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1. GDA-23 DEPARTMENT OF HEALTH AND HUMAN SERVICES................................................................................................449 Roger Severino 15. .

2. GDA-61 Paul Dans & Steven Groves The Project 2025 Advisory Board Alabama Policy Institute Alliance Defending Freedom American Compass The American Conservative America First Legal Foundation American Accountability Foundation American Center for Law and Justice American Cornerstone Institute American Council of Trustees and Alumni American Legislative Exchange Council The American Main Street Initiative American Moment American Principles Project Center for Equal Opportunity Center for Family and Human Rights Center for Immigration Studies Center for Renewing America Claremont Institute Coalition for a Prosperous America Competitive Enterprise Institute Conservative Partnership Institute Concerned Women for America Defense of Freedom Institute Ethics and Public Policy Center Family Policy Alliance Family Research Council First Liberty Institute Forge Leadership Network Foundation for Defense of Democracies Foundation for Government Accountability FreedomWorks The Heritage Foundation Hillsdale College Honest Elections Project Independent Women's Forum Institute for the American Worker Institute for Energy Research Institute for Women's Health Intercollegiate Studies Institute James Madison Institute Keystone Policy The Leadership Institute Liberty University National Association of Scholars National Center for Public Policy Research Pacific Research Institute Patrick Henry College Personnel Policy Operations Recovery for America Now Foundation 1792 Exchange Susan B. .

3. GDA-258 Department of Health and Human Services (HHS) from 2017 to 2021, he led a team of more than 250 staff enforcing civil rights, conscience, and health information privacy laws. .

4. GDA-320 Cavanaugh, American Global Strategies Spencer Chretien, The Heritage Foundation Claire Christensen, American Cornerstone Institute Victoria Coates, The Heritage Foundation Ellie Cohanim, Independent Women's Forum Ezra Cohen Elbridge Colby, Marathon Initiative Earl Comstock, White & Case LLP Lisa Correnti, Center for Family and Human Rights (C-Fam) Monica Crowley, The Nixon Seminar Laura Cunliffe, Independent Women's Forum Tom Dans, Amberwave Partners Sohan Dasgupta, Taft Stettinius & Hollister LLP Sergio de la PeΓ±a Chris De Ruyter, National Center for Urban Operations Corey DeAngelis, American Federation for Children Caroline DeBerry, Paragon Health Institute Arielle Del Turco, Family Research Council Irv Dennis, American Cornerstone Institute David Deptula, Mitchell Institute for Aerospace Studies Donald Devine, The Fund for American Studies Chuck DeVore, Texas Public Policy Foundation C. .

5. GDA-324 Gilmore III, Gilmore Global Group LLC Vance Ginn, Economic Consulting, LLC Alma Golden, The Institute for Women's Health Mike Gonzalez, The Heritage Foundation Chadwick R. .

6. GDA-325 Gore, Defense Forum Foundation David Gortler, Ethics and Public Policy Center Brian Gottstein, The Heritage Foundation Dan Greenberg, Competitive Enterprise Institute Rob Greenway, Hudson Institute Rachel Greszler, The Heritage Foundation DJ Gribbin, Madrus Consulting Garrison Grisedale, American Cornerstone Institute Joseph Grogan, USC Schaeffer School for Health Policy and Economics Andrew Guernsey Jeffrey Gunter, Republican Jewish Coalition Joe Guy, Club for Growth Joseph Guzman Amalia Halikias, The Heritage Foundation Gene Hamilton, America First Legal Foundation Richard Hanania, Center for the Study of Partisanship and Ideology Simon Hankinson, The Heritage Foundation David Harlow Derek Harvey, Office of Congressman Devin Nunes Jason Hayes, Mackinac Center for Public Policy Jennifer Hazelton Lou Heinzer Edie Heipel Troup Hemenway, Personnel Policy Operations Nathan Hitchen, Equal Rights Institute Pete Hoekstra Gabriella Hoffman, Independent Women's Forum Tom Homan, The Heritage Foundation Chris Horner Mike Howell, The Heritage Foundation Valerie Huber, The Institute for Women's Health Andrew Hughes, American Cornerstone Institute Joseph Humire, Center for a Secure Free Society Christopher Iacovella, American Securities Association Melanie Israel, The Heritage Foundation Ken Ivory, Utah House of Representatives Roman Jankowski, The Heritage Foundation Abby Jones Emilie Kao, Alliance Defending Freedom Jared M. .

7. GDA-331 Moley Caitlin Moon, American Center for Law & Justice David Moore, Brigham Young University Law School Clare Morell, Ethics and Public Policy Center Mark Morgan, The Heritage Foundation Hunter Morgen, American Cornerstone Institute Rachel Morrison, Ethics and Public Policy Center Jonathan Moy, The Heritage Foundation Iain Murray, Competitive Enterprise Institute Ryan Nabil, National Taxpayers Union Michael Nasi, Jackson Walker LLP Lucien Niemeyer, The Niemeyer Group, LLC Nazak Nikakhtar, Wiley Rein LLP Milan "Mitch" Nikolich Matt O'Brien, Immigration Reform Law Institute Caleb Orr, Boyden Gray & Associates Michael Pack Leah Pedersen Michael Pillsbury, The Heritage Foundation Patrick Pizzella, Leadership Institute Robert Poole, Reason Foundation Kevin Preskenis, Allymar Health Solutions Pam Pryor, National Committee for Religious Freedom Thomas Pyle, Institute for Energy Research John Ratcliffe, American Global Strategies Paul Ray, The Heritage Foundation Joseph Reddan, Flexilis Forestry, LLC Jay W. .

8. GDA-339 Sullivan, 1792 Exchange Brett Swearingen, Miller Johnson Michael Sweeney Robert Swope Aaron Szabo, CGCN Group Katy Talento, AllBetter Health Tony Tata, Tata Leadership Group, LLC Farnaz Farkish Thompson Todd Thurman, American Cornerstone Institute Brett Tolman, Tolman Group Kayla M. .

9. GDA-394 PROMISE #1: RESTORE THE FAMILY AS THE CENTERPIECE OF AMERICAN LIFE AND PROTECT OUR CHILDREN. .

10. GDA-399 These are the mediating institutions that serve as the building blocks of any healthy society. .

11. GDA-414 The world has never seen a thriving, healthy, free, and prosperous society where most children grow up without their married parents. .

12. GDA-425 This starts with deleting the terms sexual orientation and gender identity ("SOGI"), diversity, equity, and inclusion ("DEI"), gender, gender equality, gender equity, gender awareness, gender-sensitive, abortion, reproductive health, reproductive rights, and any other term used to deprive Americans of their First Amendment rights out of every federal rule, agency regulation, contract, grant, regulation, and piece of legislation that exists. .

13. GDA-457 PROMISE #2: DISMANTLE THE ADMINISTRATIVE STATE AND RETURN SELF-GOVERNANCE TO THE AMERICAN PEOPLE. .

14. GDA-471 In the end, congressional leaders' behavior and incentives here are no different from those of global elites insulating policy decisions --- over the climate, trade, public health, you name it --- from the sovereignty of national electorates. .

15. GDA-493 Cultural institutions like public libraries and public health agencies are only as "independent" from public accountability as elected officials and voters permit. .

16. GDA-515 PROMISE #3: DEFEND OUR NATION'S SOVEREIGNTY, BORDERS, AND BOUNTY AGAINST GLOBAL THREATS. .

17. GDA-606 PROMISE #4 SECURE OUR GOD-GIVEN INDIVIDUAL RIGHT TO ENJOY "THE BLESSINGS OF LIBERTY." The Declaration of Independence famously asserted the belief of America's Founders that "all men are created equal" and endowed with God-given rights to "Life, Liberty, and the pursuit of Happiness." It's the last --- "the pursuit of Happiness" --- that is central to America's heroic experiment in self-government. .

18. GDA-611 Think of dedicated teachers or health care professionals you know, entrepreneurs or plumbers throwing themselves into their businesses --- anyone who sees a job well done as a personal reward. .

19. GDA-636 Or when COVID-19 shutdown politicians like former House Speaker Nancy Pelosi and California Governor Gavin Newsom were caught at the hair salon or dining at fancy restaurants after moralizing about how everyone else must stay home and forgo such luxuries during the pandemic. .

20. GDA-642 Venezuela was once the richest nation in South America; today, a decade after a Marxist dictator took over, 94 percent of Venezuelans live in poverty.4 Even socialist Senator Bernie Sanders' home state of Vermont was forced to repeal the state's single-payer health care system just three years after creating it. .

21. GDA-689 Section One TAKING THE REINS OF GOVERNMENT A merica's Bicentennial, which culminated on July 4, 1976, was a spirited and unifying celebration of our country, its Founding, and its ideals. .

22. GDA-862 The White House also relies on Congress to enact reforms promised by the President on the campaign trail, whether those promises relate to health care, education, or national defense. .

23. GDA-992 For example, there are the areas of immigration and border security (either NSC or DPC); health care, energy, and environment (either NEC or DPC); and trade and international economic policy (either NSC or NEC). .

24. GDA-1017 It is essential that DPC policy expertise reflect the most prominent issues that are before the Administration: issues such as the environment, health care, housing, and immigration. .

25. GDA-1025 Another important area is the promotion of health care reform to bring down costs for the American people and the pressure that spending on health programs puts on the federal budget. .

26. GDA-1034 These efforts have included serving on the NSC Principals Committee, heading the National Space Council, addressing immigration and border issues, leading the response to health care crises, and supervising workforce programs. .

27. GDA-1139 l Health. .

28. GDA-1235 The HSC has overseen pandemic response, and its incorporation is important. .

29. GDA-1252 Today, this would include (among other topics) taxes, energy and environment, technology, infrastructure, health care, financial services, workforce, agriculture, antitrust and competition policy, and retirement programs. .

30. GDA-1382 Disrupting the flow of drugs across our borders and into our communities is of paramount importance, both to save lives and to bolster our public health efforts. .

31. GDA-1388 While it makes sense to transfer these programs eventually to the Department of Justice and Department of Health and Human Services, respectively, it is vital that the ONDCP Director ensure in the immediate term that these grant programs are funding the President's drug control priorities and not woke nonprofits with leftist policy agendas. .

32. GDA-1391 Abolishing the Gender Policy Council would eliminate central promotion of abortion ("health services"); comprehensive sexuality education ("education"); and the new woke gender ideology, which has as a principal tenet "gender affirming care" and "sex-change" surgeries on minors. .

33. GDA-1408 For example, Mike Pence was tasked with coordinating the federal response to COVID-19, and both Pence and Kamala Harris have chaired the National Space Council. .

34. GDA-1588 Code charges the OPM with executing, administering, and enforcing the rules, regulations, and laws governing the civil service.2 It grants the OPM direct responsibility for activities like retirement, pay, health, training, federal unionization, suitability, and classification functions not specifically granted to other agencies by statute. .

35. GDA-1706 Federal health benefits are more comparable to those provided by Fortune 500 employers with the government paying 72 percent of the weighted average premiums, but this is much higher than for most private plans. .

36. GDA-1752 It identified 33 actions to address mission fragmentation, overlap, and duplication in the 12 areas of defense, economic development, health, homeland security, and information technology. .

37. GDA-1904 Section Two THE COMMON DEFENSE W hile the lives of Americans are affected in noteworthy ways, for better or worse, by each part of the executive branch, the inherent importance of national defense and foreign affairs makes the Departments of Defense and State first among equals. .

38. GDA-1930 She observes, "[M]any were quick to dismiss even the possibility that COVID escaped from a Chinese research laboratory." Meanwhile, Skinner writes, "[g]lobal leaders including President Joe Biden"¦have tried to normalize or even laud Chinese behavior." She adds, "In some cases, these voices, like global corporate giants BlackRock and Disney" --- or the National Basketball Association (NBA) --- "directly benefit from doing business with Beijing." Former vice president of the U.S. .

39. GDA-2116 3. Create opportunities to improve the health of the defense supply chain with added opportunities for partners and allies to contribute. .

40. GDA-2146 3. Reinstate servicemembers to active duty who were discharged for not receiving the COVID vaccine, restore their appropriate rank, and provide back pay. .

41. GDA-2158 4. Audit all curricula and health policies in DOD schools for military families, remove all inappropriate materials, and reverse inappropriate policies. .

42. GDA-2676 Citizenship and Immigration Services (USCIS); the Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR); and the Department of Justice (DOJ) Executive Office for Immigration Review (EOIR) and Office of Immigration Litigation (OIL) into a stand- alone border and immigration agency at the Cabinet level (more than 100,000 employees, making it the third largest department measured by manpower). .

43. GDA-2747 This would integrate critical interdiction, enforcement, and investigative resources, enhancing coordination and refocusing collective efforts on the vast and complex cross-border threats impacting our nation's health, safety, and national security. .

44. GDA-2859 Not all policy changes require formal rulemaking, however, as internal guidance documents are generally exempt under the Administrative Procedure Act (APA).7 In this subregulatory space, USCIS policy memos and operational guidance should reduce the validity of employment authorization documents and end the COVID flexibilities, including the reliance on biometrics reuse. .

45. GDA-2897 Create an authority akin to the Title 42 Public Health authority that has been used during the COVID-19 pandemic to expel illegal aliens across the border immediately when certain non- health conditions are met, such as loss of operational control of the border. .

46. GDA-2911 4. Congress should amend the Homeland Security Act and portions of the TVPRA to move detention of alien children expressly from the Department of Health and Human Services to DHS. .

47. GDA-3049 Simultaneously, consistent with the Department of Defense, USCG should also make a serious effort to re-vet any promotions and hiring that occurred on the Biden Administration's watch while also re-onboarding any USCG personnel who were dismissed from service for refusing to take the COVID-19 "vaccine," with time in service credited to such returnees. .

48. GDA-3253 l Department of Health and Human Services: Agree to move the Office of Refugee Resettlement (ORR) to DHS or, alternatively, implement an aggressive and regular effort by the Secretary of HHS to ensure that ORR is fully pursuing presidential objectives in support of DHS. .

49. GDA-3498 For instance, many were quick to dismiss even the possibility that COVID-19 escaped from a Chinese research laboratory. .

50. GDA-3576 The next Administration must leverage its new insistence on a sovereign Mexico and work with other Western Hemisphere partners to halt the fentanyl crisis and put a decisive end to this unprecedented public health threat. .

51. GDA-3736 The manifest failure and corruption of the World Health Organization (WHO) during the COVID-19 pandemic is an example of the danger that international organizations pose to U.S. .

52. GDA-3768 It is paramount to create a healthy culture of respect for life, the family, sovereignty, and authentic human rights in international organizations and agencies. .

53. GDA-3770 led an effort during the Trump Administration to forge a consensus among like-minded countries in support of human life, women's health, support of the family as the basic unit of human society, and defense of national sovereignty. .

54. GDA-3771 The result was the Geneva Consensus Declaration on Women's Health and Protection of the Family.21 All U.S. .

55. GDA-3778 The COVID-19 pandemic made it painfully clear that both international organizations --- and some countries --- are only too willing to trample human rights in the name of public health. .

56. GDA-3780 The next Administration should unequivocally embrace the premise that humanity and the international community can simultaneously tackle pandemics and other emergent health threats without impeding the rights of people. .

57. GDA-3781 It must also become a vocal surrogate for people in countries where rights are being suppressed in the name of health. .

58. GDA-3782 This will likely require greater restrictions on the supply of federal dollars to the WHO and other health-focused international organizations pending adjustment of their policies. .

59. GDA-3848 Global financial infrastructure, nuclear controls, and public health are particularly important areas in which consensus may even be found across ideological lines. .

60. GDA-3917 21. "Geneva Consensus Declaration on Promoting Women's Health and Strengthening the Family," October 22, 2021, https://www.theiwh.org/wp-content/uploads/2022/02/GCD-Declaration-2021-2.pdf (accessed March 13, 2023). .

61. GDA-4087 Allowing ODNI and CIA leadership to shrink size and reduce duplication of effort while promoting healthy turnover within their senior ranks would encourage new ideas and perspectives from mid-career officers and, potentially, from employees hired from outside their agencies. .

62. GDA-4193 Senior CIA analysts and leaders made it "difficult to have a healthy analytic conversation in a confrontational environment" while violating multiple official IC tradecraft standards. .

63. GDA-4195 On election influence and other controversial issues, such as the origin of COVID-19, analysts at the most powerful intelligence agencies have increasingly tended to use the leeway they have been given to insert their political views into their work in order to influence (if possibly even control) the analytic process. .

64. GDA-4668 In 2022, the CPB submitted to the Labor, Health and Human Services, Education, and Related Agencies Subcommittees of the House and Senate Appropriations Committees its budget justification for fiscal year (FY) 2023. .

65. GDA-4788 52. Corporation for Public Broadcasting, Corporation for Public Broadcasting Appropriation Request and Justification FY 2023/FY 2025, Submitted to the Labor, Health and Human Services, Education and Related Agencies Subcommittee of the House Appropriations Committee and the Labor, Health and Human Services, Education and Related Agencies Subcommittee of the Senate Appropriations Committee, March 28, 2022, p. .

66. GDA-4798 USAID helps communities to lead their own development journeys by reducing the impact of conflict; preventing hunger and the spread of pandemic disease; and counteracting the drivers of violence, instability, transnational crime, and other threats. .

67. GDA-4822 The next conservative Administration should scale back USAID's global footprint by, at a minimum, returning to the agency's 2019 pre-COVID-19 pandemic budget level. .

68. GDA-4848 China's mercantilist penetration of the developing world and the negative consequences for developing countries' healthy economic growth have undercut U.S. .

69. GDA-4900 USAID now aggressively promotes abortion on demand under the guise of "sexual and reproductive health and reproductive rights," "gender equality," and "women's empowerment" and advocates for those who claim minority status or vulnerability. .

70. GDA-4907 It should also remove references to "abortion," "reproductive health," and "sexual and reproductive rights" and controversial sexual education materials. .

71. GDA-4912 Basic human needs include equal and safe access to potable water, sanitation, food, education, health care, houses of worship, justice, pregnancy and family resource centers, working capital, electricity, technology, and business opportunities. .

72. GDA-4913 The Office of Women, Children, and Families should implement the Geneva Consensus Declaration on Women's Health and Protection of the Family and prioritize partnerships with local organizations, including faith-based organizations (FBOs). .

73. GDA-4916 Shortly after taking office, however, President Biden issued a memorandum that reversed a myriad of pro-life policies and revoked the Protecting Life in Global Health Assistance (PLGHA) policy, widely known as the Mexico City Policy. .

74. GDA-4919 Previous pro-life Presidents beginning with Ronald Reagan applied these conditions to family planning assistance, but President Trump for the first time expanded the Mexico City Policy to protect "global health assistance furnished by all departments or agencies" (estimated to be $8.8 billion annually). .

75. GDA-4921 In reversing PLGHA, Biden declared a radical assault on the policy of protecting life, choosing instead to promote abortion on demand around the world under the guise of "sexual and reproductive health and rights." USAID's priority of funding the global abortion industry negates programs that promote life, women's health, and the family. .

76. GDA-4923 International NGOs that perform and promote abortions overseas like Population Services International, Pathfinder, PATH, the Population Council, EngenderHealth, and WomanCare Global International continued to receive funding from USAID under PLGHA and now, under Biden, receive tens of millions more in U.S. .

77. GDA-4925 When the United Nations Secretariat promoted abortion and abortion- inducing drugs under the umbrella of "sexual and reproductive health" as an element of its COVID-19 Global Humanitarian Response Plan in May 2020, the exemptions in PLGHA for humanitarian aid and multilateral organizations illuminated another loophole in the policy's effectiveness in safeguarding U.S. .

78. GDA-4927 Pro-abortion groups also have received funds under other categories of foreign aid that fall outside the scope of global health assistance, including women-related and economic assistance programs. .

79. GDA-4932 It should simultaneously rescind President Biden's memorandum entitled "Protecting Women's Health at Home and Abroad," issued on January 28, 2021.12 The new pro-life executive order should apply to foreign NGOs, including subgrantees and subcontractors, and remove exemptions for U.S.-based NGOs, public international organizations, and bilateral government-to-government agreements. .

80. GDA-4976 Global Health. .

81. GDA-4977 The United States is the world's largest funder of global health initiatives. .

82. GDA-4978 For more than 60 years, the American people have offered health assistance to the world and saved millions of lives. .

83. GDA-4979 The USAID Bureau for Global Health (GH), the second largest within USAID, oversees a multibillion-dollar operation to support maternal and child health; voluntary family planning; PEPFAR and the President's Malaria Initiative (PMI) (both started under President George W. .

84. GDA-4982 Countries with strong health institutions and sound public health practices responded quickly to and recovered more rapidly from the COVID-19 pandemic. .

85. GDA-4984 Unfortunately, many USAID-funded global health activities remain rooted in patterns that began decades ago and measure improvements in terms of inputs --- money spent --- instead of outcomes achieved. .

86. GDA-4985 From the 1950s to 1970s, the major recognized threats to human health were infectious diseases such as polio and smallpox, and USAID funded programs "in" a country, not "with" a country. .

87. GDA-4986 Maternal and child health, food, water, and sanitation programs were often intermittent. .

88. GDA-4987 USAID consistently financed population control, contraception, and abortion as essential to "development." Most programs focused on one disease or condition but had little integration with other global health activities. .

89. GDA-4989 Consequently, the next conservative Administration should focus on updating the Global Health Bureau's portfolio, emphasizing a comprehensive approach to supporting women, children, and families; building host-country institutional capacity; increasing awards to local and faith-based partners (expanding what occurred during the Trump Administration with the NPI); and improving USAID's ability to coordinate with local partners. .

90. GDA-4993 Focusing on Holistic Health Care and Support for Women, Children, and Families. .

91. GDA-4997 The next leadership at USAID must focus attention on women and children's health (including unborn children) as well as health risks across life spans, including childhood infections, cervical cancer, adolescent risks, and family stability, by utilizing a coordinated approach. .

92. GDA-5002 In sub-Saharan Africa, FBOs often provide more than 80 percent of health care, especially to the extremely poor. .

93. GDA-5003 In contrast, the Global Health Bureau historically has provided 85 percent of its funding to large U.S. .

94. GDA-5006 The training, laboratory, clinical intervention, health education, data collection, and organizational platforms of these programs became the bedrock for responding to the COVID pandemic. .

95. GDA-5007 It is time for these programs to become part of an integrated, strong, and sustainable network of health care and public health in developing countries. .

96. GDA-5011 For decades, global health programs have relied mostly on statistical modeling (rather than actual data) or survey data (the weakest type of data). .

97. GDA-5012 Poor data quality undermines both the evaluation and improvement of desired outcomes achieved by our global health programs. .

98. GDA-5014 The next conservative Administration should apply these reforms to all of USAID's global health programs. .

99. GDA-5016 The Bureau's Center for Innovation and Impact (CII) should be empowered to expand networks of private and faith-based health organizations that can develop projects using development- impact bonds, capital funds, and innovative technologies, including with the Millennium Challenge Corporation and the new U.S. .

100. GDA-5018 More flexible and agile CII funding will spur innovation within the Bureau and help to enhance countries' self-reliance in the provision of health care. .

101. GDA-5020 The Global Health Bureau should address its own management challenges by modifying the high ratio of contractors to direct hires, holding career leadership accountable for effective management, and building more flexibility in emergency responses. .

102. GDA-5024 Holding the U.N., the World Health Organization (WHO), and Other Multilateral Organizations Accountable. .

103. GDA-5032 government is the world's largest humanitarian actor, annually disbursing billions of dollars in lifesaving assistance --- food, water, shelter, emergency health care, and related protection support --- to tens of millions of vulnerable people. .

104. GDA-5046 These governments can then redirect scarce budget resources away from costly health and education toward financing their wars, supporting terrorism, repressing their citizens, and enriching themselves. .

105. GDA-5146 A key outcome of the transformation of USAID undertaken during the Trump Administration, the Bureau for Democracy, Development, and Innovation (DDI) is the home for most of the agency's non-health, nonhumanitarian funding as well as almost all of its sectoral appropriations directives, including those that reflect the pet projects of individual Members of Congress. .

106. GDA-5158 USAID enjoys a strong in-country presence in India, buttressed by recent coordination on the global response to COVID-19 as India is a global leader in vaccine production. .

107. GDA-5160 So too should development cooperation with Taiwan, which boasts effective pandemic response capacity that should be shared with developing countries. .

108. GDA-5191 Since its inception, USAID has had a strong presence in Africa, saving millions of lives through its pandemic and infectious disease responses, especially for malaria and HIV-AIDS. .

109. GDA-5200 The Biden Administration's radical global climate policies have cut off billions in investment to develop clean fossil fuels, denying Africa's billion-plus people access to cheap energy to further their own development and finance their own social services in health, water, education, and agriculture, while increasing its dependence on China's renewables industry. .

110. GDA-5227 The next Administration should extend that localization model to all global health and humanitarian assistance in view of how local African entities have strengthened their capacity for direct management of U.S. .

111. GDA-5234 foreign assistance throughout the Western Hemisphere is designed to respond to national security threats that emanate from the region, such as illicit drug and arms trafficking; illegal immigration flows; terrorism; pandemics; and strategic threats from China, Russia, and Iran. .

112. GDA-5237 During the COVID pandemic, the United States provided millions of doses of vaccines and other emergency health support. .

113. GDA-5307 Biden Jr., "Memorandum on Protecting Women's Health at Home and Abroad," Memorandum for the Secretary of State, the Secretary of Defense, the Secretary of Health and Human Services, and the Administrator of the United States Agency for International Development, The White House, January 28, 2021, https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/memorandum- on-protecting-womens-health-at-home-and-abroad/ (accessed March 18, 2023). .

114. GDA-5325 Section Three THE GENERAL WELFARE When our Founders wrote in the Constitution that the federal government would "promote the general Welfare," they could not have fathomed a massive bureaucracy that would someday spend $3 trillion in a single year --- roughly the sum, combined, spent by the departments covered in this section in 2022. .

115. GDA-5326 Approximately half of that colossal sum was spent by the Department of Health and Human Services (HHS) alone --- the belly of the massive behemoth that is the modern administrative state. .

116. GDA-5333 HHS is also home to the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), the duo most responsible --- along with President Joe Biden --- for the irrational, destructive, un-American mask and vaccine mandates that were imposed upon an ostensibly free people during the COVID-19 pandemic. .

117. GDA-5336 Under COVID, as former director of HHS's Office of Civil Rights Roger Severino writes in Chapter 14, the CDC exposed itself as "perhaps the most incompetent and arrogant agency in the federal government." Nor is the CDC the only villain in this play. .

118. GDA-5337 Severino writes of the National Institutes of Health, "Despite its popular image as a benign science agency, NIH was responsible for paying for research in aborted baby body parts, human animal chimera experiments" --- in which the genes of humans and animals are mixed, "and gain-of-function viral research that may have been responsible for COVID-19." Severino writes that "Anthony Fauci's division of the NIH" --- the National Institute of Allergy and Infectious Diseases --- "owns half the patent for the Moderna COVID- 19 vaccine," and "several NIH employees" receive "up to $150,000 annually from Moderna vaccine sales." That would be the same experimental mRNA vaccine that the CDC now wants to force on children, who are at little to no risk from COVID-19 but at great risk from public health officials. .

119. GDA-5341 HHS also pushes abortion as a form of "health care," skirting and sometimes blatantly defying the Hyde Amendment in the process. .

120. GDA-5351 The department is a convenient one-stop shop for the woke education cartel, which --- as the COVID era showed --- is not particularly concerned with children's education. .

121. GDA-5376 However, the language bringing in equity and climate change is new to the Biden Administration and part of the USDA's express effort to transform agricultural production.2 The USDA's new vision statement illuminates the focus of this effort: An equitable and climate smart food and agriculture economy that protects and improves the health, nutrition and quality of life of all Americans, yields healthy land, forests and clean water, helps rural America thrive, and feeds the world.3 This effort is one of a federal central plan to put climate change and environmental issues ahead of the most important requirements of agriculture --- to efficiently produce safe food. .

122. GDA-5385 Within this agricultural focus, the USDA should develop and disseminate information and research (the historical role of the USDA); identify and address concrete threats to public health and safety arising directly from food and agriculture; remove unjustified foreign trade barriers blocking market access for American agricultural goods; and generally remove government barriers that undermine access to safe and affordable food across the food supply chain. .

123. GDA-5388 Taking these factors into account, below is a model USDA mission statement: To develop and disseminate agricultural information and research, identify and address concrete public health and safety threats directly connected to food and agriculture, and remove both unjustified foreign trade barriers for U.S. .

124. GDA-5399 One of the important lessons learned during the COVID- 19 pandemic was how critical it is to remove barriers in the food supply chain --- not to increase them. .

125. GDA-5426 In 2020, this authority was used for $20.5 billion in food purchases and income subsidies in response to the COVID-19 pandemic.26 At the time, critics warned that this use of the CCC, which in effect created a USDA slush fund, would lead future Administrations to abuse the CCC, such as by pushing climate-change policies.27 Predictably, this is precisely what the Biden Administration has done, using the discretionary authority to create programs out of whole cloth, arguably without statutory authority,28 for what it refers to as climate-smart agricultural practices.29 The merits of the various programs funded through the CCC discretionary authority is not the focus of this discussion. .

126. GDA-5488 The next Administration should: l Move the USDA food and nutrition programs to the Department of Health and Human Services. .

127. GDA-5490 There are means-tested food-support programs in the USDA (specially FNS), whereas most means-tested programs are at the Department of Health and Human Services (HHS). .

128. GDA-5526 The NSLP launched in 1946 and the SBP in 1966, both as options specifically for children in poverty.82 During the COVID-19 pandemic, federal policymakers temporarily expanded access to school meal programs, but some lawmakers and federal officials have now proposed making this expansion permanent. .

129. GDA-5527 83 Yet even before the pandemic, research found that federal officials had already expanded these programs to serve children from upper-income homes, and these programs are rife with improper payments and inefficiencies. .

130. GDA-5615 The United States Forest Service is one of four federal government land management agencies that administer 606 million acres, or 95 percent of the 640 million acres of surface land area managed by the federal government.115 Located within the USDA, the Forest Service manages the National Forest System, which is comprised of 193 million acres.116 As explained by the USDA, "The USDA Forest Service's mission is to sustain the health, diversity, and productivity of the nation's forests and grasslands to meet the needs of present and future generations."117 The Forest Service should focus on proactive management of the forests and grasslands that does not depend heavily on burning. .

131. GDA-5626 In the 2015 Dietary Guidelines process, the influential Dietary Guidelines Advisory Committee veered off mission and attempted to persuade the USDA and HHS to adopt nutritional advice that focused not just on human health, but the health of the planet.127 Issues such as climate change and sustainability infiltrated the process. .

132. GDA-5630 This includes working with their own health professionals. .

133. GDA-5632 The Dietary Guidelines have a major impact because they not only can influence how private health providers offer nutritional advice, but they also inform federal programs. .

134. GDA-5638 In fact, if environmental concerns supersede or water down recommendations for human nutritional advice, the public would be receiving misleading health information. .

135. GDA-5706 Further, there are many myths, such as those regarding the alleged health benefit of organic food. .

136. GDA-5707 One meta study found that "[t]he published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods." Crystal Smith-Spangler et al., "Are Organic Foods Safer or Healthier Than Conventional Alternatives," Annals of Internal Medicine, Vol. .

137. GDA-5850 Crystal FitzSimons, "Free School Meals for All Is the Key to Supporting Education and Health Outcomes," Journal of Policy Analysis and Management, Vol 41, No. .

138. GDA-5988 Healthy, Hunger-Free Kids Act of 2010, S. .

139. GDA-6018 By Fiscal Year 2022, ESEA programs received $27.7 billion in appropriations, in addition to $190 billion that came through the pandemic's Elementary and Secondary Schools Emergency Relief (ESSER) Funds,4 which relied on ESEA formulas. .

140. GDA-6034 One recent example is the Biden Administration's requirement that state education agencies and school districts submit "equity" plans as a condition of receiving COVID recovery ESSER funds in the American Rescue Plan (ARP).9 This exercise led to the hiring of numerous new government employees as the rules were promulgated, plans were created after collecting public feedback, and those plans were eventually deemed satisfactory. .

141. GDA-6088 l Transfer Title I, Part A, which provides federal funding for lower- income school districts, to the Department of Health and Human Services, specifically the Administration for Children and Families. .

142. GDA-6097 is under the jurisdiction of Congress --- should be expanded into a universal program, formula-funded, and moved to the Department of Health and Human Services. .

143. GDA-6101 l Most IDEA funding should be converted into a no-strings formula block grant targeted at students with disabilities and distributed directly to local education agencies by Health and Human Service's Administration for Community Living. .

144. GDA-6227 The Department of Health and Human Services faced similar challenges in trying to evaluate healthcare outcomes since social determinants of health result in worse health outcomes among those who are socioeconomically disadvantaged, have low educational attainment levels, have struggled with addiction, or have poor diet and exercise habits. .

145. GDA-6261 They also lobbied to keep schools closed during the pandemic. .

146. GDA-6339 In 2022, fourth grade math students scored 11 points lower than fourth graders in 2019, which means District children lost an entire year of learning over the course of the pandemic. .

147. GDA-6368 Department of Health and Human Services. .

148. GDA-6478 This portal should also contain an explanation of the Health Insurance Portability and Accountability Act (HIPPA) and public school procedures to demonstrate that the law does not deprive parents of their right to access any school health records. .

149. GDA-6702 To implement many of the policies contained in these proposals, several laws will need to be amended, including the Department of Energy Organization Act, IIJA, IRA, and possibly portions of the CHIPS (Creating Healthy Incentives to Produce Semiconductors) and Science Act.17 Ending taxpayer subsidies will promote an "all of the above" energy policy, lead to more energy resources, reduce costs, and save taxpayers billions of dollars. .

150. GDA-7568 Gunasekara MISSION STATEMENT Creating a better environmental tomorrow with clean air, safe water, healthy soil, and thriving communities. .

151. GDA-7577 The challenge of creating a conservative EPA will be to balance justified skepticism toward an agency that has long been amenable to being coopted by the Left for political ends against the need to implement the agency's true function: protecting public health and the environment in cooperation with states. .

152. GDA-7598 In effect, the Biden EPA has once again presented a false choice to the American people: that they have to choose between a healthy environment and a strong, growing economy. .

153. GDA-7603 The mission to protect public health and the environment was born, and the first Administrator was sworn in on December 4, 1970. .

154. GDA-7606 This expansive status is entirely unnecessary: It has nothing to do with improving either the environment or public health. .

155. GDA-7616 Duplicative, wasteful, or superfluous programs that do not tangibly support the agency's mission should be eliminated, and a structured management program should be designed to assist state and local governments in protecting public health and the environment. .

156. GDA-7617 l Healthy, Thriving Communities. .

157. GDA-7633 l Relocating the Office of Children's Health Protection and the Office of Small and Disadvantaged Business Utilization from the AO and reabsorbing those functions within the media offices (air, water, land, and emergency management, etc.). .

158. GDA-7639 To initiate the review and reorganization, a Day One executive order should be drafted for the incoming President with explicit language requiring reconsideration of the agency's structure with reference to fulfilling its mission to create a better environmental tomorrow with clean air, safe water, healthy soil, and thriving communities. .

159. GDA-7654 Revise guidance documents that control regulations such as the social cost of carbon; discount rates; timing of regulatory review (before options are selected); causality of health effects; low-dose risk estimation (linear no-threshold analysis); and employment loss analysis. .

160. GDA-7724 OFFICE OF WATER (OW) OW is responsible for ensuring safe drinking water and restoring and maintaining oceans, watersheds, and their aquatic ecosystems to protect human health, support economic and recreational activities, and provide healthy habitats for fish, plants, and wildlife. .

161. GDA-7752 OLEM executes this mission by protecting human health and the environment while leveraging economic opportunities and creating jobs. .

162. GDA-7812 OPP has rigorous testing requirements for pesticide ingredients and products to ensure before they go to market that their use will not harm human health and the environment. .

163. GDA-7858 In the face of uncertainty around associations between certain pollutants and health or welfare endpoints, EPA's heavy reliance on default assumptions like its low-dose, linear non-threshold model bake orders of magnitude of risk into key regulatory inputs and drive flawed and opaque decisions. .

164. GDA-7935 As a result, grant funds produce little to no meaningful improvements in the environment and public health and instead fund questionably relevant projects at elite, private academic institutions that invariably produce radical environmental research. .

165. GDA-7954 Importantly, a conservative EPA will deliver tangible environmental improvements to the American people in the form of cleaner air, cleaner water, and healthier soils. .

166. GDA-8071 Supreme Court, "unquestionably pertinent" advice on the "relative contribution to air pollution concentrations of natural"¦ activity" as well as "any adverse public health, welfare, social, economic, or energy effects which may result from various strategies for attainment and maintenance" of the NAAQS. .

167. GDA-8114 14 DEPARTMENT OF HEALTH AND HUMAN SERVICES Roger Severino If the U.S. .

168. GDA-8115 Department of Health and Human Services (HHS) were a separate country, its approximately $1.6 trillion budget would rank as the world's fifth-largest national budget. .

169. GDA-8118 life expectancy, instead of returning to normal after the COVID-19 pandemic, continued to drop precipitously to levels not seen since 1996 with white populations alone losing 7 percent of their expected life span in just one year.3 Nothing less than America's long-term survival is at stake. .

170. GDA-8119 Accordingly, HHS must return to serving the health and well-being of all Americans at all stages of life instead of using social engineering that leaves us sicker, poorer, and more divided. .

171. GDA-8120 OVERVIEW HHS consists of 11 operating divisions that have varying degrees of practical independence from the Secretary of Health and Human Services and 15 staff divisions that are directly under the Office of the Secretary. .

172. GDA-8125 The Secretary must ensure that all HHS programs and activities are rooted in a deep respect for innocent human life from day one until natural death: Abortion and euthanasia are not health care. .

173. GDA-8129 This destructive dogma, under the guise of "equity," threatens American's fundamental liberties as well as the health and well-being of children and adults alike. .

174. GDA-8133 Health care is no exception. .

175. GDA-8134 Health care reform should be patient-centered and market-based and should empower individuals to control their health care-related dollars and decisions. .

176. GDA-8135 Of course, providers who deliver health care also need the freedom to address the unique needs of their patients. .

177. GDA-8137 Finally, America's broken insurance system, run largely through confusing provider networks and third-party payers (employers), induces overconsumption of health care, limits consumer shopping, and hides true costs from patients. .

178. GDA-8138 The federal government should focus reform on reducing burdens of regulatory compliance, unleashing innovation in health care delivery, ceasing interference in the daily lives of patients and providers, allowing alternative insurance coverage options, and returning control of health care dollars to patients making decisions with their providers about their health care treatments and services. .

179. GDA-8140 Families comprised of a married mother, father, and their children are the foundation of a well-ordered nation and healthy society. .

180. GDA-8146 HHS should prioritize married father engagement in its messaging, health, and welfare policies. .

181. GDA-8149 Goal #4: Preparing for the Next Health Emergency. .

182. GDA-8150 The COVID-19 pandemic demonstrated how catastrophic a micromanaging, misinformed, centralized, and politicized federal government can be. .

183. GDA-8152 Excess deaths, not due to COVID-19, skyrocketed because of forced lockdowns, isolation, vaccine-related mass firings, and colossal disruptions of the economy and daily rhythms of life. .

184. GDA-8153 The federal government's public health apparatus has lost the public's trust. .

185. GDA-8154 Before the next national public health emergency, this apparatus must be fundamentally restructured to ensure a transparent, scientifically grounded, and more nimble, efficient, transparent, and targeted response that respects the unique needs and input of patient populations and providers. .

186. GDA-8155 Every one of the overreaching policies during the pandemic --- from lockdowns and school closures to mask and vaccine mandates or passports --- received its supposed legal justification from the state of emergency declared (and renewed) by the HHS Secretary. .

187. GDA-8156 Tellingly, however, the threshold for what constitutes a public health emergency --- how many cases, hospitalizations, deaths, etc. .

188. GDA-8159 Unaccountable bureaucrats like Anthony Fauci should never again have such broad, unchecked power to issue health "guidelines" that will certainly be the basis for federal and state mandates. .

189. GDA-8160 Never again should public health bureaucrats be allowed to hide information, ignore information, or mislead the public concerning the efficacy or dangers associated with any recommended health interventions because they believe it may lead to hesitancy on the part of the public. .

190. GDA-8161 The only way to restore public trust in HHS as an institution capable of acting responsibly during a health emergency is through the best of disinfectants --- light. .

191. GDA-8163 The next Administration should guard against the regulatory capture of our public health agencies by pharmaceutical companies, insurers, hospital conglomerates, and related economic interests that these agencies are meant to regulate. .

192. GDA-8165 All National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration regulators should be entirely free from private biopharmaceutical funding. .

193. GDA-8171 Finally, HHS should adopt metrics across the agency that can objectively determine the extent to which the agency's policies and programs achieve desired health and welfare outcomes (not agency outputs). .

194. GDA-8173 CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) COVID and Structural Reform. .

195. GDA-8174 COVID-19 exposed the Centers for Disease Control and Prevention (CDC) as perhaps the most incompetent and arrogant agency in the federal government. .

196. GDA-8175 CDC continually misjudged COVID-19, from its lethality, transmissibility, and origins to treatments. .

197. GDA-8177 CDC botched the development of COVID tests when they were needed most. .

198. GDA-8182 This information is crucial for medical and public health researchers around the country. .

199. GDA-8183 On the other hand, the CDC is also responsible for making public health recommendations and policies --- an inescapably political function. .

200. GDA-8185 In February 2022, for example, it was reported that "[t]wo full years into the pandemic, the agency leading the country's response to the public health emergency has published only a tiny fraction of the data it has collected," much of which "could [have helped] state and local health officials better target their efforts to bring the virus under control." A CDC spokesman said that one of the reasons was "fear that the information might be misinterpreted."4 These distinct functions should be separated into two entirely separate agencies with a firewall between them. .

201. GDA-8187 A separate agency should be responsible for public health with a severely confined ability to make policy recommendations. .

202. GDA-8188 The CDC can and should make assessments as to the health costs and benefits of health interventions, but it has limited to no capacity to measure the social costs or benefits they may entail. .

203. GDA-8190 The CDC's initial COVID-19 testing failures were largely the result of that agency's prioritizing its own development and production of tests using its internal staff and facilities. .

204. GDA-8191 The private sector is much better positioned to tackle the challenges inherent in developing and manufacturing novel products, as illustrated by the relative success of the alternative approach to facilitating the development of COVID-19 vaccines and therapeutics by private companies that was adopted by the Food and Drug Administration (FDA). .

205. GDA-8192 When it comes to testing, the CDC's role should similarly be to facilitate rather than supplant the efforts of private test developers, academic laboratories, state public health laboratories, and clinical testing providers. .

206. GDA-8195 The CDC is a public health institution, not a medical institution. .

207. GDA-8196 According to its mission statement, the agency focuses on "disease prevention and control, environmental health, and health promotion and health education activities." 6 It is not qualified to offer (and usually does not purport to offer) professional medical opinions applicable to specific patients. .

208. GDA-8198 In this respect, CDC guidelines are analogous to guidelines from other public health associations or medical societies: They are informative, not prescriptive. .

209. GDA-8208 The COVID-19 pandemic has revealed the disastrous public health consequences of the CDC's failure to follow multiple congressional mandates to modernize its data infrastructure. .

210. GDA-8211 HHS should also enter into a public-private partnership with a data-management expert to develop a system that makes critical information available to health care workers and policymakers in real time.8 The CDC operates several programs related to vaccine safety including the Vaccine Adverse Event Reporting System (VAERS); Vaccine Safety Datalink (VSD); and Clinical Immunization Safety Assessment (CISA) Project. .

211. GDA-8215 It should ensure that it is not promoting abortion as health care. .

212. GDA-8216 It should fund studies into the risks and complications of abortion and ensure that it corrects and does not promote misinformation regarding the comparative health and psychological benefits of childbirth versus the health and psychological risks of intentionally taking a human life through abortion. .

213. GDA-8217 The CDC oversaw and funded the development and testing of the COVID-19 vaccines with aborted fetal cell lines, insensitive to the consciences of tens of thousands to hundreds of thousands of people who objected to taking a vaccine with such a link to abortion. .

214. GDA-8226 Accurate and reliable statistical data about abortion, abortion survivors, and abortion-related maternal deaths are essential to timely, reliable public health and policy analysis. .

215. GDA-8233 The Ensuring Accurate and Complete Abortion Data Reporting Act of 20239 would amend title XIX of the Social Security Act and Public Health Service Act to improve the CDC's abortion reporting mechanisms by requiring states, as a condition of federal Medicaid payments for family planning services, to report streamlined variables in a timely manner. .

216. GDA-8242 Learning from the failed early COVID-19 testing experience, Congress and the FDA should focus on reforming laws and regulations governing medical tests, especially with respect to laboratory-developed tests. .

217. GDA-8254 For its part, HHS should exempt multi-source generic drugs from requirements to pay rebates to Medicaid and other federally funded health programs, as those provisions penalize new investments in expanding manufacturing capacity when supply is unable to meet demand.15 Additionally, FDA and NIH should promote efficacy trials of new applications for generic drugs, which might include NIH funding such trials or conducting its own. .

218. GDA-8268 The FDA failed to abide by its legal obligations to protect the health, safety, and welfare of girls and women. .

219. GDA-8276 A bare-minimum policy of limiting abortion pills to the pre-2016 policy of 49 days gestation, returning to the pre-2021 in-person dispensing requirement, and returning to requiring prescribers to report all serious adverse events, not just deaths, to the drug sponsor would increase women's health and safety. .

220. GDA-8278 The Administration and policymakers should ensure that health care workers, particularly those in hospitals and emergency rooms, report abortion pill complications. .

221. GDA-8280 Submitting an adverse event to the database should be a quick and efficient process for busy health care practitioners. .

222. GDA-8290 The FDA should restore the waiver to comply with RFRA and for the obvious public health benefits of increased childhood vaccination by families seeking ethically derived alternatives. .

223. GDA-8291 To avoid future moral coercion of the sort experienced with the COVID-19 vaccines, the FDA and NIH should require the development of drugs and biologics that are free from moral taint and switch to cell lines that are not derived from aborted fetal cell lines or aborted baby body parts. .

224. GDA-8297 This buys considerable influence in the newsroom --- whether media companies acknowledge this or not --- and distorts independent reporting on public health issues. .

225. GDA-8299 NATIONAL INSTITUTES OF HEALTH (NIH) The National Institutes of Health (NIH) is the world's largest biomedical research agency and is made up of 27 different components called Institutes and Centers. .

226. GDA-8300 Despite its popular image as a benign science agency, NIH was responsible for paying for research in aborted baby body parts, human animal chimera experiments, and gain-of-function viral research that may have been responsible for COVID-19. .

227. GDA-8311 In addition, the Administration should reconvene a new National Council on Bioethics (NCB) to discuss new and emerging areas of ethical concern, to assess whether the ends justify the means when it comes to the promise of therapies and cures, and to establish what limiting principles should guide research and health policy. .

228. GDA-8317 In 2018, it was revealed that a $100 million NIH study on the benefits of moderate drinking was funded by the beer and liquor industry.19 More recently, the National Institute of Allergy and Infectious Diseases (NIAID), Anthony Fauci's division of the NIH, owns half of the patent for the Moderna COVID-19 vaccine, among thousands of other pharma patents.20 Rather than providing grants to university-based investigators to run the clinical trials on their own Moderna vaccine, the NIH conducted this research internally --- a clear conflict of interest. .

229. GDA-8320 Most of the world's other advanced science countries have stricter prohibitions on such conflicts, which helps to explain why the most significant studies on COVID treatments, on natural immunity, and on vaccine efficacy have come mostly from outside the U.S. .

230. GDA-8325 Likewise, the establishment of funding for scientific research at the state level does not preclude more modest federal funding through the National Institutes of Health: The two models are not mutually exclusive. .

231. GDA-8327 Private donations to these foundations --- a majority of them from pharmaceutical companies --- should not be permitted to influence government decisions about research funding or public health policy. .

232. GDA-8338 Medicare should be reformed according to four goals and principles: l Increase Medicare beneficiaries' control of their health care. .

233. GDA-8339 Patients are best positioned to determine the value of health care services, working with their health care providers. .

234. GDA-8346 Government's use of non-market-based methods to determine reimbursement leads to overspending on low-value services and products and underpayment for high-value services and products, stifles beneficial innovation, and because of Medicare's size distorts payments throughout the health care system. .

235. GDA-8351 The next Administration should reintroduce and restore regulations and demonstrations from the Trump Administration that were withdrawn, weakened, or never finalized by the Biden Administration, including: l The Medicare Coverage of Innovative Technologies (MCIT) rule; l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. .

236. GDA-8356 Such a policy would level the playing field among providers and remove the financial disabilities for medical professionals who would compete with hospital systems.23 Finally, HHS needs to restore and enhance conscience protection regulations that allow medical practitioners to participate in federal health care programs without being compelled to provide sex changes or similar services. .

237. GDA-8361 Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America's large and growing cohort of seniors. .

238. GDA-8362 The program provides beneficiaries with a wide range of competitive health plan choices --- a richer set of benefits than traditional Medicare provides and at a reasonable cost. .

239. GDA-8372 Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. .

240. GDA-8376 l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. .

241. GDA-8382 Over the past 45 years, Medicaid and the health safety net have evolved into a cumbersome, complicated, and unaffordable burden on nearly every state. .

242. GDA-8384 The dramatic increase in Medicaid expenditures is due in large part to the ACA (Obamacare), which mandates that states must expand their Medicaid eligibility standards to include all individuals at or below 138 percent of the federal poverty level (FPL), and the public health emergency, which has prohibited states from performing basic eligibility reviews. .

243. GDA-8385 The overlap of available benefits among the various health agencies has led to a complex, confusing system that is nearly impossible to navigate --- even for recipients. .

244. GDA-8389 These payments are evidence of the inappropriateness of Medicaid's expansion, which, stemming largely from public health emergency maintenance of effort (MOE) requirements and the Affordable Care Act, has crowded out the primary targets of these programs: those who are most in need. .

245. GDA-8390 True health care reform cannot be accomplished in a bureaucratic silo or only through Medicaid and health safety net programs. .

246. GDA-8391 Reform of the tax code is also essential to genuine, effective reform of our health care system. .

247. GDA-8392 All components of the health care system should be part of the reform efforts, and it is imperative that the system be modified to assist states with their current programs. .

248. GDA-8396 Any financial system should be designed to encourage and incentivize innovation and the efficient delivery of health care services. .

249. GDA-8398 It should also incentivize states to save money and improve the quality of health care. .

250. GDA-8419 CMS should allow states to ensure that Medicaid recipients have a stake in their personal health care and a say in decisions related to the Medicaid program. .

251. GDA-8421 Medicaid recipients, like the rest of Americans, should be given both the freedom to choose their health plans and the responsibility to contribute to their health care costs at a level that is appropriate to protect the taxpayer. .

252. GDA-8427 2. Add targeted time limits or lifetime caps on benefits to disincentivize permanent dependence.34 l Allow private health insurance. .

253. GDA-8428 Congress should allow states the option of contributing to a private insurance benefit for all members of the family in a flexible account that rewards healthy behaviors. .

254. GDA-8429 This reform should also allow catastrophic coverage combined with an account similar to a health savings account (HSA) for the direct purchase of health care and payment of cost sharing for most of the population. .

255. GDA-8435 More broadly, the federal government's role should be oversight on broad indicators like cost effectiveness and health measures like quality, health improvement, and wellness and should give the balance of responsibility for Medicaid program management to states. .

256. GDA-8436 This reform would include adding Section 111535 waiver requirements in some cases (such as imposing work requirements for able-bodied adults) while rescinding requirements in others (such as non-health care benefits and services related to climate change). .

257. GDA-8437 AFFORDABLE CARE ACT AND PRIVATE HEALTH INSURANCE l Remove barriers to direct primary care. .

258. GDA-8438 Direct primary care (DPC) is an innovative health care delivery model in which doctors contract directly with patients for their care on a subscription basis regardless of how or where the care is provided. .

259. GDA-8441 Changes should clarify that DPC's fixed fee for care does not constitute insurance in the context of health savings accounts.36 l Revisit the No Surprises Act on surprise medical billing. .

260. GDA-8450 To make health insurance coverage more affordable for those who are without government subsidies, CMS should develop a plan to separate the non-subsidized insurance market from the subsidized market, giving the non-subsidized market regulatory relief from the costly ACA regulatory mandates.39 l Strengthen hospital price transparency. .

261. GDA-8453 CMS also plays an outsized role in overseeing the Obamacare exchanges, including managing Healthcare.gov, through the Center for Consumer Information and Insurance Oversight (CCIIO). .

262. GDA-8454 While Obamacare limits plan options, CCIIO has been overly prescriptive in dictating what benefits and types of health plans may participate in the exchanges, thereby actually stifling market innovation and driving up costs. .

263. GDA-8455 Congress should build on the Trump Administration's efforts to expand choices for small businesses and workers, both in and out of the exchanges, by codifying an expansion of association health plans, short-term health plans, and health reimbursement arrangements (including individual coverage HRAs). .

264. GDA-8456 CCIIO should also work with the Treasury Department and the Office of Management and Budget (OMB) to give consumers more flexibility with their health care dollars through expanded access to health savings accounts. .

265. GDA-8458 During the COVID-19 pandemic, allowing laboratories greater regulatory flexibility regarding CLIA requirements increased access to testing. .

266. GDA-8463 The COVID-19 pandemic revealed that the U.S. .

267. GDA-8474 Policymakers should end taxpayer funding of Planned Parenthood and all other abortion providers and redirect funding to health centers that provide real health care for women. .

268. GDA-8481 Abortion is not health care, and states should be free to devise and implement programs that prioritize qualified providers that are not entangled with the abortion industry. .

269. GDA-8483 The Weldon Amendment51 declares that no HHS funding may go to a state or local government that discriminates against pro-life health entities or insurers. .

270. GDA-8484 In blatant violation of this law, seven states require abortion coverage in private health insurance plans, and HHS continues to fund those states. .

271. GDA-8492 Section 1303 of Obamacare requires that insurers collect a separate payment for certain abortion coverage in qualified health plans that are approved to be sold on exchanges and that they keep those separate payments in separate accounts that are used only to pay for elective abortion services. .

272. GDA-8504 Hospitals or physicians found to be in violation of the statute could lose all of their federal health funding --- Medicare, Medicaid, CHIP, and other funds --- and face civil penalties of up to nearly $120,000. .

273. GDA-8506 The guidance also declared that EMTALA would protect physicians and hospitals that perform abortions in violation of state law if they deem those abortions necessary to stabilize the women's health. .

274. GDA-8518 HHS should revive a Trump Administration proposed regulation, "Special Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities,"54 to achieve this end. .

275. GDA-8523 On August 4, 2022, HHS published a proposed rule entitled "Nondiscrimination in Health Programs and Activities."58 This rule addresses nondiscrimination provisions of the Affordable Care Act, known as Section 1557, which is enforced by the Office for Civil Rights and the Centers for Medicare and Medicaid Services. .

276. GDA-8524 Section 1557 prohibits discrimination on the basis of race, color, national origin, age, disability, and sex in covered health programs or activities. .

277. GDA-8527 This includes the Children's Health Insurance Program (CHIP). .

278. GDA-8530 COVID-19 Vaccination and Mask Requirements. .

279. GDA-8531 Health care workers were praised for their self-sacrifice in caring for sick patients at the beginning of the COVID-19 pandemic, but then they were fired if they objected to receiving COVID- 19 vaccines with or without complying with onerous masking requirements and regardless of whether they already had the virus and had gained natural immunity. .

280. GDA-8532 With the disease being endemic and constantly mutating, vaccines and universal masking in health care facilities do not have appreciable benefits in reducing COVID-19 transmission throughout the community. .

281. GDA-8533 Moreover, more recent COVID strains pose fewer health risks than the earlier strains, and the pandemic has been declared to be at an end. .

282. GDA-8534 CMS should: l Announce nonenforcement of the Biden Administration's COVID-19 vaccination mandate on Medicaid and Medicare hospitals. .

283. GDA-8536 l Refrain from imposing general COVID-19 mask mandates on health care facilities or personnel. .

284. GDA-8554 Marriage, healthy family formation, and delaying sex to prevent pregnancy are virtually ignored in terms of priorities, yet these goals can reverse the cycle of poverty in meaningful ways. .

285. GDA-8557 TPP is operated by the Office of Population Affairs in the Office of the Assistant Secretary for Health; PREP is operated by the ACF Office of Planning, Research, and Evaluation. .

286. GDA-8564 Risk avoidance should be prioritized, and any program that submits a proposal that promotes risk rather than health should not be eligible for funding. .

287. GDA-8565 Site visits should be revamped to ensure adherence to these optimal health metrics, and a cost analysis of programming as compared to students served should be a metric in funding (taking into account that in certain cases, intensive programs will serve fewer students and can have more positive results). .

288. GDA-8569 HHS should create a list of criteria for evaluating the sort of curriculum that should be selected for any sex education grant programs, both at OASH and at ACF, with the aim of promoting optimal health and adhering to the legislative language of each program. .

289. GDA-8578 Having health and welfare functions managed by HHS and border security functions managed by DHS has created intolerable failures in both. .

290. GDA-8613 Healthy Marriage and Relationship Education (HMRE) Program. .

291. GDA-8616 l Utilize HMRE funding or grants to provide state-level high school education resources and curriculum on healthy marriages, sexual risk avoidance, and healthy relationships. .

292. GDA-8621 However, Congress could change the law to make it clear that Title II funding can be used for healthy marriage and relationship education. .

293. GDA-8622 Funding provided under Title IV-B of the Social Security Act --- which provides grants to states for foster care and adoption services --- can also be used for promoting healthy marriage. .

294. GDA-8623 States should consider using some of their Title IV-B funding for providing healthy marriage and relationship education for families at risk of having their children placed in foster care.65 l Provide educational information on healthy marriage and relationships at Title X family planning clinics. .

295. GDA-8632 Healthy Marriage and Responsible Fatherhood (HMRF) Program. .

296. GDA-8652 At the very least, the program's COVID-19 vaccine and mask requirements should be rescinded. .

297. GDA-8660 There should also be a review of its COVID-19 policies. .

298. GDA-8661 HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) l Congress should allow CMS to use the 340B data that HRSA collects rather than having CMS conduct its own survey, especially in view of the U.S. .

299. GDA-8664 l Legally define the locus of service as where the provider is located during the telehealth visit rather than where the patient is. .

300. GDA-8667 Americans are far more mobile and technologically advanced today than they were when most health care laws were written. .

301. GDA-8668 Telehealth has become increasingly important, particularly during the height of the COVID-19 pandemic. .

302. GDA-8669 It also has great potential in rural and other areas where there are shortages of health care providers. .

303. GDA-8670 HRSA's Office for the Advancement of Telehealth includes a program known as the Licensure Portability Grant Program, which bolsters state efforts to reform licensing laws to maximize telehealth flexibility. .

304. GDA-8672 However, telehealth across state lines, when permitted, is interstate commerce, which can be regulated by the federal government according to the Constitution. .

305. GDA-8690 In August 2022, a federal court blocked this attempt to eliminate health insurance coverage for fertility awareness-based methods of family planning from requirements that cover at least 58 million women, and the judge made his ruling permanent in December 2022. .

306. GDA-8707 Investigate state medical school compliance with the Coats-Snowe Amendment,71 which prohibits discrimination against health care entities that do not provide or undergo training for abortion. .

307. GDA-8713 As HRSA's Early Childhood Health page outlines, "Currently, only about half of U.S. .

308. GDA-8717 l Provide education and resources on early childhood health. .

309. GDA-8720 Maternal and Child Health. .

310. GDA-8721 Currently, the HRSA Maternal and Child Health program is collecting data on the benefits of doulas in improving the health, safety, and emotional well-being of mothers at birth. .

311. GDA-8724 Additionally, since most Doulas' services are not covered by traditional insurance programs, the Maternal and Child Health program should work to provide funding for low-income mothers. .

312. GDA-8725 INDIAN HEALTH SERVICE (IHS) The Indian Health Service serves our American Indian and Alaska Native populations. .

313. GDA-8727 For example, contacting individuals within some of these communities and tribes during the COVID-19 pandemic proved to be difficult because many had transient addresses and unreliable cell service. .

314. GDA-8728 During the transition to the Biden Administration, IHS abandoned tribes as their sources of COVID-19 tests and vaccine supplies disappeared. .

315. GDA-8729 It is important to guard against such situations in order to preserve these tribes' access to health resources during public health emergencies (PHEs). .

316. GDA-8730 Even before the pandemic, services available to these populations through federal resources and personnel (such as vision care) were often scarce or nonexistent. .

317. GDA-8731 Patients in these populations should be empowered to rely on alternatives to IHS through better access to private health care providers. .

318. GDA-8733 RURAL HEALTH A growing concern is the decreasing access to health care services for Americans living in rural, less populated areas. .

319. GDA-8737 Both Congress and an Administration must continually keep in mind how health care policies uniquely affect these regions because their market trends and populations are different from those of more populous regions. .

320. GDA-8738 Often, rural patients face an hour's drive to the nearest medical provider or facility or have limited or no Internet access, which restricts their access to telehealth services (especially video visits). .

321. GDA-8739 To improve its health care policies that affect rural regions, HHS should: l Reduce the regulatory burden and unleash private innovation that can discover solutions to unique, local needs. .

322. GDA-8740 l Implement or encourage policies that increase the supply of health care providers, such as increased telehealth access and interstate licensure (a historically state matter), including for volunteers wishing to provide temporary, charitable services across state lines. .

323. GDA-8741 l Encourage flexibility in modes of health care delivery, including less expensive alternatives to hospitals and telehealth independent of expensive air ambulances. .

324. GDA-8742 OFFICE OF THE SECRETARY The Secretary of Health and Human Services and the Office of the Secretary necessarily set the tone for the entire department. .

325. GDA-8744 Practical reforms to enhance the Secretary's accountability should include the following: l Restrict HHS's ability to declare indefinite public health emergencies (PHEs). .

326. GDA-8749 Colluding with Big Tech to censor dissenting opinions during COVID. .

327. GDA-8752 The Office of the Secretary should eliminate the HHS Reproductive Healthcare Access Task Force and install a pro-life task force to ensure that all of the department's divisions seek to use their authority to promote the life and health of women and their unborn children. .

328. GDA-8753 Additionally, HHS should return to being known as the Department of Life by explicitly rejecting the notion that abortion is health care and by restoring its mission statement under the Strategic Plan and elsewhere to include furthering the health and well-being of all Americans "from conception to natural death." The next Administration should create a dedicated Special Representative for Domestic Women's Health. .

329. GDA-8754 In the Trump Administration, there was a Special Representative for Global Women's Health that focused on international issues, but this position lacked authority to be the lead on international policies because of overlapping issues with the U.S. .

330. GDA-8761 OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH (OASH) / OFFICE OF THE SURGEON GENERAL (OSG) The Assistant Secretary for Health (ASH) is the four-star admiral for the United States Public Health Service Commissioned Corps (USPHS), and the Surgeon General (SG) is the three-star admiral. .

331. GDA-8762 The ASH is tasked with overseeing not only the USPHS, but also 10 regional health offices, multiple presidential and secretarial advisory committees, and other offices such as the Offices of Minority Health, Women's Health, and Population Affairs. .

332. GDA-8765 The SG also issues information to the public (Surgeon General's advisories, Calls to Action, and Reports), serving in effect as a key public health spokesperson for the federal government. .

333. GDA-8773 The holder of this consolidated position, which should be filled by a health care provider, would be better positioned to ensure that the USPHS is properly focused and deployed. .

334. GDA-8777 The position previously known as the Principal Deputy Assistant Secretary for Health should be combined with and have the title of Deputy Surgeon General and become a three-star position with operational control including financial and deployment decisions. .

335. GDA-8784 In addition, the Office of Population Affairs should eliminate religious discrimination in grant selections and guarantee the right of conscience and religious freedom of health care workers and participants in the Title X program. .

336. GDA-8794 When the President declares a national emergency (per the Stafford Act) related to a public health emergency declared by the HHS Secretary, FEMA is activated and controls instead of HHS/ASPR. .

337. GDA-8795 While this arrangement has some benefits because of FEMA's unique logistical capabilities, the arrangement should be reviewed --- especially considering the COVID-19 pandemic --- for improvements in efficiency according to expertise and available resources, reduced confusion for ASPR and among HHS agencies, and avoidance of duplicated efforts among agencies and personnel. .

338. GDA-8798 The Strategic National Stockpile (SNS) should be reformed to consider the potential supply chain disruptions of pandemics or global conflicts. .

339. GDA-8799 Also, during the COVID pandemic, many states received ventilators from the SNS and hoarded them in places where a rush of COVID patients needing ventilators never materialized. .

340. GDA-8803 Such problems were evident both before and during the COVID-19 pandemic. .

341. GDA-8806 OGC issued a PREP Act liability memo that suspended application of civil rights and other laws in the context of the administration of covered countermeasures during the pandemic. .

342. GDA-8810 l Encourage DOJ to repeal OLC memos allowing abortion funding despite Hyde and memos allowing federal enclave immunity to perform abortions despite the Assimilative Crimes Act.80 l Rescind legal analysis that authorized HHS to impose a moratorium on rental evictions during COVID. .

343. GDA-8812 American Hospital Association81 prevents any proposed HHS regulations or enforcement actions concerning the denial of care to newborn infants with disabilities by covered health care entities without or against parental consent. .

344. GDA-8815 OFFICE OF GLOBAL AFFAIRS (OGA) The Director of the Office of Global Affairs should have the title of Assistant Secretary so that he or she can adequately represent HHS and the Secretary and serve as the lead on global health diplomacy for the government. .

345. GDA-8817 In addition: l All divisions that work on international health efforts should be responsive to requests and direction from the Assistant Secretary with coordination for all health diplomacy emanating from OGA. .

346. GDA-8821 l Health attachΓ©s in various global locations should be trained in the Administration's policies with clear expectations communicated and with accountability, including replacement, when their conduct and advocacy are contrary to Administration policies and programmatic priorities. .

347. GDA-8831 HHS should withdraw funding from any violating entities that refuse to correct their behavior, and OCR CRFD should work with ASFR to ensure that all grant announcements and instruments inform grantees and applicants of their obligations to comply with federal health care conscience laws specifically as a condition of obtaining or maintaining their funding. .

348. GDA-8850 Issue a proposed rule to restore the Trump regulations under Section 1557, explicitly interpreting the law not to include sexual orientation and gender identity discrimination based on the textual approach to male and female biology taken by Congress in the ACA, the need to recognize biological distinctions as part of the sound practice of health care, and the need to ensure protections of medical judgment and conscience. .

349. GDA-8857 OCR should withdraw its "Obligations Under Federal Civil Rights Laws to Ensure Access to Comprehensive Reproductive Health Care Services" guidance for retail pharmacies,85 which purports to address nondiscrimination obligations of pharmacies under federal civil rights laws and in fact orders them to stock and dispense first-trimester abortion drugs. .

350. GDA-8860 l OCR should withdraw its Health Insurance Portability and Accountability Act (HIPAA)86 guidance on abortion. .

351. GDA-8866 Department of Health and Human Services and other agencies, as well as academics, attorneys, and experts in the health care and insurance fields. .

352. GDA-8869 Department of Health and Human Services, Strategic Plan, FY 2018-2022, p. .

353. GDA-8871 2. "Strategic Goal 1: Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare" in ibid. .

354. GDA-8876 3. Karen Weintraub, "Americans' Life Expectancy Continues to Fall, Erasing Health Gains of the Last Quarter Century," USA Today, December 22, 2022, https://www.usatoday.com/story/news/health/2022/12/22/us-life- expectancy-continues-fall-erasing-25-years-health-gains/10937418002/ (accessed February 6, 2023). .

355. GDA-8881 Haislmaier, "Lessons from COVID-19: How Policymakers Should Reform the Regulation of Clinical Testing," Heritage Foundation Backgrounder No. .

356. GDA-8883 heritage.org/public-health/report/lessons-covid-19-how-policymakers-should-reform-the-regulation-clinical. .

357. GDA-8885 Department of Health and Human Services, Centers for Disease Control and Prevention, "Centers for Disease Control and Prevention (C)," https://www.cdc.gov/maso/pdf/cdcmiss.pdf (March 16, 2023). .

358. GDA-8888 Department of Health and Human Services, Centers for Disease Control and Prevention, "CDC Foundation Active Programs (October 1, 2014-September 30, 2015)," https://www. .

359. GDA-8891 8. Joel White and Doug Badger, "In Order to Defeat COVID-19, the Federal Government Must Modernize Its Public Health Data," Heritage Foundation Backgrounder No. .

360. GDA-8899 11. Sluzala and Haislmaier, "Lessons From COVID-19: How Policymakers Should Reform the Regulation of Clinical Testing." 12. .

361. GDA-8904 14. Sluzala and Haislmaier, "Lessons From COVID-19: How Policymakers Should Reform the Regulation of Clinical Testing." 15. .

362. GDA-8918 19. Joel Achenbach, "NIH Halts $100 Million Study of Moderate Drinking That Is Funded by Alcohol Industry," The Washington Post, May 17, 2018, https://www.washingtonpost.com/news/to-your-health/wp/2018/05/17/nih- halts-controversial-study-of-moderate-drinking/ (accessed February 6, 2023). .

363. GDA-8919 20. Alexander Tin, "Moderna Offers NIH Co-ownership of COVID Vaccine Patent amid Dispute with Government," CBS News, November 15, 2021, https://www.cbsnews.com/news/moderna-covid-vaccine-patent-dispute- national-institutes-health/ (accessed February 6, 2023). .

364. GDA-8920 21. Informed Consent Action Network, "NIH Officials Profiting from COVID-19 Vaccine," June 3, 2021, https://www. .

365. GDA-8921 icandecide.org/nih-officials-profiting-from-covid-19-vaccine/ (accessed February 6, 2023). .

366. GDA-8925 Moffit, "Time to Reverse Hospital Market Consolidation," Heritage Foundation Commentary, January 5, 2022, https://www.heritage.org/health-care-reform/commentary/time-reverse-hospital-market-consolidation. .

367. GDA-8931 Moffit, James Ficke, Joseph Marine, and Jesse Ehrenfeld, "Reversing Hospital Consolidation: The Promise of Physician-Owned Hospitals," Health Affairs Forefront, April 12, 2021, https:// www.healthaffairs.org/do/10.1377/forefront.20210408.980640/ (accessed February 13, 2023). .

368. GDA-8944 Nina Owcharenko Schaefer, "Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve the Health Care Safety Net," Heritage Foundation Backgrounder No. .

369. GDA-8946 Blase, "Punishing Conservative States: Payment Cuts to Hospitals Where Federal Spending Is Already Low," Paragon Health Institute, December 2021, https://paragoninstitute.org/wp-content/uploads/2022/06/Punishing-Conservative-States- HTML.html (accessed February 13, 2023). .

370. GDA-8947 32. Owcharenko Schaefer, "Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve the Health Care Safety Net." 33. .

371. GDA-8948 Brian Blase, "Managed Care in Medicaid: Need for Oversight, Accountability, and Reform," Paragon Health Institute Policy Brief, October 13, 2022, https://paragoninstitute.org/wp-content/uploads/2022/10/20221012- Managed-Care-in-Medicaid-Need-for-Oversight-Accountability-and-Reform-FOR-DISTRIBUTION-V2.pdf (accessed February 13, 2023). .

372. GDA-8949 34. Owcharenko Schaefer, "Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve the Health Care Safety Net." 35. .

373. GDA-8959 38. Doug Badger, "On Surprise Medical Bills, Congress Should Side with Consumers, Not Special Interests," Heritage Foundation Commentary, January 31, 2020, https://www.heritage.org/health-care-reform/ commentary/surprise-medical-bills-congress-should-side-consumers-not-special. .

374. GDA-8966 Department of Health and Human Services, "Transparency in Coverage," Final Rule, Federal Register, Vol. .

375. GDA-8972 Moffit, "New Price Transparency Rule Will Help Transform America's Health Care System," Heritage Foundation Commentary, November 1, 2020, https://www.heritage.org/health-care- reform/commentary/new-price-transparency-rule-will-help-transform-americas-health-care. .

376. GDA-8973 42. Sluzala and Haislmaier, "Lessons from COVID-19: How Policymakers Should Reform the Regulation of Clinical Testing." 43. .

377. GDA-8979 Biden Jr., Executive Order 14079, "Securing Access to Reproductive and Other Healthcare Services," August 3, 2022, in Federal Register, Vol. .

378. GDA-9007 Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of Civil Rights, and Office of the Secretary, "Special Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities," draft of Proposed Rule, January 14, 2021, https://www.hhs.gov/sites/default/files/infants-nprm.pdf (accessed March 17, 2023). .

379. GDA-9016 Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Office of the Secretary, "Nondiscrimination in Health Programs and Activities," Notice of Proposed Rulemaking; Notice of Tribal Consultation, Federal Register, Vol. .

380. GDA-9059 Department of Health and Human Services, Centers for Medicare and Medicaid Services, "Coverage of Certain Preventive Services Under the Affordable Care Act," Notice of Proposed Rulemaking, Federal Register, Vol. .

381. GDA-9067 Department of Health and Human Services, Health Resources and Services Administration, "Early Childhood Health," last reviewed October 2022, https://mchb.hrsa.gov/programs-impact/focus-areas/early- childhood-health (accessed March 17, 2023). .

382. GDA-9069 org/healthy-pregnancy/labor-and-birth/having-a-doula/#:~:text=Other%20studies%20have%20shown%20that%20having%20a%20doula,massage%20to%20reduce%20stress%20and%20anxiety%20during%20labor (accessed March 17, 2023). .

383. GDA-9074 Department of Health and Human Services, "Securing Updated and Necessary Statutory Evaluations Timely," Final Rule, Federal Register, Vol. .

384. GDA-9080 Department of Health and Human Services, Office of the Secretary, Office of the Assistant Secretary for Health, "Compliance with Statutory Program Integrity Requirements," Final Rule, Federal Register, Vol. .

385. GDA-9085 Department of Health and Human Services, Office of the Secretary, Office of the Assistant Secretary for Health, "Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services," Final Rule, Federal Register, Vol. .

386. GDA-9100 Department of Health and Human Services, Office of the Secretary, "Notification of Interpretation and Enforcement of Section 1557 of the Affordable Care Act and Title IX of the Education Amendments of 1972," Federal Register, Vol. .

387. GDA-9105 Department of Health and Human Services, Office for Civil Rights, "HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy," March 2, 2022, https://www.hhs.gov/sites/default/files/hhs- ocr-notice-and-guidance-gender-affirming-care.pdf (accessed March 18, 2023). .

388. GDA-9110 Department of Health and Human Services, Office for Civil Rights, "Guidance to Nation's Retail Pharmacies: Obligations Under Federal Civil Rights Laws to Ensure Access to Comprehensive Reproductive Health Care Services," content last reviewed July 14, 2022, https://www.hhs.gov/civil-rights/for-individuals/ special-topics/reproductive-healthcare/pharmacies-guidance/index.html (accessed March 18, 2023). .

389. GDA-9112 3103, "Health Insurance and Portability and Accountability Act of 1996, Public Law No. .

390. GDA-9115 Department of Human Services, "HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care," content last reviewed June 29, 2022, (accessed March 18, 2023). .

391. GDA-9116 See also "Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet," content last reviewed June 29, 2022, https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/ cell-phone-hipaa/index.html (accessed March 18, 2023). .

392. GDA-9145 The Federal Housing Administration administers the Mutual Mortgage Insurance Program (MMIF) and various other mortgage insurance, direct loan, and loan guarantee programs for single-family housing, multifamily housing, hospitals, and health care facilities that meet certain conditions.17 l Government National Mortgage Association (GNMA), headed by a Senate- confirmed GNMA President or Executive Vice President. .

393. GDA-9154 OGC handles department-wide legal and compliance oversight advice with supervision responsibilities for the Deputy General Counsel for Housing Programs, Deputy General Counsel for Operations, and Deputy General Counsel for Enforcement and Fair Housing as well as the Departmental Enforcement Center.20 l Office of Healthy Homes and Lead Hazard Control (OHHLHC), headed by a Director. .

394. GDA-9155 OHHLHC was established in the early 1990s to eliminate lead-based paint hazards in America's privately owned and low-income housing, address healthy housing initiatives, and enforce lead-based paint regulations authorized under the Residential Lead-Based Paint Hazard Reduction Act of 1992 (Title X of the Housing and Community Development Act of 1992).21 These functions overlap with similar functions of the Environmental Protection Agency (also authorized to enforce lead-based paint regulations under Title X) and the Centers for Disease Control and Prevention's Healthy Homes Initiative, Childhood Lead Poisoning Prevention Program, and National Asthma Control Program. .

395. GDA-9181 l The Office of the Secretary should execute regulatory and subregulatory guidance actions, across HUD programs and applicable to all relevant stakeholders, that would restrict program eligibility when admission would threaten the protection of the life and health of individuals and fail to encourage upward mobility and economic advancement through household self-sufficiency. .

396. GDA-9182 Where admissible in regulatory action, HUD should implement reforms reducing the implicit anti-marriage bias in housing assistance programs,34 strengthen work and work-readiness requirements,35 implement maximum term limits for residents in PBRA and TBRA programs,36 and end Housing First37 policies so that the department prioritizes mental health and substance abuse issues before jumping to permanent interventions in homelessness.38 Notwithstanding administrative reforms, Congress should enact legislation that protects life and eliminates provisions in federal housing and welfare benefits policies that discourage work, marriage, and meaningful paths to upward economic mobility. .

397. GDA-9343 Federal intervention centered on Housing First has failed to acknowledge that resolving the issue of homelessness is often a matter of resolving mental health and substance abuse challenges. .

398. GDA-9412 Conducts scientific research in ecosystems, climate, and land-use change, mineral assessments, environmental health, and water resources; produces information about natural hazards (earthquakes, volcanoes, and landslides); leads climate change research for the department. .

399. GDA-9468 Despite the dislocating impact of the COVID-19 pandemic, the BLM successfully filled hundreds of long-vacant positions, as well as those that opened because of the move West. .

400. GDA-9531 In 2019, the American Association of Equine Practitioners and the American Veterinary Medication Association --- two of the largest organizations of professional veterinarians in the world --- issued a joint policy calling for further reducing overpopulation to protect the health and well-being of wild horses and burros on public lands. .

401. GDA-9632 l When ending COVID protocols at Bureau of Indian Education (BIE) schools, Biden's DOI failed to ensure an accurate accounting of students returning from school shutdowns, which presents a significant danger to the families that trust their children to that federal agency. .

402. GDA-9671 7619-7633, and White House, "Executive Order on Protecting Public Health and the Environment and Restoring Science to Tackle the Climate Crisis," January 20, 2021, https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order- protecting-public-health-and-environment-and-restoring-science-to-tackle-climate-crisis/ (accessed March 16, 2023). .

403. GDA-9680 3398: Revocation of Secretary's Orders Inconsistent with Protecting Public Health and the Environment and Restoring Science to Tackle the Climate Crisis," April 16, 2021, https://www.doi.gov/sites/doi.gov/files/elips/documents/so-3398-508_0.pdf (accessed March 16, 2023). .

404. GDA-9992 The United States is the world's last best hope for self-government,33 and its survival relies on the ability of our people to have healthy debate free from government intervention and censorship. .

405. GDA-9994 That is a healthy component of an informed society. .

406. GDA-10089 Jackson Women's Health Organization.58 The Catholic News Agency reported more than one hundred such incidents as of September 2022.59 By engaging in disparate and viewpoint-based enforcement of an already controversial law like the FACE Act against pro-life activists, the DOJ has needlessly undermined its credibility with law-abiding people of faith. .

407. GDA-10184 The NSBA letter made outlandish demands in response to protests that were then occurring at school board meetings in response to COVID policies and revelations about the use of critical race theory-infused curricula in classrooms. .

408. GDA-10303 12. Press release, "Eleven Charged with FACE Act Violations Stemming from 2021 Blockade of Mount Juliet Reproductive Health Clinic," U.S. .

409. GDA-10398 50. Jessica Rendall, "100,000 People Died from Drug Overdoses in the US in One Year, a Record," CNET, November 18, 2021, https://www.cnet.com/health/medical/100000-people-died-from-drug-overdoses-in- the-us-in-one-year-a-record/ (accessed February 3, 2023). .

410. GDA-10547 While it is primarily the culture's responsibility to affirm the dignity of work, our federal labor and employment agencies have an important role to play by protecting workers, setting boundaries for the healthy functioning of labor markets, and ultimately encouraging wages and conditions for jobs that can support a family. .

411. GDA-10604 The Pregnant Workers Fairness Act (PWFA)4 requires employers to make reasonable accommodations for women "to the known limitations related to the pregnancy, childbirth, or related medical conditions," unless "the accommodation would impose an undue hardship on the operation of the [employer's] business." The Americans with Disabilities Act (ADA) also provides nondiscrimination and accommodation protections in the workplace for certain pregnancy-related disability.5 None of these laws requires an employer provide health insurance benefits for elective abortion. .

412. GDA-10610 Jackson Women's Health Organization decision6 that the longstanding doctrine of Employee Retirement Income Security Act of 1974 (ERISA)7 preemption should block individual states' efforts to prohibit employers from helping employees procure abortions via offering various kinds of coverage under employee-sponsored benefit plans. .

413. GDA-10638 We must replace "woke" nonsense with a healthy vision of the role of labor policy in our society, starting with the American family. .

414. GDA-10668 Moreover, a shared day off makes it possible for families and communities to enjoy time off together, rather than as atomized individuals, and provides a healthier cadence of life for everyone. .

415. GDA-10678 COVID made telework ubiquitous, but the law and regulations are still stuck in an era when telework was unique. .

416. GDA-10690 The value of flexibility extends beyond ride-sharing and other platform work; more than half of people who did independent work in 2021 said they cannot work a traditional job because of personal or family circumstances such as their health or caring for a child or family member. .

417. GDA-10702 Doing so would increase access among independent contractors to traditional pooled workplace benefits such as health care and retirement savings accounts. .

418. GDA-10746 In general, larger, higher-margin businesses are better able to absorb the costs of regulatory compliance than are small businesses, and under the Biden Administration, big-business lobbies have affirmatively embraced certain regulations (such as the COVID vaccine mandate for private employers) to reduce competition from smaller businesses. .

419. GDA-10750 l Congress (and DOL, in its enforcement discretion) should exempt small business, first-time, non-willful violators from fines issued by the Occupational Health and Safety Administration. .

420. GDA-10754 Organizations across the political spectrum have noted that the overly burdensome requirements of RAPs have contributed to limiting them to legacy trades, failing to meet growing industry demands such as in health care and technology. .

421. GDA-10808 In the post-pandemic landscape, the federal government should restore the Unemployment Insurance (UI) program's purpose with a particular focus on reestablishing program integrity and accountability. .

422. GDA-10897 National employment laws like the Fair Labor Standards Act (FLSA)21 and the Occupational Safety and Health (OSH) Act22 set out one-size-fits-all "floors" regulating the employment relationship. .

423. GDA-10919 The outdated system's myriad failures during the COVID-19 pandemic highlighted the need for innovations that respond to recipients' needs. .

424. GDA-11045 Labor shortages after the pandemic support this belief. .

425. GDA-11090 l Focus health and safety inspections on egregious offenders, as other inspections are often abused and usurp state and local government prerogatives. .

426. GDA-11126 Jackson Women's Health Organization, No. .

427. GDA-11160 22. Occupational Safety and Health Act of 1970, 29 U.S.C. .

428. GDA-11265 Congress recognized that the ICE-powered automobile has been instrumental to advancing the mobility and prosperity of the American people and that the domestic mass production of new ICE vehicles generates millions of jobs and remains critical to the overall health of the U.S. .

429. GDA-11297 The standards issued by NHTSA must be reset at reasonable levels that are technologically feasible for ICE automobiles and consistent with an increase in domestic auto production and healthy growth in the sale of safer and more affordable new vehicles. .

430. GDA-11420 The COVID-19 pandemic caused a substantial decline in usage for all forms of transportation. .

431. GDA-11423 Since facilitating travel for workers is one of the core functions of mass transit systems, a permanent reduction in commuting raises questions about the viability of fixed-route mass transit, especially considering that transit systems required substantial subsidization before the pandemic. .

432. GDA-11434 This is driven by generous pension and health benefits rather than by exorbitant wages. .

433. GDA-11463 A principal function is "maintain[ ing] the overall health of the U.S. .

434. GDA-11557 Tucker MISSION STATEMENT The Department of Veterans Affairs (VA) is the primary provider of health care, benefits, and memorial affairs for America's veterans and their families. .

435. GDA-11562 Eroding morale caused by the downstream effects of a health care access crisis in 2014 led to the resignation of Secretary Eric Shinseki and extensive oversight investigations by Congress from 2015-2016. .

436. GDA-11566 This mindset translated into a department that was better attuned to employees' and veterans' needs and experiences in the daily operations of health care, benefits, and memorial affairs. .

437. GDA-11567 During that period, the VA received the largest number of watershed congressional authorizations to reform its health care and benefits that it had received since the post-Vietnam War years along with historic increases in annual appropriations, which have tripled since the last full year of the George W. .

438. GDA-11570 However, they have not sustained the previous Administration's commitment to a genuine "Veteran-centric" philosophy, most notably with respect to the delivery of health care, and harbor a bias toward expanding the unionized federal employee workforce that has not always been aligned with a focus on "Veteran-centric" care. .

439. GDA-11571 There also is growing concern in Congress and the veteran community that the VA is poorly managing and in some cases disregarding provisions of the VA MISSION [Maintaining Internal Systems and Strengthening Integrated Outside Networks] Act of 20182 that codify broad access for veterans to non-VA health care providers. .

440. GDA-11582 As the nature of health care has evolved with a growth in same-day surgical procedures and outpatient care, so has the VA, and in 2018 Congress added access to private-sector urgent care outlets as one of the VA's health care benefits. .

441. GDA-11584 The VA also manages a Community Care Network (CCN) through contracts with Optum and TriWest, third-party health care administrators responsible for building and maintaining a robust population of community providers to meet the needs of veterans referred for care outside of the VA system. .

442. GDA-11585 Currently, approximately 6.4 million veterans out of 18 million nationally (and out of the 9.1 million who are enrolled) use the VA for health care; the remainder use employer-sponsored plans, Tricare, Medicare, and Medicaid. .

443. GDA-11586 The disability benefits system evolved significantly in the years between the Cold War era and the global war on terrorism, a period when the VA enrolled large numbers of veterans from World War II, Korea, and Vietnam who were seeking disability benefits and health care. .

444. GDA-11589 The Agent Orange Act of 19914 significantly expanded the scope of disability benefits for those who had deployed to Vietnam, and the cost of those benefits began to increase dramatically as the Vietnam generation of veterans aged and began to experience adverse health conditions, some of which were presumed to have been caused by defoliant chemicals used in Southeast Asia. .

445. GDA-11592 The Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 20225 addressed adverse health outcomes presumed to be the result of veterans' exposure to airborne toxins during the global war on terrorism and further expanded disability benefits to the most recent generation of veterans. .

446. GDA-11602 VETERANS HEALTH ADMINISTRATION (VHA) Needed Reforms l Rescind all departmental clinical policy directives that are contrary to principles of conservative governance starting with abortion services and gender reassignment surgery. .

447. GDA-11606 Of the approximately 18 million veterans alive today, roughly 9.1 million are enrolled for VA health care, and 6.4 million of these enrollees use VA health care consistently. .

448. GDA-11607 These 6.4 million veterans are split almost evenly between those who are over age 65 and those who are under age 65, but the share of VA's health care dollars is spent predominantly in the over-65 cohort. .

449. GDA-11614 The Trump Administration made Community Care part of its "Veteran- centric" approach to ensure that veterans would be able to participate more fully in their health care decisions and have options if or when the VHA was unable to meet their needs. .

450. GDA-11623 3. Section 121 (developing and administering an education program that teaches veterans about their health care options available from the Department of Veterans Affairs). .

451. GDA-11633 In 2018, Congress authorized an Asset Infrastructure Review (AIR) of national VHA medical markets to provide insight into where the VA health care budget should be responsibly allocated to serve veterans most effectively. .

452. GDA-11635 The next Administration should seek out agile, creative, and politically acceptable operational solutions to this aging infrastructure status quo, reimagine the health care footprint in some locales, and spur a realignment of capacity through budgetary allocations. .

453. GDA-11637 Embrace the expansion of Community Based Outpatient Clinics (CBOCs) as an avenue to maintain a VA footprint in challenging medical markets without investing further in obsolete and unaffordable VA health care campuses. .

454. GDA-11638 2. Explore the potential to pilot facility-sharing partnerships between the VA and strained local health care systems to reduce costs by leveraging limited talent and resources. .

455. GDA-11639 Personnel l Extend the term of the Under Secretary for Health (USH) to five years. .

456. GDA-11650 6. Further explore how to leverage telehealth to reduce personnel costs across the enterprise and serve veterans. .

457. GDA-11655 10. Examine the surpluses or deficits in mental health professionals throughout the enterprise, recognizing that the department needs a blend of social workers, therapists, psychologists, and psychiatrists with a focus on attracting high-quality talent. .

458. GDA-11656 l Conduct a high-priority assessment of Electronic Health Record (EHR) transition delays and functionality problems. .

459. GDA-11657 VA innovation in health care for the next 20 years and beyond will rest squarely on the timely implementation of the new VHA EHR in coordination with the DOD's parallel pacing effort. .

460. GDA-11676 Budget The VA's Schedule for Rating Disabilities (VASRD) has assigned disability ratings to a growing number of health conditions over time; some are tenuously related or wholly unrelated to military service. .

461. GDA-11698 The COVID-19 pandemic spurred a significant shift to hybrid and telework options for large segments of the staff in the Washington headquarters, in its satellites, and at some VBA Regional Offices. .

462. GDA-11744 Department of Veterans Affairs, Veterans Health Division, VHA Directive 1003, "VHA Veteran Patient Experience," April 14, 2020, pp. .

463. GDA-11764 Section Four THE ECONOMY The next Administration must prioritize the economic prosperity of ordinary Americans. .

464. GDA-11779 Second, China's "economic aggression" in the form of "tariffs, nontariff barriers, dumping, counterfeiting and piracy, and currency manipulation" further weakens our "manufacturing and defense industrial base even as the fragility of globally dispersed supply chains has been brought into sharp relief by the COVID-19 pandemic." In contrast to Lassman, Navarro thinks that "trade deficits matter a great deal." He writes that "offshoring not only suppresses the real wages of American blue-collar workers and denies millions of Americans the opportunity to climb up the rungs of the ladder to the middle class," but it also "raises the specter of a manufacturing and defense industrial base that, unlike our experience in World Wars I and II, will not be able to provide the weapons and matΓ©riel that would be needed should America enter another major world war." Also, China controls "much of the world's pharmaceutical production and supply chains." It is therefore essential, he writes, that our trade policy be guided by "the principle of reciprocity," whereby we coax other countries into lowering their trade barriers if possible and raise ours as necessary. .

465. GDA-11794 Yet the 2020 Census was at least somewhat compromised by overly risk-averse COVID policies that prevented census field representatives from going door-to-door for much of that year. .

466. GDA-11876 businesses and consumers on a limited number of products from certain offending countries, but those higher prices correct existing price distortions in the marketplace and ultimately ensure the healthy operation of market forces in the long term and a level playing field for U.S. .

467. GDA-11885 Process l Re-establish and expand suspended in-person pandemic-related verifications, particularly regarding the People's Republic of China. .

468. GDA-11904 defense industrial base and the health of global manufacturing. .

469. GDA-11920 government, identifying potential vulnerabilities like those exposed by the pandemic and resulting shortages in everything from semiconductors to baby formula. .

470. GDA-12142 There should be collaboration with other departments that use the information collected on these surveys (e.g., the Departments of Labor, Health and Human Services, Homeland Security, etc.) to determine how to optimize the use and collection of particular information. .

471. GDA-12150 During the government's early response to the COVID-19 pandemic, the Census Bureau began experimental pulse surveys. .

472. GDA-12156 This information would be particularly helpful in determining how to combat homelessness in conjunction with Department of Health and Human Services programs. .

473. GDA-12165 Over time, it has also served as a distribution mechanism for emergency relief funds (e.g., Hurricane Maria and COVID-19). .

474. GDA-12167 It successfully disbursed approximately $1.5 billion in funding beginning in May 2020 and throughout the COVID-19 pandemic. .

475. GDA-12205 l Oppose efforts to provide intellectual property waivers for cutting-edge technologies, including for COVID-19 vaccines and therapeutics, through the World Trade Organization's Trade-Related Aspects of Intellectual Property Rights agreement or any other mechanism. .

476. GDA-12309 In fiscal year 2022, Treasury received discretionary appropriations of approximately $16.4 billion.7 It also has highly variable "mandatory" expenses (COVID-related CARES Act spending, for example). .

477. GDA-12337 Four Inspectors General provide independent audits, investigations, and oversight of Treasury and its programs: The Office of the Inspector General of the Department of Treasury; Treasury Inspector General for Tax Administration; Special Inspector General for the Troubled Asset Relief Program; and the Special Inspector General for Pandemic Recovery. .

478. GDA-12398 Only a percentage of Health Savings Accounts (HSA) contributions (which are not taxed upon withdrawal) should count toward the limitation.26 The limitation on benefit deductions should not be indexed to increase with inflation.27 Employers should also be denied deductions for health insurance and other benefits provided to employee dependents if the dependents are aged 23 or older. .

479. GDA-12697 26. HSAs are flexible and portable, and they help contain costs by giving health care consumers skin in the game. .

480. GDA-12907 An adjacent map displays the most "competitive" ECAs around the world, implying that the U.S., which ranked eighth in terms of volume in 2019 (the year before the pandemic), is losing ground compared to more "hyperactive" (ranked higher) ECAs.21 The implication is that ECA export financing improves the overall health of the export market and thereby fuels economic and job growth --- which it does not do. .

481. GDA-12925 This fact suggests that --- contrary to the claims of EXIM's advocates --- ECA financing is irrelevant to the overall health of the export market as well as to economic growth. .

482. GDA-12931 In fact, the Bank's support for small businesses has declined from $2.3 billion in FY 201923 to "more than $2.0 billion" in FY 202024 to only $1.6 billion in FY 2021.25 This decline occurred amid a pandemic that hit small businesses especially hard, and it continues today. .

483. GDA-13119 Fiscal policy can be more effective if it is timely, targeted, and temporary.8 An example from the COVID-19 pandemic is the Paycheck Protection Program, which sustained businesses far more effectively than near-zero interest rates, which mainly aided asset markets and housing prices. .

484. GDA-13128 Over half of COVID-era deficits were monetized in this way by the Federal Reserve's purchase of Treasuries, and housing costs were driven to historic highs by the Federal Reserve's purchase of mortgage securities. .

485. GDA-13371 The largest program in SBA's history, the Paycheck Protection Program (PPP), has been credited with saving millions of jobs during the COVID-19 pandemic.3 A conservative Administration would rightly focus on saving small businesses during such a crisis. .

486. GDA-13373 For example, and more recently, more than $1 trillion in COVID-19 relief was distributed through the SBA.4 The SBA's EIDL (Economic Injury Disaster Loan) Advance program in particular shows the dangers that can come with direct government lending. .

487. GDA-13396 For example, in FY2020, the SBA received over $760.9 billion in supplemental appropriations to assist small businesses adversely affected by the novel coronavirus (COVID- 19) pandemic.18 The CRS further notes that "[o]verall, since FY2000, appropriations for SBA's other programs, excluding supplemental appropriations, have increased at a pace that exceeds inflation."19 In terms of current loan volume, the SBA "reached nearly $43 billion in funding to small businesses, providing more than 62,000 traditional loans through its 7(a), 504, and Microloan lending partners and over 1,200 investments through SBA licensed Small Business Investment Companies (SBICs) for Fiscal Year (FY) 2022."20 The agency's total budgetary resources for FY 2022 amount to $44.25 billion, which represents 0.4 percent of the FY 2022 U.S. .

488. GDA-13397 federal budget.21 HISTORY OF MISMANAGEMENT Throughout its history, various SBA programs and practices have generated negative news headlines and scathing Government Accountability Office (GAO) and Inspector General (IG) reports that have centered on mismanagement, lack of competent personnel and/or systems, and waste, fraud and abuse.22 From the 8a program23 to Hurricane Katrina24 to the more current COVID-19 (EIDL) program and PPP lending program,25 the SBA has managed to maintain its lending role even when repeated system failures have affected its distribution of funds. .

489. GDA-13398 Congress has been somewhat responsive, pressuring the SBA to clean up fraud-related matters within its COVID-19 lending and grant programs.26 Republicans in the U.S. .

490. GDA-13416 l A full accounting of and an end to waste, fraud, and abuse in all COVID-19 relief programs, including the PPP and EIDL programs, and action that follows the rule of law by ensuring that loan recipients who are not eligible for loan forgiveness or who falsified loan applications either pay back the funds or are referred to law enforcement. .

491. GDA-13429 As underscored by the Inspector General in his introduction to the report, "Pandemic response has, in many instances, magnified the challenging systemic issues in SBA's mission-related work."35 l Review all internal government watchdog recommendations and require that SBA management implement or address outstanding and ongoing OIG and GAO recommendations within a specified time frame (ideally within 90 days of a recommendation) and on an ongoing basis. .

492. GDA-13443 This would be similar to the approach adopted by President Trump in his January and February 2017 executive orders directing agencies to relieve the cost and burden of regulation on business.37 Advocacy should organize regional roundtables, onsite small-business visits, and an online platform to hear directly from small businesses and entities as it did from June 2017 through September 2018.38 This activity produced 26 letters to federal agencies and highlighted specific regulations that need reform and how Congress had addressed the most burdensome rules through the Congressional Review Act.39 COVID-19 Lending Program Accountability and Cleanup. .

493. GDA-13444 A major immediate priority for the next Administration should be a final accounting and accelerated cleanup of fraudulent COVID-19 loan and grant activity. .

494. GDA-13445 As noted by the SBA IG, "managing COVID-19 stimulus lending is the greatest overall challenge facing SBA, and it may likely continue to be for many years as the agency grapples with fraud in the programs"¦."40 The next Administration should: l Consider bringing in private-sector support and expertise to close out these programs. .

495. GDA-13459 In view of the challenges the SBA has experienced in its administration of this program, as well as the fraud and abuse in the EIDL COVID-19-related program and the IG's concern that the systemic problems within this lending program undermine the SBA's work, the next Administration should: l Work with Congress to assess the extent to which disaster loans should be offered by another agency rather than the SBA and explore private-sector channels for administering the loans. .

496. GDA-13495 The Health, Economic Assistance, Liability Protection, and Schools (HEALS) Act, introduced in 2020,66 and American Innovation and Manufacturing Act, introduced in 2021,67 would allow SBIC to offer longer-term financing to manufacturers and make the program more fiscally sustainable. .

497. GDA-13516 For example, during the COVID-19 pandemic, the SBA was often forced to outsource key decisions and administrative follow-through to the Department of the Treasury. .

498. GDA-13523 Various IG reports have noted that the lack of skilled employees within the SBA has fueled fraud and mismanagement in COVID-19 lending programs, and congressional leaders have expressed alarm about these "changes that haphazardly overextend the SBA's responsibilities at a time when they are devastated by fraud and underperforming on their core mission of serving the nation's 33 million small businesses."74 A conservative Administration should rein in these idealistic and impractical efforts, get current programs under control and properly staffed with people who can manage and perform competently, and outsource efforts where private-sector expertise is appropriate and more efficient. .

499. GDA-13539 4. Kate Rogers, Scott Zamost, Karina Hernandez, and Jennifer Schlesinger, "As Pandemic Aid Was Rushed to Main Street, Criminals Seized on Covid Relief Programs," CNBC, April 15, 2021, https://www.cnbc. .

500. GDA-13540 com/2021/04/15/as-pandemic-aid-was-rushed-to-main-street-criminals-seized-on-ppp-eidl-.html (accessed February 16, 2023). .

501. GDA-13542 6. Sacha Pfeiffer, "Virtually All PPP Loans Have Been Forgiven with Limited Scrutiny," NPR, October 12, 2022, https://www.npr.org/2022/10/12/1128207464/ppp-loans-loan-forgiveness-small-business#:~:text=As%20COVID-19%20shutdowns%20threatened,early%20days%20of%20the%20pandemic (accessed February 16, 2023). .

502. GDA-13595 26. Jay Edwards, "Bipartisan Call to Crack Down on COVID-19 PPP/EIDL Fraud, Prosecute Fraudsters to the Fullest Extent of the Law," WRNJ Radio (Hackettstown, New Jersey), October 21, 2022, https://wrnjradio.com/ bipartisan-call-to-crack-down-on-covid-19-ppp-eidl-fraud-prosecute-fraudsters-to-the-fullest-extent-of-the- law/ (accessed March 21, 2023). .

503. GDA-13696 Singer, "Federally Supported Innovations: 22 Examples of Major Technology Advances that Stem from Federal Support," Information Technology and Innovation Foundation, February 2014, https://wrnjradio.com/ bipartisan-call-to-crack-down-on-covid-19-ppp-eidl-fraud-prosecute-fraudsters-to-the-fullest-extent-of-the- law/ (accessed March 21, 2023). .

504. GDA-13758 Both the unfair, unbalanced, and nonreciprocal trade institutionalized by the WTO and Communist China's economic aggression are weakening America's manufacturing and defense industrial base even as the fragility of globally dispersed supply chains has been brought into sharp relief by the COVID-19 pandemic with its associated lockdowns and other disruptions and by the Russian invasion of Ukraine. .

505. GDA-13775 In the wake of the COVID-19 pandemic, almost certainly spawned in a CCP biological weapons lab in Wuhan, China,5 global supply chains have been under significant pressures from lockdown policies, energy price shocks, and other disruptions, including labor market disruptions. .

506. GDA-13776 At the height of the pandemic, the rising geopolitical risk associated with globalized supply chains was underscored when Communist China, which controls much of the world's pharmaceutical production and supply chains, threatened to plunge America "into a mighty sea of coronavirus" through pharmaceutical export controls6 if American politicians dared to investigate what happened at the Wuhan lab. .

507. GDA-14010 l Hold the CCP accountable for the COVID-19 virus, which almost certainly originated as a genetically engineered virus from the Wuhan Institute of Virology, and do so through the establishment of a presidential commission or select congressional committee that would investigate the origins of the virus; its various costs, both economically and in human life; and the possible means of collecting damages from the CCP, which are likely to rise to the trillions of dollars. .

508. GDA-14289 Two of them, the Great Depression and the comedown from the 1970s stagflation, were due to monetary mismanagement, not trade.64 The third, the Great Recession, was due to a financial crisis worsened by monetary mismanagement, not trade.65 The fourth was due to COVID-19 lockdowns, not trade.66 Using trade restrictions to slow this churn is a mistake for two reasons: (1) trade is at best a minor contributor to job churn compared to other factors like technology, changing consumer tastes, inflation, and business cycles, and (2) churn is evidence of a healthy economy. .

509. GDA-14334 Factories will get contaminated, and health inspectors will not always be as thorough as they should be. .

510. GDA-14344 Loosening restrictions similar to the ones that stunt the baby formula market would make it easier to navigate future crises while preventing the progressive and rent-seeking power grabs that come with every crisis, whether it is as isolated as a baby formula shortage or as expansive as a pandemic. .

511. GDA-14350 If a formula is deemed healthy for European babies, then it is also healthy for American babies. .

512. GDA-14379 The post-COVID inflation spike may be over long before the next Administration takes office, but keeping it under control should remain a high priority. .

513. GDA-14491 At the same time, recent revelations about China's official statistics overstating its GDP by 30 percent track well with other problems that were already known.77 These include one of the world's worst demographic aging curves thanks to China's one-child policy; a population that may already be declining; an unsustainable debt load that is already causing problems; countless failed boondoggles, from empty cities to its underwhelming Belt-and-Road Initiative, that are wasting significant resources; Xi Jinping's authoritarian turn; increasing state control of the economy; and a zero-COVID policy that has sabotaged the economy and driven away foreign investment.78 America has its problems, but it is in better shape than China on nearly every measure, especially in the long run. .

514. GDA-14549 China's own demographic and debt problems, along with aging leadership and growing discontent over the zero-COVID policy, might even cause an internal collapse. .

515. GDA-14579 Department of State, "Fact Sheet: Activity at the Wuhan Institute of Virology," January 15, 2021, https://2017-2021.state.gov/fact-sheet-activity-at-the-wuhan-institute-of-virology/index.html (accessed February 25, 2023); Interim Report, An Analysis of the Origins of the COVID-19 Pandemic, Minority Oversight Staff, Committee on Health, Education, Labor and Pensions, U.S. .

516. GDA-14581 senate.gov/imo/media/doc/report_an_analysis_of_the_origins_of_covid-19_102722.pdf (accessed February 25, 2023). .

517. GDA-14729 5, June 2020, https://cei.org/sites/default/files/Mario_Loyola_-_America_Last.pdf (accessed February 21, 2023); Patrick Tyrell, "Permanent Repeal of the Jones Act Would Be a Winning Response to COVID-19," Heritage Foundation Commentary, April 7, 2020, https://www.heritage.org/trade/ commentary/permanent-repeal-the-jones-act-would-be-winning-response-covid-19. .

518. GDA-14743 Section Five INDEPENDENT REGULATORY AGENCIES In addition to the executive departments and agencies discussed previously, a number of independent commissions exist that are loosely affiliated with the executive branch. .

519. GDA-15082 Expenditures from this fund subsidize rural broadband networks and low-income programs as well as connections for schools, libraries, and rural health care facilities. .

520. GDA-15083 Through various COVID-era laws, Congress has also provided the FCC with a one-time $24 billion appropriation for various low-income initiatives. .

521. GDA-15172 A new Administration should ensure that the program is fully funded and should look first at repurposing and applying unused COVID-era emergency funds for this purpose. .

522. GDA-15222 They allowed America's private sector to bring thousands of families across the digital divide and to keep Americans connected during the pandemic. .

523. GDA-15508 The FTC must consider, therefore, the role of government itself in maintaining market concentration in areas ranging from pharmaceuticals and healthcare to avionics, banking, and real estate brokerage. .

524. GDA-15548 A related concern is the degree to which concentration of industries, particularly in pharmaceuticals, health care, and the internet, encourages government collusion that undermines democratic institutions. .

525. GDA-15555 adolescents between 2011 and 2019,16 with similar trends worldwide.17 The increase occurred at the same time that social media use moved from rare to ubiquitous among teens,18 making social media a prime suspect for the sudden rise in mental health issues among teens. .

526. GDA-15556 In addition, excessive social media use is strongly linked to mental health issues among individuals. .

527. GDA-15557 Several studies strongly support the notion that social media use is a cause, not just a correlation, of subjective well-being and poor mental health.19 Social media and other large platforms form millions of contracts every year with American children. .

528. GDA-15602 can claim eight.22 Some claim that the recent drop in value of former leader and current antitrust target Meta, along with the rise of new competitors such as Zoom and Chinese-dominated TikTok, indicates that competitive forces are healthy and at work benefiting consumers in the tech space. .

529. GDA-15627 They have a propensity to collude with government to advance political goals, as documents unearthed by the Missouri and Louisiana AG suits concerning the COVID response demonstrate. .

530. GDA-15753 Cummins, "Specification Curve Analysis Shows that Social Media Use Is Linked to Poor Mental Health, Especially Among Girls," Acta Psychologica, Vol. .

531. GDA-15820 They must rein in agencies such as the Occupational Safety and Health Administration, which the Biden Administration weaponized to attempt to force COVID-19 vaccine mandates on 84 million Americans through their workplaces. .

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Save Metrics with analysis run Project-2025_MFL_FULL-SpecialCharFix.txt 07/21/024 10:04:02 Appended Metrics File

Total Lines: 15842 Blank Lines: Non Blank Lines: 15842 Imperatives: 539 Shalls: 31 Wills: 519 IsReq:

Message: These metrics are what allow you to compare different documents and different analysis runs. Consider moving the numbers into a spreadsheet for visualization. Counts of Shalls, Wills, IsReq, and Imperatives are hardcoded into the tool. You have the ability to enter a Norm value, which can be surfaced after multiple analysis sessions.

Item	Risk	Count	Children	% lines	% imperative	% shall	% will	% isreq	% Norm
COVID-19 s20s		115		0.72	21.33		22.15
Epidemics s20s		68		0.42	12.61		13.1
Health s20s		403		2.54	74.76		77.64
Promise s24s		4		0.02	0.74	12.9	0.77
Section Titles s24s		5		0.03	0.92	16.12	0.96
Ventilation s20s
z Mined Objects		531		3.35	98.51

Rules Total 7
Rules Triggered 6
Rules Not Triggered 1
Percent of Rules Triggered 85%

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Polysyllabic Count: 0
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Health:

. . . 1. COVID-19 No Comment Text in this rule.
. . . . . . Rule Summary Name: COVID-19 Color: GREEN Access Object: COVID-19|COVID Count Accessed Patterns: CHECKED

. . . 2. Epidemics No Comment Text in this rule.
. . . . . . Rule Summary Name: Epidemics Color: RED Access Object: Epidemic|Pandemic Count Accessed Patterns: CHECKED

. . . 3. Health No Comment Text in this rule.
. . . . . . Rule Summary Name: Health Color: PURPLE Access Object: Health Count Accessed Patterns: CHECKED

. . . 4. Ventilation No Comment Text in this rule.
. . . . . . Rule Summary Name: Ventilation Color: BLUE Access Object: ventilation Count Accessed Patterns: CHECKED

Sections:

. . . 1. Promise Must use parse option to capture the sections. A different search rule is needed for non-parse option.
. . . . . . Rule Summary Name: Promise Color: BLACK Case Sensitive : CHECKED Access Object: PROMISE \#\d+ Reject Object: \.\.\. Count Accessed Patterns: CHECKED

. . . 2. Section Titles Must use parse option to capture the sections. A different search rule is needed for non-parse option.
. . . . . . Rule Summary Name: Section Titles Color: BLACK Case Sensitive : CHECKED Access Object: Section \w+ TAKING THE REINS OF GOVERNMENT|Section \w+ THE COMMON DEFENSE|Section \w+ THE GENERAL WELFARE|Section \w+ THE ECONOMY|Section \w+ INDEPENDENT REGULATORY AGENCIES Reject Object: \.\.\. Count Accessed Patterns: CHECKED