high-risk
students if school districts receive COVID relief funds.
• Rep. Michelle Steel's (R-CA) amendment requiring schools reopen if teachers have had
access to the COVID- l 9 vaccine.
• Rep. Miller's (R-lL) amendment putting COVID relief funds into education savings accounts
for parents to use to pay for education if their children's public schools are closed.
• Rep. Bob Good's (R-VA) amendment to increase transparency of school reopening
negotiations between school districts and teachers' unions.
The science is clear. Congress has provided the funding. Yet, children are still stuck learning
from behind a screen, which is forcing our youngest and most vulnerable to overcome
insurmountable barriers to success.
Another missed opportunity in this bill is the lack of support for students and workers, many of
whom have lost jobs during this pandemic or are facing a challenging labor market. The
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111
Democrat bill allocates nearly $40 billion for traditional higher education, and not a dime for
those who choose to pursue other pathways outside of the same brick and mortar, four or more
year postsecondary education that Democrats believe is the best and only option for students
seeking skills. At a time of unprecedented turmoil for workers across the count:Iy, funding for
workforce development was so low on the Democrats' list of priorities that they detennined it
wasn't even worth consideration in a $1.9 trillion dollar package. Around 150,000 individuals
receive upskilling or reskilling through programs under the Workforce Innovation and
Opportunity Act every year, which would hardly scratch the surface of meeting the skills gap we
are currently facing. Once again, Democrats passed on the opportunity to provide targeted
support to American workers so they can receive competitive skills. Instead, Democrats chose
progressive priorities that will put more Americans out of work Republicans sought to rectify
this error. Rep. Elise M. Stefanik (R-NY) offered an amendment to provide targeted funding for
workforce development, but Democrats rejected that amendment on a party-line vote.
This one-sided budget reconciliation scheme accomplishes more for the left-wing play book than
it does for strnggling Americans who are desperate to get back to school and work Instead, we
should be focused on solutions that will help get our economy back on track To do so, we must
ensure that relief for Americans is temporary, targeted, and tied to COVID-19.
Permanent Partisan Policy Provisions
$15 National ]IJinimum Wage
Committee Democrats are attempting to circumvent the legitimate Committee process for
considering legislation by including a $15 national minimum wage in the House budget
reconciliation bill. This sham process is a disgraceful attempt to enact policy which should be
soundly rejected. The Democrat Amendment in the Nature of a Substitute (ANS) enacts a $15
national minimum wage by 2025; indexes the wage hike so it automatically increases in
subsequent years; and eliminates the separate minimum wages for youth employment, tipped
workers, and employers providing opportunities to individuals with disabilities. Instead of
providing tangible benefits to American workers during a worldwide pandemic, this 107 percent
increase in the national minimum wage will cause the most hann to the very people its
supporters claim to benefit. Studies cited below, including sources such as the nonpaitisan
Congressional Budget Office (CBO), demonstrate that this extreme wage hike will result in
significant job losses. Lesser-skilled workers in ent:Iy-leveljobs, Americans without a GED, and
tipped employees would bear the brunt of job losses caused by the mandate. Committee
Republicans know that a radical, one-size-fits-all minimum wage hike will redistribute poverty,
not reduce it.
First, mandating a $15 national minimum wage will hann students, as it will have a negative
impact on youth employment. Forty percent of workers paid the minimum wage are below the
age of25. 8 These are individuals at the start of their careers, working part-time or in summer
jobs. Raising the minimum wage to $15 an hour puts these types of jobs at risk of elimination.
More than doubling the current national minimum wage will hann businesses, especially small
8
U.S. BliREAll OF LAB. STATISTICS, CHARACTERISTICS OF MNJMlw[ WAGE WORKERS, 2019 (Apr. 2020),
https://www.bls.gov/opub/rcports/minimum-wagc/2019/homc.hlln.
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and local businesses, as well as the economy. This kind of unprecedented, one-size-fits-all
mandate will force many job creators to reduce workers' hours, let employees go, or close their
doors for good, not to mention the acceleration of workplace automation.
This legislation is not being considered in a vacuum and will compound COVrD-19 job which
has crippled large sectors of the economy over the past year. Congress should be cautious when
considering a policy that will come with such significant economic repercussions, especially
when employment opportunities are dwindling due to the effects of the pandemic, and businesses
of all sizes are already facing unprecedented challenges. Committee Democrats have failed
miserably in this regard and are rushing ahead with a sham process without scheduling public
hearings with impacted business owners, workers, and economists about the destructive effects
of this ill-advised proposal.
The ANS Imposes a Radical and Unprecedented Minimum Wage Hike
Imposing a 107 percent increase in the national minimum wage to $15 an hour would be a
historically unprecedented mandate. The value of the minimum wage has typically averaged
$7.44 in today's dollars, slightly above the current wage rate of $7.25 per hour. 9 The last increase
in the federal minimum wage, passed by Congress in 2007 and implemented through 2009, was
41 percent, but prior increases were "typically lower." 10 According to CBO, the federal
minimum wage reached its peak in 1968, when its value in 2018 dollars was $9.42 if the
conversion is done with the price index for personal consumption expenditures published by the
U.S. Bureau of Economic Analysis, which is the index CBO favors. 11
In January 2021, the National Bureau of Economic Research issued an analysis on the key
findings of academic literature concerning the economic effects of a minimum wage increase.
This report states that over 79 percent of the studies conducted since 1992 found that an increase
in the minimum wage leads to a decrease in the level of employment 12 Similarly, a survey of
nearly 200 US. economists conducted in February 2019 found that 84 percent believe a $15
federal minimum wage would have negative effects on youth employment, and 77 percent
believe it would have a negative impact on jobs available. n Even President Obama's former
Chairman of Economic Advisers Alan Krueger argued in October 2015 that raising the minimum
wage to $15 would "put us in uncharted waters, and risk undesirable and unintended
consequences." 14
9
EMP. POLIClES ]NST,. THE STATE EMPLOYME1'"f IMPACT OF A $15 M1:-,1~U.''"l WAGE 5 (Jan. 2021),
https://epionline.org/wp-contcnVuploads/2020/ I 0/EPI_ StateEmplo:, mentl 5MinimumWage-5 .pdf.
IO CEO, THE EFFECTS OF A MIN!MCM-WAGE !;-.:CREASE O'i EMPLOY;\!E:-,, AND F.\~l!Ly INCOME 26 (Feb. 2014 ).
11
CBO. THE EFFECTS 01\ EMPLOYMENT AND FMULY INCOME OF l:'-JCREASING THE FEDERAL MINI;-.lliM WAGE 5 (July
2019).
12
David Neu mark & Peter Shirley, Myth or ;\.Jeasurement: What Does the :Yew ,\finimum Wage Research Say About
Minimum Wages and Job loss in the l .'nited States?, NAT'L Bl TREAl' OF ECON. RESEARCH, W0RKJNG PAPER 28388,
at 3 (Jan. 2021).
13
LLOYD CORDER, EMP. P0LICJES !NSL SURVEY Of us EC0'i0"!ISTS ON '\ $ 15 FEDER·\L MINIM1 :,1 W.'-GE 4 (Mar.
2019), ~ n t c n t , ' . y l · 20 9 03/EPI Fe 20 l 9 Mi W
f,IBALp<lf.
"Alan B. Kroeger. 7he Minimum Wage: How Much ls Too.\fuch?, N.Y. Tr,n,s. Oct 9, 2015.
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The ANS Threatens Small and Local Businesses
In a January 2021 survey conducted by the National Federation oflndependent Business (NFIB),
74 percent of small businesses said a five-year phased-in $15 minimum wage would negatively
impact their business. 15 Of those reporting a negative impact, 87 percent anticipated they would
have to increase the price of goods and services, passing on some of those price increases to
consumers. Fifty-six percent anticipated using less expensive or part-time workers, 67 percent
would not fill an open position, 60 percent would reduce employee hours, and 58 percent would
rednce the number of employees working for them. According to a January 2019 study done by
NFIB, enacting a $15 national minimum wage would, over a IO-year pe1iod, reduce U.S. private
sector employment by over 1.6 million jobs and result in a cumulative reduction in U.S. real
output of over $2 trillion. 16 Small businesses would be particularly hurt. Businesses with fewer
than 500 employees would see 57 percent of private sector job losses-over 900,000 lost jobs;
businesses with fewer than 100 employees would see about 43 percent of all jobs lost--nearly
700,000 jobs.
The job losses imposed by a $15 national minimum wage would spread beyond small businesses
to vulnerable sectors of the economy already sufferingjob losses during the COVID-19
pandemic. The National Restaurant Association's 2021 State of the Industry report found that in
2020, food service industry sales fell by $240 billion, and the industry finished 2020 at 2.5
million jobs below a pre-coronavirus level. Additionally, 62 percent of fine dining operators and
54 percent of family dining and casual dining operators reported staffing levels more than 20
percent below normal. As of December 2020, l l 0,000 eating and drinking establishments were
closed for business temporarily and, in many cases, permanently .17
In 2019, about three-fourths of hourly workers earning the minimum wage or less were
employed in service occupations, mostly in food preparation and serving-related jobs. About
three-fifths of all hourly workers paid at or below the minimum wage were employed in the
leisure and hospitality industry, almost entirely in restaurants and other food services, but many
of these workers supplement their wages with tips. As a result of the number of affected workers
in this sector, an increase to a $ l 5 national minimum wage would result in the restaurant and bar
indust1y accounting for 45 percent of total job losses. 18
The ANS Will Cause .Extensive Job Losses
Raising the national minimum wage to $15 an hour would cause extensive and disruptive job
losses, harming entry-level workers in many regions around the country. In a report issued in
February 2021, CBO estimates that up to 2.7 million jobs would be lost from a minimum wage
increase to $ l 5, with a median impact of 1.4 million workers becoming jobless due to the hike. 19
15
NFIB COVID- l 9 SMALL BUSINESS SL'RVEY (202 l ), htlps://assets.nfib.com/nfibcom/Covid-19-15-
Questionnaire_.pdf.
16
MICJI\l'I. J. CHOW & PAULS. BETTENCOURT. NFIB RESEARCH FOUND., ECONOMIC EFFECTS OF ENACTING THE
RAISE THE WAGE ACT ON SMALL Bl lSINESSES AND THE U.S. ECONOldY I (fan. 25, 2019).
" News Release, National Restaurant Association Releases 2021 State of the Restaurant Iudustry Report (Jan. 26,
2021 ), https://restaurnnt.org/news/pressroom/prcss-rclcases/2021 -state-of-the-restaurant-industry -report.
18 falP. POLICIES INST., THE STATEEtdPLOYME;-.'Tl:VIPACTOFA $15 MINIMUM WAGE 19(Jan. 2021).
CBO. THE BUDGETARY EFFECTS OFTIIE R,\JSE TIIE WAGEAC'f OF 2021, at 9 (Feb. 2021).
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CBO also predicts that half of the individuals losing their job would drop out of the labor force
completely-2° This report estimates that a $15 national minimum wage would lift 900,000
individuals out of pove1ty-500,000 less than the median number of expected job losses imposed
by such a proposal. 21 Therefore, the ANS would cause roughly 1.6 jobs to be lost for every
person who moved out of poverty, and in the worst-case scenario estimated by CBO, as many as
approximately three jobs would be lost for every individual moving out of poverty. Significantly,
those losing their jobs, and the broader population, would face higher prices for goods and
services. 22
The job losses detailed above would be concentrated among certain populations and areas of
employment. Minimum wage workers tend to be young. In 2019, while workers under 25 were
about one-fifth of all hourly paid workers, they were about two-fifths of those paid the minimum
wage or less. Of hourly workers, 8.3 percent of 16- to 19-year-olds and 5.6 percent of 16- to 24-
year-olds were paid at or below the minimum wage. 23 A January 2021 report by the Employment
Policies Institute using CBO methodology found that a $15 minimum wage would cost more
than two million jobs. 24 Significantly, among individuals losing their jobs, 61 percent would be
female workers, and 60 percent would be young workers aged 16 to 24. 25 The CBO also predicts
that job losses stemming from a $15 national minimum wage would have a disproportionate
effect on younger, less educated individuals. 26 In fact, the unprecedented, one-size-fits-all l 07
percent wage hike included in the Democrat ANS would hurt workers and decimate small
businesses, forcing many job creators to cope by reducing workers' hours, eliminating workers'
jobs, increasing automation, or closing their doors for good. As such, the provision creates a very
ill-advised and dangerous trade off.
Federal Employees' Compensation Act COVID-19 Presumption
Section 2103 of the ANS establishes a presumption that certain federal workers covered under
the Federal Employees' Compensation Act (FECA) who contract COVID-19 contracted the virus
through work and are eligible for medical benefits, Jost wages, and survivor benefits under
FECA programs. This provision applies to federal workers employed by specific agencies that
are deemed to be high risk due to contact with the public, patients, or coworkers.
This expansion of the FECA program creates an unprecedented and extremely broad
presumption that many federal workers who are designated as high risk and contract COVID-19
have contracted the virus through work-related activities. This provision is problematic for
several reasons. First, under long-standing law governing federal workers' compensation
programs, there is no list of specific injuries or illnesses that are automatically covered. Worker
claims have always been evaluated on a case-by-case basis fonned on the medical and
supporting evidence available to back the benefit claim. The broad, sweeping, untested, and
20
Id. at 8.
" Id. at 2.
22 Id. al 8.
23 U.S. Bl'REAU OF LAB. STATfSTICS, CHARACTERJSTICS OFMJN!Ml'M WAGE WORKERS. 2019(Apr. 2020).
https://www.bls.gov/opub/rcports/minimum-wage/2019/home.htm.
"fa!P. POLICIES INST.• THE STATE EMPLOYMENT IMPACT OF A $15 M!NI'v!U:v! WAGE 11 (Jan. 2021).
25
Id. at 15.
CBO, THE BUDGETARY EFFECTS OF THE RAISE THE WAGE ACT OF 202 L at 8 (Feb. 2021 ).
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unprecedented definitions related to COVlD-19 in Section 2103 would set a new expansive
precedent by designating a specific illness for coverage, force taxpayers to cover many non-
employment-related claims, and pose a new and significant financial burden on federal agencies
and taxpayers.
The U.S. Department of Labor (DOL) has already recognized the unique circumstances that
COVID-19 presents related to the federal workforce and has issued guidance to address these
issues based on longstanding FECA procedures. 27 DOL has also created a COVID-19 Task Force
to support claims examiners and assist staff, employing agencies, and the general public with
COVID-19 claims. 28 Additionally, DOL maintains a reporting dashboard for employing-agency
leadership to flag positions and duty stations as high risk for claims evaluation. 29
In July 2020, DOL's Office ofinspectorGeneral found that COVID-19 had not affected DOL's
ability to meet timeliness and quality-performance indicators for claims processing. 30 A DOL
spokesperson indicated that as of November 2020, there have been 6,620 COVID-19 FECA
claims, of which 3,477 have been accepted, 339 were denied, 191 have been withdrawn, and
2,613 are still being adjudicated. 31 These statistics indicate that a large majority ofFECA
claimants are being accepted into the program upon adjudication, and a majority have already
been accepted into the program. They further indicate that Section 2103 is unnecessary to ensure
federal workers receive the benefits they deserve.
Longshore and Harbor Workers Compensation Act COVTD-19 Presumption
Section 2104 of the ANS establishes a presumption that all maritime workers covered under the
Longshore and Harbor Workers' Compensation Act (LHWCA) who contract COVID-19
contracted the virus through work and are eligible for medical benefits, lost wages, and survivor
benefits under LHWCA programs. Self-insured employers and insurance carriers in the LHWCA
program will be reimbursed from the U.S. Treasury Employees' Compensation Fund.
Similar to the FECA provision in Section 2103, the LHWCA provision creates an unprecedented
and extremely broad presumption that maritime workers who caught COVID-19 have contracted
the virus through work-related activities. Additionally, because of unique aspects of the maritime
industry, these workers can also be employed by multiple companies over a short time, which
further complicates LHWCA benefits administration. As previously stated, under long-standing
law governing workers' compensation programs administered by the federal government, there is
no list of injuries or illnesses that are covered, and this framework applies for workers covered
,, DOL, OFF. OF WORKERS' COMPENSATION PROGRAMS (OWCP), FECA BULLETIN 20-05 (Mar. 31, 2020), FECA
BULLETfN 21-01 (Oct. 21, 2020).
28
OWCP, CLAIMS l lNDER TllE FEDERAL EMPLOYEES' Co;,JPENSA110:-; ACT DlJE TO THE NOVEL CORONAVIR1!S
(COVID-19).
29
lnfonnation provided to Committee staff by DOL.
30 DOL, OFF. OF INSPECTOR G!'-''i., REPORT TO OFFICE OF WORKERS' COMPENS..\TION ON Covm-19: OWCP SHOULD
CO'-s'Tl'illE TO CLOSELY MONITOR !\!PACT O'J CLAIMS PROCESSING (July 2020).
31
Stephanie Weaver, Nearly 3,500 federal emplovees to be compensated.for contracting COVID-19 al work, Fox 5
WASHINGTON, DC, Nov. 25, 2020, https://www.fox5dc.com/newslnearly-3500-federal-employees-to-be-
compensatcd-for-contracting-covid-l 9-at-work.
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under the LHWCA. Claims have always been evaluated on a case-by-case basis depending on
the medical and supporting evidence available to support the benefit claim.
Under current law, these private-sector workers already have access to unemployment and
disability benefits. In addition, the labor unions representing longshore workers-the
International Longshoremen's Association and the International Longshore and Warehouse
Union-have negotiated a special fund for COVID-19 claims, which certain workers have
accessed since early 2020. 32
The broad and unprecedented LWHCA presumption contained in the bill would create new
financial burdens on private employers and the federal government by requiring that workers'
compensation benefits are covered for maritime workers who potentially contracted COVID-19
outside of work or were exposed to COVID-19 and ordered to remain home by a public health
official but did not test positive for the virus. Significantly, industry estimates the impact of this
presumption to range from $700 million to $1 billion, far more than the CBO preliminary
estimate of$212 million. 33 As such, Section 2104 creates unnecessary costs to private employers
and the federal government for workers who are already eligible for a range of private-sector and
LHWCA benefits.
Consolfrlated Omnibus Budget Appropriations Act of 1985 Coverage
Section 2401 of the ANS establishes an 85 percent health care insurance premium reduction for
individuals enrolled in Consolidated Omnibus Budget Appropriations Act cif 1985 (COBRA)
continuation coverage and reimburses employers for this cost through a payroll tax credit
However, under current law, workers who lose employer-sponsored coverage already have
access to additional coverage options, many of which are subsidized by the federal government.
In addition to COBRA, anyone who loses their employer-sponsored coverage qualifies for an
Exchange Special Enrollment Period (SEP). 34 Depending on their income, they may also be
eligible for tax credits or Medicaid coverage.
During the COVID-19 pandemic, the majority of the 3.9 million workers who lost their
employer-sponsored coverage were able to obtain coverage elsewhere. CBO reported that two-
thirds of these workers have enrolled in other employer-sponsored coverage through the existing
COBRA program, or other employer-sponsored coverage through a family member with
employer-sponsored coverage, Medicaid, or Exchange coverage. 35 Committee Democrats have
not demonstrated that Section 2401 is necessary to ensure those who have lost coverage obtain
the coverage they need.
There are other significant concerns with Section 2401. The provision fails to ensure only those
authorized to work in the United States can receive subsidies. Additionally, the subsidies could
be greater for people when they are unemployed than when they are employed, which could
Information provided lo Commit!ee staff from the National Association of Waterfront Employers.
"Id.
34
29 C.F.R § 2590.701-6.
35
CONG. BHXlET OFF., FEDERAL Sl'BS!D!ES FOR HEAL1H !NSl'RANCE COVERAGE FOR PEOPLE l TNDER AGE 65: 2020
TO 2030 (Sept 2020).
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make it less attractive to return to work Providing subsidies for COBRA coverage during the
public health emergency could also establish a precedent for a new program that will continue
once the emergency has passed.
Finally, Section 2401 does not prohibit federal spending for abortion services. Committee
Republicans believe that any federal funds used to subsidize private coverage must include
protections to ensure that no federal funds are used to provide abortion services. Consistent with
long-standing, bipartisan agreement, provisions included in annual Congressional appropriations
legislation prevent the federal government from using taxpayer dollars on abortion services. 36
Section 240 l excludes these protections, and Committee Democrats have been unwilling to
address these concerns.
Department ofLabor Appropriations
Section 2102 of the ANS provides DOL with $150 million in supplemental appropriations to
remain available until September 30, 2023, for the Wage and Hour Division, the Office of
Workers' Compensation Programs, the Office of the Solicitor, the Mine Safety and Health
Administration, and the Occupational Safety and Health Administration (OSHA) to carry out
COVID-19-related worker protection activities. Of the $150 million, $75 million is allocated to
OSHA and $12.5 million is directed to the Office of [nspector General.
This provision further highlights the Democrats' inappropriate focus on aggressive government
enforcement policies rather than a proper balance of activities that includes compliance
assistance to help business owners better understand their obligations and how best to fulfill
them. A balanced approach involves both the carrot and the stick to ensure compliance.
Unfortunately, the Democrat bill only focuses on using more "sticks." Chairman Robert C.
"Bobby" Scott (D-VA) made clear in his opening statement at the markup that these
supplemental funds are intended to create and enforce new one-size-fits-all national workplace
safety regulations specific to COVID-19. Committee Democrats fail to acknowledge that such
standards would place onerous new mandates on business owners already struggling to stay
afloat. These regulations would tie the hands of employers, forcing them to follow top-down
edicts that would be quickly outdated and fail to keep pace with the ever-evolving threat of
COV[D-19. Instead of rushing one-size-fits-all regulations, the Trump administration's DOL
provided robust, industry-specific guidance and compliance assistance that was regularly
updated based on scientific recommendations to help employers protect their workers from
exposure to COVID-19, while also using its existing enforcement authority to hold bad actors
accountable. 37
Amending College and Unfrersity Program Participation Agreements
The legislation amends the Higher Education Act's (HEA) Program Participation Agreement
(PP A) that institutions enter into with the Department of Education to operate federal student aid
programs like the Pell Grant program or the Direct Loan program. Specifically, the bill changes a
36 See, e.g., Michael J. New, The Hyde Amendment is Life-Saving and Worth Saving. N.'\T'L REV., July 27, 2020.
37
News Release. U.S. Department of Labor's OSHA Announces $3,930,381 In Coronavirus Violations (Jan. 8,
2021).
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revenue requirement applicable to proprietary colleges and universities. Currently, for-profit
institutions must derive at least l O percent of their revenue from sources other than the aid
programs located in Title IV of the HEA. This requirement is commonly referred to as the 90/10
rule. Sources of funding like private student loans and military or veteran education benefits like
the Post-9/1 l GI Bill funds count towards the 10 percent part of the calculation. Democrats alter
the 90/10 rule in their bill by including all "Federal funds" as part of the 90 percent portion of the
equation.
The 90/10 rule has nothing to do with COVID-19 relief. Democrats are attempting to sneak a
hyper-partisan irrelevant policy into what should be a bipartisan pandemic relief legislative
vehicle. Even worse, the 90/10 rule changes proposed in the legislation will be devastating for
student veterans in particular, and lead to a combination of higher college costs for students and
decreased student access to postsecondary education in general. The accounting gimmick in the
PPA does not measure the quality of the education delivered. The provision does not lead to
better outcomes for students. The 90/10 rule does not hold all colleges and universities
accountable. In sum, this is a tenible proposal. Attempting to jam unrelated Democrat pet
projects through budget reconciliation is not what the American people expect of Congress.
Amendments not Accepted
Committee Democrats did not accept any Republican amendments. Despite receiving the bill at
the very last minute, Committee Republicans offered thoughtful amendments that would have
improved the bill. Many of these amendments would have addressed key needs of the American
people suffering during the pandemic. The following are just a few of the many commonsense
proposals Republicans offered to dramatically improve the bill:
Mental Health Among Students. Rep. Marianette Miller-Meeks (R-IA) offered an amendment
to direct the Secretary to reserve 2 percent of the appropriation for both the Elementary and
Secondaiy School Emergency Relief and Higher Education Emergency Relief funds to award
competitive grants to elementary and secondaiy schools and institutions of higher education,
respectively, for mental health services. A study by the American Academy of Pediatrics found
that higher rates of suicide-related behaviors in youths corresponded with COVID-19 stressors
and community responses, like school closures. 38 Additionally, a special rep011 by the American
Psychological Association quotes a mental health expert saying, "we can reasonably anticipate
increases in anxiety, depression and trauma, and it goes without saying there will be significant
grief and loss issues ... we can also anticipate increases in child abuse and neglect." 39 As we work
to overcome the virus, we must address the need for mental health services in elementary and
secondary schools, as well as colleges and universities.
Education Technology. Rep. Madison Cawthorn (R-NC) offered an amendment to increase the
Elementary and Secondary School Emergency Relief Fund by $2 billion to award fomrnla funds
to states. States then would award competitive grants to their rural school districts to support the
technology needs of students and educators in those districts. Funds can be used to purchase
hardware, software, and connectivity to support educational activities. We know that rural school
38
https ://www.aappublications.org/news/2020/l 2/ l 6/pediairicssuicidestudy 121620
39 https:/lwww.apa.org/rnonitor/2020/09/safeguarding-mental-health
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districts often have less access to educational technology, and this amendment would address
that disparity.
Rural Child Care. Rep. Elise Stefanik offered an amendment to reserve about $1 billion of the
almost $40 billion from child care and early childhood education funds to address child care
needs in mral communities. The funds would recmit new providers to mral communities and
help businesses offer new options for on-site child care for employees' children, among a myriad
of other benefits. Democrats opposed the amendment, choosing instead to dole out tens of
billions of dollars in neither a targeted nor thoughtful way.
Colleges, China, aud Confucius Institutes. Rep. Elise Stefanik also offered an amendment to
prevent HEER money from going to colleges and universities that have a partnership with any
entity owned, controlled, or organized under the laws of the People's Republic of China. The
Chinese Communist Party (CCP) uses Confucius Institutes and other entities to influence
operations throughout academia and poison the well of free thought and expression. Taxpayer
money should not be going to further prop up the inhumane efforts of the CCP. Democrats voted
along party lines to preserve the CCP's efforts and jeopardize our colleges and universities.
Juvenile Justice. Rep. Victo1ia Spartz (R-IN) offered an amendment to provide funds to the
Department of Justice to help improve conditions for juveniles and staff in juvenile detention
centers and support PROMISE grants authorized in Title V of the Juvenile Justice Delinquency
Prevention Act cif 1974. The funds for PROMISE grants would gamer community support for at-
risk youth with pandemic-related stmggles, preventing youth from becoming engaged or more
deeply engaged in the juvenile justice system. This amendment was also defeated along party
lines.
Remove Worker's Compensation Presumptions. Republican Leader Virginia Foxx (R-NC)
offered an amendment to strike Sections 2!03 and 2104. These are two provisions from the ANS
that establish an unprecedented and burdensome presumption that certain federal workers
covered by the FECA and maritime workers covered by the LWHCA who caught COVID-19
contracted the virus through work and are thereby eligible for medical benefits, lost wages, and
survivor benefits. This amendment ensures that covered workers who contract COVID-19
through their employment can continue to receive appropriate compensation under the law
without exposing private-sector businesses and the federal government to a flood of 11011-work-
related claims and increased costs to taxpayers. Unfortunately, Committee Democrats proved
that they are willing to sacrifice longstanding precedents regarding how these programs are
responsibly administered by creating a new, expensive, and untested presumption without the
benefit of even one oversight hearing to receive outside expert input on the implications of these
provisions. The amendment was defeated on a party-line vote.
Small Business Survival. Rep. Fred Keller (R-PA) offered an amendment to exempt employers
with fewer than 10 employees or annual sales under $1 million from an increase of the national
minimum wage to $15 per hour. This amendment shielded the smallest of businesses from the
bill's mandated extreme spike in labor costs. This provision would protect small establishments,
which drive local economies and are the most vulnerable to the negative impacts of the radical
wage increase contained in this bill. Small businesses employ almost half of American workers
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and account for two-thirds of net new jobs. A 2019 study by the NFIB estimated that 57 percent
of job losses caused by increasing the national minimum wage to $15 will come from small
businesses,4° which make up 99.9 percent of all businesses in the United States. 41 Committee
Democrats signaled their lack of concern about the dire conditions facing small businesses and
the destructive impacts of a $15 national minimum wage and this amendment was defeated on a
party-line vote.
Protect Rural Jobs. Rep. Madison Cawthorn offered an amendment to protect workers in rural
communities around the country from the devastating impacts of a $15 national minimum wage.
This amendment prevents the l 07 percent minimum wage hike in the ANS from going into
effect in nonmetropolitan regions with a median hourly wage of less than $18. These are
generally rural areas with a cost ofliving unable to bear the shocks of implementing such a
radical proposal. By unanimously voting against this amendment, Committee Democrats
demonstrated a lack of concern and understanding about the regional implications of this radical
legislation which threatens millions of American jobs around the country.
Stop Job Loss Due to Automation. Rep. Michelle Steel offered an amendment to stop the
damaging effects of a $15 national minimum wage if the Government Accountability Office
finds that the wage hike will cause more than 200,000 jobs to be lost due to automation. The
Democrat ANS will precipitate a sudden and extreme hike in labor costs that will only accelerate
the rate of workforce automation. Committee Democrats opposed and defeated the amendment
on a party-line vote, choosing to stand behind a partisan political priority at the expense of jobs,
in the middle of a global pandemic.
Stop Job Loss Due to Adverse Economic Conditions. Rep. Burgess Owens (R-UT) offered an
amendment stating that no prospective increase in the national minimum wage will take effect if
the monthly unemployment rate increases for at least three months in the year prior to a wage
hike taking effect, the unemployment rate increases by 0.25 percentage points from the month
prior in any of the 12 months before a scheduled increase, or the national unemployment rate is
above 6.5 percent for any month during the prior 12 months. The amendment highlights a key
priority for Committee Republicans-American job growih and economic recovery from the
COVID-19 pandemic. The CBO estimated that the l 07 percent increase in the national minimum
wage contained in this legislation will result in l.4 million lost jobs, and could range as a high as
2.7 million job losses. 42 lt would be egregiously irresponsible to enact this legislation without an
"offramp" to prevent the radical increase from phasing in if harmful economic conditions arise.
Mr. Owens proposed a commonsense amendment to ensure that the extreme wage hikes
mandated by the Democrat ANS stop if jobs are being lost or the U.S. faces sudden economic
downturns, such as the one which occurred due to the COVID-19 pandemic. Committee
Democrats demonstrated a willful ignorance of economic realities by voting to defeat this
amendment on a party-line vote.
40
MICHAEL J. CHOW & PAULS. BETTENCOURT, NF!B RESEARCl!FOL1'1)._ EcONOMIC EFFECTS OF ENACTING THE
RAISE THE WAGE ACTON SMALL Bl'SlNESSFS AND THE U.S. ECONOMY (Jan. 25, 2019).
" U.S. SMALL Bus. ADMlN. OFF. OF ADYOC,\CY, WHxr·s NEW WITH SMALLBGSI?-IESS? (Oct 2020),
https://cdn.advocacy.sba.gov/wp-contcnt/uploads/2020/10/22094424/Whats-Ncw-With-Srnall-Busincss-2020.pclf.
42
CBO, THE BUlX1ETARY EfFECTS OF THE RAISE THE WAGE Acr OF 2021 (Feb. 2021).
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Remove $15 National Wage Provision. Rep. Greg Murphy offered an amendment to highlight
the destructive economic impacts imposed by a $15 national minimum wage and the
inappropriate use of the budget reconciliation process to advance this ill-conceived policy
change. Budget reconciliation is reserved for spending and revenue provisions, not extraneous
partisan proposals. The nonpartisan CBO recently released a report finding that increasing the
national minimum wage to $15 would result in 1.4 million lost jobs, with half of affected
individuals leaving the job market completely 43 Mr. Murphy's amendment would have
mitigated these effects, saving millions of American jobs, by striking Section 2101, the radical
wage-hike provisions, from the ANS. Instead of truly helping American workers find
opportunity and secure employment during a pandemic, Committee Democrats displayed their
commitment to partisan political objectives unrelated to the COVID-19 pandemic by defeating
the amendment, as a part of en bloc amendment #1 on a party-line vote.
Protect Employment Opportunities for Individuals of Differing Abilities. Rep. Glenn
Grothman (R-WI) offered an amendment to strike language in the ANS which would threaten the
elimination of the Section l4(c) cetiificate program that allows employers to offer employment
opportunities to individuals with differing levels of abilities.fl I The 14(c) program encourages the
building of employment-based skills while also affording individuals of differing abilities the
dignity and pride that result from paid, productive work According to the Bureau of Labor
Statistics, in 2019 the unemployment rate for individuals with a disability was 7.5 percent
compared to 3 .5 percent overall. Moreover, only 19.3 percent of individuals with a disability
were employed, compared to 66.3 percent of individuals without a disability. 121 By defeating this
amendment on a party line vote, Committee Democrats unanimously supported mandating a $15
national minimum wage on workers at 14(c) establishments, effectively eliminating this valued
and successful program which provides employment opportunities for individuals of differing
abilities.
Ensure Pro-Life Protections. Rep. Jim Banks (R-IN) offered an amendment to ensure that any
federal government funds or credits provided to cover COBRA premiums include a prohibition
on subsidizing abortion services. This amendment would apply protections consistent with long-
standing, bipartisan policy to avoid violating taxpayers' consciences by preventing any federal
funds from being spent on abortion services. The amendment was defeated on a party-line vote.
Support Worker Rights. Rep. Tim Walberg (R-MI) offered an amendment to appropriate $20
million to the Office of Labor Management Standards (OLMS) for enforcement activities.
OLMS is vital to protecting the rights of workers and ensuring labor-management transparency
and financial integrity in our nation's labor unions. The integrity of union programs that are
funded by forced union dues is of paramount importance. The recurring problem of corruption
and wrongdoing by leaders of private- and public-sector unions has not subsided during the
COVID-19 pandemic, with notable examples including the United Auto Workers conuption
scandal that resulted in the conviction of 15 individuals connected with the union, including
"Id.
l'l Fair Labor Standards Act§ 14(c), 29 U.S.C. ~ 214(c).
[OJ U.S. Bl'REA\' OF LAB. STATISTICS, PERSONS WITH A DISABILITY: LAtlOR FORCE CHARACTERISTICS SUMMARY,
(Feb. 2020).
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multiple past presidents and officers. 44 The ANS appropriates $150,000,000 for worker
protection activities at the DOL's Wage and Hour Division, Office of Workers' Compensation
Programs, Office of the Solicitor, Mine Safety and Health Administration, and OSHA, but did
not designate funding for the agency responsible for providing oversight of labor organization
activities on behalf of union members. Deciding to put the interest of labor unions ahead of
workers, Committee Democrats defeated this amendment on party lines.
Limit COBRA Coverage to Individuals with Lawful Immigration Status. Rep. Russ Fulcher
(R-ID) offered an amendment to prevent federal government-funded COBRA subsidies provided
in the ANS from flowing to individuals who are not lawfully authorized to work in the United
States. This amendment ensures that tax dollars only go to individuals authorized to work in the
country, and it treats COBRA subsidies consistently with programs such as Medicare, Medicaid,
and Affordable Care Act exchanges, in which illegal immigrants are not eligible for federal
benefits. By opposing this amendment, Committee Democrats demonstrated their continued
support for unlawful immigration and the amendment was defeated on a party-line vote.
Compliance Assistance for Business Owners. Rep. Mariannette Miller-Meeks offered an
amendment to direct $30 million to the DOL's OSHA for compliance assistance activities to
support employers, including small business owners, in complying with OSHA guidelines and
regulations related to protecting workers from COVID-19. Since the beginning of the COVID-19
pandemic, employers have worked around the clock to keep their workplaces safe under ever-
changing science, state and local mandates, evolving CDC and OSHA guidelines, and industry-
recognized best practices. President Biden has asked OSHA to consider imposing new and
sweeping mandates on business owners in the form of a one-size-fits-all regulation specific to
COVID-19. Rather than pursue this harmful, heavy-handed approach, Committee Republicans
believe it is critical that Congress support OSHA in its mission to provide compliance assistance
to help business owners understand evolving scientific and operational guidance on how to best
protect their workers and operate their businesses safely. Unfortunately, on a party line vote,
Committee Democrats rejected funding that would help employers, including small business
owners struggling to stay afloat, keep their workplaces safe.
Conclusion
While there has been no true evaluation of how trillions in hardworking taxpayer money has
been spent, there have been plenty of stories of waste, fraud, and abuse. USA Today reported
that international scammers have taken $36 billion in fraudulent unemployment benefits alone
from the United States. 45 Without protections against further fraud, Committee Democrats
rushed through hundreds of billions in new spending and radical policy changes. Sadly, far too
much of the legislation was devoted to long held policy wishes that the Democrats are sneaking
in under the guise of pandemic relief.
41
Ben Foldy & Nora Nanghton. UAW Reaches Settlement With Feds in jfultiyear C'orn1ption Probe. WALL ST. L
Dec. 14. 2020.
45
htm,.:/lw111r.nsatodm:.comiin-R@thlnews/im·esti!:l'tions/2020/l2/30/unem,plgymcnt-fra11d-ho1'-intcrnational-
scammern-took-16-b-us/396026,10() I/
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This is not a timely and targeted legislative proposal. It is one-third of a trillion dollars to support
misguided Democrat priorities. Not one Republican amendment was accepted or given a fair
debate. This is not a package of unity. This is not a package of relief for those begging for
support from the federal government. This is a left wing wish list that will destroy jobs, decimate
small businesses, bolster unions, and ensure our schools' doors remain shut.
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Virginia Foxx, Ranking Member
Glenn "GT" Thompson
Tim Walberg
Glenn Grothman
Elise M. Stefanik
James Comer
Fred Keller
Gregory F. Murphy
Bob Good
Diana Harshbarger
Mary E. Miller
Victoria Spartz
Madison Cawthorn
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‘Sy Fiscat Year, BNilons & Dollars
2026 2028 2028 2027 2028
increases of Decreases (} in Direct Spending
Subtle A, Education Batters
Part¢ - Dopartmont of Education
See. 200} Elementary and Secondary School Emergency Relat Furd
Budget Authority 428555 a a a a ° 9 ° a 428,565
Estimated Qutisys 6428 32593, 322 ‘28.31 19.283 8993 287t 4,283 a a = Bye 128,585
Set, 2002 Higher Education Emergency Rebet Fund
Bodget Autherity 39.585 ° a a a a a 0 ° 8 e385
Estimated Outlays $ne8 1388S 5.858 8838 ‘3.988 are 4,883 38 8 o 38,506
See, 2004 Outlying Areas
Budget Authority 860 a 3 o a a oO a o a 880
Eatimated Outiays py 22 22 470 8 es 7 8 2 2 880
Sec, 2008 Bureau of meian Education F
Budget Authority 0 2 ® 8 a a 2 2 4 ® i 650
Estimated Outlays 4“ 353 158 483 458 128 2 2B a ® ; 980
Bec, 2006 Gallaudet University
Budget Authority 8 a o a o ° o a o o 1 49
Estimated Outiaye + a 7 a o a 8 3 2 D 19
See. 2007 Duurtent Aid Administration
udyet Autrority o 8 8 9 a o 3 a 4 9 ot
Retimated Oustay 3 Ey 28 a 2 8 6 o a iN : et
‘See. ‘2068 Moward University
‘Budget Authority 8 a ° 8 a 8 8 0 o » 38
Estinvated Outays 2 48 3 s o a o 9 a g 38
Sec, 2009 National Techie Intitute forthe Deo? ‘
Budget Autberty rr) ry a ° ° ° a ° ° a 1 19
‘Eatmated Ostlays 1 B 7 3 o o o o o L) i, WwW
See, 2040 nate of Education Seiencos
Budget Authority {oa ° a o o a o 0 o a 7 100
Estimated Outays , 8 15 30 30 2 > o ° ° : oy
‘Sec, 2041 Program Administration
Budget Authority 8 e f a ° 0 ° ° a 8 SEG 18
Extimated Outays 1 Fy 6 4 2 ° 4 9 a a a oe 18
Se
ce
See. 2042 Office of Inapecter General cf
Budget Authority 8 8 6 ° a a 0 0 a 6 a 6
Estimated Outlays * 4 2 1 4 ° 4 a @ 0 ae 2 a
SU
See, 2048 roprietary aS net
Estimated Budget Authority ) 3 0 a Cy 16 “at ae to wo 0 See a 189
Estited Outeys 0 2 6 at us 18 a 0 a8 9 a
Boa, 2024 National Endowment for the Arts ok
Budget Authority 135 o 9 3 9 9 o) Q 4 8 a _ oa 135
Eplimated Outlays 20 64 a ? ° 8 a 0 a 9 a ne : 186
an
EAA
See. 24122 National Endowment fer the Humanitioa a co
Budgat Authority 498 0 ry a ° o ° a 9 9 ae (ae 498
Estimated Outlays 30 Bt M4 7 9 ry Py 9 a f) 9 oy a cf 138
SSN aS
CNS
See. 2029 httute of Museum and Library Sanices i ae
Budget Authority 300 ° 8 a a a 0 ° ry a oe B80: 200
Eetianted Ovtays 18 02 Cs 13 8 ° ° a a ° oe 08, 199
Budget Authority 40 o ° a ° ° o a ° o OE a a Y 4D
Estimated Outlays . 8 2 ° ry ° a ° e 6 a aie 10
Subtota, Suite & ae
Estiriated Budget Authority 170,004 3 0 a 38 Ae a7 AB ae 22 a 1FOA8t
Estimated Outlays 12,643 (48809 38.643, 32.042 23665 14,183 4108 4,805 “18 “48 i 170,489
Sublite 8, Labor Matters
‘Sec. 2101 Raising the Federal Minimum Wages?
Estinated Budget Authority 503 4,084 ‘2907 ang 2289 6.483 BASS 8855 ast 10,030 87,387
Exiimated Ourtays ee ot ee a ad 73,008
Estimated Budget Authorty - Orbueigat 593 1958 2873 3504 A384 5305 687 453s 5933 6922 ‘S2228
Estimated Outlays - Orsbudgat 598 2064 807t (3938 4.990 5997 7.293 Rae 6849 7.8aF SR710
Estimated Budgat Authorty - Of budget . & Bt 208 625 1978 1597 2080 2824 3108 45,1353
Estimated Outlays - Of-budget * s 34 we 625 Lae 4597 2.080 2524 2108 18,159
‘80e, 2402 Funding fox Department of Labor Worker Protastion Actties
Budget Authosty 150 ° ® a a ° ® f) 9 ° 480
Estimated Outlays SF J a & 2 o 8 o 9 a 489
‘By Fiscal Year, Malans of Dollars.
2e2e 2038 2328 Eu
incteases os Decreases £2 in Direct Spending
Bee, 2403 E
Estimated Budget Authorty ar 7 rn 8 8 8 5 8 4 3 403
Eetnatad Outlays a 7 1" 8 6 8 5 5 4 4 188
See, 2404 Compensation bet
Entimatad Budgot Authority 120 6 7 8 4 5 ‘ ‘ 4 4 224
Estiriod Outlays 129 6 7 8 ‘ 3 4 4 3 4 208
Subtetat, Subtie B :
Estimated Budget Authonty CT) $7,908
Estimated Outlays eee es ee Sr) . 74588
Sub 6, Hunan Serviees and Community Supports
‘Sas, 2001 Adionat Fundng for Aging und Disabilly Seviees Programs
Buagat Aathenty 38 188 3 a a 2 2 2 a > 78
Entinated Owtays 4 19 8 Ey a a a ° 8 5 : a8
Sec, 2202 Sugpering Cider Americans and Their Faris
uget Auttorey 148s ° 8 0 ° 0 9 3 e ° aaa
Extinated Outlays 78 or oA a a a 2 Fy a a aaa
Sec, 2208 Chile Care and Develapinent Block Grant Program
Budget Authority 34980 ° a 9 ° a 3 0 3 a i 14,980
Eatinated Outlays 2euo te? gg? 2.898 6 9 ° a o ° , E 14,999
Child Gore Stobilition
Pudge Autbasty 23978 ry a 8 ° 8 2 ° ° ° i 20.978
Eatinatad Outlays: 4585 12.467 8473 480 Fy 2 9 ° a 8 y 23,875
Child Gato Adminisvation
Budget Autoty 8 ° a a 2 ° ° 8 ° ° 35
Estinatod Outays 4 " 4 ? 2 * ° ° 2 a ; é 28
See, 2208 Head Stat
Budget Authonty 4,000 o Q ° ° 9 ° ® . 0 : 000
atimatod Outlays, 200 ‘Tso 6 ® ° ° 8 ° o o if 1,000
See, 2208 Programe for Survivors
‘Budget Aathosty 50 2 3 a ° ® ® ° ® 460
Estenatad Outlays 6 13 2 a ° o ° ° ° ie 450
Ane
Sec, 2207 Chie Abuse Prevention and Treatment oe e
‘Budget Authority 380 ° i) a 3 ° > 6 o f) oat 380
Eatinated Outlays 53 15 82 18 16 a o ° 9 a ae as 0 360
See, 2208 LINEAP SEE
Budget Authority 4505 o ° a a 0 a 0 ° o oS aio 4.500
Eatigatedd Ouays 4,508 Liz 467 sez 198 168 ° o a ® a ae 4.500
‘Sec. 2200 Departmert of Health and Human Services an aa et
Badgot Authority 425, ° a a a ° a o a ° co ae 428
Estimated Outiays 3 7 es @ 4 0 et 5 4 a a 4
cr
Gee. 2010 National and Community Servi ional Service Trust
Budget Authority 4.000 ° a a 0 ° a a . oe 0) #,000,
Extinated Outiays 200 2s 190 «0 8 so 30 ° ° ° ve eh 1000
ee
Subtotal, Subtitio ¢ aa
Budget Aathosity 48.257 103 a e a o a o v a a 49,405
Estimated Ouvlays 40384 24gSt 14,763 At a6 308 36. st 4 a ee o 49,448
Sulblitla . Chile Nutttion & Related Programs ee :
See. 240 Improvemonts to MG Banatis oe :
Budget Authority 490 a a a 9 ° a ° ® ® 0 rat 499
Ewtimated Outlays 490 8 ° G 3 a 0 8 8 8 oe 490
Sac, 2802 WIC Program Modernization
‘Budget Auttoity 290 3 ° ° a ° ° cy ° ° 200
Eninated Outtays 58 488 a 3a 8 a ° ° ° . 390
Sec, 2803 Atenls i
Estimated Budget Authority 70 410 ° ° ° 3 a ® ® ° 480
Estimated Outeys ~ 140 0 a a ° ° 8 ® ° 80
See. 2904 Pandemic BBY Program
FFetimated Budget Avebority 1585 : a 2 9 a ® 3 8 8 5.880
Estimoted Outiays 5580 ‘ 9 ® 8 2 ° ° ° ° 8.580,
‘Subtotal, Subtite D
Estimated Budget shorty a510 10 a ° > . . ° ° 8 8.020
Estimated Outlays 6.79 268 437 38 Q a 5 ° ° 870
127
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128
SUMMARY OF THE RECONCILIATION MEASURE
The purpose of the Committee Print is to respond to the needs of students, workers, and
communities as the country continues to grapple with the COVID-19 pandemic and to comply
with the reconciliation directive given to the Committee on Education and Labor included in
section 200l(b) of the Concurrent Resolution on the Budget for Fiscal Year 2021, S.Con.Res. 5.
As of February 2021, the public health crisis has sickened more than 27 million people and left
over 470,000 dead in the United States alone, 1 with the nation's most vulnerable populations-in
particular communities of color, low-income families, and older Americans--bearing the brunt
of the harm. While Congress has previously acted to provide relief during the pandemic, the
Committee Print will provide continued and urgent relief to struggling workers, students, and
families.
1
Coronav1rus 111 the U.S.: LatesL\fap and Case Count, N.Y. T!MES (Feb. 10. 202]).
hllJ&JI\\ ,nun times. com/internet h·c/2020/11s/coronaYirus-ns-cascs.html.
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129
ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section S(b) of the Federal Advisory Committee
Act were created by this Committee Print.
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130
FRANK PALLONE JR.. NEW ,JERSEY CATHY McMORRtS RODGERS, WASHINGTON
CHAIRMAN RANKING MEMBER
ONE HUNDRED SEVENTEENTH CONGRESS
COMMITTEE ON ENERGY AND COMMERCE
2125 RAYBURN HOUSE OFFICE BUILDING
WASHINGTON, DC 20515-6115
Febmary 16, 2021
The Honorable John Yarmuth
Chairman
Committee on the Budget
204-E Cannon House Office Building
Washington, DC 205 l5
Dear Chairman Yarmuth:
Pursuant to section 2001 of the Concurrent Resolution on the Budget, r hereby transmit
these recommendations which have been approved by vote of the Committee on Energy and
Commerce, and the appropriate accompanying material including additional, supplemental or
dissenting views, to the House Committee on the Budget. This submission is in order to comply
with reconciliation directives included in S. Con. Res. 5, the fiscal year 2021 budget resolution,
and is consistent with section 310 of the Congressional Budget and Impoundment Control Act of
1974,
Sincerely,
Frank Pallone, Jr.
Chairman
Committee on Energy and Commerce
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131
CONGRESSIONAL BUDGET OFFICE Phillip L. Swagel, Director
U.S. Congress
Washington, DC 20515
February 14, 2021
Honorable Frank Pallone Jr.
Chaim1an
Committee on Energy and Commerce
U.S. House of Representatives
Washington, DC 20515
Dear Mr. Chairman:
The Congressional Budget Office has prepared the enclosed cost estimate
for the Reconciliation Recommendations of the House Committee on
Energy and Commerce.
If you wish frn1her details on this estimate, we will be pleased to provide
them. The CBO staff contact is Alice Burns.
Sincerely,
Phillip L. Swagel
Enclosure
cc: Honorable Cathy McMorris Rodgers
Ranking Member
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132
CONTENTS
Page
I. Purpose and Summary
II. Background and Need for the Legislation
HI. Committee Consideration
IV. Committee Votes
V. Oversight Findings
VI. New Budget Authority, Entitlement Authority, and Tax Expenditures
VII. Congressional Budget Office Estimate
VIII. Federal Mandates Statement
IX. Statement of General Performance Goals and Objectives
X. Duplication ofFederal Programs
XI. Committee Cost Estimate
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits
XIII. Advis01y Committee Statement
XIV. Applicability to Legislative Branch
xv. Section-by-Section Analysis of the Legislation
XVI. Changes in Existing Law Made by the Bill, as Reported
XVII. Additional Views
I. PURPOSE AND SUMMARY
Subtitle A: Budget Reconciliation Legislative Recommendations Relating to Public Health
provides budget reconciliation recommendations related to public health to the House
Committee on Budget pursuant to S. Con. Res. 5 to provide comprehensive relief to the
American people in response to the coronavims disease of 2019 (COVID-19) pandemic and the
resulting public health emergency (PHE).
The legislation provides funding for comprehensive activities related to COVID-19
vaccines, including greater communication related to vaccines, strengthening vaccine
confidence, and the deployment of vaccines across the country. In addition, it invests in the
research, development, manufacturing, and purchase of vaccines, therapeutics, and ancillary
medical products and supplies utilized for the treatment and prevention of COVID-19, as well as
supports the continued evaluation of the performance, safety, and effectiveness of vaccines,
therapeutics, and diagnostics for COVID-19. It further provides funding for comprehensive
acti vi ti es related to testing, contact tracing and mi ti gati on of CO VID-19, including expansion of
a COVID-19 data surveillance system and genomic sequencing activities. It invests in public
health workforce and supports tribal health programs and services. Funding is also provided for
congregate settings to mitigate the effects of COVID-19 as well as to invest in public health and
disparities as it relates to COVID-19.
Finally, the legislation provides funding to address mental health and substance use
disorders worsened by the pandemic.
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133
II. BACKGROUND AND NEED FOR LEGISLATION
Since the first case of COVID-19 in the United States was discovered on January 21, 2020, 1
the United States response efforts have failed to mitigate or reduce COVID-19 transmission in
the country. As ofFebrnary 8, 2021, more than 26 million Americans have been infected with
COVID-19, and more than 462,000 people have died from the disease. 2
Vaccines
On May 15, 2020, the Trump Administration announced Operation Warp Speed (OWS), a
partnership led by HHS, including the Centers for Disease Control and Prevention (CDC), the
National Institutes of Health (NIH), the Biomedical Advanced Research and Development
Authority (BARDA), and the Department of Defense (DoD), along with private companies and
other federal agencies. The partnership's goal was to facilitate and accelerate development,
manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics. 3 Less
than a year from when COVID-19 was first detected, the Food and Drug Administration (FDA)
issued the first emergency use authorization (EUA) for Pfizer and BioNTech's COVID-19
vaccine on December 11, 2020, allowing it to be distributed and administered in the United
States. 4 On December 18, 2020, FDA issued an EUA for a second vaccine manufactured by
Modema. 5
As promising clinical trial data from the first vaccine candidates became public, Dr. Slaoui
stated in early December 2020 he was confident that 20 million Americans would be vaccinated
by the end of the year. 6 However, by December 31, 2020, less than three million individuals had
received even one dose of the vaccine, and total administered vaccine doses did not cross 20
million until January 23, 2021. 7 Supply chain experts attribute these delays in part to a
1
Centers for Disease Control and Prevention, F'irst Travel-related Case o/2019 novel Coronavirus
Detected in United States (Jan. 21, 2020} (www.cdc.gov/media/releases/2020/p0121-novel-
eoronavirns-travcl-casc.html} (press release).
'Centers for Disease Control and Prevention, Unites States COVTD-l 9 Cases and Deaths by State
(covid.cdc.gov/covid-data-tracker/#cascs_cascsperlO0klast7days) (accessed Feb. 9, 2021).
'U.S. Department of Health and Human Services, Trump Administration Announces Framework and
Leadership/hr 'Operation Warp Speed' (May 5, 2020}
(,vww.hhs.gov/about/news/2020/05/15/trump-administration-announces-framework-and-leadership-
for-opcration-warp-spccd.html) (press release).
"U.S. Food and Drng Administration, FDA Takes Key Action in Fight Against COVID-19 By L~suing
Emergency Use Authorization/or First COVID-19 Vaccine (Dec. 11, 2020) (www.fda.gov/ncws-
events/prcss-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-
authmization-first-covid- l 9} (press release}.
5
U,S. Food and Drng Administration, FVA Takes Additional Action in Fight Against COVJD-19 By
Issuing Emergency Use AuthorizationfiJr Second COVID-19 Vaccine (Dec. 18, 2020)
(www.fda.gov/news-cvcnts/press-announccmcnts/fda-takes-additional-action-fight-against-covid-19-
issuing-emergcncy-usc-authorization-second-covid) (press release).
6
U.S. Department of Health and Human Services, Brt~fing with Senior Ojficia!s on OWS and COVID-19
Vaccines (Dec. 2, 2020) (www.youtnbc.com/watch?v=WBdDUlqXE3M).
7
US. CDC says 41.4 million doses o.fCOHD-19 vaccines distributed, 20.5 million administered, Reuters
(Jan. 23, 202 l) (www.renters.com/article/us-health-coronavirus-nsa-edc-idUSKBN29SON0).
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decentralized distribution plan tbat relies heavily on underfunded state and local health entities
whose resources have already been spread thin by the pandemic. 8 While CDC required states
and other jurisdictions to begin planning to receive vaccines in October, which was before any
COVID-19 vaccines were authorized, few resources were made available for states that cited
hardships or distribution concerns in their plans. 9 State public health leaders urged Congress to
appropriate an additional $8.4 billion for vaccine distribution activities in a letter to
congressional leadership on October 15, 2020, noting the funding was "urgently needed" to
support a "herculean effort for a rapid, safe, and effective nationwide vaccination prograrn." 10
Additional vaccine funding was not appropriated until December 27, 2020, when the
Consolidated Appropriations Act, 2021 was signed into law, after vaccine doses were already
being delivered to states. 11
As the national COVID-19 vaccine roll out began, states noted a myriad of distribution
concerns. For example, states have cited miscommunication or a lack of communication from
the federal government about the number of doses they can expect to receive. 12 Lacking
sufficient clarity as to the number of doses they would receive, some states were forced to cancel
appointments due to a lack of supply relative to the amount the state expected to receive, and
other states have allowed vaccines to sit on shelves to ensure they would have an adequate
supply to administer both required doses. 13 Additionally, states have also cited concerns with the
complexity of administering a large number of vaccines in sparsely populated areas and
following recommendations for equitable distribution from the Advisory Committee on
Immunization Practices (ACIP) at CDC. 14 Other states, which have administered the vaccine
more quickly, have noted ongoing challenges related to lack of vaccine supply. 15
8
U.S. Covid-19 Vaccination Plan Limits Speed o(Ro!lout, Supply-Chain Experts Say, Wall Street Journal
(Jan. 11, 2021) (www.wsj.com/aiticles/u-s-covid-19-vaccination-plan-limits-speed-of-rollout-
supply-chain-cxpcrts-say-l 161028360 I).
9
Kaiser Family Foundation, States Are Getting Ready to Distribute COVTD-19 Vaccines. TVhat Do Their
Plans Tell G, So Far? (Nov. 18, 2020) (www.kff.org/coronavirus-covid-19/issue-brief/statcs-arc-
getting-ready-to-distributc-covid-19-vaccines-what-do-their-plans-tell-us-so-far/).
'° Letter to Senate Majority Leader Mitch McConnell, Speaker Nancy Pelosi, Senate Minority Leader
Charles Schumer. and House Minority Leader Kevin McCarthy from Michael Fraser, Chief
Executive Officer of the Association of State and Territorial Health Officials, and Clare Hannan.
Execntive Director of the Association oflmmunization Managers (Oct. 15, 2020).
11
Pub. L. ll6-260.
"'Pixie dust': Why some vaccine sits on shelves while shortages intensify nationwide, Washington Post
(Jan. 21, 2021) (www.washingtonpost.com/health/202 l/O 1/21/vaccine-rollout-states-shortagesi).
11 Id.
14
Pixie dust·: Why some vaccine sits on shelves while shortages intensijj1 nationwide, Washington Post
(Jan. 21, 2021) (www.washingtonpost.com/health/202 l/O 1/21/vaccine-rollout-states-shortages/);
Kaiser Family Foundation, ]he COVID-19 Vaccine l'riority Line Continues to Change as Stales
Make Further Updates (Jan. 21, 2021) (www.kff.org/policy-watch/the-covid-19-vaccine-priority-
line-continues-to-change-as-states-make-furthcr-updates/): Centers for Disease Control and
Prevention, COVID-19, Advisory Committee on Immunization Practices (ACIP)
(www.cdc.gov/vaccines/hcp/acip-rccs/vacc-specific/covid-19.html) (accessed Jan. 26, 2021).
15
States' new vaccine worr_v: Nol enough doses, Politico (Jan. 20, 2021)
(www.politico.com/news/202 l/O l/20/states-coronavirus-vaccine-shmtagcs-460899).
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The legislation takes concrete steps to address vaccine development and distribution
challenges by investing $7.5 billion for vaccine distribution activities at the CDC. Activities in
this space would include: establishing community vaccination centers, facilities enhancements,
and mobile vaccination units, particularly in underserved areas; information technology, data,
and reporting enhancements, to ensure vaccines are getting where they are most needed; and
communication activities so people will know when, where, and how to receive COVlD-19
vaccines. In addition, it invests $1 billion to strengthen vaccine confidence through education
and information sharing, and $5.2 billion for research, development, manufacturing, production,
and purchase of COVID-19 vaccines, therapeutics, and ancillary supplies. To ensure continued
safety in a resilient vaccine, therapeutic, and medical device supply chain, the legislation also
invests $500 million for activities at FDA.
Testing
Testing is a critical component of COVID-19 response efforts, including for use in
identifying infected individuals and informing public health decisions such as reopening
strategies. Widespread testing in the United States has faced many hurdles. Initial tests for
COVID-19 in the United States were developed and produced by CDC, which first received an
EUA from FDA on February 4, 2020 16 and began shipping testing kits to public health
laboratories on February 5. 17 Shortly after distribution of these tests, the reagent components
were found to be contaminated, further slowing the roll out of reliable tests. 18 Following this
discovery, CDC issued guidance to states on how to augment the faulty tests and released an
updated test on Febmary 28. 19 The first commercial test for COVID-19 was not authorized until
March 12. 20
While testing in the United States has expanded since the sta1t of the pandemic, public
health officials believe that the absence of robust COVID-19 testing has impacted the ability of
the United States to contain the virus. 21 Today, the United States tests approximately 1.5 million
"Centers for Disease Control and Prevention, COVID-19, Diagnostic Testing
(www.cdc.gov/coronavirus/2019-ncov/lab/tcsting.html) (accessed Jan. 26, 2021 ).
17
Centers for Disease Control and Prevention, Distribution of CDC Diagnostic Test Kit.Y Will E,pand
Laboratory Capacity to De tee/ 20 I 9-nCoV (Feb. 6, 2021)
(www.cdc.gov/mcdia/rclcascs/2020/p0206-coronavirus-diagnostic-test-kits.html). While most tests
must typically go through an approval process at FDA before their use, during declared public health
emergencies, tests may come to market after being authorized under an E!JA. See 21 U.S.C. §
360bbb-3.
18
EXCLUSIVE: Internal HHS investigationfindY CDC's early test kits were 'contaminated', KA TU 2
ABC News (June 19, 2020) (katu.comincwsination-world/exclusive-intemal-hhs-investigation-finds-
cdcs-early-test-kits-were-contaminated).
JG Amid testing concerns, US ofjicia/s unveil new coronavirus rest kits and streamline commercial
development, CNBC (Feb. 28, 2020) (www.cnbc.com/2020/02/28/amid-tcsting-capacity-concems-
cdc-unveils-new-coronavims-test-kits.html).
20
U.S. Food and Drug Administration, Emergency Use Authorization (www.fda.gov/cmergency-
preparedness-and-response/mcm-legal-regulatory-and-policyframework/emergency-use-
authorization) (accessed May 29, 2020).
The Lost Month: How a Failure to Test Blinded the US. to Covid-19, New York Times (March 28,
2020) (www.nytimes.com/2020/03/28/usltcsting-coronavirus-pandemic.html).
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people a day, far less than what public health experts say is needed to suppress or contain
COVID-19. 22 23
The legislation would provide the resources to establish a robust, coordinated federal testing
plan, and for other activities necessary to mitigate the spread of COVID-19. It provides $46
billion for: the implementation of a national strategy for testing, contact tracing, surveillance, and
mitigation of COVID-19; providing guidance and support for state and local public health
departments in their work to implement the COVID-19 activities and strategies to mitigate
infections; supporting the development, manufacturing, procurement, distribution, and
administration of tests, including other supplies necessary for COVID-19 testing, such as
personal protective equipment; establishing and expanding federal, state, or local testing and
contact tracing capabilities, including investments in laboratory capacity, community-based
testing sites, and mobile testing units; and sustaining a public health workforce necessary for
testing, contact tracing, surveillance, and mitigation of COVID-19.
Further, the legislation invests resources to strengthen and expand genomic sequencing,
analytics, and disease surveillance activities and workforce, as well as activities to support public
health data surveillance and analytics infrastructure modernization initiatives, modernizing the
United States disease warning system, and provide support for COVID-19 global health
activities.
Public Health Investments
The COVID-19 pandemic has now laid bare vast health disparities in our most vulnerable
populations. From 20 IO to 2016, the uninsured rate for Black Americans dropped from nearly
20 percent to l 0. 7 percent, while the uninsured rate for Hispanic Americans dropped from 32.6
percent to l 9.1 percent. 24 However, the uninsured rate for Black and Hispanic Americans
increased from 2016 on. 25 Recent data also shows that although differences in COVID-19
testing rates are small, disparities in positivity rate are vast; Black patients are two times more
likely and Hispanic patients are two and a halftimes more likely to have a positive COVID-19
test result than their white counterparts. 26 Despite that fact that people of color in America are
disproportionately burdened by the pandemic, the of lack access to paid sick leave or the
inability to work from home forces many Black and Hispanic workers to choose between going
The COVID Tracking Project at The Atlantic, US Daily Tests (covidtracking.com/data/charts/us-daily-
tests) (accessed Feb. 9, 2021).
23
Harvard University Edmond J. Safra Center for Ethics, lf'hy We Must Test 1'viillion a Day (Apr. 8, 2020)
(ethics.harvard.edu/test-millions).
24
Kaiser Family Foundation, Changes in Health Coverage by Race and Ethnicity since the ACA, 2010-
2018 (Mar. 5, 2020) (www.kff.org/raeial-equity-and-health-policy/issue-brief/changes-in-health-
ccverage-by-race-and-ethnicity-since-the-aca-2010-20181).
25
Id
Kaiser Family Foundation, COrID-19 Racial Disparities in Testing. Infection, Hospitalization. and
Death: Ana(vsis of Epic Patient Data (Sept. 16, 2020). (www.kff.org/coronavirus-covid-19/issue-
brief/covid-19-racial-disparities-testing-infection-hospitalization-dcath-ana!ysis-cpic-patient-data/).
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to work in higher-risk places or quarantining. 27
Furthermore, death rates from COVID-19 also show marked disparities with Black and
Hispanic people dying at twice the rate of Whites. 28 Despite these disparities in COVID-19
outcomes, as well as higher occupational risks, 29 Black and Hispanic patients lag markedly in
their uptake of the vaccine, with only 11.5 percent of vaccines being provided to someone of
Hispanic ethnicity and 5.4 percent to people who are Black. 30
Rural communities have also noted a negative impact of COVID-19, with over 50 percent of
rnral community members reporting that the COVID-19 pandemic has had a negative impact on
their lives, and 44 percent reporting a negative impact on their mental health. 31
The pandemic has also taken its toll on tribal communities. The United States has a treaty
and trust responsibility to provide health care to all 574 federally recognized Tribes and their
members. The COVID-19 pandemic has highlighted health care delivery and infrastructure
challenges experienced by tribal communities. Data has shown that Native Americans suffer
from COVID-19 at three and a half times higher rates than Whites and have more severe
outcomes. 32 Further, according to CDC, American Indian and Alaskan Native populations have
an age-adjusted hospitalization rate approximately five times that ofWhites. 3 3
The legislation takes numerous steps to address health disparities as they are related to and
exacerbated by the COVID-19 pandemic. It provides: $7.6 billion for Community Health
Centers to test, treat, vaccinate, and sustain COVID-19 activities, supplies, and infrastrncture,
including $20 million for Native Hawaiian Health Centers to support Native health centers; $800
million for National Health Service Corps to invest in primary care services for health
professional shortage areas nationwide; $200 million for Nurse Corps to sustain our nursing
21
Addressing Racial Health Disparities In The COVID-19 Pandemic: Immediate And Long-Term Policy
Solutions, Health Affairs (July 20, 2020)
(www.hcalthaffairs.org/do/ IO 13 77/hblog202007 l 6,620294/full/).
"Id.
29
Centers for Disease Control and Prevention, COV!D-19 Racial and Ethnic Health Disparities (Dec, 10,
2020) (www.cdc.gov/coronavirus/20 I9-ncov/commnnity/health-equity/racial-ethnic-
disparities/indcx.html).
3
°Centers for Disease Control and Prevention, Morbidity and Mortali(V Weekly Report (MMWR):
Demographic Characteristics ofPersons Vaccinated During the First Month of the COVJD-19
Vaccination Program United States, December14, 2020-January 14, 2021 (Feb. l, 2021)
(www.cdc.gov/mmwr/volumcs/70/wr/mm7005c l .htm).
31
Centers for Disease Control and Prevention, Morbidity and Mortali(v Weekly Report (MA,fWR):
COVID-19 Stats: COVID-/9 Incidence by Urban-Rural Class(fication ·· United States, Janumy 22-
October 31, 2020 (Nov. 20, 2020) (vvww.cdc.gov/mmwr/volumes/69/wr/mm6946a6.htm).
32
Centers for Disease Control and Prevention, CDC data show disproportionate COVID-19 impact in
American Indian/Alaska Native populations (Aug. 19, 2020)
(www.cdc.gov/media/rcleases/2020/p08 l 9-covid- l 9-im pact-amcrican-indian-alaska-native.html)
(press release).
33
Centers for Disease Control and Prevention, Coronavirus Disease 2019. Racial & Ethnic Minority
Groups (June 25, 2020) (www.cdc.gov/coronavirus/2019-ncov/necd-cxtra-prccautions/racial-ethnic-
minorities.html).
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workforce in critical shortage facilities nationwide; $330 million for Teaching Health Centers
that operate Graduate Medical Education to support and expand primary care medical and dental
residency programs; and $100 million in funding to HRSA's Behavioral Health Workforce
Education and Training Program to improve access to behavioral health services, particularly in
rural and underserved parts of the country. It would also enable CDC to deploy mobile
vaccination units and community vaccination centers in underserved areas; providing
supplemental funding for the Title X Family Planning Program; and supporting the care of
children in the care of HHS.
lvfental Health and Substance Use Disorders
The COVID-19 pandemic has put a strain on the mental health of many Americans and has
made access to mental health and substance use disorder services more important than ever.
Recent data shows that drug overdose deaths are up to an all-time high, with 81,230 Americans
dying of a drug overdose. 34 Underscoring the severity of this data, this past December, the CDC
issued an advisory to alert public health departments and health care professionals of the
substantial increases in drug overdose deaths during the COVD-19 pandemic. 35 An article
published in the Journal of the American Medical Association found that emergency department
visits for mental health, suicide attempts, overdose, and violence were higher in mid-March
through October 2020, when the pandemic first began, compared to the same period in 20 l 9. 36
Additionally, data shows elevated adverse mental health conditions such as depression and
anxiety since the start of the pandemic, with younger adults more likely to have worse mental
health outcomes compared to other age groups. 37 Health workers and front-line workers are also
experiencing burnout, trauma, and grief due to difficulties managing COVID-19 patients,
shortages of personal protective equipment, and fears of infecting loved ones. 38 Tragically, these
stressors have resulted in suicide for some. 39
This legislation includes $3.5 billion for SAMHSA's Mental Health and Substance Abuse
Prevention Treatment Block Grants, which support evidence-based practices for preventing
substance misuse, community-based mental health services for children, and wraparound
services for children and their families. In addition, it provides $80 million in additional grants
to direct funds to local communities; $100 million in funding to HRSA's Behavioral Health
Workforce Education and Training Program; $80 million for mental and behavioral health
34
Centers for Diseases Control and Prevention, Health Alert Network, HAN00438 (Dec. 17, 2020)
(emcrgency.cdc.gov/han/2020/han00438.asp).
JS Id
JAMA, Trend, in US Emergency Department Visits for .Mental Health, Overdose, and Violence
Outcomes Before and During the COVID-19 Pandemic (Feb. 3, 2021)
(jamanetwork. com~joumalszjarnapsychiatry/ful larticle/277 5991).
37
Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR): Mental
Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic-~ United States,
June 24-30. 2020. (Aug. 14, 2020) (www.edc.gov/mmwrlvolumes/69/wrlmm6932a1 .htm).
38
·1 Can't TurnA1y Brain 0((: PTSD and Burnout 171reatenMedical Workers, New York Times (May
16, 2020) (www.nytimcs.com/2020/05/16/hea!th/coronavims-ptsd-medical-workers.html).
39
Top ER. Doctor Who Treated Virus Patient.~ Dies by Suicide, New York Times (Apr. 27, 2020)
(www.11ytimes.com/2020104/27/nyregion/new-york-city-doctor-suicide-coronavims.h1ml).
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training for health care professionals, para-professionals, and public safety officers; $20 million
for a national evidence-based education and awareness campaign targeting health care
professionals and first responders, and $40 million for grants for health care providers to
promote mental and behavioral health among their health professional workforce; $20 million to
develop and implement youth suicide prevention and early intervention strategies and to provide
trainings and activities aimed at identifying youth at risk for suicide; $30 million to aid strategies
for addressing mental health in schools, including support for mental wellness in education
settings, building awareness of mental health issues, and early intervention with coordinated
support; $10 million for SAl\i1HSA's National Child Traumatic Stress Network, which is sharing
critical COVID-19 resources nationwide to improve behavioral health services and interventions
for children and adolescents exposed to traumatic events; and $420 million for the Indian Health
Service to bolster substance use disorder and mental health efforts with tribes and tribal entities.
III. COMMITTEE CONSIDERATION
The Committee on Energy and Commerce met in virtual open markup session, pursuant to
notice, on Febrnary 11 and 12, 2021. During consideration of Subtitle A on Febma1y 11, an
amendment in the nature of a substitute (AINS) offered by Mr. Pallone was agreed to by a voice
vote, without amendment. During consideration of the AINS, 13 amendments were offered to
the Pallone AINS, but were not agreed to. Mr. Pallone, Chairman of the Committee,
subsequently moved that Subtitle A be ordered transmitted favorably to the House Committee on
Budget, amended, by a roll call vote: 31-25 (Roll call no. J3), a quomm being present.
IV. COMMITTEE VOTES
Clause 3(b) ofmle XIII of the Rules of the House of Representatives requires the
Committee to list each record vote on the motion to report legislation and amendments thereto.
The Committee advises that there were 13 record votes taken on Subtitle A, including a motion
by Mr. Pallone ordering Subtitle A favorably reported to the House, amended. The motion on
final passage of the bill was approved by a record vote of 31 yeas to 25 nays. The following are
the record votes taken during Committee consideration, including the names of those members
voting for and against:
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117th Congress
Full Committee
(ratio: 32-26)
ROLL CALL vom#l
Bill: Subtitle A, "Budget Reconciliation Lef,~slative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr. Upton of Michigan, No. I a, to add a new chapter regarding the
National Institutes of Health (NIH), which provides the Director of the
NIH $IO billion for coronavirus-related efforts and for restarting research
delayed due to COVID-19. Of this amendment, $ ! billion is reserved for
clinical trials on the long-term studies of COVJD- l 9 and $500 million is
reserved for the Rapid Acceleration of Diagnostics.
Disposition: NOT AGREED TO by a roll call vote of 25 yeas to 31 nays
REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Rep. Welch X Rep. Long
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O' Halleran X
Rep. Rice X
Rep. Craig X
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Rep. Schrier X
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t!Connnittct on <encrw anb Qi:ommcrrc
ll 7'' Congress
Rep. Trahan X
Rep. Fletcher X
02/11/2021
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<Committee on Cfncrgp aub <!Commerce
l 17111 Congress
Full Committee
(ratio: 32-26)
ROLL Ci\LL VOTE #2
Bill Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr. Scalise of Louisiana, No. lb, appropriates an additional $2 billion to
the Secretaty of Health and Human Services (HHS) for COVID-19
vaccine activities upon receipt of a plan to vaccinate two million
individuals against COVID-19 per day by Congress.
Disposition: NOT AGREED TO by a roll call vote of25 yeas to 31 nays
REPRESENT/\TIVE YEAS AYS PRESENT REPRESENTAT!VE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNemey X Rep. Johnson X
Rep. Welch X Rep.Long
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep Rice X
Rep. Cra.ig X
Rep. Schrier X
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Rep. Trahan X
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143
<!i:ommittec on QfucrgJJ aub (:onnncrcc
117th Congress
X
02/11/202 l
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QI:ommtttcc on ~uergp ~lnb <Commerce
117'" Congress
Full Committee
(ratio: 32-26)
ROLL CALL V<Yl'E #3
Bill: Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr. Crenshaw of Texas, No. le, requires the Secretary of HHS to publish
the formula used to determine allocation of COVlD-19 vaccines to states,
localities, the Department of Defense, the Department of Veterans Affairs,
the Indian Health Service, the Department of Homeland Security, and
other federal agencies, as appropriate.
Disposition: NOT AGREED TO by a roll call vote of 25 yeas to 3 l nays
REPRESENTATIVE YEAS •SENT REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Rep. Welch X Rep. Long
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. IV!ullin X
Rep. Schrader X Rep. Hudson X
Rep Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep. Rice X
Rep. Craig X
Rep. Schrier X
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QC:ourntittcr ou '2.:ncrgp anb llommcrrr
117"' Congress
!Rep. Fletcher X
02/11/2021
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<Committee on (enct·gp anb i&onnuercc
U 7"' Congress
Full Committee
(ratio: 32-26)
ROLL CALL VOTE #4
Bill Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr. Carter of Georgia, No. ld, adds a new subsection to reserve $10
billion from the legislation's testing provision to assist States in testing
teachers and school personnel for COVID-19 for the purpose of reopening
schools.
Disposition: NOT AGREED TO by a roll call vote of 25 yeas to 31 nays
REPRESENTATI EAS NAYS PRESENT REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNemey X Rep. Johnson X
Rep. Welch X Rep.Long
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep Rice X
Rep. Craig X
Rep. Schrier X
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Rep. Trahan X
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<£ommittec on <encrgr anb <!Commcrcr
117th Congress
!Rep. Fletcher X
02/11/2021
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<Committee on Q:nct·ru, attb <r:onnncrcc
117th Congress
Full Committee
(ratio: 32-26)
ROLL CALL VOTE #5
Bill Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr. Hudson of North Carolina, No. le, increases the amount made
available for COVID-19 vaccine distribution activities at the CDC by $2
billion. Requires the Secretary of HHS, in making any grants or
cooperative agreements related to vaccine distribution activities under
Section 300l(a) to reserve $1 billion for states for purposes of vaccinating
teachers and school personnel for COV!D-19.
Disposition: NOT AGREED TO by a roll call vote of25 yeas to 31 nays
REPRESENTATIVE Y E A S ~
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep, Kinzinger X
Rep. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Rep. Welch X Rep. Long
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep.Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep. Rice X
Rep. Craig X
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Rep. Schrier X
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149
Qi:ommittcr: on Q:ncrgp anb tCommcrrc
117th Congress
Rep. Trahan X
Rep. Fletcher X
02/ll/202l
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150
Q':ommittcc on <enc-i·gp anb \Commerce
ll 7"' Congress
Full Committee
(ratio: 32-26)
ROLL CALL VlYfE #6
Bill Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr. Bucshon of Indiana, No. 1f, adds a new subsection to reserve $10
billion from the legislation's testing provision to assist States in testing
individuals for COVlD-19 for the purpose of reopening workplaces.
Disposition: NOT AGREED TO by a roll call vote of25 yeas to 31 nays
REPRESENTATlVE YEAS NAYS PRESENT REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bili rakis X
Rep. McNerney X Rep. Johnson X
Rep. Welch X Rep.Long
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep.Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep. Rice X
Rep. Craig X
Rep. Schrier X
Rep. Trahan X
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Rep. Fletcher X
02/!l/2021
Insert offset folio 155 here HR7.149
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151
~ornmittcc on Q.:ncr!!P ,m~ <Cornmcnc
t t 7ui Congress
Full Committee
(ratio: 32-26)
ROLL CALL VOTE #7
Bil!: Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr. Dunn of Florida, No. lg, requires the Secretary to reserve $100
million of the funds appropriated to the Food and Drug Administration to
be used for review of applications related to COV!D-19 therapeutics.
Disposition: NOT AGREED TO by a roll call vote of 26 yeas to 31 nays
REPRESENTATIVE YEAS NAYS PRESENT REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Gritrith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Rep. Welch X Rep.Long X
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep. Rice X
Rep. Craig X
Rep. Schrier X
Rep. Trahan X
rfrederick on DSKBCBPHB2PROD with HEARING
Rep. Fletcher X
02/ll/2021
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152
<!.C"ommittcc 011 (eutr{JP anb <!Comm.c-t·rc
117th Congress
Full Committee
(ratio: 32-26}
ROLL CALL VOTE #8
Bili Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr. McKinley of West Virginia, No. lh, increases the appropriate<!
amount for the Substance Abuse and Mental Health Services
Administration (SAMHSA) Substance Abuse Prevention and Treatment
Block Grant program from $US billion to $4.75 billion.
Disposition: NOT AGREED TO by a roll call vote of 26 yeas to 31 nays
REPRESENTATIVE: : YEAS NAYS PRESENT REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNemey X Rep. Johnson X
Rep. Welch X Rep.Long X
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep Kelly X Rep Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep Rice X
Rep. Craig X
Rep. Schrier X
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Rep. Trahan X
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153
<€-ommfttec on cEucr{I!? anb <r:ommcrcr
117th Congress
jRep. Fletcher X
02/ll/2021
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154
'li:ommittcc on ~ttCT!IJ! anb €.onrntercc
117'" Congress
Full Committee
(ratio: 32-26)
ROLL CALL VOTE #9
Bill: Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr, Guthrie of Kentucky, No. li, provides $35 million in funding to the
Public Health and Social Services Emergency Fnnd for the purpose of
making grants and providing other funding mechanisms to eligible health
care providers for health care related expenses or lost revenues that are
attributable to the coronavirus. Of this funding, $5 million is directed to
Medicaid enrolled suppliers and providers, and $5 million is directed to
suppliers and providers located in rural areas.
Disposition: NOT AGREED TO by a roll call vote of25 yeas to 31 nays
REPRESENTATIVE YEAS NAYS PRESENT REPRESENTATlVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep, DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Grift1th X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Rep. Welch X Rep< Long
Rep. Tonko X Rep Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep.Duncan X
Rep Dingell X Rep, Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep, Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep, Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep. Rice X
rfrederick on DSKBCBPHB2PROD with HEARING
Rep. Craig X
Insert offset folio 159 here HR7.153
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155
([.ommtttcc on eucrgp anb <!Cnurnn~rcc
117th Congress
Rep. Sch1ier X
Rep. Trahan X
Rep. Fletcher X
02/l l/2l)2 l
rfrederick on DSKBCBPHB2PROD with HEARING
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156
(Committee on fenc-rgp anb <&onunercc
117'" Congress
Full Committee
(ratio: 32-26)
ROLL CALL vurn#lO
Bill: Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Ms. Lesko of Arizona, No. lj, transfers appropriations for family planning
to suicide prevention program for children and adolescents at SAMHSA.
Disposition: NOT AGREED TO by a roll call voteof26yeas to 31 nays
REPRESENTATIVE YEAS NAYS PRESENT REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pa!lone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Grifrith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Rep. Welch X Rep.Long X
Rep. Tonka X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep Rice X
Rep. Craig X
Rep. Schrier X
Rep. Trahan X
rfrederick on DSKBCBPHB2PROD with HEARING
Rep. Fletcher X
02/ll/2021
Insert offset folio 161 here HR7.155
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157
<Committcr: on Q:ucrm, aub t£.onnurrrc
t 17th Congress
Full Committee
(l'lltfo: 32-26)
ROLL CALL vorn#l l
Bil!: Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mr. Mullin of Oklahoma, No. lk, increases the appropriated amount for
SAMHSA's Substance Community Mental Health Services Block Grant
from $1. 75 billion to $2. 75 billion. Also requires the Secretary to obligate
five percent of the amount available to support mental health services in
States with higher rates of unemployment related to the Keystone XL
pipeline permit or the pause in new oil and natural gas leases on public
lands or offshore waters as required by Executive Order 14008.
Disposition: NOT AGREED TO by a roll call vote of26 yeas to 31 nays
REPRESENTATIVE YEAS NAYS PRESENT REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Rep. Welch X Rep. Long X
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep. Rice X
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Rep. Craig X
Insert offset folio 162 here HR7.156
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158
~ommittcr on tencrro? anb <!.ommcrcr
I 17th Congress
Rep. Schrier X
Rep. Trahan X
Rep. Fletcher X
02/ll/2021
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159
<Cmnmittcc on <encrg_p aub <!Conrntrrcl'
l t 7"' Congress
Full Committee
(ratio: 32-26)
ROLL CALL vorn#12
Bill Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Amendment: An amendment to the amendment in the nature of a substitute, offered by
Mrs, Rodgers of Washington, No, Im, applies the funding limitations
specified in sections 506 and 507 of division A of Public Law I 16-94 to
the provisions under Subtitle A,
Disposition: NOT AGREED TO by a roll call vote of26yeas to 30 nays
REPRESENTATIVE YEAS NAYS PRESENT REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pa!lone X Rep. Rodgers X
Rep. Rush Rep, Upton X
Rep, Eshoo X Rep, Burgess X
Rep, DeGette Rep, Scalise X
Rep_ Doyle X Rep, Latta X
Rep, Schakowsky X Rep, Guthrie X
Rep, Butterfield X Rep, McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep Castor X Rep_ Griffith X
Rep, Sarbanes X Rep, Bilirakis X
Rep, McNerney X Rep, Johnson X
Rep, Welch X Rep.Long X
Rep, Tonko X Rep_ Bucshon X
Rep, Clarke X Rep.Mullin X
Rep. Schrader X Rep. Hudson X
Rep_ Cardenas X Rep. Walberg X
Rep, Ruiz X Rep, Carter X
Rep, Peters X Rep, Duncan X
Rep, Dingell X Rep, Palmer X
Rep. Veasey X Rep, Dunn X
Rep, Kuster X Rep, Curtis X
Rep. Kelly X Rep, Lesko X
Rep, Barragan X Rep. Pence X
Rep_ McEachin X Rep_ Crenshaw X
Rep, Blunt Rochester X Rep, Joyce X
Rep, Soto X Rep, Armstrong X
Rep_ O'Halleran X
Rep. Rice X
Rep, Craig X
Rep. Schrier X
Rep_ Trahan X
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Rep, Fletcher X
02/ll/2021
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160
<£:onunittrc on Q;nc-rm~ aub ~ommtrtc
ll 7"' Congress
Full Committee
(ratio: 32-26)
ROLL CALL VOTE#l3
Bi!L Subtitle A, "Budget Reconciliation Legislative Recommendations
Relating to Public Health"
Motion: A motion by Mr. Pallone of New Jersey to order Subtitle A, "Budget
Reconciliation Legislative Recommendations Relating to Public Health"
transmitted favorably to the House Committee on Budget, amended (Final
Passage).
Disposition: AGREED TO by a roll call vote of3 l yeas to 25 nays
REPRESENTATIVE YEAS NAYS PRESENT REPRESENTATIVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNemey X Rep. Johnson X
Rep. Welch X Rep.Long X
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin X Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep. Rice X
Rep. Craig X
Rep. Schrier X
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Rep. Trahan X
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161
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117th Congress
!Rep_ Fletcher X
02/11/202!
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162
V. OVERSIGHT FINDINGS
Pursuant to clause 3(c)(l) of rule XIII and clause 2(b)(l) of rule X of the Rules of the House
of Representatives, the oversight findings and recommendations of the Committee are reflected
in the descriptive portion of the report.
VI. NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX
EXPENDITURES
Pursuant to 3(c)(2) of rule XCII of the Rules of the House of Representatives, the Committee
adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures
or revenues contained in the cost estimate prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act of 1974.
VII. CONGRESSIONAL BUDGET OFFICE ESTIMATE
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163
CONGRESSIONAL BUDGET OFFICE Phillip L. Swagel, Director
U.S. Congress
Washington, DC 20515
Febmary 14, 2021
Honorable Fra11k Pallone Jr.
Chainna11
Committee on Energy and Commerce
U.S. House of Representatives
Washington, DC 20515
Dear Mr. Chairman:
The Congressional Budget Office has prepared the enclosed cost estimate
for the Reconciliation Recommendations of the House Committee on
Energy and Commerce.
lf you wish further details on this estimate, we will be pleased to provide
them. The CBO staff contact is Alice Burns.
Sincerely,
Phillip L. Swagel
Enclosure
cc: Honorable Cathy McMonis Rodgers
Ranking Member
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164
Congressional Budget Office February 14, 2021
Cost Estimate
RecQnciliation Recomi:nendations of the House Committee. on Energy
and Commerce.
As ordered reported ori Febniary 12, 2021.
By Fiacal Year, Millkms of Dollars 2021 ---~20.~1~.25l_:l0_ ________ 2021-2031 ....
Direct Spending (Outlays) 27,498 126,130 123,827
Revenues 0 1,474 1,488
Increase or Decrease(·)
in the Deficit 27,498 124,656 122,339
C~(.fh11B, I\Of fb\Ji/1:,;;e\'.J th~ l~gi~latiori for ~eels. Ofl sp~ni:ilngi-s~bj~d ttt'iii!propri~tion, .,
The legislation would
• Appropriate $105 billion for various activities related to tesling for, lrealing, and responding to COVID-19
(the disease cause by the coronavirus); and for other activities related to COVID-19
• Allow extended postpartum coverage in Medicaid and the Children's Health Insurance Program (CHIP)
• Increase the federal medical assistance percentage (FMAP) to encourage states to expand Medicaid
coverage and increase their provision of certain types of long-term services and supports
• Eliminate the cap on rebates that drug manufacturers pay to Medicaid
• Increase the cost of an existing private-sector mandate on certain commercial entitles iflhe Federal
Communications Commission increases annual fee collections
Estimated budgetary effects would mainly stem from
• Increased direct spending resulting from $105 billion in new budget authority
• Additional direct spending from increasing !he number of months of postpartum coverage under
Medicaid and CHIP
• Increased Medicaid and CHIP spending on COVID-19 vaccines, new enrollees, services for inmates in
jails and prisons, and long-term services and supports
• Reduced Medicaid spending on prescription drugs
Areas of significant uncertainty include
• Estimating the rate at which the new budget authority would be spent by federal agencies
• Predicting how many women would participate in postpartum coverage under Medicaid and CHIP
• Estimating how many states would expand Medicaid coverage as the result of higher FMAPs
• Estimating future growth in drug prices
Detailed estimate begins on the next page.
See also CBO's Cos/ Estimates Explained, www cbo gov/publication/54437;
How CBO Prepares Cost Estimates, www.cbo.gov/publication/53519; and GloMBry, ,w.,w cbo gov/publication/42904.
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Summary of the Legislation
S. Con. Res. 5, the Concu1Tent Resolution on the Budget for Fiscal Year 2021, instructed
several committees of the House of Representatives to recommend legislative changes that
would increase deficits up to a specified amount over the 2021-2030 period. As part of this
reconciliation process, the House Committee on Energy and Commerce approved legislation
on February 12, 202 l, with a number of provisions that would increase deficits.
The legislation would appropriate $92.2 billion for various activities related to testing for,
treating, and responding to COVID-19, the disease caused by the coronavirus. The
legislation would also make changes to the Medicaid program and the Children's Health
Insurance Program (CHIP), which include expanding coverage for women after the birth of
their child, encouraging states that have not already done so to expand Medicaid coverage to
adults made eligible by the Affordable Care Act (ACA), and eliminating the limit on the
rebates paid by drug manufacturers to Medicaid. Finally, the legislation would appropriate
$12.8 billion for various activities related to addressing the energy, environmental,
educational, and commerce-related effects of the coronavirns pandemic.
Estimated Federal Cost
The estimated budgetary effects of the reconciliation recommendations of the House
Committee on Energy and Commerce are shown in Table l. The costs of the legislation fall
within budget functions 300 (natural resources and environment), 370 (commerce and
housing credit), 500 (education, training, employment, and social services), 550 (health), and
600 (income security).
Basis of Estimate
For this estimate, CBO assumes that the reconciliation bill will be enacted by the end of
March 202 l. Outlay estimates ai-e based on historical spending patterns for affected
programs and information from the agencies about program implementation.
Direct Spending and Revenues
CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting the
reconciliation recommendations of the House Committee on Energy and Commerce would
increase direct spending by $126.1 billion and would increase federal revenues by
$1.5 billion over the 2021-2030 period, for a net effect on the deficit over that period of
$ l 24. 7 billion.
Funding for Public Health. Subtitle A would appropriate $92.2 billion for various activities
aimed at improving public health and responding to COVID-19.
Within subtitle A, Chapter l would provide $14.2 billion to fund activities related to
vaccination and treatment with the following specific appropriations:
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• $7.5 billion to the Centers for Disease Control and Prevention (CDC) to plan, prepare for,
promote, distribute, administer, monitor, and track COVID-19 vaccines;
• $1.0 billion to the CDC to improve vaccine education and confidence and vaccination
rates;
• $5.2 billion to the Secretary of Health and Human Services (HHS) to advance research,
development, manufacturing, production, and the purchase of vaccines, therapeutics, and
ancillary medical products to prevent, prepare, and respond to SARS-CoV-2, COVID-19,
or any disease with potential for creating a pandemic; and
• $0.5 billion to the Food and Dmg Administration to oversee the development and
marketing of COVID-19 therapeutics, vaccines, and diagnostic tests.
Chapter 2 would provide $49.0 billion for testing for COVlD-19, specifically appropriating:
• $46.0 billion to the Secretary of HHS to detect, diagnose, trace, and monitor COVID- l 9
infections;
• $1.8 billion to the CDC for genomic sequencing, analytics, and disease surveillance;
• $0.8 billion to the CDC to combat COVID-19 and other emerging infectious threats
globally; and
• $0.5 billion to the CDC to support the surveillance and analytic infrastructure of public
health data.
Chapter 3 would provide $7.8 billion for strengthening the public health workforce with two
specific appropriations:
• $7.7 billion for state, local, and territorial public health departments to establish, expand,
and sustain their public health workforce; and
• $0.1 billion to the Medical Reserve Corps.
Chapter 4 would provide $11.2 billion for other pnblic health investments that specifically
cover:
• $7.6 billion for awarding grants and cooperative agreements to community health centers
and qualified entities under the Native Hawaiian Health Care Improvement Act to
support activities related to testing for, treating, and vaccinating against COVID-19;
• $0.8 billion to the National Health Service Corps to support qualified health care
providers working in areas with limited access to care;
• $0.2 billion to the Nurse Corps to support nurses working in facilities that provide
primary health care or maternal health care to underserved populations;
• $0.3 billion to health centers that provide graduate medical education;
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• $ l, 8 billion for activities related to testing, tracing, and mitigating COVID-19 infections
in congregate settings; and
• $0.4 billion for HHS to provide services for children under its care, including
unaccompanied alien children in the custody of the Office of Refugee Resettlement
Chapter 5 would provide $6. l billion to the Indian Health Service (IHS) for lost
reimbm·sements resulting from people defening routine and elective health care, testing and
tracing of COVID-19 infections, COVID-19 vaccine promotion, distribution and
administration, additional support for purchased and refened care, and for other purposes.
Chapter 6 would provide $3.9 billion to strengthen activities related to mental health and
substance abuse, specifically appropriating:
• $ l .8 billion to the Secretary of HHS for community mental health services;
• $1.8 billion to the Secretary of HHS for activities relating to the prevention and treatment
of substance abuse;
• $0. l billion for the Health Resources and Services Administration (HRSA) to award
grants to eligible institutions that provide mental and behavioral health education and
training; and
• $0.3 billion for other activities.
Chapter 7 would appropriate $20 million to HHS for grants to eligible states to modernize
the health insurance marketplaces established under the ACA.
In total, CBO estimates that the funds appropriated by subtitle A would increase direct
spending by $91.3 billion over the 2021-2030 period.
Coverage ofCOVID-19 Vaccinations and Treatments. Subtitles Band C would make
various changes to the Medicaid and CHIP programs' coronavirus-related spending. In total,
sections 3101 and 320 l would increase direct spending by an estimated $ L 1 billion and
$68 million, respectively, over the 2021-2030 period.
Mandatory Coverage ofCOVID-19 Vaccination, Without Cost Sharing Sections 3101 and
3201 would require state Medicaid and CHIP programs to cover vaccinations, without cost
sharing, for all eligible enrollees. Under cunent law, the federal government is expected to
provide the vaccines administered through both progran1s, but some patients would still have
to pay the cost sharing associated with having the vaccine administered. In addition, if a
state implements an option under Medicaid to provide COV!D-19 testing for uninsured
people, it would have to do so without cost sharing. The sections also would extend for a
year the period in which a state must vaccinate, without cost sharing, adults enrolled in
Medicaid under the program's traditional eligibility rules.
CBO estimates that 4 million Medicaid and CHIP enrollees are currently ineligible for
vaccination under either program. By the end of the public health emergency (PHE), CBO
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estimates, fewer than 1 million adults enrolled under Medicaid's traditional eligibility rules
would be subject to cost-sharing requirements to receive the vaccine.
If enacted, CBO estimates, the requirements in sections 3101 and 3201 would increase the
number of vaccinations administered to Medicaid and CHIP enrollees by about 2 million
doses in 2021 and by about 6 million over the 2021-2023 period. Because the federal
govenunent is expected to provide the vaccine itself, sections 3101 and 3102 would only
affect the costs associated with administering the vaccines. Using information from the
Centers for Medicare & Medicaid Services, CBO estimates that in 2021, the cost of
administering a single dose will vary between $17 and $28, depending on the type of
vaccine. Over the 2021-2030 pe1iod, CBO estimates, the requirement to provide vaccination
coverage without cost shaiing would increase Medicaid's direct spending by $107 million
and CHIP's by less than $1 million.
Increased Federal Medical Assistance Percentagefor Vaccinations. Sections 3101 and 3201
also would raise the federal medical assistance percentage (FMAP) to JOO percent for
payments to states for administering vaccines for one year after the end of the PHE. Over the
2021-2030 period, CBO estimates, the higher FMAP would increase direct spending for
Medicaid and CHIP by $747 million and by $68 million, respectively.
lvfandatory Coverage of'Treatment or Prevention, Without Cost Sharing. Sections 3101 and
3201 also would require state Medicaid and CHIP programs to provide coverage, without
cost sharing, for treatment or prevention of COVID-19 for one year after the end of the PHE.
Additionally, over the same period, if a state chose to implement an option under Medicaid
to provide COVID-19 testing for uninsured people, section 310 l also would extend the
requirement to provide treatment and prevention to those people without requiring cost
shaiing.
About 5 million people enrolled in Medicaid or CHIP are expected to receive COVID-19
treatment in 2021. CBO expects that number to decline to fewer than l00,000 by 2022 and
estimates that about 25 percent of those people would be subject to cost-sharing
requirements for a physician service ($2, on average, in 2021 ), an inpatient hospital service
($70, on average, in 2021 ), or both. CBO estimates that the requirements in sections 310 l
and 3201 that would prohibit cost sharing for treatment would increase direct spending by
$34 million for Medicaid and by less than $1 million for CHIP over the 2021-2030 period.
CBO anticipates that 3 million uninsured people will receive COVID-19 treatment in 202 L
By 2022, that number is expected to fall below 50,000. In 2020, 10 states had implemented
an option under Medicaid to test uninsured people for COVID-19. In those states, CBO
estimates, the requirement in section 310 l to provide vaccinations or treatment services
would increase direct spending for Medicaid by $243 million over the 2021-2030 period.
Coverage for Pregnant and Postpartum Women. Sections 3102 and 3202 would allow
states to extend health coverage for women emolled in Medicaid or CHIP for 12 months
after the bitth of a child. In total, CBO estimates, those sections would increase federal
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deficits by $5.1 billion over the 2021-2030 period-an increase in direct spending of
$6.0 billion and an increase in revenues of $0.8 billion over the period.
Under current law, for 60 days after the birth of a child, states must provide Medicaid
coverage to women whose income does not exceed 138 percent of the federal poverty level
(FPL). Forty-six states aud the District of Columbia exercise an option under current law to
provide Medicaid coverage to pregnant women whose income is above 138 percent of the
FPL, 29 extend coverage if their income is equal to or above 200 percent of the FPL, and 3
extend coverage if their income is above 300 percent of the FPL. Under current law, states
also cau provide pregnancy-related services to women under CHIP, but they may only
provide postpartum services to women who, if not for their income, would otherwise be
eligible for coverage under Medicaid.
CBO estimates that in 2020, Medicaid and CHIP provided pregnancy-related coverage to
about 2 million women; approximately 1.8 million canied their pregnancy to term. CBO
estimates that about 35 percent of those recipients have income above 138 percent of the
FPL, which reflects the coverage options currently available to states under Medicaid and
CHIP. Regardless of a state's decision to provide optional coverage to eligible women, the
state must reevaluate applicants' eligibility for other coverage before the end of the 60-day
postpaitum period. Medicaid coverage after that point cau include the full scope of health
services or be limited to family-plam1ing services.
Medicaid Coverage Under the 12-Month Option. CBO estimates that under c1ment law, at
the end of the 60-day postpartum period about 30 percent of women will continue to receive
comprehensive services from Medicaid, 30 percent will enroll either in employment-based or
in marketplace coverage, and about 45 percent will be uninsured (although roughly two-
thirds of those women would still receive family-planning services).
Section 3102 would provide women in states that exercise the option with l Oadditional
months of Medicaid coverage. CBO estimates that by 2024, about 25 percent of all women
who would be expected to receive postpartum services from Medicaid will live in states that
implement the 12-month option. Using administrative data and information from industly
solu·ces, CBO estimates that the combined federal and state cost to provide 10 additional
months of Medicaid coverage would be about $1,500 per person, on average, in 2022; that
amount would increase at an average annual rate of about 6 percent over the 2022-2030
period. For women whose current-law Medicaid services are limited to family planning,
CBO estimates that the cost per person would be about $1, l 00, on average. In total, CBO
estimates, the additional months of coverage would increase direct spending for Medicaid by
$6.1 billion over the 2021-2030 period.
CHIP Coverage.for Pregnant and Postpartum Women. Under current law, states can provide
CHIP coverage to eligible women during pregnancy and for 60 days after the birth of a child.
CHIP cam1ot be used to replace existing Medicaid coverage for pregnant women. To cover
pregnant women under CHIP, states must provide, at a minimum, Medicaid coverage to
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women whose income is up to 185 percent of the FPL. Iu 2020, approximately 15,000
women received pregnancy and postpmtum care under CHIP. CBO estimates that all of those
women became ineligible for comprehensive Medicaid and CHIP services at the end of the
60-day postpartum period.
If a state provides CHIP coverage to eligible women up to the end of the 60-day postpartum
period, and if the state chooses to implement the Medicaid option under section 3102, the
legislation would require the state to extend similar coverage under CHIP. However, because
not all states extend CHIP coverage to pregnant women, CBO estimates that by 2024 fewer
than 1,000 pregnant women would reside in a state that implemented the option. CBO
expects that additional months of coverage under CHIP would cost about the same as under
Medicaid. On net, CBO estimates, section 3202 would increase direct spending for CHIP by
$5 million over the 2021-2030 period.
Private Health Insurance for Pregnant and Postpartum Women. Some women whose
Medicaid coverage ends after the birth of a child enroll in private health insmance. CBO
estimates that in states that are expected to implement the option under section 3102, fewer
than 5 percent of women who become ineligible each year for Medicaid or CHIP cmrently
receive coverage through a marketplace and 30 percent enroll in employment-based
coverage. Under section 3102, over the 2021-2030 period, about 10,000 and 100,000 women
annually would delay enrollment either in marketplace coverage or in employment-based
coverage, respectively, for about 10 months. That delay would lower subsidies for private
health insurance, thereby reducing direct spending by $13 7 million and increasing revenues
by $816 million over the 2021-2030 period, according to CBO and JCT's estimates.
Medicaid for Inmates During the 30-Day Period Preceding Release. Section 3103 would
create an exception for 5 years, stmting one year after enactment, to the prohibition on
making Medicaid payments for services provided to inmates of correctional institutions.
Section 3103 would permit payments for services to inmates who are enrolled in Medicaid
during the last 30 days of their incarceration. According to data from the Bureau of Justice
Statistics:
• Local jails admit and release about 10 million people per year, 89 percent of whom are
admitted and released within 30 days, and
• State prisons admit and release about 600,000 people per year, almost all of whom
remain incarcerated for longer than 30 days.
As a result, section 3103 would allow the vast majority of Medicaid enrollees to maintain
their Medicaid coverage during their incarceration in local jails and would permit those jails
to bill Medicaid for medical care provided to the incarcerated enrollees. Section 3103 would
allow incarcerated enrollees in prisons to receive Medicaid coverage in the final 30 days of
their incarceration, which would permit state prisons to bill Medicaid for services provided
pre-release.
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Based on a report by the Prison Policy Initiative, CBO estimates that about 45 percent of
inmates released from jails and prisons would be enrolled in Medicaid in the early years of
the 2021-2030 period, rising to 55 percent by the end of the period as CBO projects
additional states will adopt the ACA expansion over time.
CBO expects that the costs per Medicaid inmate would be modest, as loealjails generally
provide limited services, such as generic medications to assist with drug withdrawals and
mental health crises during the short-term stays, while prisons would be expected to provide
pre-release health screenings and short-term supplies of medications to help with the
transition to the post-release period. CBO estimates that the average cost per prisoner would
be about $100 in the beginning of the period, rising to about $200 by the end of the period
because of increases in the costs of providing medical care.
Lastly, CBO projects that state p1isons would quickly develop the infrastructure to bill
Medicaid for services to inmates in the last 30 days of their stay, which in many cases would
allow them to defray the costs incurred for pre-release services. Local jails would more
gradually establish similar capacity to bill Medicaid, delaying the full implementation of
section 3103 for several years. In total, CBO estimates that section 3103 would increase
direct spending by $3. 7 billion over the 2021-2030 period.
Bundled Community-Based Mobile Crisis Intervention. Section 3104 would, for 12 fiscal
quatters, increase a state's FMAP for crisis intervention services that qualify as mobile and
community-based, as defined by the bill. The enhanced FMAP would equal 85 percent and
would apply only to services that otherwise would be reimbursed at a state's traditional
FMAP. Based on information from state mental health agencies, CBO estimates that at least
16 states have programs that provide services that would qualify for the enhanced FMAP
provided under section 3104. Not all of those programs currently seek Medicaid
reimbursement for crisis intervention services provided to Medicaid; CBO expects that the
programs would be more likely to do so under section 3104. CBO also anticipates that those
chat1ges would encourage all of the programs to request reimbursement under their state
Medicaid programs and that the states would receive the enhanced FMAP under section
3104 for such services. In addition, based on the rate at which state Medicaid programs have
adopted other services and demonstrations specific to behavioral health care, CBO expects
additional states would begin reimbursing for crisis intervention services that qualify as
mobile and community-based.
CBO estimates that the combined federal and state cost to provide crisis intervention services
that qualify as mobile and community-based would be about $1,500 per person, on average,
in 2021; that amount would increase at an average annual rate of about 6 percent over the
2022-2030 period. In total, CBO estimates, the enhanced FMAP ai1d the decision by states to
establish new programs that provide crisis intervention services that qualify as mobile and
community-based would increase direct spending for Medicaid by $1.1 billion over the
2021-2030 period.
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Temporary Increase in FMAP for Expanding ACA Coverage. Section 3105 would, for
eight calendar quarters, provide a temporary, 5 percentage-point increase in the Medicaid
FMAP to states that expand coverage to adults made eligible by the ACA. CBO and JCT
estimate that the provision would increase federal deficits by $15.5 billion over the 2021-
2030 period--the net effect of an increase in outlays of $16.2 billion and an increase in
revenues of$0.7 billion.
Under section 3105, the FMAP increase would be available only to states that expand such
coverage after the legislation is enacted, and it would not be available to states that had
previously expanded coverage. Only services provided to traditional eligibility groups could
qualify for the increase; services provided to adults made eligible by the ACA would not be
included. The higher FMAP also would not apply to the following expenditmes:
• Medicaid payments to hospitals that serve a disproportionate share of low-income
enrollees,
• Medicaid allotments to the territories, and
• Payments for programs otl1er than Medicaid that use the FMAP to determine the federal
share of payments (such as CHIP, payments from states toward Medicare Part D, and
Title IV).
Increased Medicaid Spending. Section 3105 would increase Medicaid spending in two ways.
First, CBO expects, the additional 5 percentage-point increase in the FMAP would induce
some states to expand Medicaid coverage to low-income adults sooner than CBO's baseline
projections for Medicaid enrollment would indicate. Cunently, 3 7 states and the District of
Columbia have implemented the expansion, and those states have enrolled roughly
60 percent of eligible adults nationwide. Under its baseline forecast, CBO projects that
additional states will adopt the expansion at the historical rate of expausions since 2014 (the
initial year of the expansion's availability). CBO anticipates that by 2030 about 70 percent of
all potential enrollees will be covered.
Although the rate of expansion is subject to considerable uncertainty, CBO projects that the
5 percentage-point increase in the HvlAP would induce states that would expand during the
2021-2030 period to do so about a year sooner, on average, than they otherwise would. The
result would be an increase in Medicaid enrollment in tl1ose years among adults made
eligible by the ACA in those states. Based on CBO's projections for enrollment in states that
have not already adopted the expansion and the projected cost per adult made eligible by the
ACA, CBO estimates that those earlier expansions would cost the federal government
$17.2 billion over the 2021-2030 period.
The second effect of section 3105 would be the added cost of the 5 percentage-point increase
in the FMAP. Based on the average matching rates projected for states that have not yet
adopted the expansion, CBO estimates the cost at $4.7 billion. In total, CBO estimates,
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section 3105 would increase direct spending on Medicaid by $21.8 billion over the 2021-
2030 period.
Reduced Federal Subsidiesjbr Private Health Insurance. Section 3105 also would reduce
enrollment in private health insurance as more people enroll in Medicaid in the states that
adopt the ACA expansion. CBO and JCT estimate that over the 2021-2030 period Medicaid
enrollment would increase, on average, by about 85,000 people who would otherwise have
enrolled in coverage through the marketplaces and by another 33,000 people who would
otherwise have enrolled in employment-based coverage. CBO and JCT estimate that those
reductions in enrollment would reduce direct spending for health insurance subsidies by
$5. 7 billion and increase revenues by $0. 7 billion over the 2021-2030 period.
100 Percent FMAP for Urban Indian Organizations and Native Hawaiian Health Care.
Section 3106 would, for eight calendar qumters, provide a l 00 percent federal matching rate
for services to Medicaid enrollees who access care in the Urban Indian Health Programs
(UIHPs) or the Native Hawaiian Health Care System (NHHCS). Under cuITent law, services
provided to Medicaid enrollees are matched at 100 percent if they are received through an
!HS facility. !HS is the agency that is responsible for providing federal health services to
American Indians and Alaska Natives. UIHPs are health care organizations that m·e grantees
of the !HS but are not considered federal entities that are part of the IHS and therefore only
receive the standard federal matching rates for services to Medicaid enrollees. Similm·ly, the
NHHCS comprises five health care clinics that are grantees of HRSA that are not considered
federal entities.
The standard federal matching rates under current law average an estimated 65 percent for
traditional eligibility categories during 2021 and 2022, and will average an estimated
58.5 percent during 2023, the time period covered by the eight quarters specified under
section 3106. The matching rates for adults made eligible by the ACA will be 90 percent
during the same period.
According to infonnation from the UIHP system, the UIHP treats about 90,000 Medicaid
patients per year at an estimated average cost of about $2,000 per patient. Applying the
l 00 percent matching rate for services to these enrollees would increase direct spending by
$155 million over the 2021-2030 period. Given the size of the NHHCS relative to the UIHP
system, CBO estimates that applying a 100 percent matching rate to services provided at
NHHCS clinics would increase direct spending by another $7 million over the period.
Sunset of Limit on Maximum Rebate for Certain Drugs. Under cmTent law,
manufacturers are required to pay Medicaid a rebate on all covered outpatient drugs. The
rebate amount is determined according to statute by two fomrnlas that include a basic rebate
with separate calculations for brand and generic drugs and an additional inflationary rebate
that reflects differences in growth between the Average Manufacturer Prices (AMPs) and the
consumer price index. The total rebate amount is capped at 100 percent of the AMP. The cap
does not affect rebates paid for all dmgs: It tends to be most relevant for drugs that have
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expe1ienced substantial price increases over time and for drugs that offer particularly large
rebates to payers other than Medicaid. Section 3107 would eliminate the cap on the total
rebate amount starting January l, 2023.
Based on administrative data on AMPs and prescription drug spending in Medicaid, CBO
estimates that in 2019, the cap on the total rebate amount prevented federal and state
governments from collecting more than $3 billion in rebates for covered outpatient drugs.
CBO expects that section 3107 would increase the amount of rebates that manufacturers pay
Medicaid and would reduce direct spending in Medicaid by $15.9 billion over the 2021-2030
period.
Additional Support for Medicaid HCBS. Section 3108 would, for four fiscal quarters,
increase the federal FMAP in Medicaid by 7.35 percentage points for state expenditures on
home and community-based services (HCBS). HCBS are long-te1m care services that
beneficiaries receive in their home or in the community rather than in institutions such as
nursing facilities. CBO projects that the federal and state governments will spend almost
$200 billion on HCBS during the four quarters for which the enhanced FMAP is available to
states. Increasing the federal share of such spending would increase federal spending on
Medicaid by $9.3 billion.
Strike Teams for Nursing Facilities. Section 3109 would appropriate $250 million for
states to establish strike teams that would be deployed to nursing facilities that have patients
who have been diagnosed with COVID-19 or who are suspected of having the disease. CBO
estimates that section 3109 would increase direct spending by $250 million over the 2021-
2030 period.
Other Provisions. Subtitle D would appropriate $12.8 billion for environmental protections,
utility assistance, distance learning, and other consumer product safety.
Within subtitle D, chapter 1 would appropriate $5. l billion to fund activities related to
environmental health and assistance to people for paying utility bills:
• $0. l billion to the Environmental Protection Agency for grants and other activities that
enhance environmental justice and to support implementation of the Clean Air Act;
• $4.5 billion to the Low-Income Home Energy Assistance Progrnm; and
• $0.5 billion for grants to assist low-income households with the costs of drinking water
and wastewater services.
Chapter 2 would appropriate $7.7 billion for distance learning, primarily to reimburse
schools and libraries for the costs of telecommunications equipment and services, and
consumer product safety.
In total, CBO estimates that the flmds approp1iated by subtitle D would increase direct
spending by $12.8 billion over the 2021-2030 pe1iod.
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Uncertainty
There are two major types of uncertainty in CBO' s estimate of the reconciliation
recommendations of the House Committee on Energy and Commerce: For subtitles A and D,
the primary forms ofunce1tainty stem from CBO's estimates of the pace at which federal
agencies would spend the new budget authority. For subtitles Band C, most of the
uncertainty ofCBO's estimates stem from expectations about state behavior, people's
enrollment in various fo1ms of health coverage, and the of the increase in health care prices.
Uncertainty About the Pace at Which Federal Agencies Would Spend New Budget Authority.
The reconciliation recommendations of tl1e House Committee on Energy and Commerce
would provide $105 billion in new budget authority for fiscal year 2021, increasing
individual agencies' funding for the year by a substantial amount. For example, the 2021
budget authmity for the CDC, HRSA, and the ms would see significant increases roughly
halfway through the fiscal year. It is unce1tain whether such agencies would be able to spend
all of the new funds rapidly.
Uncertainty About State Behavior, People's Enrollment in Various Forms ofHealth
Coverage, and the Growth <!{Health Care Prices. For subtitles Band C, CBO's estimates
include projections of the results of states' choices to expand coverage, people's choices to
enroll in coverage if they were newly eligible, and the future costs of providing health care
services to beneficiaries-all of which are uncertain. Some of the more significant sources of
unce1tainty include:
• Estimating how many women would remain enrolled in Medicaid if states expand
postpartum coverage and how many additional months of coverage they would have;
• Predicting how many states will expand Medicaid under current law and how the
increased FMAP would accelerate the pace of state expansions;
• Forecasting future growth in drug prices and how drng manufacturers would change their
pricing strategies if the cap on rebates were eliminated; and
• Estimating the future growih in prices for HCBS and how states would expand their
coverage ofHCBS on account of the higher FMAP.
Pay-As-You-Go Considerations
The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or revenues. The net changes in outlays
and revenues that are subject to those pay-as-you-go procedures are shown in Table l.
Increase in Long-Term Deficits: None.
Mandates
If the FCC increases a:mmal fee collections to offset the costs of issuing rules to promote
internet connectivity for schools and libraries as required by section 3312, the legislation
12
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would increase the cost of an existing private-sector mandate on commercial entities required
to pay those fees. CBO estimates that the incrementaJ cost of the mandate would be small
and would fall well below the annual threshold established in the Unfunded Mandates
Reform Act for private-sector mandates ($170 million in 2021, adjusted annually for
inflation).
Estimate Prepared By
Federal Costs: Alice Bums, Julia Christensen, Jennifer Gray, Ryan Greenfield, Jared
Hirschfield, David Hughes, Arin Kerstein, Susanne Mehlman, Stephen Rabent, Lisa
Ramirez-Branum, Lara Robillard, Sarah Sajewski, Robett Stewart, Carolyn Ugolino, Emily
Vreeland, Ellen Werble, and Katherine Young
Mandates: Andrew Laughlin
Estimate Reviewed By
Chad Chirico
Chief, Low-Income Health Programs and Prescription Drugs Cost Estimates Unit
Sheila Dacey
Chief, Income Security and Education Cost Estimates Unit
Paul Masi
Chief, Health Systems and Medicare Cost Estimates Unit
Sarah Masi
Senior Advisor
David Newman
Chief, Defense, International Affairs, and Veterans' Affairs Cost Estimates Unit
Susan Willie
Chief, Natural and Physical Resources Cost Estimates Unit
Kathleen FitzGerald
Chief, Public and Private Mandates Unit
Leo Lex
Deputy Director of Budget Analysis
Theresa Gullo
Director of Budget Analysis
13
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Subtitle A. Funding for Public Hoolth
Chapter 1 - Vaccines and Therapeutics
Sec. 3001 Vaccine Act1vit1es at the CDC
Budget Authority 7,500 0 7 500
Estimated Outlays 1.500 4,500 750 450 225
Sec. 3002 Vaccine Confidence Act1V1t1es
1,000 0 0
200 600 100 60 30 990
Sec. 3003 Vaccmes and Therapeutics
Supply Cham
5.200 0
2033 2,803 312 52
Sec. 3004. Activities at the Food and
500 600
165 250 75 10 500
Chapter 1, Total
Budget Authority 14,200 0 0 0 0 0 0 0 0 0
Estimated Outlays 3,898 8,153 1,237 572 255 0 0 0 0 0
Chapter 2 ~ Testing
Sec. 3011 Testing< Contact Tracing, and
MItIgatIon ActMttes
Budget Authority 46.000
Estimated Outlays 9,200 27,600 4,600 1,380
Sec. 3012 SARS-CoV-2 Genomlc
Sequencing and Surveillance
1,750
350 1,050 175 105 53
Sec. 3013 Global Health
Budget Authority 750 0 0
Estimated Outlays '150 450 75 45 23 0 0 143
Sec. 3014, Data Modernization and
Forecasting Center
Budget Authority 500 0 500
Estimated Outlays 100 300 50 30 15 495
Chapter2, Total
Budget Authority 49,000 0 0 0 0 0 0 0 0 0
Estimated Outlays 9,800 29,400 4,900 2,940 1,471 0 0 0 0 0
Chapter 3 - Public Health Workforce
Sec 3021 ?ub!ic Health Workforce
7,660
1.532 3.064 2,681 383
Sec. 3022 Medical ReseNe Corps
&ldget Authority 100 0 0 0 0 100
Estimated Outlays 20 56 16 0 0 100
Chapter 3, Total
Budget Authority 7,760 0 0 0 0 0 0 0 0 0
Estimated Outlays 1,552 3,120 2,697 389 2 0 0 0 0 0
Chapter 4 - PUblic Health Investments
Sec. 3°'11 Community Health Centers
Budget Authority 7,600
Estimated Outlays 1.520 3,040 2.660 380
Sec_ 3032 National Health SeNice Corps
Budget Authority 800 800
Estimated Outlays 160 320 280 40 0 800
Sec. 3033 Nurse Corps
Budget Authority 200 0 200
Fstimated Outlays 46 100 40 10 196
Sec. 3034.
Budget Authority 330 0
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T~i:i;!ey-Estim"~t'ed~dgetarfEff;~f:£-OTR~~Ohciii~tiR:1 ~ebOf"0h1end~ti~~S•bY·t:rie f.:(~us~ G?r:t1f!11ttee,on energy-and ~mmer~ '?n feibrn~ry, 1{29?r---------
conttOu~::t' ' ~ , ' - ' ,, · ' ' ' ' '
Sec. 3035
Congregate &>ttings
Budget Authority 1,800 0
Estimated Outlays 324 99() 396 36 18
Sec. 3036
50 0 50
10 35 0 0 49
Sec. 3037
Budget Authority 425 425
Estimated Outlays 13 17 64 68 74 70 64 51
Sec_ 3038 HHS Inspector Genera!
Budget Aut!1o;ity 0 0
Estimated Oullays 0 0
Chapter 4, Total
Budget Authority 11,210 0 0 0 0 0 0 0
Estimated Outlays 2,141 4,637 3,560 547 92 70 64 51 4 0
Chapter 5 ~ Jndian Health
Sec. 3041 Indian Health
6.094 0 0 0
1,493 3,534 506 84 84 71 59 43 19
Chapter 6- Mental Health and Substance
Use Disorder
Sec. 3051 Commuri,ty Mental Health
Services
1,750 0 0
315 910 350 140 35
Sec. 3052 Prevention and Treatment of
Substance Abuse
Budget Authority 1,750 0 0 0
315 910 350 140 35 0
Sec, 3053
80 0 80
18 40 16 0 78
Sec. 3054
Budget Authority 20 0 0 20
Estimated Outlays 4 12 0 20
Sec. 3055 Grants to Health Care
Providers for Mental and
Behavioral Health Among
Workforce
Budget Authority 40 0 40
Estimated Outlays g 20 0 39
Sec. 3056
30 0 30
6 15 0 30
Sec 305'7
Budget Authority 50 0 0 50
20 10 4 1 0 50
Sec. 3058
Stress Network
Budget Authority 10 0 0 10
Esl1mated Outlays 2 0 0 10
Sec. 3059 ProJect Aware
30 0 0
15
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Sec 3059A Youth Suicide Prevention
Budget Authority
Estimated Outlays 20
Sec. 30598 Behavioral Health Workforce
Budget Authority 100 100
Estimated Outlays 23 50 20 98
Chapter6, Total
Budget Authority 3,880 0 0 0 0 0 0 0
Estimated Outlays 711 2,013 774 303 74 0 0 0
Chapter 7. Exchange Grant Program
Sec 3061 Exchange Mo,.1ern12at1on
20 0 0 20
20 0 0 20
Subtitle A, Total
Budget Authority 92,164 0 0 0 0 0
Outlays 19,615 50,857 13,674 4,835 1,978 141 123 94 23
Subtitle B. Medicaid
Sec 3101
Estimated Budget AuthOnty 287 534 247 63 0
287 534 247 63 0
Sec. 3102
0 756 1,249 1,417 1,429 1,108 0
0 756 1,249 1.417 1.429 1,108 0
Sec. 3103 Med1ca1d for Inmates During
30-Day Penod Preceding
Release
Estimeted Budget Authority 177 444 683 918 1,014 510 Q
Estimated Outlays 177 444 663 918 1,014 510
Sec. 3104 Bundled Cornmunity-8ased
Mobile Cnsrs Intervention
15 71 305 330 270 25 32 40 49
77 307 332 270 25 32 40 49
Sec. 3105
Estimated Budget Authonty 0 3,768 3,427 2,308 2,131 1,337 479 531
0 3,768 3.427 2,177 2.308 2,131 1,337 479 531
Sec. 3106
Organz1ations and Native
Hawauan Health Care
Estimated Budget AL1hority 38 81 43 0 0 162
Estimated Outlays 38 81 43 0 0 162
Sec. 3107 Sunset of Limit on Maximum
Rebate for Certain Drugs
Estimated Budget Authonty -217 -1,803 ,2.293 -2.277 -2,258 -2,279 -2,318
Estimated Outlays -217 -1,803 -2.293 -2,277 -2,258 -2,279 -2,318
Sec. 3108
4,795 4.515
4,795 4.515
Sec. 3109 Strike Teams for Nursing
Fac1lit1es
Budget Authori1y 250 0 250
Estimated Outlays 50 175 0 250
Subtitle B, Total
Budget Authority 5,385 5,307 5,112 3,924 2,549 2,744 1,516 w910
Outlays 5,170 5,487 5,143 3,926 2,551 2,744 1,518 w910
Subtitle C. Children's Health fnsurance Program
Sec 3201
47 17 68
17 4 0 68
Seo. 3202
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Subtitle D. Other Provisions
Chapter 1 - Ensuring Environmental
Health and Ratepayer Protection
Sec 3301
100 100
10 GO 20 10 100
Sec. 3302 UHEAP
Budget Authority 4,500 4,500
Estimated Outlays 1.508 1,727 467 422 188 188 4.500
Sec. 3303. Water Assistance Program
500 500
50 225 150 50 25 500
Chapter1, Total
Budget Authority 5,100- 0 0 0 0 0 0 0 0 0
Estimated Outl:,ys 1,568 2,012 637 482 213 188 0 0 0 0
Chapter 2 - Distance Leaming and
Consumer Protections
Sec. 3311 Consumer Product Safety
Budget Authority 50 50
Estimated Outlays 10 48
Sec 3312 Remote Leammg Support
BUdget Authority 7,600 0 Q
Estimated Outlays 1140 3.800 1,900 760 0
Chapter 2, Total
Budget Authority 7,650 0 0 0 0 0 0 0 0
Estimated Outlays 1,144 3,806 1,908 770 9 8 2 1 0 0
Chapter 3 - Oversight of Deparlment of
Commerce Prevention and Response to
COVID-19
Sec. 3321 Oepartme;1t of Commerce
Budget Authority 0
Estimated Outlays 0
Subtitle 0, Total
Budget Authority 12,753 0 0 0 0 0
Outlays 2,713 5,819 2,546 1,252 222 196 2 0
Total Increase in Direct Spending
Estimated Budget Authority 110,302 5,354 5,129 3,928 2,549 2,744 1,516 --910 -1,799
Estimated Outlays 27.498 62,210 21,380 10,017 4,751 3,081 1,641 -815 -1,776
Increases in Revenues
sec. 3102
76 172 192 2D9 167 816
On-Budget Revenues 0 43 98 109 119 95 0 0 464
Off.Budget Revenues 0 33 74 83 90 72 0 0 352
Sec. 3105
165 107 93 94 93 51 31 24 672
On-Budget Revenues 0 96 6J 55 58 60 33 20 15 41J9
Off-Budget F?.evenues 0 69 44 38 36 33 18 11 9 263
Total increase in Revenues 241 279 28S 303 260 51 31 24 1,488
0 1.39 161 164 177 155 33 20 15 873
0 102 118 121 126 105 18 11 9 615
Net Increase or Decrease(·) in the Defi<:it From Changes in Direct Spending and Revenues
Estimated Effect on the Deficit 27,498 62,210 21,139 9,738 4,468 2,778 1,381 -866- -1,807
On-Budget Deficits 27,498 62,210 21,241 9.1356 4,587 2,904 1.486 -848 -1.796
Offf-Budget OehClt 0 0 -102 -118 -121 -126 -105 -18 -11 -615
a, Sect!On would affect both revenues and spending, which 1s shown separately.
b The estimate for section 3102 includes the budgetary effects of sections 3202
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VIII. .FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal mandates prepared by the Director
of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform
Act
IX. STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
Pursuant to clause 3(c)(4) of rule XIII, the general performance goal or objective of this
legislation is to provide funding for coronavims emergency response and relief: and for other
purposes.
X. DUPLICATION OF FEDERAL PROGRAMS
Pursuant to clause 3(c)(5) of rule XIII, no provision of the Committee Print is known to be
duplicative of another Federal program, including any program that was included in a report to
Congress pursuant to section 21 of Public Law 111-139 or the most recent Catalog of Federal
Domestic Assistance.
XI. COMMITTEE COST ESTIMATE
Pursuant to clause 3(d)(l) of rule XIII, the Committee adopts as its own the cost estimate
prepared by the Director of the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
XII. EAR'\1ARKS, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the Committee finds that the Committee
Print contains no earmarks, limited tax benefits, or limited tariff benefits.
XIII. ADVISORY COMMITTEE STATEMENT
No advisory committee within the meaning of section 5(b) of the Federal Advisory
Committee Act was created by this legislation.
XIV. APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that the legislation does not relate to the terms and conditions of
employment or access to public services or accommodations within the meaning of section
l 02(b )(3) of the Congressional Accountability Act.
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XV. SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
CHAPTER 1 - Vaccines and Therapeutics
SECTION. 3001. FUNDING FOR COVID-I9 VACCINE ACTIVITlES AT THE CENTERS
FOR DISEASE CONTROL AND PREVENTION.
Provides $7.5 billion in funding for CDC to support vaccine related activities to prepare,
promote, distribute, administer, monitor, and track COVID-19 vaccines. This includes funding
for activities related to enhancing, expanding, and improving distribution and administration,
including activities related to the distribution of ancillary medical products and supplies related
to vaccines. This section further provides technical assistance, guidance, support, and awards to
State, local, Tribal, and territorial public health departments for enhancement of COVID-19
vaccine distribution and administration capabilities, including the distribution and administration
of licensed or authorized vaccines and ancillary medical products and supplies; the establishment
and expansion of community vaccination centers, including in particularly underserved areas; the
deployment of mobile vaccination units, particularly in underserved areas; IT, data, and reporting
enhancements; facility enhancements; and public communication.
SEC. 3002. FUNDING FOR VACCINE CONFIDENCE ACTIVITIES.
Provides $1 billion in funding for CDC to strengthen vaccine confidence in the United
States, provide further information and education with respect to authorized or licensed vaccines,
and improve vaccination rates.
SEC. 3003. FUNDING FOR SUPPLY CHAIN FOR COVID-19 VACCINES,
THERAPEUTICS, ANJ) MEDICAL SUPPLIES.
Provides $5.2 billion in funding to the Secretary of HHS to support research, development,
manufacturing, production, and purchase of vaccines, therapeutics, and ancillary medical
products and supplies for SARS-CoV-2, or any viral variant mutating therefrom, and COVTD-19
or any disease with potential for creating a pandemic.
SEC. 3004. FUNDING FOR COVID-19 VACCINE, THERAPEUTIC AND DEVICE
ACTIVITIES AT THE FOOD AND DRUG ADMINISTRATION.
Provides $500 million in funding to be made available to FDA for the evaluation of the
continued performance, safety, and effectiveness of COVID-19 vaccines, therapeutics, and
diagnostics; invest in advanced continuous manufacturing activities related to the production of
vaccines and related materials; conduct inspections; review of devices authorized for COVID-19;
and supply chain oversight including to mitigate shortages.
CHAPTER 2 - Testing
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SEC. 3011. FUNDING FOR COVID-19 TESTJNG, CONTACT TRACING, AND
MITIGATION ACTIVITIES.
Provides $46 billion in funding to the Secretary of HHS to detect, diagnose, trace, monitor
and mitigate COVID-19 infections. Specified activities include: implementing a national
strategy for testing, contact tracing, surveillance, and mitigation; providing technical assistance,
guidance, support, and grants or cooperative agreements to States, localities, and territories for
activities to detect, diagnose, trace, monitor, and mitigate COVID-19 infections; support the
development, manufacturing, procurement, distribution, administration of tests, including
supplies necessary for administration such as personal protective equipment (PPE); establishing
and expanding federal, State, local, or territorial testing and contact tracing capabilities,
including investments in laboratory capacity, community-based testing sites, and mobile testing
units, particularly in medically underserved areas; enhancing IT, data modernization, and
reporting; awarding grants, cooperative agreements, or contracts with State, local, and territorial
public health departments to establish, expand, and sustain a public health workforce; and to
cover administrative and program support costs
SEC. 3012. FUNDING FOR SARS-COV-2 GENOMIC SEQUENCIN(i AND
SURVEILLANCE.
Provides $1. 75 billion in funding to the Director of CDC to be used for activities and
workforce related to genomic sequencing and analytics, and diseases surveillance. Such funds
shall be used to conduct, expand, and improve activities to sequence genomes, identify
mutations, and survey the circulation and transmission of viruses including strains of SARS-
CoV-2; awarding grants or cooperative agreements to State, local, Tribal, and territorial public
health departments or public health laboratories to increase their genomic sequencing,
identifying mutations, identifying outbreaks, developing disease response strategies, enhancing
and expanding informatics capabilities, and facility improvements.
SEC. 3013. FUNDING FOR GLOBAL HEALTH.
Provides $750 million to CDC to combat COVID-19 and other emerging infectious disease
threats globally, including efforts related to global health security, global disease detection and
response, global health protection, global immunization, and global coordination on public
health.
SEC. 3014. FUNDING FOR DATA MODERNIZATION AND FORECASTING CENTER.
Provides $500 million to CDC to support health data surveillance and analytics
infrastructure modernization initiatives and to establish, expand, and maintain efforts to
modernize the United States disease warning system to forecast and track hotspots for COVID-
19.
CHAPTER 3 Public Health Workforce
SEC 3021. FUNDING FOR PUBLIC HEALTH WORKFORCE.
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Provides $7.66 billion in funding to the Secretary of HHS to establish, expand, and sustain a
public health workforce, including by making awards to State, local, and territorial public health
departments. Such funds shall be used for costs, including wages and benefits, related to the
recruiting, hiring, and training of individuals to serve as case investigators, contact tracers, social
support specialists, community health workers, public health nurses, disease intervention
specialists, epidemiologists, program managers, laboratory personnel, informaticians,
communication and policy experts, and any other positions as may be required to prevent,
prepare for, and respond to COVID-19. Further, such individuals shall be employed by the
State, tenitorial, or local public health department involved or a nonprofit private or public
organization with demonstrated expertise in implementing public health programs and
established relationships with such public health departments, particularly in medically
underserved areas. Such funds shall also be used for PPE, data management and other
technology, other supplies, administrative costs, reporting, or subawards.
SEC. 3022. FUNDING FOR MEDICAL RESERVE CORRY.
Provides $100 million to the Medical Reserve Corps.
CHAPTER 4 - Public Health Investments
SEC 3031. FUNDING FOR COMMUNITY HEALTH CENTERS AND COMMUNITY
CARE.
Provides $7.6 billion in funding to the Secretary of HHS to support COVID-19 response at
community health centers. No less than $20 million of the funding shall be for grants or
contracts to qualified Native Hawaiian Health Centers. Funds are required to be used to plan,
prepare for, promote, distribute, administer, and track COVID-19 vaccines and related activities;
detect, diagnose, trace, monitor, and mitigate COVID-19 infections, including equipment or
supplies necessary for such activities; purchase equipment and supplies to conduct mobile testing
or vaccinations for COVID-19, including purchasing and maintaining mobile vehicles and
equipment to conduct such testing or vaccinations, and personnel needs, in particular in
medically underserved areas; establish, expand, and sustain the health care workforce to prevent,
prepare, and respond to COVID-19; modify, enhance and expand health care services and
infrastructure; and conduct community outreach and education activities related to COVID-19.
Awardees may use amounts made available to cover the costs of carrying out such related past
COVID-l 9 activities.
SEC. 3032. FUNDING FOR NATIONAL HEALTH SERVICE CORPS.
Provides $800 million in funding for the National Health Service Corps. This includes $100
million for the State Loan Repayment Programs for which the state matching requirement shall
not apply. State loan repayment programs shall not spend more than l O percent of an award on
the cost of administering the program.
SEC. 3033. FUNDJNG FOR NURSE CORPS,
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Provides $200 million in fonding to support the Nurse Corps Loan Repayment Program.
SEC. 3034. FUNDING FOR TEACHING HEALTH CENTERS THAT OPERATE
GRADUATE MEDICAL EDUCATION.
Provides $330 million to remain availahle until September 30, 2023 for Teaching Health
Centers (THC) Graduate Medical Education (GME) sites nationwide. Such fonds shall be used
for making payments to new approved graduate medical residency training programs, increasing
the per resident allocation of existing and new THC GME providers, restoring the number of
full-time equivalent residents in existing programs to at least the numbers between fiscal years
2016 through 2018, expanding existing approved graduate medical residency programs,
establishing new accredited or expanded primary care residency programs, and covering
administrative costs necessary for carrying out these activities.
SEC. 3035. FUNDING FOR COVID-19 TESTING, CONTRACT TRAC1NG, AND
MTTl(iATION ACTIV/TlES IN CONGREGATE SETTINGS.
Provides $1.8 billion to carry out activities to detect, diagnose, trace, monitor, and report on
SARS-CoV-2 and COVID-19 infections and related strategies to mitigate the spread ofSARS-
CoV-2, in congregate settings. Funds shall be used to support activities related to testing through
the use of in vitro diagnostic products for the detection or diagnosis of SARS-Co V-2 and the
virus that causes COVID-19, including to purchase, procure, or administer tests and supplies
necessaiy for administering and processing such tests to staff of, or individuals residing in,
congregate settings. The Secretary of HHS shall pay through any mechanism deemed
appropriate, all or part of the costs to entities administering or procuring tests. Funds shall also
be used to support vaccine-related activities for authorized or licensed COVID-19 vaccines, for
the vaccination of staff of, or individuals residing in, congregate settings. The Secretary shall
pay through any mechanism deemed appropriate, all or part of the costs to entities administering
or procuring vaccines. Funds shall also be used to purchase, procure, or distribute personal
protective equipment or other products supplies for use in mitigation of COVID-19 transmission
among staff of, or individuals residing in, congregate settings. Funds shall be used to provide
technical assistance, guidance, and support and award grants, contracts, or cooperative
agreements to public health departments or public and private entities that manage congregate
settings for activities related to SARSA-Co V-2 and COVID-19 infections. Congregate settings,
are defined to include prisons, jails, detention centers (including juvenile detention centers),
other coJTectional, detention, and reentry facilities, long-term care facilities, psychiatric hospitals
and residential treatment facilities, shared living arrangements for individuals with disabilities,
immediate care, and other residential care facilities.
SEC. 3036. FUNDING FOR F'.4MILY PLANNING.
Provides $50 million in funding for fiscal year 2021 to the Secretary of HHS for necessary
expenses for grants and contracts for the Title X Family Planning Program.
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SEC. 3037. FUNDING FOR CHILDREN UNDER THE CARE OF THE DEPARTMENT
OF HEALTH AND HUMAN SERVICES.
Provides $425 million in funding to the Secretary of HHS for expenses related to the care of
children under the care of HHS. These expenses include providing child care, education
services, health care services, case management services, or other necessary services for children
in the care of personnel employed by or under a grant, cooperative agreement, or contract with
HHS. The funds shall be used for costs related to capacity to provide care to the children
described; cost related to the recruiting, hiring, and training of additional staff; activities to
detect, diagnose, trace, treat, and monitor SAR-CoV-2 and COVID-19 infections; the purchase,
procurement, or distribution of in vitro diagnostic products for the detection or diagnosis of
SARS-CoV-2 and supplies necessary for administering tests; distribution of COVID-19 vaccines
to children and staff caring for such children; or the purchase, procurement, or distribution of
personal protective equipment for mitigation and prevention of COVID-19 transmission.
SEC. 3038. FUNDING FOR OFFICE OF INSPECTOR GENERAL.
Provides $5 million in funding to the Inspector General of HHS for oversight of activities
supported with funds provided to HHS to prevent, prepare for, and respond to COVID-19.
CHAPTER 5 - Indian Health
SEC. 3041. FUNDING FOR INDTAN HEALTH.
Provides $6.94 billion to the Secretary of HHS, of which $5.484 billion for carrying out
activities of the Indian Health Service (IHS). Of these funds, $2 billion for lost reimbursements
from third party payers to IHS; $500 million for additional health care services, services
provided through the Purchased/Referred Care program, and other related services; $140 million
for IT infrastructure for telehealth and the IHS electronic health records system; $84 million for
urban Indian health programs; $600 million for expenses to plan, prepare for, promote,
distribute, administer, and track COVID-19 vaccines among Indian Tribes, Tribal organizations,
and urban Indian organizations; $1.5 billion for expenses to detect, diagnose, trace, and monitor
COVID-19 infections, as well as activities to mitigate spread, necessaiy supplies for such
activities including vaccine-related activities and workforce-related activities; $240 million for
expenses to establish, expand and sustain a public health workforce for COVID-19 response and
public health workforce-related activities, including for vaccine-related activities and testing,
contact tracing, and mitigation activities; $420 million for expenses related to mental and
behavioral health prevention and treatment services, and IT and facilities needs related to mental
and behavioral health services; $600 million for leasing, purchasing, constructing, altering,
renovating, or equipping health facilities to respond to COVID-19 and for maintenance and
improvement projects necessary to respond to COVID-19; and $10 million for potable water
delivery.
Funds appropriated in this section are available to restore funds that were incurred during
since the COVID-19 PHE began on January 30, 2020 and are available to Tribes and Tribal
organizations, including self'..governance Tribes on a one-time allotment.
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CHAPTER 6 Mental Health and Substance Use Disorder
SEC 3051. FUNDING FOR BLOCK GRANTS FOR COMMUNITY MENTAL HEALTH
SERVICES.
Provides $175 billion to the Secretary of HHS or activities related to the Community
Mental Health Services Block Grant program.
SEC 3052. FUNDING FOR BLOCK GRANTS FOR PREVENTlON AND TREATMENT OF
SUBSTANCE ABUSE.
Provides $ l. 75 billion to the Secretary for activities related to the Substance Abuse
Prevention Treatment Block Grant program.
SEC. 3053. FUNDING FOR MENTAL AND BEHAVIORAL HEALTH TRAINING FOR
HEALTH CARE PROFESSIONALS, PARAPROFESSIONALS, AND PUBLIC SAFETY
OFFICERS.
Provides $80 million in funding to the Secretary of HHS, acting through the Administrator
of HRSA, to award grants or contracts to health professions schools, academic health centers,
State or local governments, Indian Tribes and tribal organizations, or other appropriate public or
private nonprofit entities. The funding shall be used to plan, develop, operate, or participate in
health professions and nursing training activities for health care students, residents,
professionals, paraprofessionals, trainees, public safety officers, and employers of such
individuals in evidence-informed strategies for reducing and addressing suicide, burnout, and
mental and behavioral health conditions (including substance use disorders) among health care
professionals.
SEC. 3054. FUNDING FOR EDUCATION AND AWARENESS CAMPAIGNS
ENCOURAGING HEALTHY WORK CONDITIONS AND USE OF MENTAL AND
BEHAVIORAL HEALTH SERVICES BY HEALTH CARE PROFESSIONALS,
Provides $20 million in funding to the Secretary of HHS, acting through the Director of
CDC and in consultation with the medical professional community, to carry out a national
evidence-based education and awareness campaign directed at health care professionals and first
responders (such as emergency medical service providers), and employers of such professionals.
Such awareness campaign shalt encourage primary prevention of mental and behavioral health
conditions and secondary tertiary prevention by encouraging health care professionals to seek
support and treatment for their own behavioral health concerns; help such professionals to
identify risk factors and respond to such risks; include information on reducing or preventing
suicide, substance use disorders, burnout, and other mental and behavioral health conditions, and
addressing stigma associated with seeking support and treatment; and consider the needs of rural
and medically underserved communities.
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SEC. 3055. FUNDING FOR GRANTS FOR HEALTH CARE PROVIDERS TO PROMOTE
MENTAL AND REHA VIORAL HEALTH AMONG THEIR HEALTH PROFESSIONAL
WORKFORCE.
Provides $40 million in funding to the Secretary of HHS, acting through the Administrator
ofHRSA, to award grants or contracts to entities providing health care, including health care
providers associations and Federally qualified health centers to establish. enhance or expand
evidence-informed programs or protocols to promote mental and behavioral health among health
care providers and related personneL
SEC. 3056. FUNDING FOR COMJfUNITY-BASED FUNDING FOR LOCAL SUBSTANCE
USE DISORDER SERVICES.
Provides $30 million to the Secretary of HHS, acting through the Assistant Secretary of
Mental Health and Substance Use and in consultation with the Director of CDC, to award grants
to State, local, Tribal, and territorial governments, Tribal organizations, nonprofit community-
based organizations, and primary care and behavioral health organizations to suppo1t
community-based overdose prevention programs, syringe service programs, and other harm
reduction services with respect to the harms of drug misuse exacerbated by the COVID-19 public
health emergency. Such funds are to be used for preventing and controlling the spread of
infectious diseases and the consequences of such diseases for individuals with substance use
disorder, distributing opioid overdose reversal medication to at-risk individuals, connecting at-
risk individuals to overdose education, counseling, and health education, and encouraging at-risk
individuals to take steps to reduce the negative personal and public health impacts of substance
use or misuse.
SEC 3057. FUNDING FOR COMMUNITY-BASED FUNDING FOR LOCAL
BEHAVTORAL HEALTH NEEDS.
Provides $50 million to the Secretary of HHS, acting through the Assistant Secretary of
Mental Health and Substance Use to award grants to State, local, Tribal, and territorial
governments, Tribal organizations, nonprofit community-based organizations, and primary care
and behavioral health organizations to address increased community behavioral health needs
worsened by the COVID- l 9 pandemic. Such funds are to be used for supporting care
coordination among local entities; training workforce, relevant stakeholders, and community
members; expanding evidence-based integrated models of care; addressing surge capacity for
mental and behavioral health needs; providing mental and behavioral health services to
individuals with mental health needs, including for those with co-occurring substance use
disorders delivered by behavioral and mental health professionals using telehealth services; and
supporting, enhancing, or expanding mental and behavioral health preventative and crisis
intervention services.
SEC. 3058. FUNDING FOR THE NATIONAL CHILD TRAUMATIC STRESS NETWORK.
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Provides $10 million for the National Childhood Traumatic Stress Network at SAMHSA to
address the problem of high-risk or medically underserved persons who experience violence-
related stress.
SEC. 3059. FUNDING FOR PROJECT A WARE.
Provides $30 million for Project AW ARE at SA.i\1HSA to advance wellness and resiliency
in education.
SEC. 3059A. FUNDING FOR YOUTH SU/ODE PREVENTION:
Provides $20 million to SAMHSA for youth suicide early intervention and prevention
strategies program and suicide prevention for children and adolescents program.
SEC. 3059B. FUNDING FOR BEHAVIORAL HEALTH WORKFORCE EDUCATION AND
TRAlNlN(i.
Provides $JOO million in funding to HRSA's Behavioral Health Workforce Education and
Training Program.
CHAPTER 7 - Exchange Grant Program
SEC. 3061. ESTABLISHING A (iRANT PROGRAM FOR EXCHANGE
MODERNIZATION.
Provides $20 million to the Secretary of HHS to award grants to State-Based Marketplaces
(SB Ms) to modernize or update any system, program or technology utilized by SBMs.
XVI. CHANGES IN EXISTING LAW !VU.DE BY THE BILL, AS REPORTED
There are no changes to existing law made by the bill the Committee Print
XVII. ADDITIONAL VIEWS
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Energy and Commerce Committee Republican Views
Republicans have supported five targeted, bipartisan bills to crush COVID-19, to reopen
schools, to get the economy back on track, and to improve health and wellness of those suffering
from the pandemic. That is what we should be doing with this Reconciliation package.
Unfortunately, this package falls well short, but at an extraordinary cost. The Congressional
Budget Office (CBO) estimates that the Committee on Energy and Commerce's contribution to
the Reconciliation process will cost approximately $120 billion. That is still well short of the
$188 billion instruction to the Committee, which shows there was an opportunity to adopt some
of the bipartisan, targeted, and timely amendments Republicans offered during markup. For
instance:
• $1 billion for teachers to get vaccinated and ensure our children can go back to
school safely;
• $10 billion for COVID-19 research at the National [nstitutes of Health (NIH);
• $35 billion to support our frontline workers through the Provider Relief Fund
(PRF'); or
• $1 billion to boost mental health services in states with unexpected job loss due to
President Bi den's various Executive Orders.
Unfortunately, the Democrats rushed this bill through a partisan markup without bipartisan
consultation with CBO on cost, preventing any chance of adequate analysis and deliberation.
In addition to the wasteful spending, we must comment on the Democratic Majority's
decision to bypass regular order. Democrats wrote this entire package in secret without any
input from Republicans, and Republicans did not see a draft until 10:00 p.m. on Tuesday,
February 9 for a markup scheduled to start at l 1:00 a.m. on Thursday, Februaiy 11. Such
secrecy might be expected on controversial measures, but Republicans and Democrats have
already worked together to enact 5 bills in response to COVID-19. This partisan process on this
package is a failure of Democratic leadership and a huge disappointment.
Subtitle A: Budget Reconciliation Legislative Recommendations Relating to Public Health
Republicans on the Energy and Commerce Committee strongly support additional
funding for advanced research, development, manufacturing, production, and the purchase of
vaccines, diagnostic tests, therapeutics, and ancillary medical products to prevent, prepare, and
respond to SARS-CoV-2, COVID-19, or any disease with potential for creating a
pandemic. Republicans on the Energy and Commerce Committee also support additional
funding for the prevention and treatment of mental health and substance use disorders. The
COVID-19 pandemic and resulting economic downturn have significantly impacted the mental
health and wellbeing of all Americans.
Since the beginning of this pandemic, many Americans have reported that their mental
health has been negatively impacted by recent events, with about 4 in IO adults repo11ing
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symptoms of anxiety or depressive disorder. 1 Reports have found that declines in the economy,
lost jobs, and health challenges have all contributed to an increase in mental health difficulties.
Individuals in states with more restrictive measures, such as stay-at-home orders, have recorded
even more cases of mental health difficulties. 2 The pandemic has also presented unique
challenges for individuals with substance use disorder (SlJD) and those who are in recovery, as
social distancing and stay at home orders make it harder for patients to access treatment, such as
critical medications for opioid use disorders. 3
However, Subtitle A is also a departure from how the Congress has previously provided
emergency funding to address the coronavirus pandemic, and because of this, does not take into
account the time it will take for federal agencies to spend these resources, or address all the
needs, such as those of the National Institutes of Health and health care providers. The past five
legislative packages that were signed into law were negotiated in good faith between
Republicans and Democrats, with extensive input from all sides. 4
We are disappointed that the Democrats rejected bipartisanship and embraced a partisan
process. Instead of targeted and timely relief to COVID-19, the Democrats proposed mandatory
funding for all of these initiatives, abdicating responsibility for oversight, which is a troubling
departure from the oversight and repo1iing on the emergency designated discretionary
appropriations provided in the previous five COVID-19 emergency appropriations bills passed
last year.
Republicans agree with CBO that federal agencies might not be able to use the new
budget authority provided in Subtitle A quickly enough. Republicans are also concerned that the
resources may not be timely enough to help address any outstanding COVID-19 needs that
remain after the most recent relief package. 5 Subtitle A increases individual agencies' funding
for a single fiscal year by a substantial amount. The 2021 budget authority for the Centers for
Disease Control and Prevention (CDC), the Health Resources and Services Administration
(HRSA), and the Indian Health Service (IHS) would see enormous increases roughly halfway
through the fiscal year. Republicans, like the CBO, do not understand how these agencies would
be able to spend all of the new funds rapidly in a manner that has any meaningful near-term
impact on reducing COVID-19 cases and deaths in the United States. 6
1
Ninnita Panchal. ct. al .. The Implications of COVID-19 for Mental Health and Substance Use. Kaiser Family
Foundation. available at https://www.kfforg/hea!U1-refon11/issne-brief/the-implicatio11s-of-covid-l9-for-mental-
health-and-substancc-usc/ (last upda!cd Feb. lO. 202] ).
2
Madeline Hotcom!J~Ct1Y social cfl1W11fi.JJJ:.JFWl' he traumatic. /!ere is what ro CJJ2£~J~Ji
(Apr, 12~291QL.. avai !ahie at https://www.cnn.com/20 20/04/()9/health/coronaYirus-mental-health-long-ten:n-
wellness/index. btm l.
3
Dr. Francis Collins, Director, National Institutes of Health. Coping with rhe Collision of Public Hea/rh Crises:
COf7JD-/9 and Substance U,e Disorders, NIH Direc1or's Blog (Apr. 21, 2020), available at
https:!/dircctorsblog.nih.goy/2020/04/21/coping-with-the-collision-of-public-health-criscs-covid-l 9-and-substance-
use-disordcrs/.
., P.L. 116-123: P.L 116-127: P.L. 116-136; P.L. 116-139; and P.L 116-260.
5
Congressional Budget Office. Reconciliotion Recommendations ofthe House Committee on !energy and Commerce,
Febmary 14. 2021. https://www.cbo.gov/systcm/filcs/2021-02/EnergyandCommerceReconciliationEstimatc.pdf.
6
Id.
2
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For example, the state of the nation's public health infrastructure and workforce are a
result of decades of neglect by state and local governments. At the same time, states have spent
ever increasing amounts of their budgets on Medicaid. Support for states to build their public
health workforce is laudable and could be accomplished by discretionary
appropriations. However, it is unclear how an immediate infusion of$7.6 billion in mandatory
funding for establishing and expanding a public health workforce, as is done in section 3021,
will lead to more public health professionals to fight COVID-19 now. State and local health
departments have struggled for years to recruit public health professionals in a field that has lost
more than 56,000 positions in the past decade. 7 A sustainable long-term increase in
discretionary funding authorized through regular order would have been a more appropriate way
to support state and local public health departments and address the dearth in public health
professionals.
Republicans are concerned about the long-term health of critically important public
health programs that Subtitle A sets on dangerous fiscal cliffs. For example, section 303 l
provides $7.6 billion for Federally-qualified health centers, $800 million for the National Health
Service Corps, and $300 million for the Teaching Health Center Graduate Medical Education
program. This is approximately twice the amount that was authorized for these programs for
each of fiscal years 2021 through 2023 in the Consolidated Appropriations Act, 2021, which was
just signed into law two months ago. 8 These are unsustainable funding levels.
Republicans are disappointed that Subtitle A opens the door to federal funding for
elective abortions. Every Democrat voted against including the Hyde amendment protections in
Subtitle A. The Hyde Amendment prevents all other federal funds for the Depmiment of Health
and Human Services appropriated through the discretionary appropriations process, and also
mandatory health spending, from being used to fund abortion, except in the cases where the life
of the mother would be endangered if the fetus were carried to term, or in the case of rape or
incest. Since 1976, Hyde, and similar policies governing other federal programs, have been
supported and renewed annually on a bipartisan basis, multiple times, for decades. 9 Because
there are no Hyde Amendment protections, many provisions in Subtitle A, particularly where
funds have been authorized for broad purposes or for the provision of health services that are not
directly related to preventing and treating COVID-19, will support elective abortions.
For example, section 3036 authorizes $50 million in mandatory funding for grants and
contracts under section I 00 I of the Public Healtl1 Service Act, which is the Title X Family
Planning Program. First, it is unclear to Republicans how Title X funding will reduce
transmission of, and illness and death caused by, COVID-19. This funding is being authorized
on the heels of President Bi den directing the Department of Health and Human Services to
7
Blaire Bryant. Protect Funding for Core Local Public Health Services and Prevention Programs, National
Association of Counties. available at https://www.naco.org/resourees/protect-funding-core-local-public-health-
sel'\'ices-and-prcveutiou-
progmms#:-:text-According%,20to%20the%20National%20Association,in%20five%201ocal%20health%20dcpartm
ents. (last updated Feb. 28, 2019).
P.L. 116-260.
9
H.R.14232, Departments of Labor, and Health. Education, and Welfare, and Related Agencies, J 977, 94th Congress
(1976); Roll no. 846.
3
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reverse the "Protect Life Rule," 10 a rule that prohibited Title X-funded family planning services to
be perfonned at the same location where abortions are provided. Since existing Title X
appropriations have been obligated to non-abortion providing entities, section 3036 is just a way
to direct taxpayer dollars to abortion providers, like Planned Parenthood.
Lastly, Republicans are disappointed that the Democrats, in their haste to pass a partisan
package, did not assess the true budgetary needs of these agencies. The exorbitant funding levels
could lead to waste.
For example, section 3004 provides $500 million to the Food and Drug Administration
(FDA) for the evaluation of the continued performance, safety, and effectiveness of vaccines,
therapeutics, and diagnostics approved, cleared, licensed, or authorized for use for the treatment,
prevention, or diagnosis of COVID-19. Republicans believe that the agency should provide a
detailed account of how funds previously appropriated have been spent, what amount of funding
remains unobligated, and to what activities those unobligated dollars will be allocated before
appropriating additional funds, especially considering that $500 million is more than twice the
amount that has been appropriated to FDA under all previously enacted Coronavirus relief
legislation combined. 11
Additionally, advancing this legislation through regular order would have allowed both
Republicans and Democrats to have a better understanding of the FDA' s existing needs. During
the full committee markup, the only opportunity provided to Republicans to ask questions and
raise concerns about the legislation being considered, Democrats asserted they had conversations
with FDA during which the agency expressed the need for this amount of funding. The FDA has
not provided to Republicans any request or justification for these funds, nor has FDA explained
how they will be used to advance the agency's mission. In addition, the majority ofFDA's
spending is on salaries. It is unclear how the $500 million could be used to support salaries
without creating a cliff where more funding is needed to retain those employees.
With respect to product reviews, Republicans question why these funds appear to be
intended solely for post-market surveillance, as opposed to both pre- and post-market activities,
given the likelihood that new COVID-19 vaccines, therapeutics, and diagnostics will warrant
premarket review. 12 Furthermore, the funds may be used to facilitate and conduct inspections
delayed or cancelled for reasons related to COVID-19. B While Republicans agree it is critical
that FDA resume on-site inspections, we question why additional funds are required to do so.
Since March 2020, FDA has conducted few domestic or foreign inspections due to safety
concerns and travel restrictions, not due to funding limitations. During fiscal year (FY) 2020, the
total number of inspections conducted by FDA, of both foreign and domestic establishments,
lll 84 F.R. 7714.
11
P.L. 116-123: P.L. 116-136: P.L. 116-260,
12 S. Con. Res. 5, the Concurrent Resolution on the Budget for Fiscal Year 202 l (Febmary 11, 2021), 117 th Congress
(2021-2022), availah/e at !l · 1 ' i ·oo; l ) 1 - 7-A-P0000}4-
~
Jd
1'
-
4
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was fifty-six percent lower than during each of the previous two fiscal years. 14 Between March
and October of 2020, only three foreign mission critical inspections and only fifty-two domestic
inspections took place. 15 In contrast, during a similar timeframe in each of the previous two
years, more than 600 foreign and 400 domestic inspections took place. 16 Given the significant
reduction in the number of inspections conducted, FDA must answer for how funds obligated
for FY 2020 inspection activities have been used and why it needs more funds to carry out
delayed or cancelled inspections.
Subtitle B: Budget Reconciliation Legislative Recommendations Relating to Medicaid
Section 3101. Mandatory Coverage ofCOVID-19 Vaccines and Administration Treatment
Under Medicaid.
Republicans want every American to have access to the COVID-19 vaccine and we
support fully covering the cost of the vaccine for Medicaid beneficiaries for the length of the
public health emergency. This will ensure we can vaccinate every single American, which will
help us reopen schools, workplaces, and the economy. However, in this section the Democrats,
instead, chose to extend the timeframe where vaccines are fully covered by one year. The
Democrats have provided no justification for this extension. Given that the public health
emergency will continue throughout 2021, Republicans recommend ascertaining how the states
are doing at the end of the year and extend the timeframe if needed. Instead, the Democrats are
spending money on the extra year that could have been used to increase funding for mental
health or SUD providers, or a number of other targeted and temporary priorities that both parties
share.
The Democrats are also giving the states the option to provide coverage to the uninsured
for COVID-19 vaccines and treatment without cost sharing at 100 percent federal medical
assistance percentage (FMAP). Republicans want all eligible beneficiaries to receive care and
want to work with the Democrats to improve access to care for all Americans. However, the
Medicaid program has eligibility requirements for a reason and Republicans want to make sure
that the program is able to continue serving the Americans who are eligible for Medicaid
coverage.
Section 3102. Modifications to Certain Coverage Under Medicaid for Pregnant and
Postpartum Women.
Republicans are disappointed that the Democrats chose this partisan approach to a
bipartisan priority. H.R. 4996, the Helping MOMS Act of 2020, passed the House unanimously
last year and is the same policy as section 3102, except, H.R. 4996 was a permanent state option
to extend Medicaid eligibility to women for 12 months postpartum and section 3102 is a five-
year option. At markup, Republicans offered an amendment that would have implemented the
14
United States Government Aceonntability Office (GAO), COvID-19: Critical Vaccine Distrihution, S11p~v Chain,
Program lntegri(h and Other Chal/1,ng,es Require Focused Federal Attention (January 202 l), avai/ahle al
"Id.
5
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permanent policy. Predictably, the Democrats rejected the proposal because it would cause the
Committee to exceed its reconciliation instructions. However, when CBO released its estimate
of the Committee's reconciliation package, Republicans learned that the Committee is under its
instruction of$188 5 billion by over $65 billion. 17 If the Committee had an estimate and
technical assistance before markup, we could have made this change permanent.
Section 3103. Allowing for Medical Assistance Under Medicaid for Inmates During 30-Day
Period Preceding Release.
Republicans are willing to work with the Democrats to address medical assistance for
inmates during the 30-day period preceding their release from prison, but this is irrelevant to
responding to COVID-19. This is especially true since the Democrats included the coverage of
inmates in the vaccine development and distribution funding in Subtitle A, and included specific
funding for COVID-19 for those that live in congregate facilities. If this policy had been
considered through regular order, a hearing might have revealed how prisons differ from jails
when handling inmates a month before release and how we can tailor the policy to be the most
effective.
Republicans want all Americans to have access to the COVID-19 vaccine, including
inmates during the 30-day period before their release. But why is Medicaid coverage for inmates
30 days prior to release necessary? Also, bow long will it take prisons and jails to have the
administrative capacity to hill Medicaid, and will prisons need additional resources to do so? If
the Committee followed regular order, some of these questions could have been answered.
Section 3104. Enhanced Federal Medicaid Support for Bundled Community-Based Mobile
Crisis Intervention Services.
This section is another partisan disappointment. The Democrats never explained how
this section will provide immediate relief to those suffering from COVID-19' s devastating
impact on mental health or SUD. CBO indicated that only 16 states have programs that would
immediately qualify for this provision, suggesting the limited impact this provision will have on
addressing nationwide mental health and SUD impacts from COVID-19. 18 Republicans believe
that tailoring a policy like the one in section 3108 for mental health and substance use providers
would have been a better way to provide immediate relief for the next year.
Section 3105. Temporary Increase in FMAP for Medical Assistance Under State Medicaid
Plans which Begin to Expend Amounts for Certain Mandatory Individuals.
lncentivizing states to expand Medicaid to address COVID-19 is a mistake. It is neither a
targeted nor a timely approach to continue the fight against COVID. We understand the need to
provide Americans access to affordable health insurance options, but, at a minimum, it takes
17
Congressional Budget Office, Reconciliation Recommendations ofthe }fouse Committee on Energy and Commerce.
Febmary 14. 202 L https://www.cbo.gov/systcm/files/2021-02/EnergyandComrncrccReconciliationEstimate. pdf.
18
Congressional Bndge1 Office, Reconciliation Recommendations ofthe !louse Committee on Energv and Commerce1
Febmary 14, 2021, https://www.cbo.gov/system/files/2021-02/EnergyandCommerceReconciliationEstimate.pdf.
6
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several months to expand Medicaid. 19 Republicans believe that any COVlD-19 relief package
should aim to end the pandemic in weeks now that a vaccine is available. The $16 billion cost
associated with this policy should be targeted to immediate COVID-19 relief for Medicaid
providers who are working with the most at risk beneficiaries, including SUD, mental illness,
hospitals in rural areas, and nursing homes.
Section 3106. Extension of 100 Percent Federal Medical Assistance Percentage to Urban
Indian Health Organizations and Native Hawaiian Health Care Systems.
Republicans would have preferred to consider this section through regular order to ensure
that there are proper reporting and data requirements on the impact of the policy given that it is
only a two-year extension.
Section 3107. Sunset of Limit on Maximum Rebate Amount for Single Source Drugs and
Innovator Multiple Source Drugs.
Including this provision in this partisan package is another disappointment Republicans
have supported this policy to pay for a permanent option for states to provide Medicaid coverage
to women for 12 months after bi1ih. That was the bipartisan approach taken in HR. 4996, the
Helping MOMS Act of 2020, which passed the House unanimously in the 116th Congress. But
including this spending offset to fund unnecessary spending unrelated to the COVID-19 fight
will only make it harder to enact pemianent needed support for new mothers who rely on
Medicaid.
Section 3108. Additional Support for Medicaid Home and Community Based Services
During the COVID-19 Emergency Period.
This is another provision that could have been done through regular order, but instead,
Democrats chose partisansh.ip. Republicans support a temporary FMAP increase of 7.35
percentage points for states to make improvements to Medicaid home- and community-based
services (HCBS) for one year. However, the Democrats would impose a litany of required uses
of the funds, which are overly burdensome at a time when states Medicaid programs need
flexibility to target efficiently their response to COVID-19. Republicans recommend providing
states more flexibility on how to use those funds.
Section 3109. Funding for State Strike Teams for Resident and Employee Safetv in Nursing
Facilities.
Nursing homes have been devasted by COVID-19, and the pandemic has brought
attention to the need for improved infectious disease control at nursing homes. The Trump
Administration deployed "strike teams" to nursing homes starting in July, 2020, 20 and
Republicans support providing funding to continue this important initiative. However,
Republicans prefer that this funding be provided through emergency supplemental appropriations
9
https://www.kff.org/mcdicaid/issnc,bricf/status-of-statc-medicaid-cxpansion•dccisions•intcrnctive-map/.
'
20I ' ,, -1
~ 1 inst-co,· id- I 9.
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through regular order to ensure we have proper reporting and data on the impact of the policy
and its effectiveness.
Subtitle C: Budget Reconciliation Legislative Recommendations Relating to CHIP
Section 3201. Mandatory Coverage of CO VID-19 Vaccines and Administration and
Treatment Under CHIP.
Republicans want every American to have access to the COVJD-19 vaccine. We support
fully covering the cost to vaccinate CHIP beneficiaries for the length of the public health
emergency. However, the Democrats' partisan decision to extend that timeframe for a year is
not based on any data or technical assistance. Since the public health emergency will continue
through 2021, a better way would have been to see how the states are doing are at the end of the
year and adjust if needed.
Section 3202. Modifications to Certain Coverage Under CHIP for Pregnant and
Postpartum Women.
It is disappointing the Democrats chose to include a bipartisan priority in the partisan
package. As noted earlier, H.R. 4996, the Helping MOMS Act of 2020, passed the House
unanimously last year and is the same policy as section 3 l 02.
Subtitle D: Budget Reconciliation Legislative Recommendations Relating to Other
Provisions
Chapter l
Chapter l of Subtitle D is another disappointment and lost opportunity. Our concerns
with this chapter can be divided into two distinct categories: big-picture concerns and specific
policy choices reflected in the reported text, as well as those rejected by the votes of the
Democrats
Generally, the three sections in this Chapter are not consistent with the Democrats'
claims about what this bill does. Rather than providing the immediate aid the Democrats insisted
was essential for all Americans struggling with or vulnerable to COVID-19, the provisions
instead appear to craft long-term policies that deserved closer, deliberate attention.
To illustrate this overarching point, the authorized funding appropriated in sections 3301
and 3303 is not time limited it is supposed to "remain available until expended" and section
3302 makes its funding available until September 30, 2022 - a time frame exceeding current
predictions on the length of the pandemic in the United States. Moreover, none of the sections
reference the public health emergency related to COVID-19 that was issued by the Department
of Health and Human Services (HHS) and only section 3301 attempts to create a COVID-19
8
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nexus.
We believe the aid in this chapter would have been more efficiently and effectively
provided had the explicit statutory focus only been on directing actions necessary for the nation's
COVlD-19 response. Frustratingly, the Democrats were not interested in a bipartisan response
of targeted relief that was time-limited and tied directly to COVID-19.
Unfortunately, Chapter 1, particularly section 3301 and 3303, also was not considered
through regular order in the Committee. Regular order would have allowed careful review of the
scope and timing of these provisions. For example, it would have provided opportunity to adjust
the focus of Section 3301 to include increasing employment and economic opportunity, in
addition to technical assistance concerning air quality. Providing more scrutiny and opportunity
for improvement of the legislative language would have ensured resources are directed to the
most urgent economic impacts of the pandemic.
Beyond these overarching concerns, each of the three sections in this chapter contained
specific provisions that gave us pause.
For section 3301, the lack of meaningful Congressional input is concerning we should
have had more of a process to obtain assurances as to what this language intends and,
considering that these provisions could be in force for a few years, llllderstand what this language
might practically mean. These insights also are critical to conducting Congressional oversight on
the provisions, should they become enacted.
Another area of concern for us in section 3301 is its omission of health disparities of
certain workers related to COVID-19. Unemployment is well established as a risk factor for
elevated illness and mortality rates in epidemiological studies performed since the early 1980s.
In fact, the National Center for Health Statistics concluded that "children in poor families were
four times as likely to be in fair or poor health as children in families that are not poor." Most
significantly, as it relates to COVID-19 and the emergence of new more contagious variants,
Yale researcher Dr. William Gallo has stated in the past that late-career job loss results include
"substantial health consequences" and are a "potential risk factor for adverse vascular health
changes" -- the most troubling comorbidities threatening the survival of any person exposed to
the coronavirus.
The people made jobless via the White House executive orders in the first month of the
Biden Administration have been disregarded in these provisions. Our Democratic colleagues not
only rejected efforts to help these economically disadvantaged people, but their views were
punctuated by suggestions that welfare programs and green jobs for half the wages of their recent
employment should be an adequate replacement for these people. 2 1
°'"The average salary ofoil and natural gas workers is approximately $112,000, more than double the na1ional private-
sector average of $51,000. But oil and gas workers don't just make double that of the national awrage. They make
double that of wind and solar workers.
9
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Moving to section 3302, it provides $4.5 billion through the end of fiscal year 2022 for
the Low-Income Horne Energy Assistance Program (LlHEAP). This amount exceeds the entire
amount enacted for UHEAP in fiscal year 2021 just eight weeks ago ($3.75 billion). 22 In
addition, this funding is to be disbursed without regard to existing financial reasonableness
requirements placed on states for how much LIHEAP funding can be allotted at any one time.
As mentioned earlier, while we do not oppose addressing LIHEAP at this time, this scale of
spending should have been directly connected to COVID-l9, and adjusted to ensure it will do
what it is supposed to do, minimizing waste and abuse.
Section 3303 provides $500 million - for as long as it takes to spend it all - to a new
program to pay the water and wastewater bills oflow-incorne people. This $500 million amount
is in addition to the $638 million provided for a nearly identical purpose in the Consolidated
Appropriations Act, 2021. 23 Taken together, this eight-week total comes to $1.138 billion for
this new program $12 million more than the Federal government provided in capitalization
grants in fiscal year 202 l for all public water system infrastructure under the Drinking Water
State Revolving Loan Fund.
Of note, the biggest difference between the language in section 3303 and that from the
Consolidated Appropriations Act, 2021 is that section 3303 omits provisions encouraging HHS
to use its existing processes and procedures under L!HEAP to distribute this money to utilities
efficiently. This is an irnpo11ant omission. There was no Committee of review whether this
omission will create problems. For, example, because the language in the Consolidated
Appropriations Act, 202 l is only valid for that fiscal year and section 3303 is drafted to outlast
it, when section 3303 still has funding on October 1, 2021, HHS would be free to use whatever
process it wants to distribute the money, even ifit is untested or inefficient. This seems like a
recipe for potential waste and abuse; and only further reinforces why a targeted and temporary
program is the preferred way to handle this matter.
While President Biden and the Democrats should be focused on defeating COVID-19 and
rebuilding our economy, they are waging a war on fossil energy jobs that is resulting in
significant and negative disparate impacts in rural and low-income communities. Immediately
upon taking office, President Biden revoked the permit for the Keystone XL pipeline and
imposed a moratorium on oil and gas drilling on Federal lands and offshore waters. These
According to data from the U.S. Department of Labor's Bureau of Labor Statistics_ in 2()19 a worker installing solar
panels made an average of a little more than $21 an hour. Workers in oil and gas extraction made more than twice as
much, at an average of over $42 an hour.,.
https://thefederalistcom/2021/0l/27/bidens-green-energy-jobs-really-mean-no-encrgy-jobs-and-low-paying-energy-
jobs/
22 House Energy and Commerce Committee Republican Leader Cathy McMonis Rodgers se.nt a letter to the Office
of Management and Budget on Febmary 4_ 2021, requesting mt accounting of what funds have been expended already
in connection with the $3. 75 billion in LIHEAP funding from tl1e Consolidated Appropriations Act 2021. 0MB has
provided no response to that letter to date.
23 House Energy and Commerce Committee Republican Leader Cathy McMorris Rodgers sent a letter to the Office
of Management and Budget on Febrnary 4_ 202 l. requesting an accounting of what f,mds have been expended already
in connection witl1 the $618 million from the Consolidated Appropriations Act, 2021. 0MB has provided no response
to tliat letter to date.
10
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decisions will eliminate tens of thousands of jobs and deprive states of billions of dollars of tax
revenue to help pay for schools, hospitals, and government services.
Republicans offered several amendments to protect jobs, stimulate economic growth, and
provide mental health services for unemployed energy workers - particularly critical during the
global pandemic and economic downturn -- Democrats rejected them all.
In connection with Subtitle A, Rep. Mullin offered an amendment to increase funds for
community mental health block grants to strengthen mental health services in states that have
had unexpected jobs losses due to President Biden's Executive Orders. This Administration's
policies, such as implementing moratotia on oil and gas development and production, will put
tens of thousands of people in the energy sector out of work and deprive states of billions of
dollars in tax revenues. This amendment would have required the HHS Secretary to obligate 5
percent of the amounts under the mental health block grants to states suffering unemployment
from the Biden Administration's recent energy and climate executive orders. Every Democrat
rejected the Mullin amendment.
Rep. Annstrong offered an amendment to resume construction of the Keystone XL
pipeline and immediately put thousands of people back to work. This $1. 7 billion investment
would have created over 10,000 American union jobs and contributed billions to U.S. workers
through direct jobs in constmction and indirect jobs in hotels, restaurants, and thousands of
businesses across the country that were lined up to provide their services to help build the
project. This construction program was already underway when the Biden Administration
revoked their permit and eliminated thousands of jobs and over $3 billion in contracts that would
have gone to U.S. contractors and suppliers. Again, every Democrat rejected the Armstrong
amendment to authorize construction of the Keystone XL pipeline.
Rep. Duncan offered an amendment to prevent President Bi den from following through
on his campaign promise to ban hydraulic fracturing perhaps the most direct threat to our
economic security and national security. lfthe Biden Administration were to ban hydraulic
fracturing, this would eliminate millions of jobs across our American energy industry and our
economy. States and local governments, schools, hospitals, and community centers would be cut
off from billions of dollars in funding that currently comes from the oil and gas industry.
According to a recent study, 24 placing a moratorium on hydraulic fracturing would mean a $900
billion increase in U.S. household energy costs, $7.l trillion in potential losses to the U.S.
economy through 2030, and over 7 million fewer U.S jobs by 2022. Additionally, such a
moratorium would force the U.S. to import 40 percent of our oil and petroleum products and 29
percent of our natural gas by 2030. Again, every Democrat rejected the Duncan amendment.
We understand the importance of this package and wanted to support it, but defects such
as those outlined above and the unvvillingness of the Democrats to accept any of our ideas to
2
·• America ·s Progress al Risk:
An Economic Analysis of a Ban on Ft·acking and Federal leasing.for Natural Gas
and Oil Development, Amc1ican Petroleum Institute, ~ ~ 4 . : ± < J ! l \ ! i l l ! . :
Gas/Hvdraulic-F~Jl.20/fracki,w-ban-stud,-amcricas~
risl<.J>df'la=en&hash=l3423D13150A559H42D84D507F6EAB04A2312.J6.
11
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protect workers and focus the delivery of funding on those most in need leaves us no choice but
to oppose it.
Chapter 2
Section 3311. Funding for Consumer Protection Safety Fund to protect consumers from
poteutiallv dangerous products related to COVlD-19.
We are disappointed that the Democrats continued its partisan approach in drafting
section 3311, which is similar to the provisions of H.R. 8134, the Consumer Product Safety
Inspection Enhancement Act, a bill to authorize additional resources for the Consumer Product
Safety Commission (CPSC). During the 116th Congress, the Committee on Energy and
Commerce passed H.R. 8134 by a voice vote on September 24, 2020, and the bill passed the full
House of Representatives by a voice vote on September 29, 2020. Because of the Committee's
bipartisan efforts, an authorization for additional port inspection personnel for the CPSC was
included in division F, title X"X, ofH.R. 133, the Consolidated Appropriations Act of 2021,
enacted on December 27, 2020.
The Democrats ignored the bipartisan consensus recognizing the threat posed by the
People's Republic of China (PRC) and instead, allocated $50 million that are desperately
needed for the CPSC' s port inspection responsibilities to a Commission slush fund to be
used however the CPSC chooses and without regard for our bipartisan agreement.
We support enhancing our ports security and providing the necessary resources to do
so. In 2020, the House Republican China Task Force issued a report outlining many of the
Chinese Communist Party's (CCP) subversive acts against our country. The PRC is a threat to
our way of life. Resources are needed to enhance targeting, surveillance, and screening of
consumer products originating from China. But section 3311 includes new definitions like
"COVlD- l 9 products," which have not been vetted and may reach beyond the CPSC' s
authority.
Section 33 l l also includes new provisions that were not included in the 2020 bipartisan
agreement and that the Democrats never discussed with us. In particular, we are concerned that
authorizing the CPSC to undertake "enhanced monitoring of Internet websites" will distract the
Commission from its port inspection duties.
The CPSC does not need more full-time personnel surfing the Internet. The Commission
needs more personnel on the ground at ports, protecting us from dangerous products from the
CCP. These resources should be targeted on counterfeit and illicit products originating in the
PRC. In a January 24, 2020, report entitled "Combating Trafficking in Counterfeit and Pirated
Goods," the Department of Homeland Secmity (DHS) estimated that 100,000 packages that
12
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could harm or defraud our constituents arrive in Amelica every day from China and more than
85 percent of all contraband seized at our borders comes from China and Hong Kong.
There is another DHS report, "Operation Stolen Promise," which found that more than 50
percent of the nations' counterfeit COVID-19 products oliginate from China and Hong
Kong. And a recent article from Reuters found that Chinese internment camps in the Xinjiang
region force Uighur Muslims into labor camps and often shave the heads of women to use their
hair in products shipped to the U.S. We wrote to the CPSC about these Uighur women recently,
and the CPSC has acknowledged that it has not tracked this matter.
This section is a disappointment and a missed opportunity to continue our bipartisan
work to keep Americans safe from dangerous products from China.
Section 3312. Fnnding for E-Rate Support for Emergency Educational Connections and
Devices.
This section wastes $7.6 billion dollars in taxpayer funding for purposes that Congress
has already funded. It provides funding for schools and libraries to buy and distribute Wi-Fi
hotspots, modems, routers, and other devices for students to use for off-premise schoolwork.
This funding is duplicative of a cumulative $110 billion that Congress appropriated in 2020 to
the Department of Education to respond to the coronavims pandemic, and much of that money
remains unspent. It is irresponsible for Congress to appropriate more money for this purpose
before the existing money is spent and Congress can determine where, if any, there are
remaining gaps.
Besides the fact that Congress already appropriated money in the early days of the
pandemic for remote learning purposes, this program is also inconsistent with the President's
goal to reopen schools because it encourages the continuation of remote learning. Similarly, it
conflicts with the Administration's Centers for Disease Control and Prevention guidance, which
states that it is safe for schools to reopen and that they should do so as quickly as possible.
In addition, and contrary to claims from the Democrats, section 3312 does nothing to
support the Federal Communications Commission's (FCC) E-Rate program. Rather, it creates a
new program with no rules, no requirements, and no oversight to track the devices once they are
given to students, or to verify eligibility and ensure that there is no double dipping at schools and
libraries. The statute also does not clearly state whether or not this funding is available only for
the duration of the COVID-19 pandemic, or until 2030, which is well beyond the scope of the
pandemic. This program is simply a vehicle for the Democrats to implement its longstanding
partisan policies endorsed by the teachers' unions rather than helping Americans.
During the Committee markup of this provision, Rep. Latta and Rep. Walberg offered
amendments that would provide long-term solutions to close the digital divide and incentivize
schools to re-open for in-person learning. To provide a permanent solution to close the digital
divide, Rep. Latta offered an amendment to redirect this funding to mral broadband deployment
in unserved areas. Rep. Walberg offered an amendment to put this money directly into the
existing E-Rate program at the FCC, which funds connections and certain technologies in
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schools and libraries where it is not economically feasible for carriers to otherwise serve.
Eligibility would have been contingent on schools and libraries being open 5 days per week. The
word "open" was not defined, which would ensure that schools and libraries had the flexibility to
follow appropriate CDC guidance to reopen safely. Both proposals were unanimously opposed
by the Democrats.
Section 3312 is another bad public policy and missed opportunity. The only way to close
the so-called "homework gap" is to invest in permanent broadband infrastructure that closes the
digital divide between urban and rural America once and for all. In order to recover from this
pandemic and ensure our students are not left behind, we need to focus on policies that reopen
schools and the economy as quickly as possible. We are disappointed the Democrats rejected
bipartisanship and again embraced a partisan process that will waste billions of dollars on
temporary, unreliable options such as hotspots, with no oversight and no accountability.
Cathy McMorris Rodgers Fred Upton
Ranking Member Ranking Member
Subcommittee on Energy
Robert E. Latta Brett Guthrie
Ranking Member Ranking Member
Subcommittee on Communications Subcommittee on Health
and Technology
David B. McKinley Gus M. Bilirakis
Ranking Member Ranking Member
Subcommittee on Environment Subcommittee on Consumer Protection
and Climate Change and Commerce
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CONTENTS
Page
I. Purpose and Summary
II. Background and Need for the Legislation
III. Committee Consideration
IV. Committee Votes
V. Oversight Findings
VI. New Budget Authority, Entitlement Authority, and Tax Expenditures
VII. Congressional Budget Office Estimate
VIII. Federal Mandates Statement
IX. Statement of General Performance Goals and Objectives
X. Duplication of Federal Programs
XI. Committee Cost Estimate
XII. Eannarks, Limited Tax Benefits, and Limited Tariff Benefits
XIII. Advisory Committee Statement
XIV. Applicability to Legislative Branch
xv. Section-by-Section Analysis of the Legislation
XVI. Changes in Existing Law Made by the Bill, as Reported
XVII. Additional Views
I. PURPOSE AND SUMMARY
Subtitle B: Budget Reconciliation Legislative Recommendations Relating to Medicaid
provides budget reconciliation recommendations related to the Medicaid program to the House
Committee on Budget pursuant to S. Con. Res. 5 to provide comprehensive relief to the
American people in response to the coronavirus disease of2019 (COVID-19) pandemic and the
resulting public health emergency (PHE).
Subtitle B requires Medicaid coverage of COVID-19 vaccines without beneficiary cost
sharing with a 100 percent federal medical assistance percentage (FMAP) through one-year after
the end of the PHE, as well as a 100 percent FMAP for vaccine administration. It requires states
to cover treatment for COVID-19 without cost sharing through one-year after the end of the
PHE. It also gives states the option to provide coverage to the uninsured for COVTD-19 vaccines
and treatment without cost sharing at 100 percent FMAP through the PHE.
The legislation provides Medicaid eligibility, for five years, to incarcerated individuals 30
days prior to their release; allows states the option to expand Medicaid coverage to women for 12
months postpartum; provides an enhanced FMAP for state Medicaid programs to cover mobile
crisis intervention services for individuals experiencing a mental health or substance use disorder
crisis; provides a temporary five percentage point increase to a state's base FMAP for two years
for a state that newly expands Medicaid; provides a two-year l 00 percent FMAP for services
provided to Medicaid beneficiaries receiving care through Urban Indian Organizations and
Native Hawaiian Centers; eliminates the cap on Medicaid drug rebates, sta1iing in calendar year
2023; provides a one-year temporary FMAP increase of 7.35 percentage points for states to
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spend on Medicaid home- and community-based services (HCBS). Finally, Subtitle D provides
funding to states to create nursing home strike teams to help facilities manage COVID-19
outbreaks.
II. BACKGROUND AND NEED FOR LEGISLATION
Since the first case ofCOVID-19 in the United States was discovered on January 21, 2020, 1
the United States response efforts have failed to mitigate or reduce COVID-19 transmission in
the country. As oflidjmary 8, 2021, more than 26 million Americans have been infected with
COVID-19, and mdr~than 462,000 people have died from the disease. 2
The most recent data shows that l O million Americans are still unemployed,' and there are
still 9.8 million fewer jobs in the US. economy than there were in February 2020, right before
the pandemic began. 4 In addition, non-universal take up of Medicaid expansion has left millions
of working-age adults uninsured. Nationally, there are an estimated 2 million uninsured
individuals who would gain coverage if their state expanded Medicaid. 5 The uninsured rate in
non-expansion states was 42.5 percent for unemployed adults, nearly double that in expansion
states, which stands at 22.6 percent. 6 Medicaid has been a critical safety net program helping
states respond to and mitigate the effects of COVID-19 and the economic downturn. Medicaid
enrollment grew by an estimated 7 million people as it helped to provide health insurance to the
millions of Americans who lost their jobs and employer-based health insurance. 7 States expect
these trends to continue into 2021, with many predicting enrollment growths of more than 8
percent this year. 8
The legislation would stren1,>then the ability for Medicaid to help millions of Americans
through numerous health coverage provisions intended to ensure that Americans get the health
care needed as a result of COVID-19 and the resulting economic downturn from the COVID-19
pandemic.
1
Centers for Disease Control and Prevention, First Travel-related Case o/'2019 novel Coronavirus Detected in
United States (Jan. 21, 2020) (www.cdc.govimedia/releascs/2020/p012!-novel-coronavims-travel-case.html)
(press release).
'Centers for Disease Control and Prevention, United Slates COHD-19 Cases and Deaths by State
(covid. cdc.gov/covid-data-tracker/#cases_ casesper lO0klast 7days) (accessed Feb. 9, 2021 ).
3
Bureau of Labor Statistics, 711E EMPLODIENT SITC'l110N J,LVUARY 2021 (Feb. 5. 202 l)
(www.bls.gov/news.release/pdf/empsitpdi) (press release).
4
The economy gained just ./9, 000 jobs in January as recove.1y sputters amid pressure from virus. Washington Post
(Feb. 6, 2021) (www. washingtonpostcom/bnsiuess/2021/02/05/january~iobs-report-202 l -uuemployment/).
'Kaiser Family Fom1dation, The Coverage Gap: Uninswred Poor Adults in States that Do Not Expand Medicaid
(Jan. 2 l. 2021) (www.leff.org/medicaid/issne-brief/the-coverage-gap-uninsnrcd-poor-adnlts-in-states-that-do-
not-cxpand-medicaidl).
'Id
'Center on Budget and Policy Priorities, Afedicaid Enrollment Still Rising (Nov. 10. 2020)
(www.cbpp.org/blog/mcdicaid-enrollment-still-rising).
8
Kaiser Family Foundation, Medicaid Enrollment & Spending Growth: FY 2020 & 202 I (Oct 14. 2020)
(www.kfforg/medicaid/issuc-bricf/mcdicaid-cnrollment-spending-growth-fy-2020-2021/),
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In addition, although federal legislation in previous COVID relief packages expanded access
to vaccines and treatment for COVID-19 free of cost-sharing, gaps in coverage remain both for
Medicaid beneficiaries and the uninsured. 9 The legislation takes concrete steps to address these
gaps and expand access to vaccination and treatment for COVID-19.
The legislation also includes measures to address the issue of COVID-l 9 in congregate
settings. COVID-19 has had a disproportionate impact on nursing home and other long-term
care facility residents and staff. 10 Six percent of all COVID-19 cases nationally and 38 percent
of deaths from the vims have been associated with long-term care settings. 11 The legislation
strengthens Medicaid home and community-based services (HCBS) and helps keep vulnerable
populations out of congregate settings and helps states establish strike teams to be deployed to
nursing facilities with diagnosed or suspected cases of COVID-19 among residents.
Finally, the legislation includes measures to address the ongoing issue of affordability in
prescription drug prices, as drug manufacturers continue to raise prices throughout the
pandemic. 12
III. COMMITTEE CONSIDERATION
The Committee on Energy and Commerce met in virtual open markup session, pursuant to
notice, on February 11 and 12, 2021During consideration of Subtitle Bon February 12, an
amendment in the nature of a substitute (AINS) offered by Ms. Eshoo was agreed to by a voice
vote, without amendment. During consideration of the AlNS, three amendments were offered to
the Eshoo AINS, but were not a1:,,reed to. Mr. Pallone, Chairman of the Committee, subsequently
moved that Subtitle B be ordered transmitted favorably to the House Committee on Budget,
amended, and the Committee on Energy and Commerce agreed to the motion by a record vote of
30 yeas to 25 nays, a quorum being present.
IV. COMMITTEE VOTES
Clause 3(b) ofmle XIII of the Rules of the House of Representatives requires the
Committee to list each record vote on the motion to report legislation and amendments thereto.
9
Kaiser Family Foundation, Gaps in Cost Sharing Protecrions for COnD-19 Testing and Treatment Could Spark
Puhlic Concerns About COVID-19 Vaccine Costs (Dec. 18, 2020) (www.kff.org/hcalth-costs/issuc-bricflgaps-
in-cost-sharing-protections0for-covid-l9-testing-and-treatment-could-spark-public-concems-about-covid-l9-
vaccine-costs/).
10
Kaiser Family Foundation_ Despite Fjforts 10 Slow the Spread of/he Virus in Long-Term Care Facilities, KFF
Analvsis Finds lvlany States Experienced the rViJrst COIJD-19 Outbreaks and Highest Number o_{Deaths in
December (Jan. 14. 202 l) (www.kff.orglcoronavims-covid-19/press-relcase/despitc-efforts-to-slow-the-
sprcad-of-the-virus-in-long-tcrm-care-facilitics-kff-analysis-finds-many-statcs-cxpericnced-the-worst-covid-
19-outbrcaks-and-highcst-number-ot~dcaths-in-dccember/).
"Id.
"46Brooklyn, Drugmakers break record for most January list price increases in a decade (Jan. 29, 2021)
(www.46brooklyn.com/news/ 1/29/2020/w hats-happening-to-gcneric-drug-prices:ian-2021-nadac-slllVey-
updatc-lunthw-yzegb-db9lb-pkwcs-tw4ya-ashth-rhlgc ).
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The Committee advises that there were four record votes taken on Subtitle B, including a motion
by Mr. Pallone orde1ing Subtitle B favorably transmitted to the House Committee on Budget,
amended. The motion ou final passage of the bill was approved by a record vote of30 yeas to 25
nays. The following are the record votes taken during Committee consideration, including the
names of those members voting for and against:
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iE0111111ittcc 011 Qfucrw aub (Commcrrc
117th Congress
Full Committee
(ratio: 32-26)
ROLL CALL VOrE#]4
Bill Subtitle B, "Budget Reconciliation Legislative Recommendations
Relating to Medicaid"
Motion: An amendment to Subtitle B by Mr. Scalise of Louisiana, No. 2, to
decrease the Federal medical assistance percentage by one percentage
point for a state Medicaid program during the period which the State
Attorney General of such State finds the State department of health
undercounted the number of deaths of residents of nursing facilities.
Disposition: NOT AGREED TO by a roll cal! vote of26 yeas to 30 nays
REPRESENTATIVE YEAS NAYS PRESENT REPRESENTATIVE YEAS N A Y ~
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep Burgess X
Rep. DeGette Ren. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Ren. Castor X Rep Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Ren. Welch X Ren Long X
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Ren. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Rep. Peters X Rep Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Ren. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin Ren. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
Rep. O'Halleran X
Rep. Rice X
Rep Craig X
Rep. Schrier X
Rep. Trahan X
Rep. Fletcher X
02/1212021
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209
~oum1lttl'l' on QEncrqr. aub (!Commerce
117th Congress
Full Committee
/rati(}: 32-26)
ROLL CALL VOTE#! 5
Bill Subtitle B, "Budget Reconciliation Legislative Recommendations
Relating to Medicaid"
Motion: An amendment to the amendment in the nature of a substitute, offered by
Mr. Burgess of Texas, No. 1a, to pennanently authorize a state plan option
to extend Medicaid eligibility for 12 months postpartum.
Disposition: NOT AGREED TO by a roll call vote of26 yeas to 30 nays
E YEAS NAYS PRESENT YEAS NAYS PRESENT
. Pallone X Rep. Rodgers X
Rush X Rep. Unton X
. Eshoo X Rep. Burgess X
. DeGette Rep. Scalise X
Doyle X Rep Latta X
. Schakowsky X Rep. Guthrie X
. Butterfield X Rep. McKinley X
Matsui X Rep. Kinzinger X
Ren. Castor X Rep. Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Rep Welch X Rep. Long X
men. Tonko X Rep. Bucshon X
Rep Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter X
Re . Peters X Ren. Duncan X
. Dingell X Rep. Palmer X
. Veasey X Rep. Dunn X
ep. Kuster X Rep. Curtis X
ep. Kelly X Rep. Lesko X
ep. Barragan X Rep. Pence X
iM~ohh•
. Blunt Rochester
. Soto
X
X
Rep Crenshaw
Rep. Joyce
Rep. Armstrong
X
X
X
. O'Halleran X
. Rice X
. Craig X
p. Schrier X
IRep. Trahan X
Rep. Fletcher X
02112/2021
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210
Qi:onnnittcc on Q:.ucrgp anb -<!Couuncrcc
117'" Congress
Full Committee
(ratio: 32-26)
ROLL CALL VOTE#l6
Bill: Subtitle B, "Budget Reconciliation Legislative Recommendations
Relating to Medicaid"
Motion: An amendment to the amendment in the nature of a substitute, offered by Mr.
Burgess of Texas, No. lb, to direct the Secreta,y of Health and Human Services
to issue and disseminate guidance to states to increase access to telchealth in
Medicaid. It requires the Medicaid and CHIP Payment and Access Commission
to issue a report to Congress to health care access, utilization. cost, and
outcomes. It requires a report by the Comptroller General with recommendations
on expanding access to tclehcalth in Medicaid.
Disposition: NOTAGREEDT oil call vote of 25 veas to 30 nays
Ren. Pallone X Ren. Rodgers X
Ren Rush X Ren. Unton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
ep. Doyle X Rep.Latta X
.en. Schakowskv X Rep. Guthrie X
en. Butterfield X Ren. McKinlev X
en. Matsui X Rep. Kinzinger X
en. Castor X Rep Griffith X
en. Sarbanes X Reo. Bilirakis X
eo. McNemev X Reo. Johnson X
ep. Welch X Rep. Long X
ep. Tonko X Rep. Bucshon X
ep. Clarke X Rep. Mullin X
Rep. Schrader X Rep Hudson X
Ren. Cardenas X Ren. Walberg X
Ren. Ruiz X Ren Carter
Ken Peters X Ren. Duncan X
Reo. Dingell X Reo. Palmer X
Reo Veasey X Reo Dunn X
Rep. Kuster X Rep. Curtis X
Rep Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin Rep. Crenshaw X
Ren Blunt Rochester X Reo. Joyce X
Reo. Soto X Ren. Arm strong X
Reo O'Halleran X
Ren. Rice X
Reo. Craig X
Rep Schrier X
Rep. Trahan X
Rep Fletcher X
02/12/2021
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211
~ommtttcc on <!En.trgp anb 1£:ommcrcc
117th Congress
Full Committee
(ratio: 32w26)
ROLL CALL VOTE#l7
Bill Subtitle B, "Budget Reconciliation Legislative Recommendations
Relating to Medicaid"
Motion: A motion by Mr. Pallone of New Jersey to order Subtitle B, "Budget
Reconciliation Legislative Recommendations Relating to Medicaid"
reported favorably to the House Committee on Budget, amended (Final
Passage).
Disposition: AGREED TO by a roll call vote of 30 yeas to 25 nays
PRESENTATIVE YEAS NAYS p ESENTATIVE YEAS NAYS PRESENT
. Pallone X odgers X
. Rush X Upton X
Rep. Eshoo X ep. Burgess X
Rep. DeGette ep. Scalise X
Rep. Doyle X ep. Latta X
Rep. Schakowsky X e . Guthrie X
Rep. Butterfield X . McKinley X
Rep. Matsui X . Kinzinger X
Rep. Castor X . Griffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNerney X Rep. Johnson X
Rep. Welch X Rep.Long X
Rep. Tonko X Rep. Bucshon X
Rep. Clarke X Rep. Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep.Kelly X Rep. Lesko X
I
Ren. Barragan X Rep. Pence X
Rep. McEachin Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Armstrong X
X
OHslle<so
. Rice X
. Craig X
. Schrier X
Trahan X
. Fletcher X
02/1212021
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February 2021
Fact Sheet on House's Reconciliation Package & the
Biden Administration's COVID-19 American Rescue Plan
COMMITTEE ON ENERGY & COMMERCE
The Fiscal Year 2021 Reconciliation Act pots into action the policies and budgetary requests outlined
by the Biden Administration's American Rescu~ PIAn.
VACCINES:
The American Rescue Plan calls for the establishment of a national vaccination program, and this
legislation provides critical funding and resources to increase COVID-19 vaccinations across the
country.
• Many states have struggled to distribute vaccines after the Trump Administration chose to defer almost
entirely to the states to distribute and administer all vaccines.
• The American Rescue Plan requests $20 billion for improving COVID- l 9 vaccine administration and
distribution, including vaccination clinics and mobile vaccination units, a vaccine awareness campaign,
and increasing the Federal Medical Assistance Percentage (FMAP) to Medicaid-covered recipients of a
vaccine. It also requests over $5 billion for research, development, and manufactming of vaccines,
therapeutics, and ancillary supplies.
• Specifically, the Fiscal Yea,· 2021 Reconciliation Act provides:
o $7.5 billion for Centers for Disease Control and Prevention (CDC) to prepare, promote, distribute,
administer, monitor, and track COVID-19 vaccines. This includes distribution and administration,
support for state, local, tribal, and territorial public health departments, community vaccination
centers, IT enhancements, facility enhancements, and public communication;
o $600 million to be directed to the Indian Health Service (IHS) for vaccine-related activities;
o $5.2 billion to the Biomedical Advanced Research and Development Authority (BARDA) to
support advanced research, development, manufacturing, production, and purchase of vaccines,
therapeutics, and ancillary medical products for COVlD-19;
o $1 billion for the CDC to undertake a vaccine awareness and engagement campaign;
o $500 million for the Food and Drug Administration (FDA) to support the review, facilitate the
development of, and post-marketing surveillance of COv1D-19 vaccines and therapeutics and
address drug shortages, among other activities; and
o Medicaid coverage of COVID-19 vaccines, including the option for states to provide coverage to
the uninsured, without cost sharing at 100 percent FMAP for the duration of the public health
emergency.
TESTING:
The American Rescue Plan proposes scaling np testing in order to stop the spread of COVTD-19, safely
reopen schools, and protect at-risk populations. A robust testing program remains a critical tool in the
Prepar~d by the Comrnitt~~ on Energy and Cornrnerce
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213
fight against this virus in conjunction with vaccinations. This legislation provides the funding and
resources to do just that
• Despite innovations and adaptations in the testing space, COVID-19 tests are still not widely accessible,
and supplies continue to be in shortage.
• According to a Government Accountability Office (GAO) report from November 202Q, a national survey
to states and territories found that 21 states reported shortages of testing reagents, 16 states reported
shortages of testing instruments, and 24 states reported shortages of rapid point-of~care tests in the 30 days
prior to the report's release, and those same states predicted shortages would continue through the winter
months.
• The American Rescue Plan requests $50 billion for testing related resources and activities, including
procurement and administration of regular screening tests, and investments in United States laboratory
capacity for diagnostic and screening tests.
• The Fiscal Year 2021 Reconciliation Act provides:
o $46 billion for testing, contact tracing, and mitigation. These activities include: implementing a
national strategy for testing, contact tracing, surveillance, and mitigation; providing technical
assistance, guidance, support, and grants or contracts to States; manufacturing, procurement,
distribution, administration of tests, including personal protective equipment (PPE) and supplies
necessary for administration; and establishing and expanding federal, State, or local testing and
contact tracing capabilities, including investments in laboratory capacity, community-based testing
sites, and mobile testing units;
o $1.5 billion for IHS testing, tracing, and mitigation needs;
o $1.75 billion for genomic sequencing and surveillance of the circulating strains ofCOVlD-19.
There are currently m ~ ~ . some of which have recently
emerged in the Uni1ed Stat~; and
o $500 million to allow CDC to establish, expand, and maintain data surveillance and analytics,
including to modernize the United States' disease warning system to forecast and track hotspots
for COVlD-19.
PUBLIC HEALTH WORKFORCE:
The American Rescue Plan calls for the mobilization of a public health jobs program to support the
COVID-19 response.
• The Fiscal Year 2021 Reconciliation Act provides:
o $7.6 billion in funding to public health depmtments to hire 100,000 full time employees into the
public health workforce. These positions would include contact tracers, social support specialists,
community healtb workers, public health nurses, epidemiologists, lab personnel, and
communications. Funds would also support PPE, technology, data management, supplies, and
reporting;
o $240 million for !HS public health workforce needs: and
Prf"p.ared by the Comr:'iitt~e on fnergv and Cornmerc~
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214
o $100 million to suppo1t the Medical Reserve Corps, which consists of a network of volunteer
medical and public health professionals that support emergency response efforts and community
health activities.
HEALTH DISPARITIES:
The American Rescue Plan includes funding to provide health services to the underserved and
addressing ongoing health disparities.
• COVID-19 has l,tid bill:£ the harsh realities of health disparities in the United States. For instance, Black
and Hispanic Americans are e v ated t si ifi n l w than White Americans, a trend
that advocates blame on the federal government's failure to prioritize equitable distribution. Communities
of color are · V
;&a result.
• The Fiscal Year 2021 Reconciliation Act provides a total of $25.2 billion for addressing health disparities
and protecting vulnerable populations, including:
o $250 million for nursing home strike teams to help facilities manage COVID-19 outbreaks when
they occur;
o $7.6 billion in funding to support COVID-19 response at Community Health Centers;
o $1.8 billion to support the purchase, procurement, or distribution ofCOVID-19 test and testing
supplies, PPE, and vaccines for staff and individuals in congregate settings. This would include
support to states, localities, territories, and tribes for strategies and activities to detect, diagnose,
trace or monitor COVID-19 in congregate settings, including p1isons, jails, detention centers, long-
term care facilities, psychiatric hospitals and residential treatment facilities, intermediate care
facilities, and other settings providing care for individuals with disabilities;
o $3.3 billion to lHS in flexible funding to support lost third-party revenue, infonnation technology
infrastructure for telehealth and electronic health records, urban Indian organizations, and other
health services and costs;
o $800 million to the National Health Service Corps to support primary health care clinicians in
high-need areas;
o $331 million for Teaching Health Centers to expand the number of sites nationwide, increase
resident allocations, and provide administrative support for expanding the program;
o $240 million to support the Nurse Corps Loan Repayment program, which helps support nurses
working in critical shortage and underserved areas;
o A Medicaid state option to allow states to cover postpartum women for 12 months after birth, to
help address the maternal mortality crisis disproportionately affecting women of color; and
o Medicaid coverage for incarcerated individuals 30 days prior to their release, to ensure continuity
of care for justice-connected individuals.
MENTAL HEALTH:
The American Rescue Plan proposes scaling up mental health services, inclnding to expand access to
behavioral and mental health prevention and treatment.
Prep.ued by tht.., Commiltc-e c,n Eneqw and Commt•ro2
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215
• The Fiscal Year 2021 Reconciliation Act provides a total of $4 billion for behavioral and mental health
services. including:
o $3.5 billion for the Substance Abuse and Mental Health Services Agency (SAMHSA) to be split
between the Substance Abuse Prevention and Treatment and Community Mental Health block
grant programs. Both programs provide funding to all 50 States, the District of Columbia, Pue1to
Rico, the United States Virgin Islands, and six Pacific jurisdictions. The Substance Abuse block
grant program also supports one tribal entity, the Chippewa Tribe;
$420 million will be made available to lHS for mental and behavioral health prevention and
treatment services;
o $100 million to the Behavioral Health Workforce Education and Training Program within the
Health Resources and Services Administration (HRSA) to expand access to behavioral health
services by focusing on training behavioral health paraprofessionals, such as peer support
specialists;
o $140 million to develop a program for mental and behavioral health and to prevent burnout among
health care providers and public safety officers, including training and outreach;
o $80 million to provide support for mental health and substance use disorder services at
community-hased entities and behavioral health organizations;
o $10 million to support the National Childhood Traumatic Stress Network, which works to develop
and promote effective community practices for children and adolescents exposed to a wide array of
traumatic events; and
o $50 million to Suicide Prevention and Project Aware programs at SAMHSA, which support youth
mental bealth services and suicide prevention efforts.
HEALTH COVERAOE:
The American Rescue Plan commits to preserving and expanding access to health care coverage during
the pandemic.
• Between March and September of 2020, [Q!L!l,!,lv 2 to :J milliQ!l people lost employer sponsored health
insurance.
• Prior to that, o!Y-..lli.Vll>L!l.!lS'4L'-"already lacked coverage, barring them from accessing the health care
system from pandemic.
• The Fiscal Year 2021 Reconciliation Act provides a number of complementary provisions to make
coverage more affordable and accessible to millions of Americans by:
o Expanding Affordable Care Act (ACA) Marketplace premium tax credits to more middle-class
Americans for 2021 and 2022, including those with incomes above 400 percent of the federal
poverty line (FPL).
o Allowing individuals receiving unemployment compensation during the public health emergency to
access ACA premium tax credits regardless of income.
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216
o Providing a new incentive for states to expand Medicaid by temporarily increasing the federal
medical assistance percentage by five percentage points. If all 12 remaining states expanded
Medicaid, more than two million people currently in the coverage gap would gain access to
Medicaid.
o Ensuring that workers can continue to afford their employer health care by providing partial
COBRA subsidies. COBRA allows workers who experience layoffs or reduction in hours to
continue with their job-based health coverage for a limited period of time to avoid a disruption in
care.
CONSUMER £jVER(iYAND WATER ASSISTANCE:
The American Rescue Plan helps Americans who are struggling to make ends meet keep the lights on,
the heat working and the water running by proposing $5 billion in assistance.
• Energy access is crucial to residential health and to sustaining socially-distanced and remote work
lifestyles.
• Unpaid electric and natural gas bills were expected to reach $32 billion by the end of 2020, with an
estimated 20 percent of residential customers at least 60 days behind on their bills. A projected five
million additional households are eligible for energy assistance due to pandemic-related job losses.
• Households in California and Virginia, two states that are tracking water debt, are facing more than $1
billion and more than $88 million, respectively, in unpaid water bills. These debts threaten the long-term
viability of municipal water utilities and raise the risk of interruptions in water service, which is essential
to maintain hygiene during the Covid-19 pandemic.
• The Fiscal Year 2021 Reconciliation Act provides $5 billion to those most in need to pay their utility
bills at a time when so many Americans are spending unprecedented amounts of time at home,
including:
o $4.5 billion to the Department of Health and Human Services (HHS) for home energy assistance
through the Low-lncome Home Energy Assistance Program (LlHEAP); and
o $500 million in additional funds for HHS for the Low-Income Household Drinking Water and
Wastewater Emergency Assistance Program established by Congress at the end of 2020. This
brings the total amount of money available to assist families with their water and sewer bills to over
$11 billion.
POLLUTION AND THE PANDEl\JIC:
The Fiscal Year 202 l Reconciliation Act helps address health outcome disparities from pollution and
the COVID-19 Pandemic.
• Recent work by GAO found that our national air monitoring network infrastructure is aging and needs to
be modernized to identify localized pollution that threatens environmental justice communities.
• The Fiscal Year 2021 Reconciliation Act provides the Environmental Protection Agency (EPA) with
$100 million to address health outcome disparities from pollution and the COVID-19 pandemic:
o $50 million to EPA for environmental justice grants and activities to help communities facing a
disproportionate burden of pollution and disease; and
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217
o $50 million to EPA for air quality monito1ing grants and other purposes.
REMOTE LEARNING:
The American Rescue Plan will help bridge the digital divide for students and teachers withont home
internet access.
• To keep communities safe and prevent further spread of COVID-19, schools need the flexibility to engage
in remote learning when necessary for public health and safety.
• Studies estimate that as many as 12 million students still lack internet service at their homes, with
minorities and those in rural areas most often among the unconnected. Without a reliable internet
connection to log into classes. submit work, and engage with teachers and other students, these students
have fallen even further behind in school.
• The Fiscal Year 2021 Reconciliation Act provides $7.6 billion to expand internet connectivity to
students and communities by:
o Reimbursing schools and libraries-central points for connectivity in many communities-to
purchase equipment such as hotspots. internet service, and computers on behalf of students and
patrons; and
o Ensuring schools and libraries can quickly access this critical funding by relying upon the Federal
Communications Commission and its E-rate program to administer the funds.
CONSUMER PROTECTION:
The Fiscal Year 202 l Reconciliation Act will make Americans safer in their homes by reducing the
number of unsafe imported consumer products.
• More than $174 billion spent by consumers online can be attributed to COVfD-19-related boosts in online
shopping with online spending jumping 44 percent in 2020 compared with 2019.
• The Consumer Product Safety Commission (CPSC) has not been able lo keep pace with changing
consumer trends brought on by the pandemic, including the substantial shift to online shopping and the
influx of e-commerce shipments from foreign countries. The CPSC does not have enough funding to
adequately staff United States polis of entry, leaving already struggling families vulnerable to risk of
injury or death from uninspected consumer products, especially in-demand COVID-19 products.
• The Fiscal Year 2021 Reconciliation Act provides $50 million for the CPSC to ensure the safety of
consumer products entering our country and into people's homes - an essential priority during the
COVID-19 pandemic.
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V. OVERSIGHT FINDINGS
Pursuant to clause 3(c)(l) of rule XIII and clause 2(b)(l) of rule X of the Rules of the House
of Representatives, the oversight findings and recommendations of the Committee are reflected
in the descriptive portion of the report.
VI. NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX
EXPENDITURES
Pursuant to 3(c)(2) of rule XIII of the Rules of the House of Representatives, the Committee
adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures
or revenues contained in the cost estimate prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act of 1974.
VII. CONGRESSIONAL BUDGET OFFICE ESTIMATE
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219
Congressional Budget Office February 14, 2021
Cost Estimate
Reconciliation Recommendations of the House Committee on Energy
and Commerce
As ordered reported on February 12, 2021
By Fiscal Year, Million• of Dollars 2021 _ _ _ _2021-2030 .. ···-·-··--· ~0?1:?0~1__ _
Direct Spending iOutlays) 27,498 126,130 123,827
Revenues 0 1,474 1,488
Increase or Decrease(·)
in the Deficit
8\llfu\t)(Y pay'as:yt\u'QO
27,498
• Ya•
---,~-~... -.----.-,,.--~.
124,656
--
Mande,te Effecis .
122,339
~c11aures apP.lf? . · '·•\\'':-..•;'.
N~
.1111.resses ~n-bodg~t dell~s in any
Iyeacaiter 2oao? . ·
;:·\. \ >, :'/, .·:, "'. ',. ';:':~<'·.·j <\\ :.,
. ! CQRlalns Rriv~te.,se~tor ffi!Uldat~~.
~~.? hasmll ~viewed ttie l~gi&llll!on for effect!, OR ~~6iriQ l!li.~eµ! \<, appropi-itltilin •••.·
The legislation would
• Appropriate $105 billion for various activities related to testing for, treating, and responding to COVID-19
(the disease cause by the coronavirus); and for other activities related to COVID-19
• Allow extended postpartum coverage in Medicaid and the Children's Health Insurance Program (CHIP)
• Increase the federal medical assistance percentage (FMAP) to encourage states to expand Medicaid
coverage and increase their provision of certain types of long-term services and supports
• Eliminate the cap on rebates that drug manufacturers pay to Medicaid
• Increase the cost of an existing private-sector mandate on certain commercial entities if the Federal
Communications Commission increases annual fee collections
Estimated budgetary effects would mainly stem from
• Increased direct spending resulting from $105 billion in new budget authority
• Additional direct spending from increasing the number of months of postpartum coverage under
Medicaid and CHIP
• Increased Medicaid and CHIP spending on COVID-19 vaccines, new enrollees, services for inmates in
jails and prisons, and long-term services and supports
• Reduced Medicaid spending on prescription drugs
Areas of significant uncertainty include
• Estimating the rate at which the new budget authority would be spent by federal agencies
• Predicting how many women would participate in postpartum coverage under Medicaid and CHIP
• Estimating how many states would expand Medicaid coverage as the result of higher FMAPs
• Estimating future growth in drug prices
Detailed estimate begins on the next page,
See also CBO's Cost Estimates Explained, VN,"N.cbo.govtpublication/54'437;
How CBO Prepares Cost Estimates, www.cbo.gov/pc,bltcat,onl53519; and Glo•.ary, wNw.cbo govlpublication/42904.
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220
Summary of the Legislation
S. Con. Res. 5, the ConcmTent Resolution on the Budget for Fiscal Year 2021, instructed
several committees of the House of Representatives to recommend legislative changes that
would increase deficits up to a specified amount over the 2021-2030 period. As part of this
reconciliation process, the House Committee on Energy and Commerce approved legislation
on February 12, 2021, v,,ith a number of provisions that would increase deficits.
The legislation would appropriate $92.2 billion for various activities related to testing for,
treating, and responding to COVID-19, the disease caused by the coronavirus. The legislation
would also make changes to the Medicaid program and the Children's Health Insurance
Program (CHIP), which include expanding coverage for women after the birth of their child,
encouraging states that have not already done so to expand Medicaid coverage to adults made
eligible by the Affordable Care Act (ACA), and eliminating the limit on the rebates paid by
drug manufacturers to Medicaid. Finally, the legislation would appropriate $12.8 billion for
various activities related to addressing the energy, environmental, educational, and
commerce-related effects of the coronavirus pandemic.
Estimated Federal Cost
The estimated budgetary effects of the reconciliation recommendations of the House
Committee on Energy and Commerce are shown in Table l. The costs of the legislation fall
within budget functions 300 (natural resources and environment), 370 (commerce and
housing credit), 500 (education, training, employment, and social services), 550 (health), and
600 (income security).
Basis of Estimate
For this estimate, CBO assumes that the reconciliation bill will be enacted by the end of
March 2021. Outlay estimates are based on historical spending patterns for affected programs
and inforrnation from the agencies about program implementation.
Direct Spending and Revenues
CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting the
reconciliation recommendations of the House Committee on Energy and Commerce would
increase direct spending by $126. l billion and would increase federal revenues by
$ l.5 billion over the 2021-2030 period, for a net effect on the deficit over that period of
$124. 7 billion.
Funding for Public Health. Subtitle A would appropriate $92.2 billion for various activities
aimed at improving public health and responding to COVID-19.
Within subtitle A, Chapter l would provide $14.2 billion to fund activities related to
vaccination and treatment with the follov,,ing specific appropriations:
• $7.5 billion to the Centers for Disease Control and Prevention (CDC) to plan, prepare for,
promote, distribute, administer, monitor, and track COVID-19 vaccines;
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• $1.0 billion to the CDC to improve vaccine education and confidence and vaccination
rates;
• $5.2 billion to the Secretaiy of Health and Human Se1vices (HHS) to advance research,
development, manufacturing, production, and the purchase of vaccines, therapeutics, and
ancillary medical products to prevent, prepare, and respond to SARS-CoV-2, COVID-19,
or any disease with potential for creating a pandemic; and
• $0.5 billion to the Food and Dmg Administration to oversee the development and
marketing of COVID-19 therapeutics, vaccines, and diagnostic tests.
Chapter 2 would provide $49.0 billion for testing for COVID-19, specifically appropriating:
• $46.0 billion to the Secretaiy of HHS to detect, diagnose, trace, and monitor COVID-19
infections;
• $ 1.8 billion to the CDC for genomic sequencing, aimlytics, and disease smveillance;
• $0.8 billion to the CDC to combat COVID-19 and other emerging infectious threats
globally; and
• $0.5 billion to the CDC to support the sU1Veillance and analytic infrastmcture of public
health data.
Chapter 3 would provide $7.8 billion for strengthening the public health workforce with two
specific appropriations:
• $7.7 billion for state, local, and territorial public health departments to establish, expand,
and sustain their public health workforce; and
• $0.l billion to the Medical Reserve Corps.
Chapter 4 would provide $11.2 billion for other public health investments that specifically
cover:
• $7.6 billion for awarding grants and cooperative agreements to community health centers
and qualified entities under the Native Hawaiian Health Care Improvement Act to suppmt
activities related to testing for, treating, and vaccinating against COVID-19;
• $0.8 billion to the National Health Service Corps to suppmt qualified health cai·e
providers working in areas with limited access to care;
• $0.2 billion to the Nurse Corps to suppo1t nurses working in facilities that provide
primaiy health care or maternal health care to underserved populations;
• $0.3 billion to health centers that provide graduate medical education;
• $1.8 billion for activities related to testing, tracing, and mitigating COVID-19 infections
in congregate settings; and
• $0.4 billion for HHS to provide services for children under its care, including
1maccompanied alien children in the custody of the Office of Refugee Resettlement.
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Chapter 5 would provide $6.1 billion to the Indian Health Service (IHS) for lost
reimbmsements resulting from people defening routine and elective health care, testing and
tracing of COVID-19 infections, COVID-19 vaccine promotion, distribution and
administration, additional support for purchased and refened care, and for other purposes.
Chapter 6 would provide $3.9 billion to strengthen activities related to mental health and
substance abuse, specifically appropriating:
• $1.8 billion to the Secretary of HHS for community mental health services;
• $1.8 billion to the Secretary of HHS for activities relating to the prevention and treahnent
of substance abuse;
• $0.1 billion for the Health Resources and Services Administration (HRSA} to award
grants to eligible institutions that provide mental and behavioral health education and
training; and
• $0.3 billion for other activities.
Chapter 7 would appropriate $20 million to HHS for grants to eligible states to modernize the
health insmance marketplaces established under the ACA.
In total, CBO estimates that the funds appropriated by subtitle A would increase direct
spending by $91.3 billion over the 2021-2030 period.
Coverage of COVID-19 Vaccinations and Treatments. Subtitles B and C would make
various changes to the Medicaid and CHIP programs' coronavirus-related spending. In total,
sections 3101 and 3201 would increase direct spending by an estimated $1.1 billion and
$68 million, respectively, over the 2021-2030 period.
Mandatory Coverage of COV!D-19 Vaccination, Without Cost Sharing Sections 3101 and
3201 would require state Medicaid and CHIP programs to cover vaccinations, without cost
sharing, for all eligible enrollees. Under cunent law, the federal government is expected to
provide the vaccines administered through both programs, but some patients would still have
to pay the cost sharing associated with having the vaccine administered. In addition, if a
state implements an option under Medicaid to provide COVID-19 testing for uninsured
people, it would have to do so without cost sharing. The sections also would extend for a year
the period in which a state must vaccinate, without cost sharing, adults enrolled in Medicaid
under the program's traditional eligibility rules.
CBO estimates that 4 million Medicaid and CHIP enrollees are currently ineligible for
vaccination under either program. By the end of the public health emergency (PRE}, CBO
estimates, fewer than l million adults enrolled under Medicaid's traditional eligibility rules
would be subject to cost-sharing requirements to receive the vaccine.
If enacted, C BO estimates, the requirements in sections 3 10 l and 3 20 I would increase the
number of vaccinations administered to Medicaid and CHIP enrollees by about 2 million
doses in 2021 and by about 6 million over the 2021-2023 period. Because the federal
government is expected to provide the vaccine itself, sections 3101 and 3102 would only
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affect the costs associated with administe1ing the vaccines. Using info1mation from the
Centers for Medicare & Medicaid Services, CBO estimates that in 2021, the cost of
administering a single dose will vaiy between $17 and $28, depending on the type of vaccine.
Over the 2021-2030 period, CBO estimates, the requirement to provide vaccination coverage
without cost sharing would increase Medicaid's direct spending by $107 million a11d CHIP's
by less than $1 million.
Increased Federal Medical Assistance Percentage for Vaccinations. Sections 3101 a11d 320 l
also would raise the federal medical assistance percentage (FMAP) to I 00 percent for
payments to states for administering vaccines for one year after the end of the PHE. Over the
2021-2030 period, CBO estimates, the higher FMAP would increase direct spending for
Medicaid and CHIP by $747 million and by $68 million, respectively.
Mandatory Coverage c>fTreatment or Prevention, Without Cost Sharing. Sections 3101 a11d
3201 also would require state Medicaid and CHIP programs to provide coverage, without
cost sharing, for treatment or prevention of COVID-19 for one year after the end of the PHE.
Additionally, over the same period, if a state chose to implement an option under Medicaid to
provide COVID-19 testing for uninsured people, section 3101 also would extend the
requirement to provide treatment and prevention to those people without requiring cost
sharing.
About 5 million people enrolled in Medicaid or CHIP are expected to receive COVID-19
treatment in 2021. CBO expects that number to decline to fewer tha11 100,000 by 2022 and
estimates that about 25 percent of those people would be subject to cost-shaiing requirements
for a physicia11 service ($2, on average, in 2021 ), an inpatient hospital service ($70, on
average, in 2021), or both. CBO estimates that the requirements in sections 3 lOl ai1d 3201
that would prohibit cost sharing for treatment would increase direct spending by $34 million
for Medicaid and by less than $1 million for CHIP over the 2021-2030 pe1iod.
CBO ai1ticipates that 3 million uninsured people will receive COVID-19 treatment in 202 l.
By 2022, that number is expected to fall below 50,000. In 2020, 10 states had implemented
all option under Medicaid to test uninsured people for COVID-19. In those states, CBO
estimates, the requirement in section 3101 to provide vaccinations or treatment services
would increase direct spending for Medicaid by $243 million over the 2021-2030 petiod.
Coverage for Pregnant and Postpartum Women. Sections 3102 and 3202 would allow
states to extend health coverage for women enrolled in Medieaid or CHIP for 12 months after
the birth of a child. In total, CBO estimates, those sections would inerease federal deficits by
$5.1 billion over the 2021-2030 period-an increase in direct spending of $6.0 billion and an
increase in revenues of $0.8 billion over the period.
Under cun-ent law, for 60 days after the bitth of a child, states must provide Medicaid
coverage to women whose income does not exceed 138 percent of the federal poverty level
(FPL). Fo1ty-six states and the District of Columbia exercise an option under cmTent law to
provide Medicaid coverage to pregnant women whose income is above 138 percent of the
FPL, 29 extend coverage if their income is equal to or above 200 percent of the FPL, and 3
extend coverage if their income is above 300 percent of the FPL. Under cun-ent law, states
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also can provide pregnancy-related services to women under CHIP, but they may only
provide postpmtum services to women who, if not for their income, would otherwise be
eligible for coverage under Medicaid.
CBO estimates that in 2020, Medicaid and CHIP provided pregnancy-related coverage to
about 2 million women; approximately 1.8 million carried their pregnancy to tetm. CBO
estimates that about 35 percent of those recipients have income above 138 percent of the
FPL, which reflects the coverage options cmTently available to states under Medicaid and
CHIP. Regardless of a state's decision to provide optional coverage to eligible women, the
state must reevaluate applicm1ts' eligibility for oilier coverage before the end of the 60-day
postpartum period. Medicaid coverage after tltat point can include the full scope of health
services or be limited to family-planning services.
Medicaid Coverage Under the 12-Month Option. CBO estimates that under current law, at
the end of the 60-day postpartum period about 30 percent of women will continue to receive
comprehensive services from Medicaid, 30 percent will enroll either in employment-based or
in marketplace coverage, and about 45 percent will be uninsured ( altl1ough roughly two-
thirds of those women would still receive family-planning services).
Section 3102 would provide women in states that exercise the option with l O additional
montl1s of Medicaid coverage. CBO estimates that hy 2024, about 25 percent of all women
who would be expected to receive postpartum services from Medicaid will live in states that
implement the 12-month option. Using administrative data and information from industry
sources, CBO estimates that the combined federal at1d state cost to provide 10 additional
months of Medicaid coverage would be about $1,500 per person, on average, in 2022; that
amount would increase at an average atmual rate of about 6 percent over the 2022-2030
period. For women whose c111Tent-law Med.icaid services are limited to family planning,
CBO estimates that the cost per person would be about $1, 100, on average. In total, CBO
estimates, the additional months of coverage would increase direct spending for Medicaid by
$6.1 billion over the 2021-2030 period.
CHIP Coveragef/Jr Pregnant and Postpartum Women. Under current law, states can provide
CHIP coverage to eligible women during pregnancy and for 60 days after the birth of a child.
CHIP cannot be used to replace existing Medicaid coverage for pregnant women. To cover
pregnant women under CHIP, states must provide, at a minimum, Medicaid coverage to
women whose income is up to 185 percent of the FPL. In 2020, approximately 15,000
women received pregnancy and postpartum care under CHIP. CBO estimates that all of those
women became ineligible for comprehensive Medicaid and CHIP services at the end of the
60-day postpartum period.
If a state provides CHIP coverage to eligible women up to the end of the 60-day postpartum
period, and if the state chooses to implement the Medicaid option under section 3102, the
legislation would require the state to extend similar coverage under CHIP. However, because
not all states extend CHIP coverage to pregnant women, CBO estimates that by 2024 fewer
than 1,000 pregnant women would reside in a state that implemented the option. CBO
expects tltat additional montlts of coverage 1111der CHIP would cost about the same as under
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Medicaid. On net, CBO estimates, section 3202 would increase direct spending for CHIP by
$5 million over the 2021-2030 period.
Private Health lnsurancefbr Pregnant and Postpartum Women. Some women whose
Medicaid coverage ends after the bitth of a child enroll in private health insurance. CBO
estimates that in states that are expected to implement the option under section 3102, fewer
than 5 percent of women who become ineligible each year for Medicaid or CHIP cmTently
receive coverage through a marketplace and 30 percent enroll in employment-based
coverage. Under section 3102, over the 2021-2030 period, about 10,000 and l00,000 women
annually would delay enrollment either in marketplace coverage or in employment-based
coverage, respectively, for about 10 months. That delay would lower subsidies for ptivate
health insurance, thereby reducing direct spending by $137 million and increasing revenues
by $816 million over the 2021-2030 petiod, according to CBO and JCT's estimates.
Medicaid for Inmates During the 30-Day Period Preceding Release. Section 3103 would
create an exception for 5 years, starting one year after enactment, to the prohibition on
making Medicaid payments for services provided to inmates of cotTectional institutions.
Section 3103 would permit payments for services to inmates who are enrolled in Medicaid
dming the last 30 days of their incarceration. According to data from the Bureau of Justice
Statistics:
• Local jails admit and release about 10 million people per year, 89 percent of whom are
admitted and released within 30 days, and
• State prisons admit and release about 600,000 people per year, almost all of whom remain
incarcerated for longer than 30 days.
As a result, section 3103 would allow the vast majority of Medicaid enrollees to maintain
their Medicaid coverage during their incarceration in local jails and would pennit those jails
to bill Medicaid for medical care provided to the incarcerated enrollees. Section 3103 would
allow incarcerated enrollees in prisons to receive Medicaid coverage in the final 30 days of
their incarceration, which would permit state prisons to bill Medicaid for services provided
pre-release.
Based on a report by the Prison Policy Initiative, CBO estimates that about 45 percent of
imnates released from jails and prisons would be enrolled in Medicaid in the early years of
the 2021-2030 period, rising to 55 percent by the end of the period as CBO prq_iects
additional states will adopt the ACA expansion over time.
CBO expects that the costs per Medicaid inmate would be modest, as local jails generally
provide limited services, such as generic medications to assist with drug withdrawals and
mental health ctises during the sh01t-te1m stays, while prisons would be expected to provide
pre-release health screenings and short-tetm supplies of medications to help with the
transition to the post-release period. CBO estimates that the average cost per prisoner would
be about $100 in the beginning of the period, rising to about $200 by the end of the period
because of increases in the costs of providing medical care.
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Lastly, CBO projects that state prisons would quickly develop the infrastructure to bill
Medicaid for services to inmates in the last 30 days of their stay, which in many cases would
allow them to defray the costs incurred for pre-release services. Local jails would more
gradually establish similar capacity to bill Medicaid, delaying the full implementation of
section 3 l 03 for several years. In total, CBO estimates that section 3 l03 would increase
direct spending by $3.7 billion over the 2021-2030 period.
Bundled Community-Based Mobile Crisis Intervention. Section 3104 would, for 12 fiscal
quarters, increase a state's FMAP for crisis intervention services that qualify as mobile and
community-based, as defined by the bill. The enhanced FMAP would equal 85 percent and
would apply only to services that otherwise would be reimbursed at a state's traditional
FMAP. Based on infonnation from state mental health agencies, CBO estimates that at least
16 states have programs that provide services that would qualify for the enhanced FMAP
provided under section 3104. Not all of those programs cnrrently seek Medicaid
reimbursement for crisis intervention services provided to Medicaid; CBO expects that the
programs would be more likely to do so under section 3104. CBO also anticipates that those
changes would encourage all of the programs to request reimbursement under their state
Medicaid programs and that the states would receive the enhanced FMAP tmder section 3104
for such services. In addition, based on the rate at which state Medicaid programs have
adopted other services and demonstrations specific to behavioral health care, CBO expects
additional states would begin reimbursing for crisis intervention services that qualify as
mobile and community-based.
CBO estimates that the combined federal and state cost to provide crisis intervention services
that qualify as mobile and community-based would be about $1,500 per person, on average,
in 2021; that amount would increase at an average annual rate of about 6 percent over the
2022-2030 period. In total, CBO estimates, the enhanced FMAP and the decision by states to
establish new programs that provide crisis intervention services that qualify as mobile and
community-based would increase direct spending for Medicaid by $1.1 billion over the 2021-
2030 period.
Temporary Increase in FMAP for Expanding ACA Coverage. Section 3 l05 would, for
eight calendar quarters, provide a temporary, 5 percentage-point increase in the Medicaid
FMAP to states that expand coverage to adults made eligible by the ACA. CBO and JCT
estimate that the provision would increase federal deficits by $15.5 billion over the 2021-
2030 period-the net effect of an increase in outlays of $16.2 billion and an increase in
revenues of$0.7 billion.
Under section 3 l05, the FMAP increase would be available only to states that expand such
coverage after the legislation is enacted, and it would not be available to states that had
previously expanded coverage. Only services provided to traditional eligibility groups could
qualify for the increase; services provided to adults made eligible by the ACA would not be
included. The higher FMAP also would not apply to the following expenditures:
• Medicaid payments to hospitals that serve a disproportionate share oflow-income
enrollees,
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• Medicaid allotments to the tenitories, and
• Payments for programs other than Medicaid that use the FMAP to detennine the federal
share of payments ( such as CHIP, payments from states toward Medicare Part D, and
Title IV).
Increased Medicaid Spending. Section 3105 would increase Medicaid spending in two ways.
First, CBO expects, the additional 5 percentage-point increase in the FMAP would induce
some states to expand Medicaid coverage to low-income adults sooner than CBO's baseline
projections for Medicaid enrollment would indicate. Currently, 3 7 states and the Distiict of
Columbia have implemented the expansion, and those states have enrolled roughly
60 percent of eligible adults nationwide. Under its baseline forecast, CBO projects that
additional states will adopt the expansion at the historical rate of expansions since 2014 (the
initial year of the expansion's availability). CBO anticipates that by 2030 about 70 percent of
all potential enrollees will be covered.
Although the rate of expansion is subject to considerable unce1iainty, CBO projects that the 5
percentage-point increase in the FMAP would induce states that would expand during the
2021-2030 period to do so about a year sooner, on average, than they othe1wise would. The
result would be an increase in Medicaid enrollment in those years among adults made
eligible by the ACA in those states. Based on CBO's projections for enrollment in states that
have not already adopted the expansion and the projected cost per adult made eligible by the
ACA, CBO estimates that those earlier expansions would cost the federal government
$17.2 billion over the 2021-2030 period.
The second effect of section 3105 would be the added cost of the 5 percentage-point increase
in the FMAP. Based on the average matching rates projected for states that have not yet
adopted the expansion, CBO estimates t!Je cost at $4.7 billion. In total, CBO estimates,
section 3105 would increase direct spending on Medicaid by $21.8 billion over the 2021-
2030 period.
Reduced Federal Subsidies for Private Health Insurance. Section 3105 also would reduce
enrollment in private health insurance as more people enroll in Medicaid in the states that
adopt the ACA expansion. CBO and JCT estimate t!Jat over the 2021-2030 period Medicaid
enrollment would increase, on average, by about 85,000 people who would otherwise have
enrolled in coverage through the marketplaces and by another 33,000 people who would
otherwise have enrolled in employment-based coverage. CBO and JCT estimate that those
reductions in enrollment would reduce direct spending for health insurance subsidies by
$5.7 billion and increase revenues by $0.7 billion over the 2021-2030 period.
100 Percent FMAP for Urban Indian Organizations and Native Hawaiian Health Care.
Section 3106 would, for eight calendar quarters, provide a 100 percent federal matching rate
for services to Medicaid emollees who access care in the Urban Indian Health Programs
(UIHPs) or the Native Hawaiian Health Care System (NHHCS). Under current law, services
provided to Medicaid emollees are matched at 100 percent if they are received t!Jrough an
IHS facility. IHS is the agency that is responsible for providing federal health services to
American Indians and Alaska Natives. UIHPs are health care organizations that are grantees
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of the lHS but are not considered federal entities that are part of the IHS and therefore only
receive the standard federal matching rates for services to Medicaid enrollees. Similarly, the
NHHCS comprises five health care clinics that are grantees of HRSA that are not considered
federal entities.
The standard federal matching rates under current law average an estimated 65 percent for
traditional eligibility categories dming 2021 and 2022, and will average an estimated
58.5 percent during 2023, the time period covered by the eight quatters specified under
section 3106. The matching rates for adults made eligible by the ACA will be 90 percent
during the same period.
According to infonnation from the UIHP system, the UIHP treats about 90,000 Medicaid
patients per year at an estimated average cost of about $2,000 per patient. Applying the
100 percent matching rate for services to these enrollees would increase direct spending by
$155 million over the 2021-2030 period. Given the size of the NHHCS relative to the UIHP
system, CBO estimates that applying a 100 percent matching rate to services provided at
NHHCS clinics would increase direct spending by another $7 million over the period.
Sunset of Limit on Maximum Rebate for Certain Drugs. Under current law,
manufacturers are required to pay Medicaid a rebate on all covered outpatient drugs. The
rebate amount is dete1miued according to statute by two formulas that include a basic rebate
with sepat·ate calculations for brand and generic dmgs and an additional inflationaty rebate
that reflects differences in growth between the Average Manufacturer Prices (AMPs) and the
consumer price index. The total rebate amount is capped at 100 percent of the AMP. The cap
does not affect rebates paid for all drugs: lt tends to be most relevant for drugs that have
experienced substantial price increases over time and for dmgs that offer particularly large
rebates to payers other than Medicaid. Section 3107 would eliminate the cap on the total
rebate amount sta1ting Jannaty l, 2023.
Based on administrative data on A MPs and prescription dmg spending in Medicaid, CBO
estimates that in 2019, the cap on the total rebate amount prevented federal and state
governments from collecting more than $3 billion in rebates for covered outpatient dmgs.
CBO expects that section 3107 would increase the amount of rebates that manufacturers pay
Medicaid at1d would reduce direct spending in Medicaid by $15.9 billion over the 2021-2030
period.
Additional Support for Medicaid HCBS. Section 3108 would, for four fiscal quarters,
increase the federal FMAP in Medicaid by 7.35 percentage points for state expenditures on
home at1d community-based services (HCBS). HCBS are long-term care services that
beneficiaries receive in their home or in the community rather that1 in institutions such as
nursing facilities. CBO projects that the federal and state governments will spend almost
$200 billion on HCBS during the four qua1ters for which the enhanced FMAP is available to
states. Increasing the federal share of such spending would increase federal spending on
Medicaid by $9.3 billion.
Strike Teams for Nursing Facilities. Section 3109 would appropriate $250 million for
states to establish strike teatns that would be deployed to nursing facilities that have patients
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who have been diagnosed with COVTD-19 or who are suspected of having the disease. CBO
estimates that section 3 I09 would increase direct spending by $250 million over the 2021-
2030 period.
Other Provisions. Subtitle D would appropriate $12.8 billion for environmental protections,
utility assistance, distance learning, and other consumer product safety.
Within subtitle D, chapter l would appropriate $5.1 billion to fund activities related to
environmental health and assistance to people for paying utility bills:
• $0.1 billion to the Environmental Protection Agency for grants and other activities that
enhance environmental justice and to support implementation of the Clean Air Act;
• $4.5 billion to tl1e Low-Income Home Energy Assistance Program; and
• $0.5 billion for grants to assist low-income households with the costs of drinking water
and wastewater services.
Chapter 2 would appropriate $7. 7 billion for distance learning, primarily to reimburse
schools and libraries for the costs of telecommunications equipment and services, and
consumer product safety.
In total, CBO estimates that the funds appropriated by subtitle D would increase direct
spending by $12.8 billion over the 2021-2030 period.
Uncertainty
There are two major types of uncertainty in CBO's estimate of the reconciliation
recommendations of the House Committee on Energy and Commerce: For subtitles A and D,
the primary fonns of uncertainty stem from CBO's estimates of the pace at which federal
agencies would spend the new budget authority. For subtitles B and C, most of the
uncertainty ofCBO's estimates stem from expectations about state behavior, people's
enrollment in various forms of health coverage, and the of the increase in health care prices.
Uncertainty About the Pace at Which Federal Agencies Would Spend New Budget Authority.
The reconciliation recommendations of the House Committee on Energy and Commerce
would provide$ l05 billion in new budget authority for fiscal year 2021, increasing
individual agencies' funding for the year by a substantial amount. For example, the 2021
budget authority for t!Je CDC, HRSA, and the IHS would see significant increases roughly
halfway through the fiscal year. It is tmcertain whether such agencies would be able to spend
all of t!Je new funds rapidly.
Uncertainty About State Behavior, People's Enrollment in Various Forms ofHealth
Coverage, and the Growth ofHealth Care Prices. For subtitles Band C, CBO's estimates
include projections of tl1e results of states' choices to expand coverage, people's choices to
enroll in coverage if they were newly eligible, and the future costs of providing healt!J care
services to beneficiaries-all of which are uncertain. Some of the more significant sources of
uncertainty include:
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• Estimating how many women would remain enrolled in Medicaid if states expand
postpartum coverage and how many additional months of coverage they would have;
• Predicting how many states will expand Medicaid under current law and how the
increased FMAP would accelerate the pace of state expansions;
• Forecasting future growth in drug prices and how drug manufacturers would change their
pricing strategies if the cap on rebates were eliminated; and
• Estimating the future growth in prices for HCBS and how states would expand their
coverage ofHCBS on account of the higher FMAP.
Pay-As-You-Go Considerations
The Statut01y Pay-As-You-Go Act of 20] 0 establishes budget-reporting and enforcement
procedmes for legislation affecting direct spending or revenues. The net changes in outlays
and revenues that are subject to those pay-as-you-go procedmes are shown in Table 1.
Increase in Long-Term Deficits: None.
Mandates
If the FCC increases annual fee collections to offset the costs of issuing rules to promote
internet connectivity for schools and libraries as required by section 3312, the legislation
would increase the cost of an existing private-sector mandate on commercial entities required
to pay those fees. CBO estimates that the incremental cost of the mandate would be small and
would fall well below the annual threshold established in the Unfunded Mandates Refonn
Act for private-sector mandates ($170 million in 2021, adjusted annually for inflation).
Estimate Prepared By
Federal Costs: Alice Bums, Julia Christensen, Jennifer Gray, Ryan Greenfield, Jared
Hirschfield, David Hughes, Arin Kerstein, Susanne Mehlman, Stephen Rabent, Lisa
Ramirez-Branum, Lara Robillard, Sarah Sajewski, Robert Stewart, Carolyn Ugolino, Emily
Vreeland, Ellen Werble, and Katherine Young
Mandates: Andrew Laughlin
Estimate Reviewed By
Chad Chirico
Chief, Low-Income Health Programs and Prescription Drugs Cost Estimates Unit
Sheila Dacey
Chief, Tncome Security and Education Cost Estimates Unit
Paul Masi
Chief, Health Systems and Medicare Cost Estimates Unit
Sarah Masi
Senior Advisor
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David Newman
Chief, Defense, International Affairs, and Veterans' Affairs Cost Estimates Unit
Susan Willie
Chief, Natura] and Physical Resources Cost Estimates Unit
Kathleen FitzGerald
Chief, Public and Private ,\1andates Unit
Leo Lex
Deputy Director of Budget Analysis
Theresa Gullo
Director of Budget Analysis
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Subtitle A, Funding for Public Health
Chapter 1 - Vaccines and Therapeutics
Sec 3001 Vaccine Activities at the CDC
Budget Authority 7,500 0 0 7500
Estimated Outlays 1,500 4,500 750 450 7,425
Sec. 3002 Vacctr.e ConMence Activities
Budget Authonty 1,000 1.000
200 [,{JO 100 60 30 990
Sec. 3003
Supply Chain
Budget Authority 5,200 0 5200
Estimated Outlays 2,033 2,803 312 52 0 5,200
Sec. 3004 Act1v;t1es at !he Food and
Drug Admirnstrat1on
Budget Authority 500 0 500
Estimated Outlays 165 250 75 10 500
Chapter 1, Total
Budget Authority 14,200 0 0 0
Estimated Outlays 3,898 8,153 1,237 572 255 0 0
Chapter 2 - Te.sting
Sec 3011 and
Budget Authority 46,000 0
Estimated Outlays 9,200 27,600 4,600 2,760 1,380 0
Sec. 3012 SARS-CoV-2 Genomic
Sequencing and Surveillance
Budget Authority 1,750 0 0 1-750
Estimated Outlays 350 1,050 175 105 53 0 1,733
Sec 3013 Global Health
Budget Authority 750 0 0 750
Estimated Outlays 150 450 75 45 23 0 743
Sec 3014 Data Modernization and
Forecasting Center
Budget Authority 500 0 0 0 0 500
Estimated Outlays 100 300 50 30 15 0 495
Chapter 2, Total
Budget Authority 49,000 0 0 0
Estimated Outlays 9,800 29.400 4,900 2,940 1,471 0
Chapter 3 - Public H-ealth Workforce
Sec 3021 Public Health Workforce
Budget Authority 7,660
Estimated Outlays 1,532 3,064 2,681 383 7,660
Sec 3022 Medical Reserve Corps
Budget Authority 100 0 0 100
Est1mated Outlays 20 56 16 6 0 1\X)
Chapter 3, Total
Budget Authority 7,760 0 0 0 0 0 7,760
Estimated Outlays 1,552 3,120 2,697 389 0 7,760
Chapter 4 ~ Pubtic Health Investments
Sec 3031,
7,600 0 0 7,600
Estimated Outlays 1,520 3,040 2,660 380 0 7,600
Sec 3032 National Health Service- Corps
Budget Authority BOO 0 0 0 800
Estimated Outlays 160 320 280 40 a 0 800
Sec 3033 Nurse Corps
BLKlget Authority 200 0 200
Estimated Outlays 46 100 40 10 0 196
Sec 3034
Budget Authority 330 0
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m•• . . . . .. . . , ....
Tabt-e:1 \ Est\mE!!e.d _Bud~ef~ry;Effects, o'. gec:?'ncl~i;itlon Recqm:(le.n?~~1?ns ~i1!1~·rfou$~ Qorrii:t'!ltt~ 9.n_ Erierl:fY·and Codt!1J:rce on. FB~r~:arv, \,2, ;202'.,·: ·, . ·
Sec. 3035
Congregate Settings
Budget Authonty 1,800 1,800
Estimated Outlays 324 990 398 36 18 1,764
Sec. 3036 Fam1iy Planning
50 50
10 35 49
Sec 3037 Children Under HHS Care
Budget Authonty 425 0 425
Estimated Outlays 13 17 64 68 74 70 64 51 425
Sec. 3038 HHS Inspector General
Budget Authonty
Estimated Outlays
Chapter 4, Total
Budget Authority 11,210 0 0 0 0
Estimated Outlays 2,141 4,637 3,560 547 92 70 64 51 0
Chapter 5 ~ Indian Health
Sec 3041 lndian Health
6.094 0
1,493 3,534 506 84 84 71 59 43 19
Chapter 6- Mental Health and Substance
Use Disorder
Sec 3051 Community Mental Health
Services
Budget Authority 1,750 G 1,750
Estimated OuUays 315 910 350 140 35 1,750
Sec. 3052 Preven!lon and Treatment of
Substance Abuse
Budget Authonty 1,750 0
Estimated 0.Jtlays 315 910 350 140 35
Seo. 3053 Training for Health Care
Professionals
80 G 80
Estimated Outlays 18 40 16 78
Sec. 3054 Education and Awareness
Budget Authonty 20 0 20
Estimated Outlays 12 20
Sec_ 3055 Grants to Health Care
Providers for Menta! and
8ehav1ora! Health Among
Workforce
Budget Authonty 40 G G 0 40
Estimated OVtlays 9 20 0 39
Sec 3056
Budget A uthonty 30 0 30
Estimated Outlays 15 30
Sec. 3057
Budget Authority 50 0 50
Estimated Outlays 26 10 1 50
Sec. 3058 National Child Traumatic
Stress Network
Budget Authorit'J 10 10
Estimated Ouilays 10
Sec. 3059 Project .Aware
30
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Sec_ 3059A Youth Suicide Prevention
Budget AUlhOnty
Estimated Outlays 10 20
sec 30598 BBMv10ra1 Health workforce
Budget Authonty 100 100
Estimated Outlays 23 50 20 98
Chapter 6, Total
Budget Authority 3,880 0 0 0 0 0 0 0 0
Estimated Outlays 711 2,013 774 303 74 0 0 0 0 0
Chapter 7 - Exchange Grant Program
Sec. 3061
20 0 0 20
Estimated Outlays 20 0 20
Subtitle A, Total
Budget Authority 92,164 0 0 0 0 0
Outlays 19,615 50,857 13,674 4,835 1,978 141 123 94 23
Subtitle B. Medicaid
Sec_ 3101
Estimated Budget Authonty 287 534 247 63 1,131
Estimated Outlays 534 247 63 113·1
Sec, 3102
Estimated Budget Authority 756 t249 1.417 1.429 1,108 5,959
Eetimated Outlavs 756 1,249 1,417 1,429 1,108 5.959
Sec 3103 Medicaid for Inmates Durmg
JO-Day Period Preceding
Release
Estimated Budget AuthOrlty 177 444 683 918 1,014 510 0 3,746
Estimated Outlays 177 444 683 918 1,014 510 3J46
Sec. 3104. Bundled Community-Based
Mobile Cns1s ln1ervent1on
Estimated Budget Authority 15 71 305 330 270 25 32 40 49 1,195
Estimated Outlays 0 307 332 270 25 32 40 49 1,185
Sec. 3105
0 3,768 3,427 2.177 Z308 2,131 1.337 479 531
0 3,768 3,427 2,177 2,308 2,131 1,337 479 531 16.370
Sec_ 3106 100% FMAP for Urban lndlan
Orgam:iatfons and Native
Hawaaan Health Care
Estimated Budget Authority 38 81 43 0 162
Estimated Outlays 38 81 43 0 162
sec, 3107_ Sunset of Umlt on Maximum
Rebate for Certam Drugs
0 -217 -1,$03 -2,293-2,277 -2,258 -2,279 -2,318-2,443 -2,573
0 -217 -1,803 -2,293-2.277 -2.258 -2 279 -2,318 -2,443 -2,573
Sec. 3108
Estimated Budget Authority 4,795 4,515 9,310
Estimated Outlays 4,795 4,515 9,310
Sec_ 310R StnKe Teams for Nursing
Facil;ties
Budget Authority :'250 0 0 250
Estimated Outlays 50 175 25 250
Subtitle 8, Total
Budget Authority 5,385 5,307 5,112 3,924 2,549 2,744 1,516
Outlays 5,170 5,487 5,143 3,926 2,551 2,744 1,516
Subtitle C< Children's Health Insurance Program
Sec. 3?01
B~Klget Authority 47 17 68
Estimated Outlays 17 68
Sec, 3202 Coverage for Pregnant and
Postpartum Women (a)
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Subtitle D. Other Provisions
Chapter 1 - Ensuring Environmental
Health and Ratepayer Protection
Sec 3301
Budget Authority 100 100
Estimated Outlays 10 60 20 10 100
Sec 3302 UHEAP
Budget Authority 4,500 4500
Estimated Outlays 1.508 1,727 467 188 1BB 4,500
Seo. 3303 Water Assistance Program
Budget Authonty 500 500
Es!:Jrnated Outlays 50 225 150 50 25 500
Chapter 1, Total
Budget Authority 5,100 0 0 0 0 0 0 0 5,100
Estimated Outlays 1,568 2.012 637 482 213 188 0 0 0 5,100
Chapter 2 - Distance Learn;ng and
consumer Protections
Sec 3311. Consumer Product Safety
Budget Authonty 50 50
EstirnatedOutlays 4 10 48
Sec 3312
7600 7 600
Estimated Outlays 1,140 3,800 1,900 7.600
Chapter 2, Total
Budget Authority 7,650 0 0 0 0 0 0 0 7,65{)
Estimated Outlays 1,144 3,806 1,908 770 9 2 1 0
Chapter 3 - Oversight of Department of
Commerce Prevention and Response to
COVID~19
Sec. 3321. Department of Commerce
Budget Authority
Estimated Outlays 0
Subtitle D, Total
Budget Authority 12,753 0 0 0 0 0 0
Outlays 2,713 5.819 2,546 1,252 222 196 0
Total Increase in Direct Spending
Estimated Budget Authority 110,302 5,354 5,129 3,928 2,549 2,744 1,516
Estimated Outlays 27,498 62,210 21,380 10,017 4,751 3,081 1,641
Increases in Revenues
Sec, 3102
76 192 209 167 816
On-Budget Revenues 0 0 43 98 109 119 95 0 0 464
Off-Budget Revenues 0 0 33 74 83 90 72 0 352
Sec. 3105 Temporary increase m FMAP
0 0 165 107 93 94 93 51 31 24 672
0 0 96 83 55 58 60 33 20 15 409
Off-BUdget Revenues 0 69 44 38 36 33 18 11 263
Total Increase in Revenues 0 241 279 285 303 260 51 31 24 1,488
On-Budget Revenues 0 0 139 161 164 177 155 33 20 15 873
Off-Budget Revenues 0 102 118 121 126 105 18 11 9 615
Net increase or Decrease{-) in the Deficit From Changes ln Direct Spending and Revenues
Estimated Effect on the Deficit 27,498 62,210 21,139 9,738 4,466 2,778 1,381 -866-1,807-1,881-2,317
On-Budget Deficrts 27,498 62.210 21,241 9,856 4,587 2,904 1,486 -848 -1, 796 •1, 872 -2_312
Offf-Budget Def/Cl{ 0 0 -102 -118 -121 -126 -105 -18 -i1 -9 -615
a Section would affect both revenues and spending, which Is shown separately.
b The estimate for section 3102 Includes the bud~eta;,;i: effects of sections 3202.
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February 2021
Fact Sheet on House's Reconciliation Package & the
Biden Administration's COVID-19 American Rescue Plan
COMMITTEE ON ENERGY & COMMERCE
The Fiscal Year 2021 Reconciliation Act puts into action the policies and budgetary requests outlined
by the Biden Administration's Americim Rc3cuc Plan.
VACCLIVES:
The American Rescue Plan calls for the establishment of a national vaccination program, and this
legislation provides critical funding and resources to increase COVl0-19 vaccinations across the
country.
• Many s t a t e s ~ to distribute vaccines after the Trump Administration chose to defer almost
entirely to the states to distribute and administer all vaccines.
• The American Rescue Plan requests $20 billion for improving COV!D-19 vaccine administration and
distribution, including vaccination clinics and mobile vaccination units, a vaccine awareness campaign,
and increasing the Federal Medical Assistance Percentage (FMAP) to Medicaid-covered recipients of a
vaccine. It also requests over $5 billion for research, development, and manufacturing of vaccines,
therapeutics, and ancillary supplies.
• Specifically, the Fiscal Year 2021 Reconciliation Act provides:
o $7.5 billion for Centers for Disease Control and Prevention (CDC) to prepare, promote, distribute,
administer, monitor, and track COV!D-19 vaccines. This includes distribution and administration,
support for state, local, tribal, and territorial public health departments, community vaccination
centers, IT enhancements, facility enhancements, and public communication;
o $600 million to be directed to the Indian Health Service (IHS) for vaccine-related activities;
o $5.2 billion to the Biomedical Advanced Research and Development Authority (BARDA) to
support advanced research, development, manufacturing, production, and purchase of vaccines,
therapeutics, and ancillary medical products for COV!D-19;
o $1 billion for the CDC to undertake a vaccine awareness and engagement campaign;
o $500 million for the Food and Drug Administration (FDA) to support the review, facilitate the
development of, and post-marketing surveillance of COVID-19 vaccines and therapeutics and
address dmg shortages, among other activities; and
o Medicaid coverage of COV!D-19 vaccines, including the option for states to provide coverage to
the uninsured, without cost sharing at 100 percent FMAP for the duration of the public health
emergency.
TESTING:
The American Rescue Plan proposes scaling up testing iu order to stop the spread of COVID-19, safely
reopen schools, and protect at-risk populations. A robust testing program remains a critical tool in the
Prepared by the Committee on En~rgy and Commerce
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fight against this virus iu conjunction with vaccinations. This legislation provides the funding and
resources to do just that.
• Despite innovations and adaptations in the testing space, COVID-19 tests are still not widely accessible,
and supplies continue to be in shortage.
• According to a Government Accountability Office (GAO) report from November 202Q, a national survey
to states and territories found that 21 states reported shortages of testing reagents, 16 states reported
shortages of testing instruments, and 24 states reported shortages of rapid point-of~care tests in the 30 days
prior to the report's release, and those same states predicted shortages would continue through the winter
months.
• The American Rescue Plan requests $50 billion for testing related resources and activities, including
procurement and administration of regular screening tests, and investments in United States laboratory
capacity for diagnostic and screening tests.
• The Fiscal Year 2021 Reconciliation Act provides:
o $46 billion for testing, contact tracing, and mitigation. These activities include: implementing a
national strategy for testing, contact tracing, surveillance, and mitigation; providing technical
assistance, guidance, support, and grants or contracts to States; manufacturing, procurement,
distribution, administration of tests, including personal protective equipment (PPE) and supplies
necessary for administration; and establishing and expanding federal, State, or local testing and
contact tracing capabilities, including investments in laboratory capacity, community-based testing
sites, and mobile testing units;
o $1.5 billion for ms testing, tracing, and mitigation needs;
o $1.75 billion for gonomic sequencing and surveillance of the circulating strains of COVID-19.
There are c u r r e n t l y ~ ~ . some of which have recently
emen.,ed in the United States; and
o $500 million to allow CDC to establish, expand, and maintain data surveillance and analytics,
including to modernize the United States' disease warning system to forecast and track hotspots
for COVID-19.
PUBLJC HEALTH WORKFORCE:
The American Rescue Plan calls for the mobilization of a public health jobs program to support the
COVID-19 response.
• The Fiscal Year 2021 Reconciliation Act provides:
o $7.6 billion in funding to public health departments to hire I 00,000 full time employees into the
public health workforce. These positions would include contact tracers, social support specialists,
community health workers, public health nurses, epidemiologists, lab personnel, and
communications. Funds would also suppolt PPE, technology, data management, supplies, and
reporting;
o $240 million for ms public health workforce needs; and
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o $100 million to suppo1t the Medical Reserve Corps, which consists ofa network of volunteer
medical and public health professionals that support emergency response efforts and community
health activities,
HEALTH DISPARITIES:
The American Rescue Plan includes funding to provide health services to the underserved and
addressing ongoing health disparities.
• COVID-l 9 has lQj_d bare the harsh realities of health disparities in the United States, For instance, Black
and Hispanic Ameticans are ~ t l v lower rates than White Americans, a trend
that advocates blame on the federal government's failure to priotitize equitable distribution, Communities
of color are -19
as a resulJ
• The Fiscal Year 2021 Reconciliation Act provides a total of $25.2 billion for addressing health disparities
and protecting vulnerable populations, including:
o $250 million for nursing home strike teams to help facilities manage COVID-19 outbreaks when
they occur;
o $7.6 billion in funding to support COVID-19 response at Community Health Centers;
o $1.8 billion to support the purchase, procurement, or distribution of COVID-19 test and testing
supplies, PPE, and vaccines for staff and individuals in congregate settings, This would include
support to states, localities, territories, and tribes for strategies and activities to detect, diagnose,
trace or monitor COVID-19 in congregate settings, including prisons, jails, detention centers, long-
term care facilities, psychiatric hospitals and residential treatment facilities, intermediate care
facilities, and other settings providing care for individuals with disabilities;
o $3.3 billion to lHS in flexible funding to support lost third-party revenue, information technology
infrastrncture for telehealth and electronic health records, urban Indian organizations, and other
health services and costs;
o $800 million to the National Health Service Corps to support primary health care clinicians in
high-need areas;
o $331 million for Teaching Health Centers to expand the number of sites nationwide, increase
resident allocations, and provide administrative support for expanding the program;
o $240 million to suppott the Nurse Corps Loan Repayment program, which helps support nurses
working in critical sh011age and underserved areas;
o A Medicaid state option to allow states to cover postpmtum women for 12 months after bi1th, to
help address the maternal mortality crisis disproportionately affecting women of color; and
o Medicaid coverage for incarcerated individuals 30 days prior to their release, to ensure continuity
of care for justice-connected individuals,
MENTAL HEALTH:
The American Rescue Plan proposes scaling up mental health services, including to expand access to
behavioral and mental health prevention and treatment.
Prepan~d by !he 1:omn1itte~ on Energy and Commercf:'
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• The Fiscal Year 2021 Reconciliation Act provides a total of $4 billion for behavioral and mental health
services, including:
o $3.5 billion for the Substance Abuse and Mental Health Services Agency (SAMHSA) to be split
between the Substance Abuse Prevention and Treatment and Community Mental Health block
grant programs. Both programs provide funding to all 50 States, the District of Columbia, Puerto
Rico, the United States Virgin Islands, and six Pacific jurisdictions. The Substance Abuse block
grant program also supports one tribal entity, the Chippewa Tribe;
o $420 million will be made available to lHS for mental and behavioral health prevention and
treatment services;
o $100 million to the Behavioral Health Workforce Education and Training Program within the
Health Resources and Services Administration (HRSA) to expand access to behavioral health
services by focusing on training behavioral health paraprofessionals, such as peer support
specialists;
o $140 million to develop a program for mental and behavioral health and to prevent burnout among
health care providers and public safety officers, including training and outreach;
o $80 million to provide support for mental health and substance use disorder services at
community-based entities and behavioral health organizations;
o $10 million to support the National Childhood Traumatic Stress Network, which works to develop
and promote effective community practices for children and adolescents exposed to a wide affay of
traumatic events; and
o $50 million to Suicide Prevention and Project Aware programs at SAMHSA, which support youth
mental health services and suicide prevention efforts.
HEALTH COVERA<iE:
The American Rescue Plan commits to preserving and expanding access to health care coverage during
the pandemic.
• Between March and September of 2020, roughlu to 3 mjlljQ!! people lost employer sponsored health
insurance.
• Prior to that, 10 11Ji.!Jjg_lJJlllQl!l!e already lacked coverage, barring them from accessing the health care
system from the outset of the pandemic.
• The Fiscal Year 2021 Reconciliation Act provides a number of complementary provisions to make
coverage more affordable and accessible to millions of Americans by:
o Expanding Affordable Care Act (ACA) Marketplace premium tax credits to more middle-class
Americans for 2021 and 2022, including those with incomes above 400 percent of the federal
poverty line (FPL).
o Allowing individuals receiving unemployment compensation during the public health emergency to
access ACA premium tax credits regardless of income.
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o Providing a new incentive for states to expand Medicaid by temporarily increasing the federal
medical assistance percentage by five percentage points. If all 12 remaining states expanded
Medicaid, more than two million people currently in the coverage gap would gain access to
Medicaid.
o Ensuring that workers can continue to afford their employer health care by providing partial
COBRA subsidies. COBRA allows workers who experience layoffs or reduction in hours to
continue with their job-based health coverage for a limited period of time to avoid a disruption in
care.
CONSUMER ENER<iY AND WATER ASSISTANCE:
The American Rescue Plan helps Americans who are struggling to make ends meet keep the lights on,
the heat working and the water running hy proposing $5 billion in assistance.
• Energy access is crucial to residential health and to sustaining socially-distanced and remote work
lifestyles.
• Unpaid electric and natural gas bills were expected to reach $32 billion by the end of 2020, with an
estimated 20 percent of residential customers at least 60 days behind on their bills. A projected five
million additional households are eligible for energy assistance due to pandemic-related job losses.
• Households in California and Virginia, two states that are tracking water debt, are facing more than $1
billion and more than $88 million, respectively, in unpaid water bills. These debts threaten the long-term
viability of municipal water utilities and raise the risk of interruptions in water service, which is essential
to maintain hygiene during tbe Covid-19 pandemic.
• The Fiscal Year 2021 Reconciliation Act provides $5 billion to those most in need to pay their utility
bills at a time when so many Americans are spending unprecedented amounts of time at home,
including:
o $4.5 billion to the Department of Health and Human Services (HHS) for home energy assistance
through tbe Low-Income Home Energy Assistance Program (UHEAP); and
o $500 million in additional funds for HHS for the Low-Income Household Drinking Water and
Wastewater Emergency Assistance Program established by Congress at the end of 2020. This
brings the total amount of money available to assist families with their water and sewer bills to over
$LI billion.
POUC!T/ON AND THE PANDEMIC:
The Fiscal Year 202 l Reconciliation Act helps address health outcome disparities from pollution aud
the COVID-19 Pandemic.
• Recent work by GAO found that our national air monitoring network infrastructnre is aging and needs to
be modernized to identify localized pollution that threatens environmental justice communities.
• The Fiscal Year 202 l Reconciliation Act provides the Environmental Protection Agency (EPA) with
$100 million to address health outcome disparities from pollution and the COVI0-19 pandemic:
o $50 million to EPA for environmental justice grants and activities to help communities facing a
disproportionate burden of pollution and disease; and
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o $50 million to EPA for air quality monitoring grants and other purposes.
REMOTE LEARNING:
The American Rescue Plan will help bridge the digital divide for students and teachers without home
internet access.
• To keep communities safe and prevent further spread ofCOVID-19, schools need the flexibility to engage
in remote learning when necessary for public health and safety.
• Studies estimate that as many as 12 million students still lack internet service at their homes, with
minorities and those in rural areas most often among the unconnected. Without a reliable internet
connection to log into classes, submit work, and engage with teachers and other students, these students
have fallen even further behind in school.
• The Fiscal Year 2021 Reconciliation Act provides $7.6 billion to expand internet connectivity to
students and communities by:
o Reimbursing schools and libraries-central points for connectivity in many communities-to
purchase equipment such as hotspots, internet service, and computers on behalf of students and
patrons; and
o Ensuring schools and libraries can quickly access this critical funding by relying upon the Federal
Communications Commission and its E-rate program to administer the funds.
CONSUMER PROTECTION:
The Fiscal Year 2021 Reconciliation Act will make Americans safer in their homes by reducing the
number of unsafe imported consumer products.
• More than $174 billion spent by consumers online can be attributed to COVID-19-related boosts in online
shopping with online spending jumping 44 percent in 2020 compared with 2019.
• The Consumer Product Safety Commission (CPSC) has not been able to keep pace with changing
consumer trends brought on by the pandemic, including the substantial shift to online shopping and the
influx of e-commerce shipments from foreign countries. The CPSC does not have enough funding to
adequately staff United States ports of entry, leaving already struggling families vulnerable to risk of
injury or death from uninspected consumer products, especially in-demand COVID-19 products.
• The Fiscal Year 2021 Reconciliation Act provides $50 million for the CPSC to ensure the safety of
consumer products entering onr country aud into people's homes - an essential priority during tbe
COVlD-19 pandemic.
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VIII. FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal mandates prepared by the Director
of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform
Act
IX. STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
Pursuant to clause 3(c)(4) of rule XIII, the general performance goal or objective of this
legislation is to provide coronavirus emergency response and relief, and for other purposes.
X. DUPLICATION OF FEDERAL PROGRAMS
Pursuant to clause 3(c)(5) of rule XIII, no provision of the Committee Print is known to be
duplicative of another Federal program, including any program that was included in a report to
Congress pursuant to section 21 of Public Law 111-139 or the most recent Catalog of Federal
Domestic Assistance.
XI. COMMITTEE COST ESTIMATE
Pursuant to clause 3(d)(l) of rule XIII, the Committee adopts as its own the cost estimate
prepared by the Director of the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
XII. EARMARKS, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the Committee finds that the Committee
Print contains no earmarks, limited tax benefits, or limited tariff benefits.
XIII. ADVISORY COMMITTEE STATEMENT
No advisory committee within the meaning of section S(b) of the Federal Advisory
Committee Act was created by this legislation.
XIV. APPLICABILITY TO LEGISLATIVE BRt\NCH
The Committee finds that the legislation does not relate to the terms and conditions of
employment or access to public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
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XV. SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
SECTION. 3101. MANDATORY COVERAGE OF COVID-19 VACCINES AND
ADMINLSTRA110N TREATMENT UNDER MEDIC'.4.ID
This provision requires Medicaid coverage of COVID-19 vaccines and treatment without
beneficiary cost sharing with coverage and administration of vaccines matched at a l 00 percent
FMAP through one year after the end of the PHE. It also gives states the option to provide
coverage to the uninsured for COVID-19 vaccines and treatment without cost sharing through
the PHE, with vaccines matched at 100 percent FMAP.
SEC. 3102. MODIFIC'.4.TIONS TO CERTAIN COVERAGE UNDER MEDICAID FOR
PREGNANT AND POSTPARTUM WOMEN
This provision allows states, for five years, to extend Medicaid eligibility to women for 12
months postpartum.
SEC. 3103. ALLOWING FOR MEDICAL ASSISTANCE UNDER MEDIC'.4.ID FOR
INMATES DURING 30-DAY PERIOD PRECEDIN(i RELEASE
This provision provides Medicaid eligibility, for five years, to incarcerated individuals 30
days prior to their release.
SEC. 3104. ENHANCED FEDERAL MEDICAID SUPPORT FOR BUNDLED
COMMUNITY-BASED MOBILE CRLWS INTERVENTION SERVICES
This provision provides an enhanced FMAP for state Medicaid programs to cover
mobile crisis intervention services for individuals experiencing a mental health or substance use
disorder crisis.
SEC. 3105. TEMPORARY INCREASE IN FMAP FOR MEDICAL ASSISTANCE UNDER
STATE MEDICAID PLANS WHICH BEG'IN TO EXPEND AMOUNTS FOR CERTAIN
MANDATORY INDIVIDUALS
This provision temporarily increases a state's base FMAP by five percentage points for two
years for states that newly expand Medicaid.
SEC. 3106. EXTENSION OF 100 PERCENT FEDERAL MEDICAL ASSISTANCE
PERCENTAGE TO URBAN INDIAN HEALTH ORGANIZATIONS AND NATIVE
HAWAIIAN HEAL1H CARE SYSTEMS
This provision provides 100 percent FMAP for services provided to Medicaid beneficiaries
receiving care through Urban Indian Organizations and Native Hawaiian Health Centers for two
years.
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SEC. 3107. SUNSET OF LIMIT ON MAXIMUM REBATE AMOUNT FOR SINGLE
SOURCE DRUGS AND INNOVATOR MULTIPLE SOURCE DRUGS
This provision eliminates the cap on Medicaid drng rebates, statiing in calendar year 2023.
SEC. 3108. ADDITIONAL SUPPORT FOR MEDICAID HOME AND COMMUNITY
BASED SERVICES DURING THE COVID-19 EMERGENCY PERIOD
This provision provides a temporary FMAP increase of 7.35 percentage points for states to
make improvements to Medicaid HCBS for one year.
SEC. 3109. FUNDING FOR STATE STRIKE TEAMS FOR RESIDENT AND EMPLOYEE
SAFETY IN NURSING FACILITIES
This provision provides $250 million to the Secreta1y of Health and Human Services to
allocate to states for the purposes of establishing strike teams to be deployed to nursing facilities
with diagnosed or suspected cases of COVID-19 among residents.
XVI. CHANGES IN EXISTING LAW MADE BY THE BlLL, AS REPORTED
A Ramseyer was requested but not yet received. Therefore, with respect to clause 3(e) of
rnle XIII of the Rules of the House of Representatives, the Committee advises that compliance
prior to submission to the Committee on the Budget was not possible.
XVII. ADDITIONAL VIEWS
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Energy and Commerce Committee Republican Views
Republicans have supported five targeted, bipartisan bills to crush COVID-19, to reopen
schools, to get the economy back on track, and to improve health and wellness of those suffering
from the pandemic. That is what we should be doing with this Reconciliation package.
Unfortunately, this package falls well short, but at an extraordinary cost. The Congressional
Budget Office (CBO) estimates that the Committee on Energy and Commerce's contribution to
the Reconciliation process will cost approximately $120 billion. That is still well short of the
$188 billion instruction to the Committee, which shows there was an opportunity to adopt some
of the bipartisan, targeted, and timely amendments Republicans offered during markup. For
instance:
• $1 billion for teachers to get vaccinated and ensure our children can go back to
school safely;
• $10 billion for COVlD-19 research at the National Institutes of Health (NIH);
• $35 billion to support our frontline workers through the Provider Relief Fund
(PRF); or
• $1 billion to boost mental health services in states with unexpected job loss due to
President Biden's various Executive Orders.
Unfortunately, the Democrats rushed this bill through a partisan markup without bipartisan
consultation with CBO on cost, preventing any chance of adequate analysis and deliberation.
In addition to the wasteful spending, we must comment on the Democratic Majority's
decision to bypass regular order. Democrats wrote this entire package in secret without any
input from Republicans, and Republicans did not see a draft until I 0:00 p.m. on Tuesday,
February 9 for a markup scheduled to start at 11 :00 a.m. on Thursday, February 11. Such
secrecy might be expected on controversial measures, but Republicans and Democrats have
already worked together to enact 5 bills in response to COVID-19. This partisan process on this
package is a failure of Democratic leadership and a huge disappointment.
Subtitle A: Budget Reconciliation Legislative Recommendations Relating to Public Health
Republicans on the Energy and Commerce Committee strongly support additional
funding for advanced research, development, manufacturing, production, and the purchase of
vaccines, diagnostic tests, therapeutics, and ancillary medical products to prevent, prepare, and
respond to SARS-Co V-2, COVlD-19, or any disease with potential for creating a
pandemic. Republicans on the Energy and Commerce Committee also support additional
funding for the prevention and treatment of mental health and substance use disorders. The
COVID-19 pandemic and resulting economic downturn have significantly impacted the mental
health and wellbeing of all Americans.
Since the beginning of this pandemic, many Americans have reported that their mental
health has been negatively impacted by recent events, with about 4 in IO adults reporting
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symptoms of anxiety or depressive disorder. 1 Reports have found that declines in the economy,
lost jobs, and health challenges have all contributed to an increase in mental health difficulties.
Individuals in states with more restrictive measures, such as stay-at-home orders, have recorded
even more cases of mental health difficulties. 2 The pandemic has also presented unique
challenges for individuals with substance use disorder (SUD) and those who are in recovery, as
social distancing and stay at home orders make it harder for patients to access treatment, such as
critical medications for opioid use disorders. 3
However, Subtitle A is also a departure from how the Congress has previously provided
emergency funding to address the coronavirus pandemic, and because of this, does not take into
account the time it will take for federal agencies to spend these resources, or address all the
needs, such as those of the National Institutes of Health and health care providers. The past five
legislative packages that were signed into law were negotiated in good faith between
Republicans and Democrats, with extensive input from all sides. 4
We are disappointed that the Democrats rejected bipartisanship and embraced a partisan
process. Instead of targeted and timely relief to COVID-19, the Democrats proposed mandatory
funding for all of these initiatives, abdicating responsibility for oversight, which is a troubling
departure from the oversight and reporting on the emergency designated discretionary
appropriations provided in the previous five COVID-19 emergency appropriations bills passed
last year.
Republicans agree with CBO that federal agencies might not be able to use the new
budget authority provided in Subtitle A quickly enough. Republicans are also concerned that the
resources may not be timely enough to help address any outstanding COVID-19 needs that
remain after the most recent relief package. 5 Subtitle A increases individual agencies' funding
for a single fi seal year by a substantial amount. The 2021 budget authority for the Centers for
Disease Control and Prevention (CDC), the Health Resources and Services Administration
(HRSA), and the Indian Health Service (IHS) would see enormous increases roughly halfway
through the fiscal year. Republicans, like the CBO, do not understand how these agencies would
be able to spend all of the new funds rapidly in a manner that has any meaningful near-term
impact on reducing COVID-19 cases and deaths in the United States. 6
1 Ninnita Panchal, ct al., The Implications of COVID-19 for Mental Health and Substance Use, Kaiser Family
Foundation, available at https:/lwww.kIT.org/health-refonnlissue-brief/the-implications-of-covid-l9-for-mental-
hcalth-and-substancc-usc/ (last updated Feb. 10, 2021).
2
Madeline Holcomb.Q_,j,on.£:itlm social distanc,~vumatic.f!cre is what to expect and what lo do, CNN
{ ~ 2020.L_ available . m __ https://www.cnn.com/2020/04/09/health/corooodrus-mentaJ-health-tong-tenn-
wellncss/index.html.
3 Dr. Francis Collins. Director, National Institutes of Health. Coping with the Collision ,,{ Public Ilea/th Crises:
COV!D-19 and Substance Use Disorders, NIH Director·s Blog (Apr. 2L 2020), available at
https://dircctorsblog.nil1.gov12020/04/2 l /coping-with-thc-collision-of-public-hcalth-criscs-covid-19-and-substance-
usc-disorders/.
4 PL ll6-123; P.L l16-l27; PL 116-136; PL 116-139; and P.L I 16-260.
'Congressional Budget Office, Reconciliation Recommendations ofthe {louse Committee on F.i1ergv and Commerce,
Fcbmary 14. 2021. l1t1ps:/lwww.cbo.gov/sys1em/filcs/2021-02/EncrgyandCommerceReconciliationEstimate.pdf.
6 Id.
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For example, the state of the nation's public health infrastructure and workforce are a
result of decades of neglect by state and local governments. At the same time, states have spent
ever increasing amounts of their budgets on Medicaid. Support for states to build their public
health workforce is laudable and could be accomplished by discretionary
appropriations. However, it is unclear how an immediate infusion of $7.6 billion in mandatory
funding for establishing and expanding a public health workforce, as is done in section 3021,
will lead to more public health professionals to fight COVID-19 now. State and local health
departments have struggled for years to recruit public health professionals in a field that has lost
more than 56,000 positions in the past decade. 7 A sustainable long-term increase in
discretionary funding autho1ized through regular order would have been a more appropriate way
to support state and local pub lie health departments and address the deaith in public health
professionals.
Republicans are concerned about the long-te1m health of critically important public
health programs that Subtitle A sets on dangerous fiscal cliffs. For example, section 303 l
provides $7.6 billion for Federally-qualified health centers, $800 million for the National Health
Service Corps, and $300 million for the Teaching Health Center Graduate Medical Education
program. This is approximately twice the amount that was authorized for these programs for
each of fiscal years 2021 through 2023 in the Consolidated Appropriations Act, 2021, which was
just signed into law two months ago. 8 These are unsustainable funding levels.
Republicans are disappointed that Subtitle A opens the door to federal funding for
elective abortions. Every Democrat voted against including the Hyde ainendment protections in
Subtitle A. The Hyde Amendment prevents all other federal funds for the Department of Health
and Human Services appropriated through the discretionary appropriations process, and also
mandatory health spending, from being used to fund abortion, except in the cases where the life
of the mother would be endangered if the fetus were earned to term, or in tbe case of rape or
incest. Since 1976, Hyde, and similar policies governing other federal programs, have been
supported and renewed annually on a bipartisan basis, multiple times, for decades. 9 Because
there are no Hyde Amendment protections, many provisions in Subtitle A, particularly where
funds have been authorized for broad purposes or for the provision of health services that are not
directly related to preventing and treating COVlD-19, will support elective abortions.
For example, section 3036 authorizes $50 million in mandatory fnnding for grants and
contracts under section 1001 of the Public Health Service Act, which is the Title X Family
Planning Program. First, it is unclear to Republicans how Title X funding will reduce
transmission of, and illness and death caused by, COVID-19. This funding is being authorized
on the heels of President Bi den directing the Department of Health and Human Services to
' Blaire Bryant Protect Funding for Core Local Public Health Se1vices and Prevention Progrnms, National
Association of Counties, available at https://www.naco.org/resources/protcct-funding-core-local-public-health-
services-and-preventiou-
programs#:~:text=According%20to%20the%20National%20Association,in%20fivc%201oca1%20health%20dcpartm
ents. (last updated Feb. 28, 2019).
8
P.L. l 16-260,
9
H.R.14232, Departments of U1bor, and Health. Education, and Welfare, and Related Agencies. 1977, 94th Congress
(l 976); Roll no. 846.
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reverse the "Protect Life Rule," 10 a rnlethat prohibited Title X-funded family planning services to
be performed at the same location where abortions are provided. Since existing Title X
appropriations have been obligated to non-abortion providing entities, section 3036 is just a way
to direct taxpayer dollars to abortion providers, like Planned Parenthood.
Lastly, Republicans are disappointed that the Democrats, in their haste to pass a partisan
package, did not assess the true budgetary needs of these agencies. The exorbitant funding levels
could lead to waste.
For example, section 3004 provides $500 million to the Food and Drug Administration
(FDA) for the evaluation of the continued performance, safety, and effectiveness of vaccines,
therapeutics, and diagnostics approved, cleared, licensed, or authorized for use for the treatment,
prevention, or diagnosis of COVID-19. Republicans believe that the agency should provide a
detailed account of how funds previously appropriated have been spent, what amount of funding
remains unobligated, and to what activities those unobligated dollars will be allocated before
appropriating additional funds, especially considering that $500 million is more than twice the
amount that has been appropriated to FDA under all previously enacted Coronavirus relief
legislation combined. 11
Additionally, advancing this legislation through regular order would have allowed both
Republicans and Democrats to have a better understanding of the FDA's existing needs. During
the full committee markup, the only opportunity provided to Republicans to ask questions and
raise concerns about the legislation being considered, Democrats asserted they had conversations
with FDA during which the agency expressed the need for this amount of funding. The FDA has
not provided to Republicans any request or justification for these funds, nor has FDA explained
how they will be used to advance the agency's mission. In addition, the majority ofFDA's
spending is on salaries. It is unclear how the $500 million could be used to support salaries
without creating a cliff where more funding is needed to retain those employees.
With respect to product reviews, Republicans question why these funds appear to be
intended solely for post-market surveillance, as opposed to both pre- and post-market activities,
given the likelihood that new COVlD-19 vaccines, therapeutics, and diagnostics will warrant
premarket review. 12 Furthermore, the funds may be used to facilitate and conduct inspections
delayed or cancelled for reasons related to COVID-19. t 3 While Republicans agree it is critical
that FDA resume on-site inspections, we question why additional funds are required to do so.
Since March 2020, FDA has conducted few domestic or foreign inspections due to safety
concerns and travel restrictions, not due to funding limitations. During fiscal year (FY) 2020, the
total number of inspections conducted by FDA, of both foreign and domestic establishments,
JO 84 F.R. 7714.
"P.L. 116-123: P.L. 116-136: P.L. 1!6-260.
12 S. Con. Res. 5, the Concurrent Resolution on the Budget for Fiscal Year 2021 (Febmary 11, 2021), l l7' h Congress
(2021-2022), available at ~ ~ I F / I F 0 0 / 2 0 2 1 0 2 l l/l l 1190/BILLS-l 17-A-P0000.14-
~-
)3 J,l
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was fifty-six percent lower than during each of the previous two fiscal years. 14 Between March
and October of 2020, only three foreign mission critical inspections and only fifty-two domestic
inspections took place. 15 In contrast, during a similar timeframe in each of the previous two
years, more than 600 foreign and 400 domestic inspections took place. 16 Given the significant
reduction in the number of inspections conducted, FDA must answer for how funds obligated
for FY 2020 inspection activities have been used and why it needs more funds to carry out
delayed or cancelled inspections.
Subtitle B: Budget Recouciliatiou Legislative Recommendations Relating to Medicaid
Section 3101. Mandatory Coverage ofCOVID-19 Vaccines and Administration Treatment
Under Medicaid.
Republicans want every American to have access to the COVID-19 vaccine and we
support fully covering the cost of the vaccine for Medicaid beneficiaries for the length of the
public health emergency. This will ensure we can vaccinate every single American, which will
help us reopen schools, workplaces, and the economy. However, in this section the Democrats,
instead, chose to extend the timeframe where vaccines are fully covered by one year. The
Democrats have provided no justification for this extension. Given that the public health
emergency will continue throughout 2021, Republicans recommend ascertaining how the states
are doing at the end of the year and extend the timeframe if needed. Instead, the Democrats are
spending money on the extra year that could have been used to increase funding for mental
health or SUD providers, or a number of other targeted and tempora1y priorities that both parties
share.
The Democrats are also giving the states the option to provide eoverage to the uninsured
for COVID-19 vaccines and treatment without cost sharing at I 00 percent federal medical
assistance percentage (FMAP). Republicans want all eligible beneficiaries to receive care and
want to work with the Democrats to improve access to care for all Americans. However, the
Medicaid program has eligibility requirements for a reason and Republicans want to make sure
that the program is able to continue serving the Americans who are eligible for Medicaid
coverage.
Section 3102. Modifications to Certain Coverage Under M.edicaid for Pregnant and
Postpartum Women.
Republicans are disappointed that the Democrats chose this partisan approach to a
bipartisan priority. H.R. 4996, the Helping MOMS Act of 2020, passed the House unanimously
last year and is the same policy as section 3102, except, H.R. 4996 was a permanent state option
to extend Medicaid eligibility to women for 12 months postpartum and section 3102 is a five-
year option. At markup, Republicans offered an amendment that would have implemented the
14 U nitcd States Government Accountability Office (GAO), Cm 1D-/ 9: Critical Vaccine Distribution, Sup!v Chain,
Program integrity, and Other Challenges Require Focused Federal Arlen/ion (January 2021). available at
~l1Llla9...i!lli&>Scts~[.
"Id
16 Id.
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permanent policy. Predictably, the Democrats rejected the proposal because it would cause the
Committee to exceed its reconciliation instructions. However, when CBO released its estimate
of the Committee's reconciliation package, Republicans learned that the Committee is under its
instruction of$188 5 billion by over $65 billion. 17 If the Committee had an estimate and
technical assistance before markup, we could have made this change permanent.
Section 3103. Allowing for Medical Assistance Under Medicaid for Inmates During 30-Dav
Period Preceding Release.
Republicans are willing to work with the Democrats to address medical assistance for
inmates during the 30-day period preceding their release from prison, but this is irrelevant to
responding to COVID-19. This is especially true since the Democrats included the coverage of
inmates in the vaccine development and distribution funding in Subtitle A, and included specific
funding for COVID-19 for those that live in congregate facilities. If this policy had been
considered through regular order, a hearing might have revealed how prisons differ from jails
when handling inmates a month before release and how we can tailor the policy to be the most
effective.
Republicans want all Americans to have access to the COVID-19 vaccine, including
inmates during the 30-day period before their release. But why is Medicaid coverage for inmates
30 days prior to release necessary? Also, how long will it take prisons and jails to have the
administrative capacity to bill Medicaid, and will prisons need additional resources to do so? If
the Committee followed regular order, some of these questions could have been answered.
Section 3104. Enhanced Federal Medicaid Support for Bundled Community-Based Mobile
Crisis Intervention Services.
This section is another partisan disappointment. The Democrats never explained how
this section will provide immediate relief to those suffering from COVID-19' s devastating
impact on mental health or SUD. CBO indicated that only 16 states have programs that would
immediately qualify for this provision, suggesting the limited impact this provision will have on
addressing nationwide mental health and SUD impacts from COVID-19. 18 Republicans believe
that tailoring a policy like the one in section 3108 for mental health and substance use providers
would have been a better way to provide immediate relief for the next year.
Section 3105. Temporary Increase in FMAP for Medical Assistance Under State Medicaid
Plans which Begin to Expend Amounts for Certain Mandatory Individuals.
Incentivizing states to expand Medicaid to address COVID-19 is a mistake. It is neither a
targeted nor a timely approach to continue the fight against COVID. We understand the need to
provide Americans access to affordable health insurance options, but, at a minimum, it takes
Congressional Budget Office, Reconciliation Recommendations ofrhe House Committee on Ene1:c;y and Commerce.
Febmary 14, 2021, https://www.cbo.gov/systcm/files/2021-02/EnergyandCommcrccReconciliationEstimatc.pdf.
18 Congressional Budget Office, Reconciliation Recommendations ofthe House Committee on Energy and Commerce,
Febmary 14, 2021, https://www.cbo.gov/system/files/2021-02/EnergyandCommerceReconciliationEstimate.pdf.
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several months to expand Medicaid. 19 Republicans believe that any COVID-19 relief package
should aim to end the pandemic in weeks now that a vaccine is available. The $16 billion cost
associated with this policy should be targeted to immediate COVlD-19 relief for Medicaid
providers who are working with the most at risk beneficiaries, including SUD, mental illness.
hospitals in rural areas, and nursing homes.
Section 3106. Extension of 100 Percent Federal Medical Assistance Percentage to Urban
Indian Health Organizations and Native Hawaiian Health Care Systems.
Republicans would have preferred to consider this section through regular order to ensure
that there are proper reporting and data requirements on the impact of the policy given that it is
only a two-year extension.
Section 3107. Sunset of Limit on Maximum Rebate Amount for Single Source Drugs and
Innovator Multiple Source Drugs.
Including this provision in this partisan package is another disappointment. Republicans
have supported this policy to pay for a permanent option for states to provide Medicaid coverage
to women for 12 months after birth. That was the bipartisan approach taken in H.R. 4996, the
Helping MOMS Act of 2020, which passed the House unanimously in the 116th Congress. Bnt
including this spending offset to fund unnecessary spending unrelated to the COVID-19 fight
will only make it harder to enact permanent needed support for new mothers who rely on
Medicaid.
Section 3108. Additional Support for Medicaid Home and Community Based Services
During the COVID-19 Emergencv Pe,·iod.
This is another provision that could have been done through regular order, but instead,
Democrats chose partisanship. Republicans support a temporary FMAP increase of7.35
percentage points for states to make improvements to Medicaid home- and community-based
services (HCBS) for one year. However. the Democrats would impose a litany of required uses
of the funds, which are overly burdensome at a time when states Medicaid programs need
flexibility to target efficiently their response to COVID-19. Republicans recommend providing
states more flexibility on how to use those funds.
Section 3109. Funding for State Strike Teams for Resident and Employee Safety in Nursing
Facilities.
Nursing homes have been devasted by COVID-19, and the pandemic has brought
attention to the need for improved infectious disease control at nursing homes. The Trump
Administration deployed "strike teams" to nursing homes starting in July, 2020, 20 and
Republicans support providing funding to continue this important initiative. However,
Republicans prefer that this funding be provided through emergency supplemental appropriations
19
https://www.kff.org/medicaid'issnc-brief/statns-of-statc-mcdicaid-expansion-dccisions-interactive-rnap/.
:.0 l -/ \ ll l\'-
~ - c m id-19.
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through regular order to ensure we have proper reporting and data on the impact of the policy
and its effectiveness.
Subtitle C: Budget Reconciliation Legislative Recommendations Relating to CHIP
Section 3201. Mandatory Coverage ofCOVID-19 Vaccines and Administration and
Treatment Under CHIP.
Republicans want every American to have access to the COVlD-19 vaccine. We support
folly covering the cost to vaccinate CHIP beneficiaries for the length of the public health
emergency. However, the Democrats' partisan decision to extend that timeframe for a year is
not based on any data or technical assistance. Since the public health emergency will continue
through 2021, a better way would have been to see how the states are doing are at the end of the
year and adjust if needed.
Section 3202. Modifications to Certain Coverage Under CHIP for Pregnant and
Postpartum Women.
It is disappointing the Democrats chose to include a bipartisan priority in the partisan
package. As noted earlier, H.R. 4996, the Helping MOMS Act of 2020, passed the House
unanimously last year and is the same policy as section 3102.
Subtitle D: Budget Reconciliation Legislative Recommendations Relating to Other
Provisions
Chapter 1
Chapter 1 of Subtitle Dis another disappointment and lost opportunity. Our concerns
with this chapter can be divided into two distinct categories: big-picture concerns and specific
policy choices reflected in the reported text, as well as those rejected by the votes of the
Democrats
Generally, the three sections in this Chapter are not consistent with the Democrats'
claims about what this bill does. Rather than providing the immediate aid the Democrats insisted
was essential for all Americans struggling with or vulnerable to COVID-19, the provisions
instead appear to craft long-term policies that deserved closer, deliberate attention.
To illustrate this overarching point, the authorized fonding appropriated in sections 3301
and 3303 is not time limited it is supposed to "remain available until expended" and section
3302 makes its funding available until September 30, 2022 - a time frame exceeding cun-ent
predictions on the length of the pandemic in the United States. Moreover, none of the sections
reference the public health emergency related to COVLD-19 that was issued by the Department
of Health and Human Services (HHS) and only section 3301 attempts to create a COVID-19
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nexus.
We believe the aid in this chapter would have been more efficiently and effectively
provided had the explicit statutory focus only been on directing actions necessary for the nation's
COVID-19 response. Frustratingly, the Democrats were not interested in a bipartisan response
of targeted relief that was time-limited and tied directly to COVID-19.
Unfortunately, Chapter 1, particularly section 3301 and 3303, also was not considered
through regular order in the Committee. Regular order would have allowed careful review of the
scope and timing of these provisions. For example, it would have provided opportunity to adjust
the focus of Section 3301 to include increasing employment and economic opportunity, in
addition to technical assistance concerning air quality. Providing more scrutiny and opportunity
for improvement of the legislative language would have ensured resources are directed to the
most urgent economic impacts of the pandemic.
Beyond these overarching concerns, each of the three sections in this chapter contained
specific provisions that gave us pause.
For section 3301, the lack of meaningful Congressional input is concerning we should
have had more of a process to obtain assurances as to what this language intends and,
considering that these provisions could be in force for a few years, understand what this language
might practically mean. These insights also are critical to conducting Congressional oversight on
the provisions, should they become enacted.
Another area of concern for us in section 3301 is its omission of health disparities of
certain workers related to COVID-19. Unemployment is well established as a risk factor for
elevated illness and mortality rates in epidemiological studies performed since the early 1980s.
In fact, the National Center for Health Statistics concluded that "children in poor families were
four times as likely to be in fair or poor health as children in families that are not poor." Most
significantly, as it relates to COVID-19 and the emergence of new more contagious variants,
Yale researcher Dr. William Gallo has stated in the past that late-career job loss results include
"substantial health consequences" and are a "potential risk factor for adverse vascular health
changes" -- the most troubling comorbidities threatening the survival of any person exposed to
the coronavirus.
The people made jobless via the White House executive orders in the first month of the
Biden Administration have been disregarded in these provisions. Our Democratic colleagues not
only rejected efforts to help these economically disadvantaged people, but their views were
punctuated by suggestions that welfare programs and green jobs for half the wages of their recent
employment should be an adequate replacement for these people. 21
""The average salary of oil and natural gas workers is approximately $112,000. more. than double the national private-
sector average of $51,000. But oil and gas workers don·tjust make double that of the national average. They tnake
double that of wind and solar workers.
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Moving to section 3302, it provides $4.5 billion through the end of fiscal year 2022 for
the Low-Income Home Energy Assistance Program (LIHEAP). This amount exceeds the entire
amount enacted for LIHEAP in fiscal year 2021 just eight weeks ago ($3.75 billion). 22 In
addition, this funding is to be disbursed without regard to existing financial reasonableness
requirements placed on states for how much LIHEAP funding can be allotted at any one time.
As mentioned earlier, while we do not oppose addressing LlHEAP at this time, this scale of
spending should have been directly connected to COVID-19, and adjusted to ensure it will do
what it is supposed to do, minimizing waste and abuse.
Section 3303 provides $500 million - for as long as it takes to spend it all - to a new
program to pay the water and wastewater bills oflow-income people. This $500 million amount
is in addition to the $638 million provided for a nearly identical purpose in the Consolidated
Appropriations Act, 2021 23 Taken together, this eight-week total comes to $1.138 billion for
this new program $12 million more than the Federal government provided in capitalization
grants in fiscal year 2021 for all public water system infrastructure under the Drinking Water
State Revolving Loan Fund.
Of note, the biggest difference between the language in section 3303 and that from the
Consolidated Appropriations Act, 2021 is that section 3303 omits provisions encouraging HHS
to use its existing processes and procedures under .LIHEAP to distribute this money to utilities
efficiently. This is an important omission. There was no Committee of review whether this
omission will create problems. For, example, because the language in the Consolidated
Appropriations Act, 2021 is only valid for that fiscal year and section 3303 is drafted to outlast
it, when section 3303 still has funding on October I, 2021, HHS would be free to use whatever
process it wants to distribute the money, even ifit is untested or inefficient. This seems like a
recipe for potential waste and abuse; and only further reinforces why a targeted and temporary
program is the preferred way to handle this matter.
While President Bi den and the Democrats should be focused on defeating COVID-19 and
rebuilding our economy, they are waging a war on fossil energy jobs that is resulting in
significant and negative disparate impacts in rural and low-income communities. Immediately
upon taking office, President Biden revoked the permit for the Keystone XL pipeline and
imposed a moratorium on oil and gas drilling on Federal lands and offshore waters. These
According to data from the U.S. Department of Labor's Bureau of Labor Statistics, in 2019 a worker installing solar
panels made an average of a little more than $21 an hour. Workers in oil and gas extraction made more than twice as
much. at an average of over $42 au hour.•·
https://thcfedera list com/2021/0 l/27/bidens-greeu-energy-jobs-rea!ly -mean-110-energy-jobs-and-low-payiug-euergy-
jobs/
02 House Energy and Commerce Committee Republican Le;ider Cathy McMorris Rodgers sent a letter to the Office
of Management and Budget on Febmaty 4, 202 L requesting an accounting of what funds have been expended already
in com1ection with the $3. 75 billion in LIHEAP funding from the Consolidated Appropriations Act, 2021. 0MB has
proyided no response to lhal letter to date.
o.1 House Energy and Commerce Committee Republican Leader Cathy McMonis Rodgers sent a letter to the Office
of Management and Budget on Febmary 4, 2021, requesting aJl accounting of what funds have been expended already
in connection with the $638 million from the Consolidated Appropriations Act, 2021. 0MB bas provided no response
to that letter to date.
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decisions will eliminate tens of thousands of jobs and deprive states of billions of dollars of tax
revenue to help pay for schools, hospitals, and government services.
Republicans offered several amendments to protect jobs, stimulate economic growth, and
provide mental health services for unemployed energy workers - particularly critical during the
global pandemic and economic downturn -- Democrats rejected them all.
In connection with Subtitle A, Rep. Mullin offered an amendment to increase funds for
community mental health block grants to strengthen mental health services in states that have
had unexpected jobs losses due to President Biden's Executive Orders. This Administration's
policies, such as implementing morat01ia on oil and gas development and production, will put
tens of thousands of people in the energy sector out of work and deprive states of billions of
dollars in tax revenues. This amendment would have required the HHS Secretary to obligate 5
percent of the amounts under the mental health block grants to states suffering unemployment
from the Biden Administration's recent energy and climate executive orders. Every Democrat
rejected the Mullin amendment.
Rep. Annstrong offered an amendment to resume construction of the Keystone XL
pipeline and immediately put thousands of people back to work. This $1. 7 billion investment
would have created over 10,000 American union jobs and contributed billions to U.S. workers
through direct jobs in construction and indirect jobs in hotels, restaurants, and thousands of
businesses across the country that were lined up to provide their services to help build the
prClject. This construction program was already underway when the Biden Administration
revoked their permit and eliminated thousands of jobs and over $3 billion in contracts that would
have gone to U.S. contractors and suppliers. Again, every Democrat rejected the Armstrong
amendment to authorize construction of the Keystone XL pipeline.
Rep. Duncan offered an amendment to prevent President Bi den from following through
on his campaign promise to ban hydranlic fracturing perhaps the most direct threat to our
economic security and national security. If the Biden Administration were to ban hydraulic
fracturing, this would eliminate millions of jobs across our American energy industry and our
economy. States and local governments, schools, hospitals, and community centers would be cut
off from billions of dollars in funding that currently comes from the oil and gas industry.
According to a recent study, 24 placing a moratorium on hydraulic fracturing would mean a $900
billion increase in U.S. household energy costs, $7.1 trillion in potential losses to the U.S.
economy through 2030, and over 7 million fewer U.S. jobs by 2022. Additionally, such a
moratorium would force the U.S. to import 40 percent of our oil and petroleum products and 29
percent of our natural gas by 2030. Again, every Democrat rejected the Duncan amendment.
We understand the importance of this package and wanted to support it, but defects such
as those outlined above and the unwillingness of the Democrats to accept any of our ideas to
24 America's Progress at Risk: An Economic Ana(vsis of a Ban on },'racking and r~deral Leasing.for Natural Gas
ond 01/ Development, American Petroleum Institute, ]JJ~~edia/Fiks/Oil-and-Natural-
Gas/H_Ydrauli~f020/f~~~=
J:i&&\IL'.!!J=en&;hash=l 3421!2!.1 I 50A5594H2DX-IQ507F6EAB04A23 J 2.JG.
11
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protect workers and focus the delivery of funding on those most in need leaves us no choice but
to oppose it.
Chapter2
Section 3311. Funding for Consumer Protection Safety Fnnd to protect consumers from
potentially dangernus products related to COVlD-19.
We are disappointed that the Democrats continued its partisan approach in drafting
section 3311, which is similar to the provisions ofH.R. 8134, the Consumer Product Safety
Inspection Enhancement Act, a bill to authorize additional resources for the Consumer Product
Safety Commission (CPSC). During the ! 16th Congress, the Committee on Energy and
Commerce passed H.R. 8134 by a voice vote on September 24, 2020, and the bill passed the full
House of Representatives by a voice vote on September 29, 2020. Because of the Committee's
bipartisan efforts, an authorization for additional port inspection personnel for the CPSC was
included in division F, title XX, ofH.R. 133, the Consolidated Appropriations Act of 2021,
enacted on December 27, 2020.
The Democrats ignored the bipartisan consensus recognizing the threat posed by the
People's Republic of China (PRC) and instead, allocated $50 million that are desperately
needed for the CPSC' sport inspection responsibilities to a Commission slush fund to be
used however the CPSC chooses and without regard for our bipartisan agreement.
We support enhancing our ports security and providing the necessary resources to do
so. In 2020, the House Republican China Task Force issued a report outlining many of the
Chinese Communist Party's (CCP) subversive acts against our country. The PRC is a threat to
our way of life. Resources are needed to enhance targeting, surveillance, and screening of
consumer products originating from China. But section 3311 includes new definitions like
"COVTD-19 products," which have not been vetted and may reach beyond the CPSC's
authority.
Section 3311 also includes new provisions that were not included in the 2020 bipartisan
agreement and that the Democrats never discussed with us. In particular, we are concerned that
authorizing the CPSC to undertake "enhanced monitoring of Internet websites" will distract the
Commission from its port inspection duties.
The CPSC does not need more full-time personnel surfing the Internet. The Commission
needs more personnel on the ground at ports, protecting us from dangerous products from the
CCP. These resources should be targeted on counterfeit and illicit products originating in the
PRC. In a January 24, 2020, report entitled "Combating Trafficking in Counterfeit and Pirated
Goods," the Department of Homeland Security (DHS) estimated that 100,000 packages that
12
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could harm or defraud our constituents arrive in America every day from China and more than
85 percent of all contraband seized at our borders comes from China and Hong Kong.
There is another DHS report, "Operation Stolen Promise," which found that more than 50
percent of the nations' counterfeit COVID-19 products originate from China and Hong
Kong. And a recent article from Reuters found that Chinese internment camps in the Xinjiang
region force Uighur Muslims into labor camps and often shave the heads of women to use their
hair in products shipped to the U.S. We wrote to the CPSC about these Uighur women recently,
and the CPSC has acknowledged that it has not tracked this matter.
This section is a disappointment and a missed opportunity to continue our bipartisan
work to keep Americans safe from dangerous products from China.
Section 3312. Funding for E-Rate Support for Emergency Educational Connections and
Devices.
This section wastes $7.6 billion dollars in taxpayer funding for purposes that Congress
has already funded. It provides funding for schools and libra1ies to buy and distribute Wi-Fi
hotspots, modems, routers, and other devices for students to use for off-premise schoolwork
This funding is duplicative ofa cumulative $110 billion that Congress appropriated in 2020 to
the Department of Education to respond to the coronavirus pandemic, and much of that money
remains unspent. It is irresponsible for Congress to appropriate more money for this purpose
before the existing money is spent and Congress can determine where, if any, there are
remaining gaps.
Besides the fact that Congress already appropriated money in the early days of the
pandemic for remote learning purposes, this program is also inconsistent with the President's
goal to reopen schools because it encourages the continuation of remote learning. Similarly, it
conflicts with the Administration's Centers for Disease Control and Prevention guidance, which
states that it is safe for schools to reopen and that they should do so as quickly as possible.
[n addition, and contrary to claims from the Democrats, section 3312 does nothing to
support the Federal Communications Commission's (FCC) E-Rate program. Rather, it creates a
new program with no rules, no requirements, and no oversight to track the devices once they are
given to students, or to verify eligibility and ensure that there is no double dipping at schools and
libraries. The statute also does not clearly state whether or not this funding is available only for
the duration of the COVID-19 pandemic, or until 2030, which is well beyond the scope of the
pandemic. This program is simply a vehicle for the Democrats to implement its longstanding
partisan policies endorsed by the teachers' unions rather than helping Americans.
During the Committee markup of this provision, Rep. Latta and Rep. Walberg offered
amendments that would provide long-term solutions to close the digital divide and incentivize
schools to re-open for in-person learning. To provide a pe1manent solution to close the digital
divide, Rep. Latta offered an amendment to redirect this funding to rural broadband deployment
in unserved areas. Rep. Walberg offered an amendment to put this money directly into the
existing E-Rate program at the FCC, which funds connections and certain technologies in
13
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CONTENTS
Page
I. Purpose and Summary
II. Background and Need for the Legislation
III. Committee Consideration
IV. Committee Votes
V. Oversight Findings
VI. New Budget Authority, Entitlement Authority, and Tax Expenditures
VII. Congressional Budget Office Estimate
VIII. Federal Mandates Statement
IX. Statement of General Performance Goals and Objectives
X. Duplication of Federal Programs
XI. Committee Cost Estimate
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits
xrn. Advisory Committee Statement
XIV. Applicability to Legislative Branch
xv. Section-by-Section Analysis of the Legislation
XVI. Changes in Existing Law Made by the Bill, as Reported
XVII. Additional Views
I. PURPOSE AND SUMMARY
Subtitle C: Budget Reconciliation Legislative Recommendations Relating to Children's
Health Insurance Program (Subtitle C) provides budget reconciliation recommendations related
to the Children's Health Insurance Program (CHIP) to the House Committee on Budget pursuant
to S. Con. Res. 5 to provide comprehensive relief to the American people in response to the
coronavirus disease of 2019 (COVID-19) pandemic and the resulting public health emergency
(PHE). The legislation would give states the option to extend CHIP eligibility to women for 12
months postpartum for five years. Tt also requires CHIP coverage of COVID-19 vaccines and
treatment without beneficiary cost sharing with the vaccines and the administration of vaccines
matched at a 100 percent of Federal Medical Assistance Percentages (FMAP) through one year
after the end of the PHE.
II. BACKGROUND AND NEED FOR LEGISLATION
Since the first case of COVID-19 in the United States was discovered on January 21, 2020, 1
the United States response efforts have failed to mitigate or reduce COVID-19 transmission in
the country. As of February 4, 2021, approximately 2.93 million children in American have
1
Centers for Disease Control and Prevention, First Travel-related Case c,{2019 novel Coronavirus
Detected in United States (Jan. 21, 2020) (www.cdc.gov/media/releases/2020/pO 121-novel-
coronavims-travel-case.html) (press release).
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tested positive for COVID-19. 2
The most recent data shows that 10 million Americans are still unemployed, 3 and there are
still 9.8 million fewer jobs in the U.S. economy than there were in February 2020, right before
the pandemic began. 4 CHIP has been an important source of coverage that has helped states
respond to and mitigate the effects ofCOVID-19 and the economic downturn. 5 The legislation
would strengthen CHIP coverage by authorizing states to invest additional resources to extend
CHIP eligibility for women to 12 months postpartum.
In addition, although federal legislation in previous COVID relief packages has expanded
access to vaccines and treatment for COVID-19 free of cost-sharing, gaps in coverage remain. 6
The legislation expands access to vaccination and treatment for COVID-19, by providing
children and pregnant and postpartum women enrolled in CHIP with free COVID-19 vaccines
and treatment fully funded by the federal government through one-year after the end of the PHE.
III. COMMITTEE CONSIDERATION
The Committee on Energy and Commerce met in virtual open markup session, pursuant to
notice, on February J 1 and 12, 2021. During consideration of Subtitle Con February 12, an
amendment in the nature of a substitute (AINS) offered by Ms. Eshoo was agreed to by a voice
vote. Mr. Pallone, Chairman of the committee, subsequently moved that Subtitle C be ordered
transmitted favorably to the House Committee on Budget, amended, by a roll call vote: 30-24
(Roll call no. 18), a quorum being present.
IV. COMMITTEE VOTES
Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the
Committee to list each record vote on the motion to report legislation and amendments thereto.
The Committee advises that there was one record vote taken on Subtitle C, including a motion by
Mr. Pallone ordering Subtitle C favorably transmitted to the Committee on Budget, amended.
The motion on final passage of the bill was approved by a record vote of 30 yeas to 24 nays. The
2
American Academy of Pediatrics, Children and COVJD-19: State-Level Data Report, (Feb. 8, 2021)
(scrvices.aap.org/cn/pagcs/20 ! 9-novel-coronavirus-covid-19-infoctions/childrcn-and-covid- l 9-state-
level-data-report/).
3
Bureau of Labor Statistics. THE J,MPLOYlVlENT SITUATION·· ~ JANUARY 2021 (Feb. 5, 2021)
(www.bls.gov/news.release/pdtlempsit.pdf) (press release).
4
The economy gained just 49,000jobs in January as recovery sputters amid pressure.from vin,s,
Washington Post (Feb. 6, 2021) (www.washingtonpost.com/business/2021/02/05/january-jobs-
rcport-2021-unemploymcnt).
5 Kaiser Family Foundation, Analysis ofRecent National Trends in Medicaid and CHIP Enrollment (Jan.
21, 2021) (www .kff.org/coronavims-covid-19/issuc-brief/analysis-of-recent-national-trends-in-
medicaid-and-chip-enrollment).
6
Kaiser Family Foundation, Gaps in Cost Sharing Protections.for COVID-19 Testing and Treatment
Could Spark Public Concerns About COVJD-19 Vaccine Costs (Dec. 18, 2020) (www.kfforg/health-
costs/issue-brief/gaps-in-cost-sharing-protections-for-covid-19-testing-and-trcatment-could-spark-
public-concerns-about-covid-19-vaccinc-costs/).
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following is the record vote taken during Committee consideration, including the names of those
members voting for and against:
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<Connnittct on Q.:nerro? anb <£ommtrcc
117th Congress
Full Committee
(ratio: 32-26)
ROLLCALLVCYrE#l8
Bill Subtitle C, ''Budget Reconciliation Legislative Recommendations
Relating to Children's Health Insurance Program"
Motion: A motion by Mr. Pallone of New Jersey to order Subtitle C, "Budget
Reconciliation Legislative Recommendations Relating to Children's
Health lnsmance Program" transmitted favorably to the House Committee
on Budget, amended (Final Passage).
Disposition: AGREED TO by a roll call vote of 30 yeas to 24 nays
REPRESENTATIVE YEAS NAYS PRESENT REPRESENT ATlVE YEAS NAYS PRESENT
Rep. Pallone X Rep. Rodgers X
Rep. Rush X Rep. Upton X
Rep. Eshoo X Rep. Burgess X
Rep. DeGette Rep. Scalise X
Rep. Doyle X Rep. Latta X
Rep. Schakowsky X Rep. Guthrie X
Rep. Butterfield X Rep. McKinley X
Rep. Matsui X Rep. Kinzinger X
Rep. Castor X Rep. G1iffith X
Rep. Sarbanes X Rep. Bilirakis X
Rep. McNemey X Rep. Johnson
Rep. Welch X Rep. Long X
Rep. Tonka X Rep. Bucshon X
Rep. Clarke X Rep.Mullin X
Rep. Schrader X Rep. Hudson X
Rep. Cardenas X Rep. Walberg X
Rep. Ruiz X Rep. Carter
Rep. Peters X Rep. Duncan X
Rep. Dingell X Rep. Palmer X
Rep. Veasey X Rep. Dunn X
Rep. Kuster X Rep. Curtis X
Rep. Kelly X Rep. Lesko X
Rep. Barragan X Rep. Pence X
Rep. McEachin Rep. Crenshaw X
Rep. Blunt Rochester X Rep. Joyce X
Rep. Soto X Rep. Annstrong X
Rep. O'Halleran X
Rep. Rice X
Rep. Craig X
Rep. Schrier X
Rep. Trahan X
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Rep. Fletcher X
021!212021
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V. OVERSJGHT FINDINGS
Pursuant to clause 3(c)(1) of rule XIII and clause 2(b )(1) of rule X of the Rules of the House
of Representatives, the oversight findings and recommendations of the Committee are reflected
in the descriptive portion of the report.
VJ. NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX
EXPENDITURES
Pursuant to 3(c)(2) of rule XHI of the Rules of the House of Representatives, the Committee
adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures
or revenues contained in the cost estimate prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act of 1974.
VII. CONGRESSIONAL BUDGET OFFICE ESTIMATE
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Congressional Budget Office February 14, 2021
Cost Estimate
Reconciliation Rec.ommendations of the House Committee on Energy
and Commerce
As ordered reported on February 12, 2021
Miliion"i. of Dollars 2021 2021-2030~ 2021-2031
--•,.•-•• ••~--.. .,~• n•~.-- •••• ••-.- •••
Direct Spending iOutlays) 27,498 126,130 123,827
Revenues 0 1,474 1,488
Increase or Decrease(-)
in the Deficit 27,498 124,656 122,339
Yes' ·--r
j Contains intergovernmental mandate?
!
j Contains private-sector mandate?
J:~eO haS::ruifav.ie~6d- ihe le~i~~~tion ~; etfeoi$ on·SP~~di~-0 ·subjtia ttraptJtQpriatfOtl.'
-- ~ -,~ .,,.,_.· --.--· -'" '"____ -•• '--~--~ -_,,_,_ __ -·.-.- \ -~--~.-.". -~..... <-- .__ ' ',,,,_,__________ -" -
·1
.... -"~-- ... -~- -. - __.,.,_________ --- ------·-· ,' _,- •. -'. - "_____ i
The legislation would
• Appropriate $105 billion for various activities related to testing for, treating, and responding to COVID-19
(the disease cause by the coronavirus); and for other activities related to COVID-19
• Allow extended postpartum coverage in Medicaid and the Children's Health Insurance Program (CHIP)
• Increase the federal medical assistance percentage (FMAP) to encourage states to expand Medicaid
coverage and increase their provision of certain types of long-term services and supports
• Eliminate the cap on rebates that drug manufacturers pay to Medicaid
• Increase the cost of an existing private-sector mandate on certain commercial entities if the Federal
Communications Commission increases annual fee collections
Estimated budgetary effects would mainly stem from
• Increased direct spending resulting from $105 billion in new budget authority
• Additional direct spending from increasing the number of months of postpartum coverage under
Medicaid and CHIP
• Increased Medicaid and CHIP spending on COVID-19 vaccines, new enrollees, services for inmates in
jails and prisons, and long-term services and supports
• Reduced Medicaid spending on prescription drugs
Areas of significant uncertainty include
• Estimaling the rate at which the new budget authority would be spent by federal agencies
• Predicting how many women would participate in postpartum coverage under Medicaid and CHIP
• Estimating how many states would expand Medicaid coverage as the result of higher FMAPs
• Estimating future growth in drug prices
Detailed estimate begins on the next page.
See also CBO's Cost Estimates Explained, www.cbo.gov/pub1icatlon/54437;
How CBO Prepares Cost Estimates, www.cbo gov/pub!ic..tion/53519; ond Glossary, WNW cbo gov/publication/42904.
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Summary of the Legislation
S. Con. Res. 5, the Conctment Resolution on the Budget for Fiscal Year 2021, instructed
several committees of the House of Representatives to recommend legislative changes that
would increase deficits up to a specified amount over the 2021-2030 pe1iod. As part of this
reconciliation process, the House Committee on Energy and Commerce approved legislation
on February 12, 2021, with a number of provisions that would increase deficits.
The legislation would appropriate $92.2 billion for various activities related to testing for,
treating, and responding to COVID-19, the disease caused by the coronavirns. The legislation
would also make changes to the Medicaid program and the Children's Health Insurance
Program (CHIP), which include expanding coverage for women after the birth of their child,
encouraging states that have not already done so to expand Medicaid coverage to adults made
eligible by the Affordable Care Act (ACA), and eliminating the limit on the rebates paid by
drug manufacturers to Medicaid. Finally, the legislation would appropriate $12.8 billion for
various activities related to addressing the energy, environmental, educational, and
commerce-related effects of the coronavirus pandemic.
Estimated Federal Cost
The estimated budgetary effects of the reconciliation recommendations of the House
Committee on Energy and Commerce are shown in Table 1. Tl1e costs of the legislation fall
within budget functions 300 (natural resources and environment), 370 (commerce and
housing credit), 500 (education, training, employment, and social services), 550 (health), and
600 (income security).
Basis of Estimate
For this estimate, CBO assumes that the reconciliation bill will be enacted by the end of
March 202 l. Outlay estimates are based on historical spending patterns for affected programs
and information from the agencies about program implementation.
Direct Spending and Revenues
CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting the
reconciliation recommendations of the House Committee on Energy and Commerce would
increase direct spending by $126. l billion and would increase federal revenues by
$ l.5 billion over the 2021-2030 period, for a net effect on the deficit over that period of
$124. 7 billion.
Funding for Public Health. Subtitle A would appropriate $92.2 billion for various activities
aimed at improving public health and responding to COVID-19.
Within subtitle A, Chapter l would provide $14.2 billion to fund activities related to
vaccination and treatment with the following specific appropriations:
• $7.5 billion to the Centers for Disease Control and Prevention (CDC) to plan, prepare for,
promote, distribute, administer, monitor, and track COVID-19 vaccines;
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• $1 .0 billion to the CDC to improve vaccine education and confidence and vaccination
rates;
• $5.2 billion to the Secretary of Health and Human Services (HHS) to advance research,
development, manufacturing, production, and the purchase of vaccines, therapeutics, and
ancillary medical products to prevent, prepare, and respond to SA RS-CoV-2, COVID-19,
or any disease with potential for creating a pandemic; and
• $0.5 billion to the Food and Drug Administration to oversee the development and
marketing of COVID-19 therapeutics, vaccines, and diagnostic tests.
Chapter 2 would provide $49.0 billion for testing for COVID-19, specifically appropriating:
• $46.0 billion to the Secretary of HHS to detect, diagnose, trace, and monitor COVID-19
infections;
• $1.8 billion to the CDC for genomic sequencing, analytics, and disease surveillance;
• $0.8 billion to the CDC to combat COVID-19 and other emerging infectious threats
globally; and
• $0.5 billion to the CDC to support the surveillance and analytic infrastructure of public
health data.
Chapter 3 would provide $7.8 billion for strengthening the public health workforce with two
specific appropriations:
• $7.7 billion for state, local, and territorial public health departments to establish, expand,
and sustain their public health workforce; and
• $0. l billion to the Medical Reserve Corps.
Chapter 4 would provide $11.2 billion for other public health investments that specifically
cover:
• $7.6 billion for awarding grants and cooperative agreements to community health centers
and qualified entities under the Native Hawaiian Health Care Improvement Act to support
activities related to testing for, treating, and vaccinating against COVID-19;
• $0.8 billion to the National Health Service Corps to support qualified health care
providers working in areas with limited access to care;
• $0.2 billion to the Nurse Corps to suppo1i nurses working in facilities that provide
primary health care or maternal health care to underserved populations;
• $0.3 billion to health centers that provide graduate medical education;
• $1.8 billion for activities related to testing, tracing, and mitigating COVID-19 infections
in congregate settings; and
• $0.4 billion for HHS to provide services for children under its care, including
unaccompanied alien children in the custody of the Office of Refugee Resettlement.
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Chapter 5 would provide $6.1 billion to the Indian Health Service (IHS) for lost
reimbursements resulting from people deferring routine and elective health care, testing and
tracing of COVID-19 infections, COVID-19 vaccine promotion, distribution and
administration, additional support for purchased and referred care, and for other purposes.
Chapter 6 would provide $3.9 billion to strengthen activities related to mental health and
substance abuse, specifically appropriating:
• $1.8 billion to the Secretary of HHS for community mental health services;
• $1.8 billion to the Secretary of HHS for activities relating to the prevention and treatment
of substance abuse;
• $0.1 billion for the Health Resources and Services Administration (HRSA) to award
grants to eligible institutions that provide mental and behavioral health education and
training; and
• $0.3 billion for other activities.
Chapter 7 would appropriate $20 million to HHS for grants to eligible states to modernize the
health insurance marketplaces established under the ACA.
In total, CBO estimates that the funds appropriated by subtitle A would increase direct
spending by $91.3 billion over the 2021-2030 period.
Coverage of COVID-19 Vaccinations and Treatments. Subtitles Band C would make
various changes to the Medicaid and CHIP programs' coronavirus-related spending. In total,
sections 3101 and 3201 would increase direct spending by an estimated $1. l billion and
$68 million, respectively, over the 2021-2030 period.
Mandatory Coverage of COV!D-19 Vaccination, Without Cost Sharing. Sections 3101 and
3201 would require state Medicaid and CHIP programs to cover vaccinations, without cost
sharing, for all eligible enrollees. Under current law, the federal government is expected to
provide the vaccines administered through both programs, but some patients would still have
to pay the cost sharing associated with having the vaccine administered. In addition, if a
state implements an option under Medicaid to provide COVID-19 testing for uninsured
people, it would have to do so without cost sharing. The sections also would extend for a year
the period in which a state must vaccinate, without cost sharing, adults enrolled in Medicaid
under the program's traditional eligibility rules.
CBO estimates that 4 million Medicaid and CHIP enrollees are currently ineligible for
vaccination under either program. By the end of the public health emergency (PHE), CBO
estimates, fewer than l million adults enrolled under Medicaid's traditional eligibility rules
would be subject to cost-sharing requirements to receive the vaccine.
If enacted, CBO estimates, the requirements in sections 3101 and 3201 would increase the
number of vaccinations administered to Medicaid and CHIP enrollees by about 2 million
doses in 2021 and by about 6 million over the 2021-2023 pe1iod. Because the federal
government is expected to provide the vaccine itself, sections 310 I and 3102 would only
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affect the costs associated with administering the vaccines. Using infonnation from the
Centers for Medicare & Medicaid Services, CBO estimates that in 2021, the cost of
administering a single dose will vary between $17 and $28, depending on the type of vaccine.
Over the 2021-2030 period, CBO estimates, the requirement to provide vaccination coverage
without cost sharing would increase Medicaid's direct spending by $107 million and CHIP's
by less than $1 million.
Increased Federal Medical Assistance Percentage for Vaccinations. Sections 3101 and 3201
also would raise the federal medical assistance percentage (FMAP) to l 00 percent for
payments to states for administering vaccines for one year after the end of the PHE. Over the
2021-2030 period, CBO estimates, the higher FMAP would increase direct spending for
Medicaid and CHIP by $747 million and by $68 million, respectively.
Mandatory Coverage c>[Treatment or Prevention, Without Cost Sharing Sections 3101 and
3201 also would require state Medicaid and CHIP programs to provide coverage, without
cost sharing, for treatment or prevention of COVID-19 for one year after the end of the PHE.
Additionally, over the same period, if a state chose to implement an option under Medicaid to
provide COVID-19 testing for uninsured people, section 3101 also would extend the
requirement to provide treatment and prevention to those people without requiting cost
sharing.
About 5 million people emolled in Medicaid or CHIP are expected to receive COVID-19
treatment in 2021. CBO expects that number to decline to fewer than 100,000 by 2022 and
estimates that about 25 percent of those people would be subject to cost-sharing requirements
for a physician service ($2, on average, in 2021 ), an inpatient hospital service ($70, on
average, in 2021), or both. CBO estimates that the requirements in sections 3101 and 3201
that would prohibit cost sharing for treatment would increase direct spending by $34 million
for Medicaid and by less than $1 million for CHIP over the 2021-2030 period.
CBO anticipates that 3 million uninsured people will receive COVID-19 treatment in 2021.
By 2022, that number is expected to fall below 50,000. In 2020, 10 states had implemented
an option under Medicaid to test uninsured people for COVID-19. In those states, CBO
estimates, the requirement in section 3 JO l to provide vaccinations or treatment services
would increase direct spending for Medicaid by $243 million over the 2021-2030 period.
Coverage for Pregnant and Postpartum Women. Sections 3 l02 and 3202 would allow
states to extend health coverage for women enrolled in Medicaid or CHIP for 12 months after
the birth of a child. In total, CBO estimates, those sections would increase federal deficits by
$5.1 billion over the 2021-2030 period-an increase in direct spending of $6.0 billion and an
increase in revenues of $0.8 billion over the period.
Under cunent law, for 60 days after the birth of a child, states must provide Medicaid
coverage to women whose income does not exceed 138 percent of the federal poverty level
(FPL). Forty-six states and the District of Columbia exercise an option under cunent law to
provide Medicaid coverage to pregnant women whose income is above 138 percent oftbe
FPL, 29 extend coverage if their income is equal to or above 200 percent of the FPL, and 3
extend coverage if their income is above 300 percent of the FPL. Under c1ment law, states
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also can provide pregnancy-related services to women under CHIP, but they may only
provide postpmtum services to women who, if not for their income, would otherwise be
eligible for coverage under Medicaid.
CBO estimates that in 2020, Medicaid and CHIP provided pregnancy-related coverage to
about 2 million women; approximately 1.8 million cmried their pregnancy to tem1. CBO
estimates that about 35 percent of those recipients have income above 138 percent of the
FPL, which reflects the coverage options cmTently available to states under Medicaid and
CHIP. Regardless of a state's decision to provide optional coverage to eligible women, the
state must reevaluate applicants' eligibility for oilier covernge before the end of the 60-day
postpmtum period. lVIedicaid coverage after that point can include the full scope of healtl1
services or be limited to family-planning services.
Medicaid Coverage Under the 12-Month Option. CBO estimates that under cun-ent law, at
the end of the 60-day postpartum period about 30 percent of women will continue to receive
comprehensive services from Medicaid, 30 percent will enroll either in employment-based or
in mm·ketplace coverage, and about 45 percent will be uninsured (although roughly two-
thirds of those women would still receive family-planning services).
Section 3 l 02 would provide women in states that exercise the option witli l O additional
months of Medicaid coverage. CBO estimates that by 2024, about 25 percent of all women
who would be expected to receive postprutum services from Medicaid will live in states that
implement the 12-month option. Using administrative data and information from industly
sources, CBO estimates that the combined federal and state cost to provide IO additional
months of Medicaid coverage would be about $ l,500 per person, on average, in 2022; tliat
mnount would increase at an average annual rate of about 6 percent over the 2022-2030
period. For women whose Cllffent-law Medicaid services are limited to fatnily planning,
CBO estimates that the cost per person would be about $1,100, on average. In total, CBO
estimates, the additional months of coverage would increase direct spending for Medicaid by
$6. l billion over the 2021-2030 period.
CHIP Coverage ji1r Pregnant and Postpartum Women. Under cun-ent law, states can provide
CHIP coverage to eligible women during pregnancy and for 60 days after the birth of a child.
CHIP cannot be used to replace existing Medicaid coverage for pregnant women. To cover
pregnant women under CHIP, states must provide, at a minimum, Medicaid coverage to
women whose income is up to 185 percent of the FPL. In 2020, approximately 15,000
women received pregnancy and postpartum care under CHIP. CBO estimates that all of those
women became ineligible for comprehensive Medicaid and CHIP services at the end of the
60-day postpartum period.
If a state provides CHIP coverage to eligible women up to the end of the 60-day postpartum
period, and if the state chooses to implement the Medicaid option under section 3102, the
legislation would require tlie state to extend similar coverage under CHIP. However, because
not all states extend CHIP coverage to pregnant women, CBO estimates that by 2024 fewer
than 1,000 pregnant women wonld reside in a state that implemented the option. CBO
expects that additional months of coverage under CHIP would cost about the same as under
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Medicaid. On net, CBO estimates, section 3202 would increase direct spending for CHIP by
$5 million over the 2021-2030 period.
Private Health Insurance.for Pregnant and Postpartum Women. Some women whose
Medicaid coverage ends after the birth of a child enroll in private health insurance. CBO
estimates that in states that are expected to implement the option nnder section 3102, fewer
than 5 percent of women who become ineligible each year for Medicaid or CHIP cmTently
receive coverage through a marketplace and 30 percent enroll in employment-based
coverage. Under section 3102, over the 2021-2030 period, about 10,000 and 100,000 women
annually would delay enrollment either in marketplace coverage or in employment-based
coverage, respectively, for about l O months. That delay would lower subsidies for private
health insurance, thereby reducing direct spending by $137 million and increasing revenues
by $816 million over the 2021-2030 pe1iod, according to CBO and JCT's estimates.
Medicaid for Inmates During the 30-Day Period Preceding Release. Section 3103 would
create an exception for 5 years, starting one year after enactment, to the prohibition on
making Medicaid payments for services provided to inmates of cmTectional institutions.
Section 3103 would permit payments for serviees to inmates who are enrolled in Medicaid
dming the last 30 days of their incarceration. According to data from the Bureau of Justice
Statistics:
• Local jails admit and release about 10 million people per year, 89 percent of whom are
admitted and released within 30 days, and
• State prisons admit and release about 600,000 people per year, almost all of whom remain
incarcerated for longer than 30 days.
As a result, section 3103 would allow the vast majority of Medicaid enrollees to maintain
their Medicaid coverage during their incarceration in local jails and would pennit those jails
to bill Medicaid for medical care provided to the incarcerated enrollees. Section 3103 would
allow incarcerated enrollees in prisons to receive Medicaid coverage in tl1e final 30 days of
their incarceration, which would permit state prisons to bill Medicaid for services provided
pre-release.
Based on a report by the Prison Policy Initiative, CBO estimates that about 45 percent of
inmates released from jails and prisons would be enrolled in Medicaid in the early years of
the 2021-2030 period, rising to 55 percent by the end of the period as CBO projects
additional states will adopt the ACA expansion over time.
CBO expects that the costs per Medicaid inmate would be modest, as local jails generally
provide limited services, such as generic medications to assist with drug withdrawals and
mental health crises <luting the short-te1m stays, while prisons would be expected to provide
pre-release health screenings and sho1t-te1m supplies of medications to help with the
transition to the post-release period. CBO estimates that the average cost per prisoner would
be about $100 in the beginning of the period, rising to about $200 by the end of the period
because of increases in the costs of providing medical care.
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Lastly, CBO projects that state prisons would quickly develop the infrastructure to bill
Medicaid for services to inmates in the last 30 days of their stay, which in many cases would
allow them to defray the costs inctmed for pre-release services. Local jails would more
gradually establish similar capacity to bill Medicaid, delaying the full implementation of
section 3103 for several years. In total, CBO estimates that section 3103 would increase
direct spending by $3.7 billion over the 2021-2030 period.
Bundled Community-Based Mobile Crisis Intervention. Section 3104 would, for 12 fiscal
quarters, increase a state's FMAP for crisis intervention services that qualify as mobile and
community-based, as defined by the bill. The enhanced FMAP would equal 85 percent and
would apply only to services that otherwise would be reimbursed at a state's traditional
FMAP. Based on information from state mental health agencies, CBO estimates that at least
16 states have programs that provide services that would qualify for the enhanced FMAP
provided under section 3104. Not all of those programs currently seek Medicaid
reimbursement for crisis intervention services provided to Medicaid; CBO expects that the
programs would be more likely to do so under section 3104. CBO also anticipates that those
changes would encourage all of the programs to request reimbursement under their state
Medicaid programs and that the states would receive the enhanced FMAP under section 3104
for such services. In addition, based on the rate at which state Medicaid programs have
adopted other services and demonstrations specific to behavioral health care, CBO expects
additional states would begin reimbursing for crisis intervention services that qualify as
mobile and community-based.
CBO estimates that the combined federal and state cost to provide c1isis intervention services
that qualify as mobile and community-based would be about $1,500 per person, on average,
in 2021; that amount would increase at an average annual rate of about 6 percent over the
2022-2030 period. In total, CBO estimates, the enhanced FMAP and the decision by states to
establish new programs that provide crisis intervention services that qualify as mobile and
community-based would increase direct spending for Medicaid by $1. l billion over the 2021-
2030 period.
Temporary Increase in FMAP for Expanding ACA Coverage. Section 3105 would, for
eight calendar quarters, provide a temporary, 5 percentage-point increase in the Medicaid
FMAP to states that expand coverage to adults made eligible by the ACA. CBO and JCT
estimate that the provision would increase federal deficits by $15.5 billion over the 2021-
2030 period-the net effect of an increase in outlays of $16.2 billion and an increase in
revenues of $0. 7 billion.
Under section 3105, the FMAP increase would be available only to states that expand such
coverage after the legislation is enacted, and it would not be available to states that bad
previously expanded coverage. Only services provided to traditional eligibility groups could
qualify for the increase; services provided to adults made eligible by the ACA would not be
included. The higher FMAP also would not apply to the following expenditures:
• Medicaid payments to hospitals that serve a disproportionate share oflow-income
emollees,
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• Medicaid allotments to the te1Tito1ies, and
• Payments for programs other than Medicaid that nse the FMAP to determine the federal
share of payments ( such as CHIP, payments from states toward Medicare Part D, and
Title IV).
Increased Medicaid Spending Section 3105 would increase Medicaid spending in two ways.
First, CBO expects, the additional 5 percentage-point increase in the FMAP would induce
some states to expand Medicaid coverage to low-income adults sooner than CBO's baseline
projections for Medicaid enrollment would indicate. CuJTently, 37 states and the District of
Columbia have implemented the expansion, and those states have enrolled roughly
60 percent of eligible adults nationwide. Under its baseline forecast, CBO projects that
additional states will adopt the expansion at the histo1ical rate of expansions since 2014 (the
initial year of the expansion's availability). CBO anticipates that by 2030 about 70 percent of
all potential enrollees ,vill be covered.
Although the rate of expansion is subject to considerable uncertainty, CBO projects that the 5
percentage-point increase in the FMAP would induce states that would expand during the
2021-2030 petiod to do so about a year sooner, on average, than they otherwise would. The
result would be an increase in Medicaid enrollment in those years among adults made
eligible by the ACA in those states. Based on CBO's projections for enrollment in states that
have not already adopted the expansion and the projected cost per adult made eligible by the
ACA, CBO estimates that those earlier expansions would cost the federal government
$17.2 billion over the 2021-2030 period.
The second effect of section 3105 would be the added cost of the 5 percentage-point increase
in the FMAP. Based on the average matching rates projected for states that have not yet
adopted the expansion, CBO estimates the cost at $4.7 billion. In total, CBO estimates,
section 3 l 05 would increase direct spending on Medicaid by $21.8 billion over the 2021-
2030 period.
Reduced Federal Subsidies.fbr Private Health Insurance. Section 3105 also would reduce
enrollment in private health insurance as more people enroll in Medicaid in the states that
adopt the ACA expansion. CBO and JCT estimate that over the 2021-2030 period Medicaid
enrollment would increase, on average, by about 85,000 people who would otherwise have
enrolled in coverage through the marketplaces and by another 33,000 people who would
otherwise have enrolled in employment-based coverage. CBO and JCT estimate that those
reductions in enrollment would reduce direct spending for health insurance subsidies by
$5.7 billion and increase revenues by $0.7 billion over the 2021-2030 period.
100 Percent FMAP for Urban Indian Organizations and Native Hawaiian Health Care.
Section 3106 would, for eight calendar qua1ters, provide a 100 percent federal matching rate
for services to Medicaid enrollees who access care in the Urban Indian Health Programs
(UIHPs) or the Native Hawaiian Health Care System (NHHCS). Under current law, services
provided to Medicaid enrollees are matched at l 00 percent if they are received through an
I.HS facility. I.HS is the agency that is responsible for providing federal health services to
American Indians and Alaska Natives. UIHPs are health care organizations that are grantees
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oftl1e lHS but are not considered federal entities that are part oftlie lHS and therefore only
receive tlie standard federal matching rates for services to Medicaid enrollees. Similarly, tlie
NHHCS comprises five health care clinics that are grantees of HRSA that are not considered
federal entities.
The standard federal matching rates under current law average an estimated 65 percent for
traditional eligibility categories during 2021 and 2022, and will average an estimated
58.5 percent during 2023, the time period covered by the eight quarters specified under
section 3106. The matching rates for adults made eligible by the ACA will be 90 percent
dming the same period.
According to infonnation from the UIHP system, the UlHP treats about 90,000 Medicaid
patients per year at an estimated average cost of about $2,000 per patient. Applying tl1e
100 percent matching rate for services to these enrollees would increase direct spending hy
$155 million over the 2021-2030 period. Given the size of the NHHCS relative to the UlHP
system, CBO estimates tliat applying a 100 percent matching rate to services provided at
NHHCS clinics would increase direct spending by another $7 million over the pe1iod.
Sunset of Limit on Maximum Rebate for Certain Drugs. Under current law,
manufacturers are required to pay Medicaid a rebate on all covered outpatient drngs. The
rebate amount is detennined according to statute by two formulas that include a basic rebate
with separate calculations for brand and generic drugs and an additional inflationary rebate
that reflects differences in growth between tlie Average Manufacturer Prices (AMPs) and the
consumer price index. The total rebate amount is capped at 100 percent of the AMP. The cap
does not affect rebates paid for all drngs: It tends to be most relevant for drugs that have
experienced substantial price increases over time and for drugs that offer particularly large
rebates to payers other than Medicaid. Section 3107 would eliminate the cap on the total
rebate amount starting January 1, 2023.
Based on administrative data on AMPs and prescription drug spending in Medicaid, CBO
estimates that in 2019, tlie cap on the total rebate amount prevented federal and state
governments from collecting more than $3 billion in rebates for covered outpatient drugs.
CBO expects that section 3107 would increase the amount of rebates that manufacturers pay
Medicaid and would reduce direct spending in Medicaid by $15.9 billion over the 2021-2030
period.
Additional Support for Medicaid HCBS. Section 3108 would, for four fiscal quarters,
increase the federal FMAP in Medicaid by 7.35 percentage points for state expenditures on
home and community-based services (HCBS). HCBS are long-term care services that
beneficiaries receive in their home or in the community rather than in institutions such as
nursing facilities. CBO projects that the federal and state governments will spend almost
$200 billion on HCBS during the four quarters for which the enhanced FMAP is available to
states. Increasing the federal share of such spending would increase federal spending on
Medicaid by $9.3 billion.
Strike Teams for Nursing Facilities. Section 3109 would appropriate $250 million for
states to establish strike teams that would be deployed to nursing facilities that have patients
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who have been diagnosed with COV!D-19 or who are suspected of having the disease. CBO
estimates that section 3109 would increase direct spending by $250 million over the 2021-
2030 period.
Other Provisions. Subtitle D would appropriate $12.8 billion for environmental protections,
utility assistance, distance learning, and other consumer product safety.
Within subtitle D, chapter I would appropriate $5. l billion to fund activities related to
environmental health and assistance to people for paying utility bills:
• $0.1 billion to the Environmental Protection Agency for grants and other activities that
enhance environmental justice and to support implementation of the Clean Air Act;
• $4.5 billion to the Low-Income Home Energy Assistance Program; and
• $0.5 billion for grants to assist low-income households with the costs of drinking water
and wastewater services.
Chapter 2 would appropriate $7. 7 billion for distance learning, primarily to reimburse
schools and libraries for the costs of telecommunications equipment and services, and
consumer product safety.
In total, CBO estimates that the funds appropriated by subtitle D would increase direct
spending by $12.8 billion over the 2021-2030 period.
Uncertainty
There are two major types of uncertainty in CBO' s estimate of the reconciliation
recommendations of the House Committee on Energy and Commerce: For subtitles A and D,
the primary forms of uncertainty stem from CBO' s estimates of the pace at which federal
agencies would spend the new budget authority. For subtitles Band C, most of the
uncertainty ofCBO's estimates stem from expectations about state behavior, people's
enrollment in various forms of health coverage, and the of the increase in health care ptices.
Uncertainty About the Pace at Which Federal Agencies Would Spend New Budget Authority.
The reconciliation recommendations of the House Committee on Energy and Commerce
would provide $105 billion in new budget authority for fiscal year 2021, increasing
individual agencies' funding for the year by a substantial amount. For example, the 2021
budget authority for the CDC, HRSA, and the !HS would see significaut increases roughly
halfway through the fiscal year. It is tmce1tain whether such agencies would be able to spend
all of the new funds rapidly.
Uncertainty About State Behavior, People's Enrollment in Various Forms ofHealth
Coverage, and the Growth ofHealth Care Prices. For subtitles Band C, CBO's estimates
include projections of the results of states' choices to expand coverage, people's choices to
enroll in coverage if they were newly eligible, and the future costs of providing health care
services to beneficiaries-all of which are uncertain. Some of the more significant sources of
uncertainty include:
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• Estimating how many women would remain enrolled in Medicaid if states expand
postpmtum coverage and how many additional months of coverage they would have;
• Predicting how many states will expand Medicaid under current law and how the
increased FMAP would accelerate the pace of state expansions;
• Forecasting future growth in drng prices and how drug manufacturers would change their
pricing strategies if the cap on rebates were eliminated; and
• Estimating the future growth in prices for HCBS and how states would expand their
coverage ofHCBS on account of the higher FMAP.
Pay-As-You-Go Considerations
The Statut01y Pay-As-You-Go Act of 20 IO establishes budget-repo1ting and enforcement
procedures for legislation affecting direct spending or revenues. The net changes in outlays
and revenues that are subject to those pay-as-you-go procedures are shown in Table l.
Increase in Long-Term Deficits: None.
Mandates
If the FCC increases annual fee collections to offset the costs of issuing rnles to promote
internet connectivity for schools and libraries as required by section 3312, the legislation
would increase the cost of an existing private-sector mandate on commercial entities required
to pay those fees. CBO estimates that the incremental cost of the mandate would be small and
would fall well below the annual threshold established in the Unfm1ded Mandates Reform
Act for private-sector mandates ($170 million in 2021, adjusted annually for inflation).
Estimate Prepared By
Federal Costs: Alice Bums, Julia Christensen, Jennifer Gray, Ryan Greenfield, Jared
Hirschfield, David Hughes, Arin Kerstein, Susanne Mehlmm1, Stephen Rabent, Lisa
Ramirez-Branum, Lara Robillard, Sarah S~jewski, Robert Stewmt, Carolyn Ugolino, Emily
Vreeland, Ellen Werble, and Katherine Young
Mandates: Andrew Laughlin
Estimate Reviewed By
Chad Chirico
Chief, Low-Income Health Programs a11d Prescription Dmgs Cost Estimates Unit
Sheila Dacey
Chief, [ncome Security and Education Cost Estimates Unit
Paul Masi
Chief, Healtl1 Systems and Medicare Cost Estimates Unit
Sarah Masi
Senior Advisor
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David Newman
Chief, Defense, International Affairs, and Veterans' Affairs Cost Estimates Unit
Susan Willie
Chief, Natmal and Physical Resources Cost Estimates Unit
Kathleen FitzGerald
Chief, Public and Private Mandates Unit
Leo Lex
Deputy Director of Budget Analysis
Theresa Gullo
Director of Budget Analysis
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Subtitle A. Funding for Public Health
Chapter 1 - Vaccines and Therapeutics
Sec. 3001 Vaccine Activities at the CDC
Budget Authority 7.500 0 0 7,500
Estimated Outlays 1,500 4,500 750 450 225 7 425
Sec 3002 Vaccine Confidence Activities
Budget Authonty 1.000 1,000
200 600 100 60 30 900
Sec 3003
Supply Chain
Budget Authority 5,200 0 5,200
Estimated Outlays 2,033 2,803 312 52 0 5.200
Sec. 3004 Activities at the Food and
500 0 0 500
Estimated Outlays 165 250 75 10 500
Chapter 1, Tott¾f
Budget Authority 14,200 0 0 0 0
Estimated Outlays 3,898 8,153 1,237 572 255 0
Chapter 2 - Te$ting
Sec 3011 and
Budget Authority 46,000 0 0
Estimated Outlays 9.200 27,600 4,-600 2,760 1,380 0
Sec 3012, SARS-CoV-2 Genomic
Sequencing and Surveillance
Budget Authority 1.750 0 1,750
Estimated Outlays 350 1,050 175 105 53 0 1.733
Sec 3013 Global Health
750 Q 750
150 450 75 45 23 743
Sec 3014 Data Modernization and
500 0 0 0 500
Estimated Outlays 100 3G'O 50 30 15 0 496
Chapter 2, Total
Budget Authority 49,000 0 0 0
Estimated Outlays 9,800 29,400 4,900 2,940 1,471 0 0
Chapter 3 - Public Health Workforce
Sec 3021 Public Health Workforce
Budget Authority 7,660 7,660
Estimated Outlays 1,532 3,064 2,681 383 0 7660
Sec. 3022 Medical Reserve Corps
Budget Authority 100 0 100
Estimated Outlays 20 56 16 0 100
Chapter 3, Total
Budget Authority 7,760 0 0 0 0 7,760
Estimated Outlays 1,552 3,120 2,697 389 0 7,760
Chapter 4 ~ Public Health Investments
Sec. 3031 Community Health Centers
Budget Authority 7,600 0 0 7,600
Estimated Outlays 1,520 3,040 2,660 380 0 7,600
Sec 3032 National Heallh Service Corps
Budget Authority 800 0 0 800
Estimated Outlays 160 320 280 40 0 800
Sec. 3033 Nurse Corps
Budget Authority 200 0 0 200
Estimated Outlays 48 100 40 10 0 196
Sec 3034
Education
Budget Authority 330
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Sec. 3035,
Congregate Settings
Budget Authonty 1,800 0
Estimated Outlays 324 990 396 36 18 1.764
Sac. 3036 Family Planning
Budget Authonty 50 0 50
Estimated Outlays 10 35 0 49
Sec. 3037 Children Under HHS Care
BUdget Authonty 425 0 425
13 17 64 68 74 70 64 51 425
Sec. 3038
Budget Authonty 0
Estimated Outlays
Chapter 4, Total
Budget Authority 11,210 0 0 0 0 0
Estimated OUtlays 2,141 4,637 3,560 547 92 70 64 51 0
Chapter 5 - Indian Health
Sec. 3041 Indian Heafth
BUdget Authority 6,094 0
Estimated Outlays 1,493 3,534 506 84 84 71 59 43 19
Chapter 6- Mental Health and Substance
Use Disorder
Sec 3051 Community Mental Health
Serv1ces
Budget Authority 1.750 1,750
Estimated ouuays 315 910 350 140 35 1,750
Sec Prevention and Treatment of
Substance Abuse
Budget A.uthonty 1,750
Estimated Outlays 315 910 050 140 35
Sec. 3053
80 0 0 80
Estimated Outlays 18 40 16 0 78
Sec. 3054 Education and Awareness
Budget Authority 20 20
4 12 20
Sec 3055
Providers for Mental and
Behavioral Health Among
Workforce
Budget Authority 40 0 0 40
Estimated Outlays 9 20 39
Seo 3056
Bl1dget Aut!1onty 30 0 0
Estimated Outlays 15 30
Sec. 3057
Bt.Klget Authority 50 0 0 50
Estimated Outlays 26 10 50
Sec. 3058 Nahonat Child Traumatic
Stress Network
BUdget Authority 10 0 0 10
Estimated Outlays 10
Sec, 3059 Project Aware
Budget Authority 30 0
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Tab!~.1i E;stt0?teU ~µqge~ary};;tt~ct% ~f. ~econ.ci\!a~ori R<;com:n~~?-fiN)S ;~Y t~ Ho_u~?'.Gotn911t~~~p:n E;:~ergy a~~-.c~mmeroe on ~eb_,~tmy _12, ~021
p_on!lnued.
Sec. 3059A Youth Suicide Prevention
Budget AuthOnty
Estimated Outlays 10
sec_ 3059B Behavioral Health workforce
Budget Authonty 100 100
Estimated Outlays 23 50 20 98
Chapter 6, Total
Budget Authority 3,880 0 0 0 0 0 0 0 0 0
Estimated Outlays 711 2,013 n4 303 74 0 0 0 0 0
Chapter 7 - Exchange Grant Program
Sec. 3061
20 0 20
Estimated Outlays 20 0 20
Subtitle A, Totat
Budget Authority 92,164 0 0 0 0 0 0
Outlays 19,615 50,857 13,674 4,835 1,978 141 123 94 23
Subtitle B. Medicaid
Sec. 3101 Coverage of COVID-19
Vaccinations and Treatments
Estimated Budget Authon!y 287 534 247 63 U31
Estimated Outlays 534 247 63 1,i3i
Sec. 3102
756 1,249 1,417 1,429 1,108 5,959
0 1,249 1,417 1,429 1,108
Sec 3103 Medicaid for Inmates During
30-Day Period Preced:ng
Release
Est1mat-ed Budget Authority 177 444 683 918 1,014 510 0 3,746
Estimated Outlays 177 683 918 1,014 510 3,746
Sec. 3104 Bundled Commurnty-Based
Mobile Crisis Intervention
Estimated Budget Authority 15 0 71 305 330 270 25 32 40 49 1,195
Estimated Outlays 0 307 332 270 25 32 40 49 1,195
sec_ 3105
Estimated Budget AuthOnty 0 3,768 3,427 2,177 2,308 2,131 1.337 479 531
Estimated Outlays 0 3,768 3.427 2,177 2,308 2,131 1,337 479 531
sec_ 3106, 100% FMAPfor Urban lndian
Organziatrnns 1;1nd Na!ive
Hawanan Health Care
Estimated Budge! Authonty 38 81 43 162
Estimated Outlays 38 81 43 162
Sec_ 3107 Sunset of Limit on MBx1rnum
Rebate for Certain Drugs
0 -217 -1,803-2,293-2,277 -2.258 -2,279 -2,318-2,443 -2,573
217 -1,803 -2,293 -2.277 -2.258 ~2,279 -2,318 -2,443 -2,573
Sec, 3108
Estimated Budget Authority 4.795 4,515 0 9,310
Estimated Outlays 4.795 4,515 9,310
Sec. 3109 Strike Te;:ims for Nursing
Facilities
Budget Authority 250 0 0 250
Estimated Outlays 50 175 25 250
Subtitle 8, Total
Budget Authority 5,385 5,307 5,112 3,924 2,549 2,744 1,516
Outlays 5,170 5,487 5,143 3,926 2,551 2,744 1,516
Subtitle C. Children's Health Insurance Program
Sec. 3201
Budget Authority 47 0 0 68
Estimated Outlays 17 0 0 68
Sec. 3202. Coverage for Pregnant and
Postpartum Women (a)
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Subtitle 0. Other Provisions
Chapter 1 ~ Ensuring Environmental
Health and Ratepay-er Protection
Sec. 3301
Budget Atlthorlty 100 0 100
Estrmated Outlays 10 60 20 10 100
Sec 3302 UHEAP
Budget Authority 4,500 4,500
Estimated Outlays 1.508 1,727 467 422 188 188 4.500
Sec. 3303. Water Assistance Program
Budget Autt,onty 500 500
Estimated Outlays 50 225 150 50 25 0 500
Chapter 1, Total
Budget Authority 5,100 0 0 0 0 0 0 0
Estimated Outlays 1,568 2.012 637 482 213 188 0 0 0
Chapter 2 - Distance Learning and
Consumer Protections
Sec 3311 Consumer Product Safety
Budget AutMnty 50 0 0 5D
Estimated Outlays 10 48
Sec 3312
7,600 7,600
Estimated Outlays 1,140 3,800 1,900 760 7,600
Chapter 2, Total
Budget AuthOrity 7,65(} 0 0 0 0 0 0 0 0 7,650
Estimated Outlays 1,144 3,806 1,908 770 0
Chapter -3 - Oversight of Department of
Commerce Prevention and Response to
COVID-19
Sec 3321, Department of Commerce
Budget Authority
EstImatedOutiays
Subtitle D, Total
Budget Authority 12,753 0 0 0 0 0 0
Outlays 2,713 5,819 2,546 1,252 222 196 0
Total lncreas-e in Direct Spending
Estimated Budget Authority 110,302 5,354 5,129 3,928 2,549 2,744 1.516
Estimated Outlays 27,498 62,210 21,380 10,017 4,751 3,081 1,641
Increases in Revenues
Sec. 3102
76 172 192 209 167 818
On-Budget Revenues 0 0 43 98 109 119 95 0 0 464
Off-Budget Revenues 0 0 33 74 83 90 72 0 0 352
Seo, 3105. Temporary Increase m FMAP
0 0 165 107 93 94 93 51 31 24 672
0 0 98 63 55 58 60 33 20 15 409
Off-Budget Revenues 0 0 69 44 38 36 33 18 11 9 263
Total Increase in Revenues 0 241 279 285 303 260 51 31 24 1,488
On-Budge/ Revenues 0 0 139 161 164 177 155 33 20 15 873
Off-Budget Revi;mues 0 102 118 121 126 105 18 11 9 615
Net Increase or Decrease H in the Oefi<::it From Changes ln Direct Spending and Revenues
Estimated Effect on the Deficit 27,498 62,210 21,139 9,738 4,466 2,778 1,381 -866-1.807-1,881 -2,317
On-Budget Def1c1ts 27,498 62,210 21,241 9,856 4.587 2,904 1,486 -84J3 ~1, 796 -1,812 -2,312
Offf-Budget Def1e1t 0 0 -102 -118 -121 -126 -105 -18 -11 -9 -615
a Sedion would .affect both revenues and sp,:mding, which is shown s1;parately.
b The estimate for section 3102 !nciudes the bud~etai:i:: effect~ of sectlons3Z0"2,
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VII. FEDERAL MANDATES STATElVIENT
The Committee adopts as its own the estimate of Federal mandates prepared by the Director
of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
IX. STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
Pursuant to clause 3(c)(4) of rule XIII, the general performance goal or objective of this
legislation is to provide coronavirus emergency response and reliet~ and for other purposes.
X. DUPLICATION OF FEDERAL PROGRAMS
Pursuant to clause 3(c)(5) of rule XIII, no provision of the Committee Print is known to be
duplicative of another Federal program, including any program that was included in a report to
Congress pursuant to section 21 of Public Law 111-139 or the most recent Catalog of Federal
Domestic Assistance.
XI. COMMITTEE COST ESTIMATE
Pursuant to clause 3(d)( I) of rule XIU, the Committee adopts as its own the cost estimate
prepared by the Director of the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
XII. EARMARKS, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS
Pursuant to clause 9( e), 9(t), and 9(g) of rule XXI, the Committee finds that the Committee
Print contains no earmarks, limited tax benefits, or limited tariff benefits.
XIII. ADVISORY COMMITTEE STATEMENT
No advisory committee within the meaning of section 5(b) of the Federal Advisory
Committee Act was created by this legislation.
XIV. APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that the legislation does not relate to the terms and conditions of
employment or access to public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
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X. SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
SECTION. 3201. MANDATORY COVERAGE OF COVID-19 VACCINES AND
ADMINISTRA110N TREATMENT VNDER CHIP
Requires CHIP coverage ofCOVID-19 vaccines and treatment without beneficiary cost
sharing with the vaccines and the administration of vaccines matched at a 100 percent FMAP
through one year after the end of the PHE.
SEC. 3202. MODIFICATIONS TO CERTAIN COVERAGE UNDER CHIP FOR
PREGNANTAND POSTPARTUM WOMEN
This provision allows states, for five years, to ex'i:end CHIP eligibility to women for 12
months postpartum.
XVI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
A Ramseyer was requested but not yet received. Therefore, with respect to clause 3(e) of
rule XIII of the Rules of the House of Representatives, the Committee advises that compliance
prior to submission to the Committee on the Budget was not possible.
XVII. ADDITIONAL VIEWS
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Energy and Commerce Committee Republican Views
Republicans have supported five targeted, bipartisan bills to crush COVID-19, to reopen
schools, to get the economy back on track, and to improve health and wellness of those suffering
from the pandemic. That is what we should be doing with this Reconciliation package.
l/nf011unately, this package falls well sho11, but at an extraordinaiy cost. The Congressional
Budget Office (CBO) estimates that the Committee on Energy and Commerce's contribution to
the Reconciliation process will cost approximately $120 billion. That is still well short of the
$188 billion instruction to the Committee, which shows there was an opportunity to adopt some
of the bipartisan, targeted, and timely amendments Republicans offered during markup. For
instance:
• $1 billion for teachers to get vaccinated and ensure our children can go back to
school safe! y;
• $10 billion for COVID-19 research at the National Institutes of Health (NIH);
• $35 billion to support our frontline workers through the Provider Relief Fund
(PRF); or
• $1 billion to boost mental health services in states with unexpected job loss due to
President Bi den's various Executive Orders.
Unfortunately, the Democrats rnshed this bill through a partisan markup without bipartisan
consultation with CBO on cost, preventing any chance of adequate analysis and deliberation.
In addition to the wasteful spending, we must comment on the Democratic Majority's
decision to bypass regular order. Democrats wrote this entire package in secret without any
input from Republicans, and Republicans did not see a draft until 10:00 p.m. on Tuesday,
February 9 for a markup scheduled to start at 11 :00 a.m. on Thursday, February l 1. Such
secrecy might be expected on controversial measures, but Republicans and Democrats have
already worked together to enact 5 bills in response to COVID-19. This partisan process on this
package is a failure of Democratic leadership ai1d a huge disappointment.
Subtitle A: Budget Reconciliation Legislative Recommendations Relating to Public Health
Republicans on the Energy and Commerce Committee strongly support additional
fonding for advanced research, development, manufacturing, production, and the purchase of
vaccines, diagnostic tests, therapeutics, and ancillary medical products to prevent, prepare, and
respond to SARS-CoV-2, COVID-19, or any disease with potential for creating a
pandemic. Republicans on the Energy and Commerce Committee also suppo11 additional
funding for the prevention and treatment of mental health and substance use disorders. The
COVID-19 pandemic and resulting economic downturn have significantly impacted the mental
health and wellbeing of all Americans.
Since the beginning of this pandemic, many Americans have reported that their mental
health has been negatively impacted by recent events, with about 4 in 10 adults reporting
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symptoms of anxiety or depressive disorder. 1 Reports have found that declines in the economy,
lost jobs, and health challenges have all contributed to an increase in mental health difficulties.
Individuals in states with more restrictive measures, such as stay-at-home orders, have recorded
even more cases of mental health difficulties. 2 The pandemic has also presented unique
challenges for individuals with substance use disorder (SUD) and those who are in recovery, as
social distancing and stay at home orders make it harder for patients to access treatment, such as
c1itical medications for opioid use disorders. 3
However, Subtitle A is also a departure from how the Congress has previously provided
emergency funding to address the coronavirus pandemic, and because of this, does not take into
account the time it will take for federal agencies to spend these resources, or address all the
needs, such as those of the National Institutes of Health and health care providers. The past five
legislative packages that were signed into law were negotiated in good faith between
Republicans and Democrats, with extensive input from all sides. 4
We are disappointed that the Democrats rejected bipartisanship and embraced a partisan
process. Instead of targeted and timely relief to COVID-19, the Democrats proposed mandatory
funding for all of these initiatives, abdicating responsibility for oversight, which is a troubling
departure from the oversight and reporting on the emergency designated discretionary
appropriations provided in the previous five COVID-19 emergency appropriations bills passed
last year.
Republicans agree with CBO that federal agencies might not be able to use the new
budget authority provided in Subtitle A quickly enough. Republicans are also concerned that the
resources may not be timely enough to help address any outstanding COVID-19 needs that
remain after the most recent relief package. 5 Subtitle A increases individual agencies' funding
for a single fiscal year by a substantial amount. The 202 l budget authority for the Centers for
Disease Control and Prevention (CDC), the Health Resources and Services Administration
(HRSA), and the Indian Health Service (IHS) would see enormous increases roughly halfway
through the fiscal year. Republicans, like the CBO, do not understand how these agencies would
be able to spend all of the new funds rapidly in a manner that has any meaningful near-term
impact on reducing COVID-19 cases and deaths in the United States. 6
1
Nim1ila Panchal, ct aL The Implications of COVID-19 for Mental Health and Substance Use, Kaiser Family
Foundation, available at l11tps://www.kff.org/health-refom!lissue-brief/the-implications-of-covid-l9-for-mental-
health-and-substance-use/ (last updated Feb. I 0, 2021 ).
2
!\..fadclinc HolcQ~erm social d i s l a n - f 1 1 . J Q. . fJJ!£QLJ1nd wha! to sf.Q, CNN
i.t.~L--~~p1·ailaP.if;___g]_https://www.cnn.com/2020/04/09n-.ealthlcoronavims-mental-health-long-tcrm-
welh-.ess/index.htmL
·1 Dr. Francis Collins, Director, National Institutes of Health, Coping wilh the Collision al Public llealth Crises:
COi'!D-19 and Substance ,:se Disorders, NIH Director's Blog (Apr. 21, 2020). available at
https://directorsblog.nih.gov/2020/04/21/coping-with-the-collision-of-public-health-ctises-covid- J9-and-substancc-
use-disorders/.
'P.L 116-123; P.L 116-127: P.L 116-136; P.L ll6-139; and P.L 116-260.
5
Congressional Budget Office, Reconciiialion Recommendations oj"lhe House Committee on J'."nergy and Commerce,
Febmary 14, 2021, lmps://www.cbo.gov/system/files/2021-02/EucrgyaudCommerceReconciliationEstimate.pdf
6 Id.
2
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For example, the state of the nation's public health infrastructure and workforce are a
result of decades of neglect by state and local governments. At the same time, states have spent
ever increasing amounts of their budgets on Medicaid. Support for states to build their public
health workforce is laudable and could be accomplished by discretionary
appropriations. However, it is unclear how an immediate infusion of$7.6 billion in mandatory
funding for establishing and expanding a public health workforce, as is done in section 3021,
will lead to more public health professionals to fight COVID-19 now. State and local health
departments have struggled for years to recruit public health professionals in a field that has lost
more than 56,000 positions in the past decade. 7 A sustainable long-term increase in
discretionary funding authorized through regular order would have been a more appropriate way
to support state and local public health departments and address the dearth in public health
professionals.
Republicans are concerned about the long-term health of critically important public
health programs that Subtitle A sets on dangerous fiscal cliffs. For example, section 3031
provides $7.6 billion for Federally-qualified health centers, $800 million for the National Health
Service Corps, and $300 million for the Teaching Health Center Graduate Medical Education
program. This is approximately twice the amount that was authorized for these programs for
each of fiscal years 2021 through 2023 in the Consolidated Appropriations Act, 2021, which was
just signed into law two months ago. 8 These are unsustainable funding levels.
Republicans are disappointed that Subtitle A opens the door to federal funding for
elective abortions. Every Democrat voted against including the Hyde amendment protections in
Subtitle A. The Hyde Amendment prevents all other federal funds for the Department of Health
and Human Services appropriated through the discretionary appropriations process, and also
mandatory health spending, from being used to fund abortion, except in the cases where the life
of the mother would be endangered if the fetus were carried to tenn, or in the case of rape or
incest. Since 1976, Hyde, and similar policies governing other federal programs, have been
supported and renewed annually on a bipartisan basis, multiple times, for decades. 9 Because
there are no Hyde Amendment protections, many provisions in Subtitle A, particularly where
funds have been authorized for broad purposes or for the provision of health services that are not
directly related to preventing and treating COVID-19, will support elective abortions.
For example, section 3036 authorizes $50 million in mandatory funding for grants and
contracts under section l 00 l of the Public Health Service Act, which is the Title X Family
Planning Program. First, it is unclear to Republicans how Title X funding will reduce
transmission of, and illness and death caused by, COVID-19. This funding is being authorized
on the heels of President Bi den directing the Department of Health and Human Services to
7 Blaire Bryant. Protec! Funding for Core Local Public Health Services and Prevention Programs, National
Association of Counties, available at https://www.naco.org/resources/protect-funding-core-local-public-health-
services-and-prevcntion-
programs#:-:tcxt-According'¼,20to%20thc'11<>20National%20Association,in%20fivc%201ocal'¼,20health'¼,20dcpartm
ents. (last updated Feb. 28, 2019).
'P.L. 116-260,
9 H.R 14232, Departments of Labor, and Health, Education, and Welfare, and Related Agencies, 1977, 94th Congress
(1976); Roll no. 846,
3
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reverse the "Protect Life Rule," 10 a rule that prohibited Title X-funded family planning services to
be perfonned at the same location where abortions are provided. Since existing Title X
appropriations have been obligated to non-abortion providing entities, section 3036 is just a way
to direct taxpayer dollars to abortion providers, like Planned Parenthood.
Lastly, Republicans are disappointed that the Democrats, in their haste to pass a partisan
package, did not assess the true budgetary needs of these agencies. The exorbitant funding levels
could lead to waste.
For example, section 3004 provides $500 million to the Food and Drug Administration
(FDA) for the evaluation of the continued performance, safety, and effectiveness of vaccines,
therapeutics, and diagnostics approved, cleared, licensed, or authorized for use for the treatment,
prevention, or diagnosis of COVID-19. Republicans believe that the agency should provide a
detailed account of how funds previously appropriated have been spent, what amount of funding
remains unobligated, and to what activities those unobligated dollars will be allocated before
appropriating additional funds, especially considering that $500 million is more than twice the
amount that has been appropriated to FDA under all previously enacted Coronavirus relief
legislation combined. 11
Additionally, advancing this legislation through regular order would have allowed both
Republicans and Democrats to have a better understanding of the FD A's existing needs. During
the full committee markup, the only opportunity provided to Republicans to ask questions and
raise concerns about the legislation being considered, Democrats asserted they had conversations
with FDA during which the agency expressed the need for this amount of funding. The FDA has
not provided to Republicans any request or justification for these funds, nor has FDA explained
how they will be used to advance the agency's mission. In addition, the majority ofFDA's
spending is on salaries. It is unclear how the $500 million could be used to support salaries
without creating a cliff where more funding is needed to retain those employees.
With respect to product reviews, Republicans question why these funds appear to be
intended solely for post-market surveillance, as opposed to both pre- and post-market activities,
given the likelihood that new COVID- l 9 vaccines, therapeutics, and diagnostics will waffant
premarket review. 12 Furthermore, the funds may be used to facilitate and conduct inspections
delayed or cancelled for reasons related to COVID- l 9. 13 While Republicans agree it is critical
that FDA resume on-site inspections, we question why additional funds are required to do so.
Since March 2020, FDA has conducted few domestic or foreign inspections due to safety
concerns and travel restrictions, not due to funding limitations. During fiscal year (FY) 2020, the
total number of inspections conducted by FDA, of both foreign and domestic establishments,
10 84 FK 7714.
l! P.L, 116-123; P.L. 116-136; PL. 116-260,
"S. Con, Res. 5, the Concurrent Resolution on the Budget for Fiscal Year 2021 (Febmary 11, 2021), 117th Congress
(202 l-2022), available at ~ l ! i ' ( 0 l I· ' - "-A-P0()00]4-
~-
t3 [d,
4
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was fifty-six percent lower than during each of the previous two fiscal years. 14 Between March
and October of 2020, only three foreign mission critical inspections and only fifty-two domestic
inspections took place. 15 In contrast, during a similar timeframe in each of the previous two
years, more than 600 foreign and 400 domestic inspections took place. 16 Given the significant
reduction in the number of inspections conducted, FDA must answer for how funds obligated
for FY 2020 inspection activities have been used and why it needs more funds to carry out
delayed or cancelled inspections.
Subtitle B: Budget Reconciliation Legislative Recommendations Relating to Medicaid
Section 3101. Mandatory Coverage ofCOVID-19 Vaccines and Administration Treatment
Under Medicaid.
Republicans want every American to have access to the COVID-19 vaccine and we
support fully covering the cost of the vaccine for Medicaid beneficiaries for the length of the
public health emergency. This will ensure we can vaccinate eve1y single American, which will
help us reopen schools, workplaces, and the economy. However, in this section the Democrats,
instead, chose to extend the timeframe where vaccines are fully covered by one year. The
Democrats have provided no justification for this extension. Given that the public health
emergency will continue throughout 2021, Republicans recommend ascertaining how the states
are doing at the end of the year and extend the timeframe if needed. Instead, the Democrats are
spending money on the extra year that could have been used to increase funding for mental
health or SUD providers, or a number of other targeted and temporaiy priorities that both parties
share.
The Democrats are also giving the states the option to provide coverage to the uninsured
for COVID-19 vaccines and treatment without cost sharing at 100 percent federal medical
assistance percentage (FMAP). Republicans want all eligible beneficiaries to receive care and
want to work with the Democrats to improve access to care for all Americans. However, the
Medicaid program has eligibility requirements for a reason and Republicans want to make sure
that the program is able to continue serving the Americans who are eligible for Medicaid
coverage.
Section 3102. Modifications to Certain Coverage Under Medicaid for Pregnant and
Postpartum Women.
Republicans are disappointed that the Democrats chose this partisan approach to a
bipartisan priority. H.R. 4996, the Helping MOMS Act of 2020, passed the House unanimously
last year and is the same policy as section 3 l 02, except, H.R. 4996 was a permanent state option
to extend Medicaid eligibility to women for 12 months postpartum and section 3102 is a five-
year option. At markup, Republicans offered an amendment that would have implemented the
14 U nitcd States Government Accountability Office (GAO), COi• 1D-l 9: ( 'ritical f 'accine Distribution, Sup(y Chain,
Program lntegri~v' and Other Cltal/enges Require Focused Federal Attenlion (Januazy 202 l). amilable at
hlll1s;/i,rn-w iol2.J.O,-/asscts/720/lJ1ill.Q.Jl.df.
15 1d
16 fd.
5
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permanent policy. Predictably, the Democrats rejected the proposal because it would cause the
Committee to exceed its reconciliation instructions. However, when CBO released its estimate
of the Committee's reconciliation package, Republicans learned that the Committee is under its
instruction of$188 5 billion by over $65 billion. 17 If the Committee had an estimate and
technical assistance before markup, we could have made this change permanent.
Section 3103. Allowing for Medical Assistance Under Medicaid for Inmates During 30-Day
Period Preceding Release.
Republicans are willing to work with the Democrats to address medical assistance for
inmates during the 30-day period preceding their release from prison, but this is irrelevant to
responding to COVID-19. This is especially true since the Democrats included the coverage of
inmates in the vaccine development and distribution funding in Subtitle A, and included specific
funding for COVID-19 for those that live in congregate facilities. If this policy had been
considered through regular order, a hearing might have revealed how prisons differ from jails
when handling inmates a month before release and how we can tailor the policy to be the most
effective.
Republicans want all Americans to have access to the COVID-19 vaccine, including
inmates during the 30-day period before their release. But why is Medicaid coverage for inmates
30 days prior to release necessary? Also, how long will it take prisons and jails to have the
administrative capacity to bill Medicaid, and will prisons need additional resources to do so? If
the Committee followed regular order, some of these questions could have been answered.
Section 3104. Enhanced Federal Medicaid Support for Bundled Community-Based Mobile
Crisis Intervention Services.
This section is another partisan disappointment. The Democrats never explained how
this section will provide immediate relief to those suffering from COVID-19' s devastating
impact on mental health or SUD. CBO indicated that only 16 states have programs that would
immediately qualify for this provision, suggesting the limited impact this provision will have on
addressing nationwide mental health and SlJD impacts from COVID-19. 18 Republicans believe
that tailoring a policy like the one in section 3108 for mental health and substance use providers
would have been a better way to provide immediate relief for the next year.
Section 3105. Temporary Increase in FMAP for Medical Assistance Under State Medicaid
Plans which Begin to Expend Amounts for Certain Mandatory Individuals.
Incentivizing states to expand Medicaid to address COVID-19 is a mistake. It is neither a
targeted nor a timely approach to continue the fight against COVID. We understand the need to
provide Americans access to affordable health insurance options, but, at a minimum, it takes
17 Congressional Budget Office, Reconciliation Recommendations ofthe House Committee on Energy and Commerce,
February 14, 2021, https://www.cbo.gov/system/filcs/2021-02/EneigyandCommcrccRcconciliationEstimatc. pdf.
18 Congressional Budget Office, Reconciliation Recommendations ofthe House Committee on Energy and Commerce,
February 14, 2021, https://www.cbo.gov/system/files/2021-02/EnergyandCommerceReconciliationEstimate.pdf.
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several months to expand Medicaid. 19 Republicans believe that any COVID-19 relief package
should aim to end the pandemic in weeks now that a vaccine is available. The $16 billion cost
associated with this policy should be targeted to immediate COVID-19 relief for Medicaid
providers who are working with the most at risk beneficiaries, including SUD, mental illness,
hospitals in rural areas, and nursing homes.
Section 3106. Extension of 100 Percent Federal Medical Assistance Percentage to Urban
Indian Health Organizations and Native Hawaiian Health Care Systems.
Republicans would have preferred to consider this section through regular order to ensure
that there are proper reporting and data requirements on the impact of the policy given that it is
only a two-year extension.
Section 3107. Sunset of Limit on Maximum Rebate Amount for Single Source Drugs and
Innovator Multiple Source Drugs.
Including this provision in this partisan package is another disappointment Republicans
have supported this policy to pay for a permanent option for states to provide Medicaid coverage
to women for 12 months after birth. That was the bipartisan approach taken in HK 4996, the
Helping MOMS Act of 2020, which passed the House unanimously in the ] 16th Congress. But
including this spending offset to fund unnecessary spending unrelated to the COVID-19 fight
will only make it harder to enact permanent needed support for new mothers who rely on
Medicaid.
Section 3108. Additional Support for Medicaid Home and Community Based Services
During the COVID-19 Emergency Period.
This is another provision that could have been done through regular order, but instead,
Democrats chose partisanship. Republicans support a temporary FMAP increase of 7.35
percentage points for states to make improvements to Medicaid home- and community-based
services (HCBS) for one year. However, the Democrats would impose a litany of required uses
of the funds, which are overly burdensome at a time when states Medicaid programs need
flexibility to target efficiently their response to COVID-19. Republicans recommend providing
states more flexibility on how to use those funds.
Section 3109. Funding for State Strike Teams for Resident and Employee Safety in Nursing
Facilities.
Nursing homes have been devasted by COVID-19, and the pandemic has brought
attention to the need for improved infectious disease control at nursing homes. The Trump
Administration deployed "strike teams" to nursing homes starting in July, 2020, 20 and
Republicans support providing funding to continue this important initiative. However,
Republicans prefer that this funding be provided through emergency supplemental approp1iations
19
https:/lwww.kfforglmcdicaid/issne-brieflstatus-of-statc-medicaid-expansion-dccisions-intcractivc-map/.
20 ill!~ n· w-·
~-co,·id-19.
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through regular order to ensure we have proper reporting and data on the impact of the policy
and its effectiveness.
Subtitle C: Budget Reconciliation Legislative Recommendations Relating to CHIP
Section 3201. Mandatory Coverage of COVID-19 Vaccines and Administration and
Treatment Under CHIP.
Republicans want every American to have access to the COVID-19 vaccine. We support
fully covering the cost to vaccinate CHIP beneficiaries for the length of the public health
emergency. However, the Democrats' partisan decision to extend that timeframe for a year is
not based on any data or technical assistance. Since the public health emergency will continue
through 2021, a better way would have been to see how the states are doing are at the end of the
year and adjust if needed.
Section 3202. Modifications to Certain Coverage Under CHIP for Pregnant and
Postpartum Women.
It is disappointing the Democrats chose to include a bipartisan priority in the partisan
package. As noted earlier, HK 4996, the Helping MOMS Act of 2020, passed the House
unanimously last year and is the same policy as section 3102.
Subtitle D: Budget Reconciliation Legislative Recommendations Relating to Other
Provisions
Chapter 1
Chapter l of Subtitle Dis another disappointment and lost opportunity. Our concerns
with this chapter can be divided into two distinct categories: big-picture concerns and specific
policy choices reflected in the reported text, as well as those rejected by the votes of the
Democrats
Generally, the three sections in this Chapter are not consistent ,vith the Democrats'
claims about what this bill does. Rather than providing the immediate aid the Democrats insisted
was essential for all Americans struggling with or vulnerable to COVID-19, the provisions
instead appear to craft long-term policies that deserved closer, deliberate attention.
To illustrate this overarching point, the authorized funding appropriated in sections 3301
and 3303 is not time limited it is supposed to "remain available until expended" - and section
3302 makes its funding available until September 30, 2022 a time frame exceeding current
predictions on the length of the pandemic in the United States. Moreover, none of the sections
reference the public health emergency related to COVID-19 that was issued by the Department
of Health and Human Services (HHS) and only section 330 l attempts to create a COVID-19
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nexus.
We believe the aid in this chapter would have been more efficiently and effectively
provided had the explicit statutory focus only been on directing actions necessary for the nation's
COVID-19 response. Frustratingly, the Democrats were not interested in a bipartisan response
of targeted relief that was time-limited and tied directly to COVID-19.
Unfortunately, Chapter 1, particularly section 3301 and 3303, also was not considered
through regular order in the Committee. Regular order would have allowed careful review of the
scope and timing of these provisions. For example, it would have provided opportunity to adjust
the focus of Section 3301 to include increasing employment and economic opportunity, in
addition to technical assistance concerning air quality. Providing more scrutiny and opportunity
for improvement of the legislative language would have ensured resources are directed to the
most urgent economic impacts of the pandemic.
Beyond these overarching concerns, each of the three sections in this chapter contained
specific provisions that gave us pause.
For section 3301, the lack of meaningful Congressional input is concerning we should
have had more of a process to obtain assurances as to what this language intends and,
considering that these provisions could be in force for a few years, understand what this language
might practically mean. These insights also are critical to conducting Congressional oversight on
the provisions, should they become enacted.
Another area of concern for us in section 3301 is its omission of health disparities of
certain workers related to COVID-19. Unemployment is well established as a risk factor for
elevated illness and mortality rates in epidemiological studies pe1formed since the early 1980s.
In fact, the National Center for Health Statistics concluded that "children in poor families were
four times as likely to be in fair or poor health as children in families that are not poor." Most
significantly, as it relates to COVID-19 and the emergence of new more contagious variants,
Yale researcher Dr. William Gallo has stated in the past that late-career job loss results include
"substantial health consequences" and are a "potential risk factor for adverse vascular health
changes" -- the most troubling comorbidities threatening the survival of any person exposed to
the coronavirus.
The people made jobless via the White House executive orders in the first month of the
Biden Administration have been disregarded in these provisions. Our Democratic colleagues not
only rejected efforts to help these economically disadvantaged people, but their views were
punctuated by suggestions that welfare programs and green jobs for half the wages of their recent
employment should be an adequate replacement for these people. 21
21
"The aYerage salary of oil and natural gas workers is approximately $112,000, more than double the national private-
sector average of $51,000. But oil and gas workers don't just make double that of the national average. They make
double that of wind and solar workers.
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Moving to section 3302, it provides $4.5 billion through the end of fiscal year 2022 for
the Low-Income Home Energy Assistance Program (LIHEAP). This amount exceeds the entire
amount enacted for LIRE.AP in fiscal year 2021 just eight weeks ago ($3.75 billion). 22 In
addition, this funding is to be disbursed without regard to existing financial reasonableness
requirements placed on states for how much LIHEAP funding can be allotted at any one time.
As mentioned earlier, while we do not oppose addressing LlliEAP at this time, this scale of
spending should have been directly connected to COVID-19, and adjusted to ensure it will do
what it is supposed to do, minimizing waste and abuse.
Section 3303 provides $500 million - for as long as it takes to spend it all - to a new
program to pay the water and wastewater bills oflow-income people. This $500 million amount
is in addition to the $638 million provided for a nearly identical purpose in the Consolidated
Appropriations Act, 2021. 23 Taken together, this eight-week total comes to$ l.138 billion for
this new program $12 million more than the Federal government provided in capitalization
grants in fiscal year 2021 for all public water system infrastructure under the Drinking Water
State Revolving Loan Fund.
Of note, the biggest difference between the language in section 3303 and that from the
Consolidated Appropriations Act, 2021 is that section 3303 omits provisions encouraging HHS
to use its existing processes and procedures under LIHEAP to distribute this money to utilities
efficiently. This is an important omission. There was no Committee of review whether this
omission will create problems. For, example, because the language in the Consolidated
Appropriations Act, 2021 is only valid for that fiscal year and section 3303 is drafted to outlast
it, when section 3303 still has funding on October 1, 2021, HHS would be free to use whatever
process it wants to distribute the money, even if it is untested or inefficient. This seems like a
recipe for potential waste and abuse; and only further reinforces why a targeted and temporary
program is the preferred way to handle this matter.
While President Biden and the Democrats should be focused on defeating COVID-19 and
rebuilding our economy, they are waging a war on fossil energy jobs that is resulting in
significant and negative disparate impacts in rural and low-income communities. Immediately
upon taking office, President Biden revoked the permit for the Keystone XL pipeline and
imposed a moratorium on oil and gas drilling on Federal lands and offshore waters. These
Accordit1g to data from the U.S. Department of Labor's Bureau of Labor Statistics, in 2019 a worker installing solar
panels made an average of a little more than $21 an hour. Workers in oil and gas extraction made more than twice as
much, at an average of over $42 an bour."
htlps://thefederalist com/2021/0 l/27/bidens-green•cnergy-jobs-really-mean-no-energy-jobs-and-lo,v-paying-cnergy-
jobs/
"House Energy and Commerce Committee Republican Leader Cathy McMorris Rodgers sent a letter to the Office
of Management and Budget on Februmy 4, 2021, requesting an accounting of what funds have been expended already
in connection with the $3. 75 billion in LIHEAP funding from the Consolidated Appropriations Act, 2021. 0MB has
provided no response to that letter to date.
23
House Energy and Commerce Committee Republican Leader Cathy McMonis Rodgers sent a letter to the Office
of Management and Budget on February 4. 2021, requesting an accounting of what funds have been expended already
in connection with the $638 million from the Consolidated Appropriations Act, 2021. 0MB bas provided no response
to that letter to date.
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decisions will eliminate tens of thousands of jobs and deprive states of billions of dollars of tax
revenue to help pay for schools, hospitals, and government services.
Republicans offered several amendments to protect jobs, stimulate economic growth, and
provide mental health services for unemployed energy workers - particularly critical during the
global pandemic and economic downturn -- Democrats rejected them all.
In connection with Subtitle A, Rep. Mullin offered an amendment to increase funds for
community mental health block grants to strengthen mental health services in states that have
had unexpected jobs losses due to President Bi den's Executive Orders. This Administration's
policies, such as implementing moratoria on oil and gas development and production, will put
tens of thousands of people in the energy sector out of work and deprive states of billions of
dollars in tax revenues. This amendment would have required the HHS Secretary to obligate 5
percent of the amounts under the mental health block grants to states suffering unemployment
from the Biden Administration's recent energy and climate executive orders. Every Democrat
rejected the Mullin amendment.
Rep. Armstrong offered an amendment to resume construction of the Keystone XL
pipeline and immediately put thousands of people back to work. This $1.7 billion investment
would have created over 10,000 American union jobs and contributed billions to U.S. workers
through direct jobs in construction and indirect jobs in hotels, restaurants, and thousands of
businesses across the country that were lined up to provide their services to help build the
project. This construction program was already underway when the Biden Administration
revoked their permit and eliminated thousands of jobs and over $3 billion in contracts that would
have gone to U.S. contractors and suppliers. Again, every Democrat rejected the Armstrong
amendment to authorize construction of the Keystone XL pipeline.
Rep. Duncan offered an amendment to prevent President Bi den from follmving through
on his campaign promise to ban hydraulic fracturing perhaps the most direct threat to our
economic security and national security. If the Biden Administration were to han hydraulic
fracturing, this would eliminate millions of jobs across our American energy industry and our
economy. States and local governments, schools, hospitals, and community centers would be cut
off from billions of dollars in funding that currently comes from the oil and gas industry.
According to a recent study, 24 placing a moratorium on hydraulic fracturing would mean a $900
billion increase in U.S. household energy costs, $7.1 trillion in potential losses to the U.S.
economy through 2030, and over 7 million fewer US jobs by 2022. Additionally, such a
moratorium would force the U.S. to import 40 percent of our oil and petroleum products and 29
percent of our natural gas by 2030. Again, every Democrat rejected the Duncan amendment.
We understand the importance of this package and wanted to support it, but defects such
as those outlined above and the unwillingness of the Democrats to accept any of our ideas to
24
America's Progress 01 Risk: An Economic Ana!ysis of a Ban on }'racking and Federal Leasing/or .VatIJra/ Gas
and Oil Developmertt, American Petroleum Institute. ~media/rilcs/Oil-and-Nat11ral-
Gas/H,-draulic-Fractu~stud~~
!i,l\&df!\a=cn&hash= 1~423DJ 3 !50A5594442D8-ID507F_(t_EAB04A23 J 246.
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protect workers and focus the delivery of funding on those most in need leaves us no choice but
to oppose it
Chapter2
Section 3311. Fnnding for Consumer Protection Safetv Fund to protect consumers from
potentially dangerous products related to COVID-19.
We are disappointed that the Democrats continued its partisan approach in drafting
section 3311, which is similar to the provisions ofH.R. 8134, the Consumer Product Safety
Inspection Enhancement Act, a bill to authorize additional resources for the Consumer Product
Safety Commission (CPSC). During the 116th Congress, the Committee on Energy and
Commerce passed H.R. 8134 by a voice vote on September 24, 2020, and the bill passed the full
House of Representatives by a voice vote on September 29, 2020. Because of the Committee's
bipartisan efforts, an authorization for additional port inspection personnel for the CPSC was
included in division F, title XX, ofH.R. 133, the Consolidated Appropiiations Act of 2021,
enacted on December 27, 2020.
The Democrats ignored the bipaitisan consensus recognizing the threat posed by the
People's Republic of China (PRC) and instead, allocated $50 million that are desperately
needed for the CPSC's port inspection responsibilities to a Commission slush fund to be
used however the CPSC chooses and without regard for our bipartisan agreement.
We support enhancing our ports security and providing the necessary resources to do
so. In 2020, the House Republican China Task Force issued a report outlining many of the
Chinese Communist Party's (CCP) subversive acts against our country. The PRC is a threat to
our way of life. Resources are needed to enhance targeting, surveillance, and screening of
consumer products originating from China. But section 3311 includes new definitions like
"COVID-19 products," which have not been vetted and may reach beyond the CPSC's
authority.
Section 3311 also includes new provisions that were not included in the 2020 bipartisan
agreement and that the Democrats never discussed with us. In particular, we are concerned that
authorizing the CPSC to undertake "enhanced monitoring ofinternet websites" will distract the
Commission from its port inspection duties.
The CPSC does not need more full-time personnel surfing the Internet. The Commission
needs more personnel on the ground at ports, protecting us from dangerous products from the
CCP. These resources should be targeted on counterfeit and illicit products originating in the
PRC. In a January 24, 2020, report entitled "Combating Trafficking in Counterfeit and Pirated
Goods," the Department of Homeland Security (DHS) estimated that 100,000 packages that
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could harm or defraud our constituents arrive in America every day from China and more than
85 percent of all contraband seized at our borders comes from China and Hong Kong.
There is another DHS report, "Operation Stolen Promise," which found that more than 50
percent of the nations' counterfeit COVID-19 products originate from China and Hong
Kong. And a recent article from Reuters found that Chinese internment camps in the Xinjiang
region force Uighur Muslims into labor camps and often shave the heads of women to use their
hair in products shipped to the U.S. We wrote to the CPSC about these Uighur women recently,
and the CPSC has acknowledged that it has not tracked this matter.
This section is a disappointment and a missed opportunity to continue our bipartisan
work to keep Americans safe from dangerous products from China.
Section 3312. Funding for E-Rate Support for Emergency Educational Connections and
Devices.
This section wastes $7.6 billion dollars in taxpayer funding for purposes that Congress
has already funded. It provides funding for schools and libraries to buy and distribute Wi-Fi
hotspots, modems, routers, and other devices for students to use for off-premise schoolwork.
This funding is duplicative of a cumulative $110 billion that Congress appropriated in 2020 to
the Department of Education to respond to the coronavims pandemic, and much of that money
remains unspent. It is irresponsible for Congress to appropriate more money for this purpose
before the existing money is spent and Congress can determine where, if any, there are
remaining gaps.
Besides the fact that Congress already appropriated money in the early days of the
pandemic for remote learning purposes, this program is also inconsistent with the President's
goal to reopen schools because it encourages the continuation of remote learning. Similarly, it
conflicts with the Administration's Centers for Disease Control and Prevention guidance, which
states that it is safe for schools to reopen and that they should do so as quickly as possible.
In addition, and contrary to claims from the Democrats, section 3312 does nothing to
support the Federal Communications Commission's (FCC) E-Rate program. Rather, it creates a
new program with no mies, no requirements, and no oversight to track the devices once they are
given to students, or to verify eligibility and ensure that there is no double dipping at schools and
libraries. The statute also does not clearly state whether or not this funding is available only for
the duration of the COVID-19 pandemic, or until 2030, which is well beyond the scope of the
pandemic. This program is simply a vehicle for the Democrats to implement its longstanding
partisan policies endorsed by the teachers' unions rather than helping Americans.
During the Committee markup of this provision, Rep. Latta and Rep. Walberg offered
amendments that would provide long-term solutions to close the digital divide and incentivize
schools to re-open for in-person learning. To provide a permanent solution to close the digital
divide, Rep. Latta offered an amendment to redirect this funding to mral broadband deployment
in unserved areas. Rep. Walberg offered an amendment to put this money directly into the
existing E-Rate program at the FCC, which funds connections and certain technologies in
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