Ensuring quality care at nursing homes has become even more critical with the emergence of COVID-19. The Department of Veterans Affairs provided nursing home care for over 39,000 veterans in 2019. More than half received care at homes that states own and operate. The VA pays a contractor to inspect these homes. We testified about our June 2019 findings on state home inspections. We made 3 recommen...

Three children died in U.S. Customs and Border Protection’s custody in fiscal year 2019, prompting questions about medical care in the agency’s southwest border facilities. CBP developed health screening policies and received emergency funds to enhance detainees’ medical care. But CBP hasn’t consistently overseen these policies, so some children were not given health screenings as intende...

In response to the COVID-19 pandemic, Congress appropriated $2.6 trillion in emergency assistance for people, businesses, the health care system, and state and local governments. How are federal agencies spending these funds? We testified that the Small Business Administration processed over $512 billion in guaranteed small business loans, but isn’t ready to address fraud risks and hasn’t sa...

COVID-19 is only the latest disease to raise concerns over contagions spread through air travel. In 2015, during the Ebola epidemic, we recommended that the Department of Transportation develop a comprehensive national aviation-preparedness plan for communicable disease outbreaks. However, it has yet to do so. Such a plan could have improved coordination between public-health and aviation sectors...

The outbreak of COVID-19 has called greater attention to the United States’ reliance on foreign drug manufacturers. Much of the drug manufacturing for the U.S. market happens overseas—and drugs for treating COVID-19 are no exception. Food and Drug Administration inspections of foreign and domestic drug manufacturers are critical to ensuring drug safety and effectiveness. But FDA began to pos...

Biological threats can be manmade biological weapons, naturally occurring diseases such as novel coronavirus COVID-19, and more. The National Biodefense Strategy, issued in 2018 along with implementation guidance, spells out the nation’s plan to address these threats. It calls for a joint effort by multiple agencies and private sector partners. We testified about how well the strategy has work...

Veterans rely on long-term care from the VA for everything from occasional help around the house to round-the-clock care. Eligibility is mostly based on the extent of a service-connected disability. We testified that demand for long-term care increased 14% and VA’s spending went up 33% from FY 2014-2018. VA projects that demand will continue to increase and spending will double by 2037. VA fac...

The federal government’s Black Lung Disability Trust Fund faces financial challenges and has borrowed billions to cover costs. The Trust pays benefits to certain coal miners when no coal mine operator can be held responsible, or when the liable operator does not pay. Three mine operator bankruptcies have further strained Trust finances by transferring $865 million in estimated benefit responsib...

More than 60% of drug manufacturers for the U.S. market are located overseas. The Food and Drug Administration inspects foreign and domestic drug manufacturers to ensure drug safety and effectiveness. Among other things, we testified that: The number of inspections of foreign drug manufacturers has declined since FY 2016, which FDA attributes in part to fewer inspectors and difficulty filling jo...

According to the U.S. Commission on Civil Rights, the federal government inadequately supports Native Americans’ physical, social, and economic well-being. Inefficient delivery of federal services is one factor. We testified that a high number of staff vacancies, inadequate funding, management weaknesses, and other factors prevent key agencies—the Bureau of Indian Affairs, the Bureau of India...