Reports & Testimonies

The 340B Program allows certain hospitals to buy outpatient drugs at discounted prices. To be eligible for the program, hospitals generally must treat a minimum percentage of low-income Medicare and Medicaid patients. In 2022, Congress passed a law allowing hospitals to request an exception to this requirement if they were unable to meet it due to the COVID-19 pandemic. The Health Resources and Services Administration...

The Global Markets unit in the Commerce Department's International Trade Administration helps small- and medium-sized U.S. businesses enter and expand into international markets. We found that the Global Markets unit hasn't developed a comprehensive strategic workforce plan that covers all of its employees. Doing so would help focus priorities across the domestic and overseas workforces. In addition, the unit's human capital office has had vacancies...

The World Bank provides financing to low and middle-income countries for things like infrastructure, social, and economic development projects. Countries use World Bank money to award contracts to businesses for the projects. Countries award an annual average of about $15 billion, and U.S. businesses got about 1% of these funds. In the past 6 years, when U.S. businesses bid, they won their bids about 70%...

Each year, the U.S. government spends over $100 billion on information technology. Most of that will be used to operate and maintain existing systems, including aging—or "legacy"—systems. These systems can be costly to maintain and vulnerable to hackers. This testimony updates our work in this area. In 2019, we analyzed 65 federal legacy systems and identified the 10 most critical at 10 agencies. The agencies...

Broadband internet has become critical for work, school, and other parts of daily life. The COVID-19 pandemic underscored the "digital divide" and the disadvantages people without access to broadband face. We testified about our work on the federal government's efforts to expand broadband access. The government has subsidized costs in underserved areas, largely through 25 programs dedicated to broadband access—administered by 7 agencies. But the...

Each year, we make more than 1,000 recommendations to help the federal government save money, address issues on our High Risk List, and significantly improve government operations. This letter to NASA outlines 9 open recommendations that it should prioritize. For example, we recommended that NASA create cost and schedule targets for some of the major systems required for upcoming Artemis lunar missions. NASA implemented 1...

Each year, we make more than 1,000 recommendations to help the federal government save money, address issues on our High Risk List, and significantly improve government operations. This letter to the Department of Education outlines 6 open recommendations that it should prioritize. For example, one of these recommendations would help the Department of Education ensure that it's fully protecting the privacy of financial aid recipients...

Veterans Affairs is in the process of replacing its IT system used to maintain veterans' health records—and has deployed its new system to a few locations. We testified that the new system has presented issues for some users. For example, many users said that they weren't adequately trained to use the new system. Users also said that the pharmacy-related part of the system contributed to...

The Department of Homeland Security is responsible for security at federal buildings and facilities. We previously reported that federal agencies don't implement many of DHS's Federal Protective Service recommendations for security improvements. When we followed up with agency representatives, they cited cost or feasibility concerns. DHS requires federal agencies to self-report some information about security recommendations. But because DHS does not verify this information, it...

Midwives provide care during pregnancy and birth, and may attend births in hospitals, birth centers, or homes. In 2021, midwives attended 12% of births in the U.S. We found that the number of midwives and midwifery students in the U.S. has increased—although the extent of care they can provide varies by state. Also, some students may have trouble with the cost of education and the...

The federal government faces an unsustainable fiscal future. If policies don't change, debt will continue to grow faster than the economy. Our review of the nation's fiscal health found: Large annual budget deficits drive debt growth, as the government borrows to finance spending that exceeds revenue Interest costs rise and make up a larger share of total spending as overall debt and interest rates increase...

The National Institutes of Health—the largest public funder of biomedical research in the U.S.—invests billions of dollars each year to help develop new drugs or new uses for existing drugs. But the extent of NIH's contributions to drug development isn't well understood or recognized by the public. One reason may be that recipients of NIH funds aren't always disclosing agency support fully or correctly when...

Access to health care is critical for veterans, particularly those living in rural areas. The Veterans Health Administration's Office of Rural Health funds research and initiatives aimed at improving the health of veterans living in rural areas. In 2022, ORH supported 120 research projects. But it informs researchers of funding opportunities via word-of-mouth and existing relationships, leaving some researchers potentially unaware. Also, ORH knows what...

Federal employees who are whistleblowers can help fight fraud, waste, and abuse, so laws protect them from retaliation, such as demotion and firing. We're looking into whistleblower retaliation cases at the Department of Veterans Affairs. This report covers our observations on cases reported to the federal Office of Special Counsel. From FY 2018-22: 69% of cases involving VA employees included claims of whistleblower retaliation The...

We testified that the Department of Defense faces several challenges as it works to rebuild and restore readiness across the military while also modernizing its forces. For example, we've previously reported: the Navy's ship maintenance backlog has grown to $1.8 billion maintenance and supply issues limit the availability of aging aircraft space readiness goals are unclear Although the readiness of ground forces—such as the Army...

Federal grants play a key role in funding national priorities, like responding to the COVID-19 pandemic. The government provides hundreds of billions of dollars for grants annually. This testimony covers our body of work on federal grants management challenges, including: Capacity—financial and resource issues make it harder to access grants Streamlining—burdensome requirements for managing grants make programs more expensive Transparency—better public reporting of how grants...

Demand for Federal Emergency Management Agency help has increased with more frequent and complex disasters like hurricanes, wildfires, and the COVID-19 pandemic. FEMA is a key federal agency that helps respond to and recover from such disasters. But FEMA has had trouble building a workforce to meet these needs. It has fallen short of its yearly staffing target since 2019—and that gap continues to grow...

In March 2023, Silicon Valley Bank and Signature Bank suffered two of the largest bank failures in U.S. history. Risky business strategies, weak risk management practices, and weak liquidity drove the failures. Both banks grew rapidly from 2019-2021—which can signal risk. Further, the growth was fueled heavily by deposits that weren't federally insured. Federal regulators raised concerns about these risks with the banks but didn't...

When demand for air travel dropped during the COVID-19 pandemic, commercial airlines took steps to cut costs, such as suspending hiring and reducing staff. The industry has largely recovered, but cancellations and delays have persisted—affecting millions of passengers. Generally, cancellations and delays in late 2021 were due to factors that were within an airline's control, such as airplane maintenance or lack of crew. The Department...

The Office of Personnel Management reviews federal agency requests to hire current or recent political appointees for permanent career positions. OPM approved 129 of 187 such requests from Mar. 2016-Jan. 2021. This process helps assure fair competition—free from political influence. But identifying which applicants are current or recent political appointees isn't always easy for agencies. A new law requires OPM to maintain a public website...