Rural Community Hospital Demonstration Program Reauthorization

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Bill ID: 119/s/4460
Last Updated: July 17, 2026

Sponsored by

Sen. Grassley, Chuck [R-IA]

ID: G000386

Follow the money

The bill

Rural Community Hospital Demonstration Program Reauthorization

S. 4460, 119th Congress — read as touching Hospitals & Health Systems.

The sponsor

Sen. Grassley, Chuck [R-IA]

Every bill has someone who introduced it. That name is where the paper trail starts.

The money

$82,472 raised

23 itemised contributions to this sponsor, pulled from FEC filings.

The alignment

55% match to Project 2025

This bill's text tracks the "Department of Veterans Affairs" section, p. 679-681 of the Mandate for Leadership.

Bill's Journey to Becoming a Law

Track this bill's progress through the legislative process

Latest Action

Held at the desk.

May 20, 2026

Introduced

📍 Current Status

Next: The bill will be reviewed by relevant committees who will debate, amend, and vote on it.

🏛️

Committee Review

🗳️

Floor Action

✅

Passed Senate

🏛️

House Review

🎉

Passed Congress

🖊️

Presidential Action

⚖️

Became Law

📚 How does a bill become a law?

1. Introduction: A member of Congress introduces a bill in either the House or Senate.

2. Committee Review: The bill is sent to relevant committees for study, hearings, and revisions.

3. Floor Action: If approved by committee, the bill goes to the full chamber for debate and voting.

4. Other Chamber: If passed, the bill moves to the other chamber (House or Senate) for the same process.

5. Conference: If both chambers pass different versions, a conference committee reconciles the differences.

6. Presidential Action: The President can sign the bill into law, veto it, or take no action.

7. Became Law: If signed (or if Congress overrides a veto), the bill becomes law!

Bill Summary

Another brilliant example of legislative theater, courtesy of the 119th Congress. Let's dissect this masterpiece, shall we?

**Main Purpose & Objectives:** The main purpose of S. 4460 is to extend the Rural Community Hospital Demonstration Program for an additional five years, because, of course, throwing more money at a problem always solves it. The objective is to keep the gravy train rolling for rural hospitals, which are no doubt struggling to stay afloat due to the sheer incompetence of their management and the crushing weight of bureaucratic red tape.

**Key Provisions & Changes to Existing Law:** The bill amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 by extending the demonstration program from 15 to 20 years. Because, you know, 15 years just wasn't enough time to figure out if this program is actually working. The changes are largely cosmetic, with plenty of opportunities for creative accounting and bureaucratic obfuscation.

**Affected Parties & Stakeholders:** The affected parties include rural community hospitals, which will continue to receive funding for their demonstration programs. One can only assume that the lobbyists for these hospitals have been busy greasing palms and writing checks to ensure the continuation of this boondoggle. The stakeholders also include the taxpayers, who will be footing the bill for this extension, and the patients, who will no doubt benefit from the continued mismanagement of their healthcare.

**Potential Impact & Implications:** The potential impact of this bill is to further entrench the culture of dependency and inefficiency that pervades rural healthcare. By extending this program, Congress is essentially saying, "Don't worry, we'll just keep throwing money at the problem, and maybe, just maybe, it will magically solve itself." The implications are clear: more waste, more abuse, and more opportunities for corruption and cronyism.

In conclusion, S. 4460 is a textbook example of legislative malpractice. It's a bill that prioritizes special interests over sound policy, and it's a stark reminder that our elected officials are more interested in perpetuating their own power and influence than in actually solving the problems they claim to care about. So, let's all just take a moment to applaud the 119th Congress for their outstanding achievement in doing absolutely nothing to address the real issues facing rural healthcare. Bravo, folks. Bravo.

Related Topics

Healthcare & Insurance Reform
Generated using Llama 3.1 70B (Dr. Haus personality)

💰 Campaign Finance Network

Sen. Grassley, Chuck [R-IA]

Congress 119 • 2024 Election Cycle

Total Contributions
$130,307
63 donors
PACs
$0
Organizations
$0
Committees
$3,000
Individuals
$127,307

No PAC contributions found

No organization contributions found

1
SAC & FOX TRIBE OF THE MISSISSIPPI IN IOWA
1 transaction
$2,000
2
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
1 transaction
$1,000
1
KUMAR, SHALLI
2 transactions
$9,900
2
SCHWARZMAN, CHRISTINE
2 transactions
$9,900
3
SCHWARZMAN, STEPHEN
2 transactions
$9,900
4
ARVIG, ALLEN
3 transactions
$6,710
5
STARRETT, RONALD
2 transactions
$5,800
6
COLLINS, RICHARD
1 transaction
$5,523
7
MALONE, KIP
6 transactions
$4,520
8
DETERMAN, MARK
1 transaction
$3,300
9
MCKEE, JACK C
1 transaction
$3,300
10
WEISS, LUKE
1 transaction
$3,300
11
PECK JR, JOHN
1 transaction
$2,900
12
LEIGH, JOHN
4 transactions
$2,715
13
COLLINS, III, HENRY L.
1 transaction
$2,601
14
POSNER, IDA MOLLOY
1 transaction
$2,500
15
VANDERHAAG, JOHN
3 transactions
$2,500
16
DIMARE, SCOTT
3 transactions
$1,500
17
RADY, PAUL
2 transactions
$1,500
18
VANDER HAAG, JOHN C
1 transaction
$1,500
19
RICHARDS, MARY
2 transactions
$1,435
20
NWANERI, MATTHEW
1 transaction
$1,200
21
FRENCH, ARTHUR
1 transaction
$1,000
22
JUCKETTE, LINDA
1 transaction
$1,000
23
KOROLOGOS, TOM C
1 transaction
$1,000
24
LARSON, ELLEN T
1 transaction
$1,000
25
MANATOS, ANDREW E
1 transaction
$1,000
26
MERCHANT, AHMED
1 transaction
$1,000
27
PATRICK, CHRIS MR..
1 transaction
$1,000
28
ROGERS, DIRKSEN
1 transaction
$1,000
29
SABIN, DANIEL
2 transactions
$1,000
30
SCUDDER, JACK
1 transaction
$1,000
31
SMITH, JAMES A
1 transaction
$1,000
32
SMITH, THOMAS STUART MR..
1 transaction
$1,000
33
VANDERPOOL, MARYLEE
1 transaction
$1,000
34
JOHNS, SUSAN
1 transaction
$990
35
PHELPS, DICK
1 transaction
$910
36
HESS, CURTIS
1 transaction
$750
37
LUO, KERRI
1 transaction
$750
38
WILLIAMS, ANGELA
1 transaction
$630
39
AXMEAR, FRED
1 transaction
$500
40
FRANKEN, KEN
1 transaction
$500
41
HARKEN, MARY J
1 transaction
$500
42
HASKENHOFF, TINA
1 transaction
$500
43
HILL, VERNON
1 transaction
$500
44
HUSSAIN, SULEMAN
1 transaction
$500
45
JOHNSON, WAYNE
1 transaction
$500
46
KOESTNER, RICHARD
1 transaction
$500
47
LILLIS, TERRY
1 transaction
$500
48
MCKEON, PATRICIA
1 transaction
$500
49
MCMICKLE, JOHN
1 transaction
$500
50
MOGLER, DEVIN
1 transaction
$500
51
PECK, JOHN
1 transaction
$500
52
RITTS, SUSAN BUTLER
1 transaction
$500
53
SUTTER, THEODORE
1 transaction
$500
54
VANDER HAAG, RUTH
1 transaction
$500
55
VANKERCKHOVE, BRUCE
1 transaction
$500
56
VIGO, JUDITH
1 transaction
$500
57
WHITCOMB, STANLEY
1 transaction
$500

Cosponsors & Their Campaign Finance

This bill has 10 cosponsors. Below are their top campaign contributors.

Sen. Bennet, Michael F. [D-CO]

ID: B001267

Top Contributors

24

1
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$1,000
Oct 18, 2024
2
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$1,000
Jun 21, 2024
3
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 30, 2024
4
QUILLER GALLERY LLC
OrganizationCREEDE, CO
$250
Nov 20, 2023
5
BARRON, THOMAS A
SELF EMPLOYED • AUTHOR
IndividualBOULDER, CO
$5,000
Sep 18, 2023
6
WALLINGER, DANIELLE
STUDIO D DESIGN • CEO
IndividualENGLEWOOD, CO
$5,000
Oct 15, 2024
7
WALLINGER, DIRK
YORK SPACE SYSTEMS • CEO
IndividualENGLEWOOD, CO
$5,000
Oct 15, 2024
8
LEPRINO, TERRY LYNN
NOT EMPLOYED • NOT EMPLOYED
IndividualDENVER, CO
$3,300
Dec 3, 2024
9
SIE, JOHN J.
NOT EMPLOYED • NOT EMPLOYED
IndividualENGLEWOOD, CO
$3,300
Dec 3, 2024
10
HEGYI, ALBERT
1ST FINANCIAL • BANKER
IndividualSOUTHPORT, CT
$3,300
Oct 26, 2023

Sen. Crapo, Mike [R-ID]

ID: C000880

Top Contributors

25

1
MORONGO BAND OF MISSION INDIANS
OrganizationBANNING, CA
$3,300
Jun 30, 2023
2
SAN MANUEL BAND OF MISSION INDIANS
OrganizationLOS ANGELES, CA
$2,000
Dec 19, 2024
3
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Apr 30, 2024
4
ONEIDA NATION
OrganizationONEIDA, WI
$1,000
Sep 10, 2024
5
RENO-SPARKS INDIAN COLONY
OrganizationRENO, NV
$500
Sep 10, 2024
6
ARNOLD, JOHN D. MR.
NONE • RETIRED
IndividualHOUSTON, TX
$6,600
May 6, 2024
7
LEPRINO, TERRY L
NONE • RETIRED
IndividualDENVER, CO
$3,300
Nov 1, 2024
8
BUKOWSKY, BRANT
MORTGAGE RESEARCH CENTER • ENTREPRENEUR
IndividualCOLUMBIA, MO
$3,300
Oct 9, 2023
9
BUKOWSKY, BROCK
VETERANS UNITED • FINANCE
IndividualCOLUMBIA, MO
$3,300
Nov 28, 2023
10
SILBEY, ALEXANDER
ATS COMMUNICATIONS, INC. • CONSULTANT
IndividualWASHINGTON, DC
$3,300
Dec 21, 2023

Sen. Wyden, Ron [D-OR]

ID: W000779

Top Contributors

30

1
SANTA YNEZ BAND OF MISSION INDIANS
OrganizationSANTA YNEZ, CA
$2,000
Dec 12, 2024
2
MOHEGAN TRIBE OF INDIANS OF CONNECTICUT
OrganizationUNCASVILLE, CT
$1,000
Dec 28, 2023
3
SANTA YNEZ BAND OF MISSION INDIANS
OrganizationSANTA YNEZ, CA
$1,000
Dec 30, 2023
4
SAN MANUEL BAND OF MISSIONS INDIANS
OrganizationLOS ANGELES, CA
$1,000
Mar 26, 2024
5
SHAKOPEE MDWEKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 12, 2024
6
SHAKOPEE MDWEKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
May 31, 2023
7
MS BAND OF CHOCTAW INDIANS
OrganizationCHOCTAW, MS
$1,000
Dec 31, 2023
8
CHOCTAW NATION OF OKLAHOMA
OrganizationDURANT, OK
$550
Oct 3, 2023
9
RENO-SPARKS INDIAN COLONY
OrganizationRENO, NV
$500
Jul 18, 2023
10
RENO-SPARKS INDIAN COLONY
OrganizationRENO, NV
$500
Sep 10, 2024

Sen. Sullivan, Dan [R-AK]

ID: S001198

Top Contributors

75

1
SEND IN THE SEAL PAC
PACALEXANDRIA, VA
$45,000
Aug 9, 2024
2
THE LINCOLN CLUB OF ORANGE COUNTY FEDERAL PAC
PACNEWPORT BEACH, CA
$25,000
Oct 18, 2024
3
SEND IN THE SEAL PAC
PACALEXANDRIA, VA
$15,000
Aug 9, 2024
4
WINRED
PACARLINGTON, VA
$6,600
Oct 19, 2023
5
RON JOHNSON VICTORY
COMOSHKOSH, WI
$1,997
Sep 30, 2024
6
MACLEAN-FOGG COMPANY
OrganizationMUNDELEIN, IL
$58,700
Dec 28, 2023
7
AK-CHIN INDIAN COMMUNITY
OrganizationMARICOPA, AZ
$41,300
Dec 29, 2023
8
MACLEAN-FOGG COMPANY
OrganizationMUNDELEIN, IL
$41,300
Dec 28, 2023
9
PASCUA YAQUI TRIBE
OrganizationTUCSON, AZ
$41,300
Dec 29, 2023
10
TIGUA INDIAN RESERVATION
OrganizationEL PASO, TX
$41,300
Dec 19, 2023

Sen. Luján, Ben Ray [D-NM]

ID: L000570

Top Contributors

45

1
LYTTON BAND OF POMO INDIANS
OrganizationSANTA ROSA, CA
$3,300
Dec 5, 2023
2
OTOE-MISSOURIA TRIBE
OrganizationRED ROCK, OK
$3,300
Dec 7, 2023
3
LYTTON BAND OF POMO INDIANS
OrganizationSANTA ROSA, CA
$3,300
Dec 5, 2023
4
TAOS PUEBLO GOVERNOR'S OFFICE
OrganizationTAOS, NM
$3,300
Dec 2, 2024
5
OHKAY OWINGEH TRIBE
OrganizationOHKAY OWINGEH, NM
$3,300
Dec 2, 2024
6
BARONA BAND OF MISSION INDIANS
OrganizationLAKESIDE, CA
$3,300
Apr 18, 2023
7
BARONA BAND OF MISSION INDIANS
OrganizationLAKESIDE, CA
$3,300
May 22, 2024
8
MESCALERO APACHE TRIBE
OrganizationMESCALERO, NM
$3,300
Sep 25, 2023
9
SAN MANUEL BAND OF MISSION INDIANS
OrganizationWASHINGTON, DC
$2,500
Jun 25, 2024
10
SHAKOPEE MDEWAKANTON SIOUX
OrganizationPRIOR LAKE, MN
$2,000
Mar 21, 2024

Sen. Hyde-Smith, Cindy [R-MS]

ID: H001079

Top Contributors

24

1
POARCH BAND OF CREEK INDIANS
OrganizationATMORE, AL
$2,900
Feb 28, 2023
2
MS BAND OF CHOCTAW INDIANS
OrganizationCHOCTAW, MS
$1,500
May 31, 2023
3
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 20, 2024
4
THE CHICKASAW NATION
OrganizationADA, OK
$250
Mar 11, 2024
5
LUROS, HILARY
HOUSEWIFE • HOUSEWIFE
IndividualSUGAR LAND, TX
$6,600
Oct 21, 2024
6
LUROS, HILARY
HOUSEWIFE • HOUSEWIFE
IndividualSUGAR LAND, TX
$6,600
Oct 21, 2024
7
BESSENT, SCOTT
KEY SQUARE GROUP • INVESTMENT MANAGEMENT
IndividualCHARLESTON, SC
$6,600
Dec 31, 2024
8
FREEMAN, JOHN
HIGH PLAINS ACRES LLP • ATTORNEY/AGRICULTURE
IndividualCHARLESTON, SC
$6,600
Dec 31, 2024
9
CASTLE, JOHN
CASTLE HARLAN • MERCHANT BANKER
IndividualNEW YORK, NY
$6,600
Mar 26, 2024
10
SEEMANN, WILLIAM III
SEEMANN COMPOSITES • CHAIRMAN
IndividualPASS CHRISTIAN, MS
$6,600
Jun 20, 2024

Sen. Welch, Peter [D-VT]

ID: W000800

Top Contributors

22

1
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 8, 2023
2
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
May 3, 2024
3
FIELD, MARSHALL
THE OLD MOUNTAIN COMPANY, INC. • EXECUTIVE
IndividualCHICAGO, IL
$3,300
May 18, 2023
4
RECHNITZ, JOAN
IndividualRED BANK, NJ
$3,300
Apr 22, 2024
5
RECHNITZ, JOAN
IndividualRED BANK, NJ
$3,300
Apr 22, 2024
6
GORDON, PATRICIA
SELF • MD
IndividualLOS ANGELES, CA
$3,300
May 22, 2024
7
STILLER, ROBERT
NOT EMPLOYED • NOT EMPLOYED
IndividualPALM BEACH, FL
$3,300
Sep 22, 2024
8
STILLER, ROBERT
NOT EMPLOYED • NOT EMPLOYED
IndividualPALM BEACH, FL
$3,300
Sep 22, 2024
9
KALKUT, CRAIG
WEST FRONT STRATEGIES • GOVERNMENT AFFAIRS
IndividualWASHINGTON, DC
$2,500
May 3, 2023
10
SCHWARTZ, MARTIN
MINILEC SERVICE • CONSUMER ELECTRONICS
IndividualCARMEL, CA
$2,000
May 18, 2023

Sen. Moran, Jerry [R-KS]

ID: M000934

Top Contributors

20

1
BORCK, LEON H.
INNOVATIVE LIVESTOCK SERVICES • EXECUTIVE
IndividualMANHATTAN, KS
$6,600
Mar 11, 2024
2
MANDELBLATT, DANIELLE
DMM PROPRIETA MANAGEMENT • MANAGER
IndividualASPEN, CO
$6,600
Sep 26, 2024
3
MANDELBLATT, ERIC
SOROBAN CAPITAL PARTNERS LP • MANAGING PARTNER
IndividualASPEN, CO
$6,600
Sep 26, 2024
4
CATZ, SAFRA
ORACLE CORPORATION • CEO
IndividualWASHINGTON, DC
$5,000
May 5, 2023
5
MISSION INDIANS, MORONGO BAND OF
INDIAN TRIBE • INDIAN TRIBE
IndividualBANNING, CA
$5,000
Aug 13, 2024
6
WILLIS, THOMAS M
CONESTOGA ENERGY PARTNERS • CEO
IndividualLIBERAL, KS
$5,000
Aug 26, 2024
7
WEILERT, STANLEY R
S&B MOTELS, INC. • HOTELIER
IndividualWICHITA, KS
$3,500
Jun 26, 2023
8
BORCK, JACKIE
KANSAS STATE UNIVERSITY • DIRECTOR OF COMMUNITY RELATIONS
IndividualMANHATTAN, KS
$3,300
Mar 11, 2024
9
BORCK, JACKIE
KANSAS STATE UNIVERSITY • DIRECTOR OF COMMUNITY RELATIONS
IndividualMANHATTAN, KS
$3,300
Mar 11, 2024
10
THOMAS, ROBERT
SENIOR STAR • CO-OWNER
IndividualTULSA, OK
$3,300
Feb 22, 2024

Sen. King, Angus S., Jr. [I-ME]

ID: K000383

Top Contributors

24

1
2120 SEA ISLAND LLC
OrganizationRIVER FOREST, IL
$3,300
Oct 26, 2023
2
THE CHICKASAW NATION
OrganizationADA, OK
$3,300
May 22, 2024
3
THE CHICKASAW NATION
OrganizationADA, OK
$2,000
Mar 29, 2024
4
THE CHICKASAW NATION
OrganizationADA, OK
$1,300
May 22, 2024
5
SMITH, BRAD
MICROSOFT CORPORATION • ATTORNEY
IndividualBELLEVUE, WA
$6,600
Feb 13, 2024
6
SMITH, BRAD
IndividualBELLEVUE, WA
$6,600
Feb 20, 2024
7
DOWNEY, NANCY A.
IndividualNEW YORK, NY
$5,000
Sep 4, 2024
8
DOWNEY, NANCY A.
NOT EMPLOYED • RETIRED
IndividualNEW YORK, NY
$5,000
Aug 31, 2024
9
OTTEN, LESLIE B.
AMERICAN SKIING COMPANY • OWNER
IndividualBETHEL, ME
$5,000
Oct 4, 2024
10
BEKENSTEIN, ANITA
NOT EMPLOYED • RETIRED
IndividualWAYLAND, MA
$3,300
Oct 24, 2024

Sen. Murkowski, Lisa [R-AK]

ID: M001153

Top Contributors

29

1
MUCKLESHOOT INDIAN TRIBE
OrganizationAUBURN, WA
$3,300
May 15, 2023
2
THE CHICKASAW NATION
OrganizationADA, OK
$2,500
Dec 20, 2023
3
MUCKLESHOOT INDIAN TRIBE
OrganizationAUBURN, WA
$1,000
Nov 20, 2024
4
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Oct 26, 2023
5
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 3, 2024
6
PUYALLUP TRIBE OF INDIANS
OrganizationTACOMA, WA
$1,000
Sep 30, 2024
7
SUQUAMISH INDIAN TRIBE
OrganizationSUQUAMISH, WA
$1,000
Sep 30, 2024
8
TOHONO O'ODHAM NATION
OrganizationSELLS, AZ
$1,000
Aug 9, 2024
9
CHOCTAW NATION OF OKLAHOMA
OrganizationDURANT, OK
$550
Oct 26, 2023
10
SEGAL, PAUL
LS POWER DEVELOPMENT, LLC • CHIEF EXECUTIVE OFFICER
IndividualNEW YORK, NY
$3,300
Dec 16, 2023

Donor Network - Sen. Grassley, Chuck [R-IA]

PACs
Organizations
Individuals
Politicians

Hub layout: Politicians in center, donors arranged by type in rings around them.

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Showing 42 nodes and 59 connections

Total contributions: $59

Top Donors - Sen. Grassley, Chuck [R-IA]

Showing top 15 donors by contribution amount

1 PAC2 Committees12 Individuals

Industry Impact

Which industries are materially affected by specific provisions in this bill. 1 helped.

  • Section 2 extends the Rural Community Hospital Demonstration Program from 15 to 20 years, providing continued funding and support for rural community hospitals, which are part of the hospitals and health systems industry.

Project 2025 Policy Matches

This bill shows semantic similarity to the following sections of the Project 2025 policy document.AI-enhanced analysis provides detailed alignment ratings.

Department of Veterans Affairs

Weak
Vector: 58%
Pages: 679-681AI Enhanced

AI Analysis:

"The bill focuses on extending a rural hospital demonstration program under Medicare, while the Project 2025 VA policy emphasizes VA healthcare reform, infrastructure realignment, caregiver programs, and innovation within the Veterans Health Administration. There is minimal thematic overlap, as the bill does not address veterans' healthcare, VA operations, or any of the specific VA initiatives outlined in the policy."

Key themes:healthcare accessrural healthcaredemonstration programs

— 646 — Mandate for Leadership: The Conservative Promise 3. Section 121 (developing and administering an education program that teaches veterans about their health care options available from the Department of Veterans Affairs). 4. Section 152 (returning the Office for Innovation of Care and Payment to the Office of Enterprise Integration with a joint governance process set up with the VHA). 5. Section 161 (overhauling Family Caregiver Program expansion, which has gone poorly, so that it focuses on consistency of eligibility and awareness that the most severely wounded or injured may require the program indefinitely). l Require the VHA to report publicly on all aspects of its operation, including quality, safety, patient experience, timeliness, and cost-effectiveness, using standards similar to those in the Medicare Accountable Care Organization program so that the government may monitor and achieve continuous improvement in the VA system more effectively. l Encourage VA Medical Centers to seek out relevant academic and private- sector input in their communities to improve the overall patient experience. Budget l Conduct an independent audit of the VA similar to the 2018 Department of Defense (DOD) audit to identify IT, management, financial, contracting, and other deficiencies. l Assess the misalignment of VHA facilities and rising infrastructure costs. The VHA operates 172 inpatient medical facilities nationally that are an average of 60 years old. Some of these facilities are underutilized and inadequately staffed. Facilities in certain urban and rural areas are seeing significant declines in the veteran population and strong competition for fresh medical staff. 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. However, the Senate Veterans Affairs Committee lacked the political will to act on the White House’s nominations of commission members, and this ultimately led to termination of the AIR process. The next Administration should seek out agile, creative, and politically acceptable operational solutions to this aging infrastructure status quo, — 647 — Department of Veterans Affairs reimagine the health care footprint in some locales, and spur a realignment of capacity through budgetary allocations. Specifically: 1. 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. 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. Personnel l Extend the term of the Under Secretary for Health (USH) to five years. Additionally, authority should be given to reappoint this individual for a second five-year term both to allow for continuity and to protect the USH from political transition. l Establish a Senior Executive Service (SES) position of VHA Care System Chief Information Officer (CIO), selected by and reporting to the chief of the VHA Care System with a dotted line to the VA CIO. l Identify a workflow process to bring wait times in compliance with VA MISSION Act–required time frames wherever possible. 1. Assess the daily clinical appointment load for physicians and clinical staff in medical facilities where wait times for care are well outside of the time frames required by the VA MISSION Act. 2. Require VHA facilities to increase the number of patients seen each day to equal the number seen by DOD medical facilities: approximately 19 patients per provider per day. Currently, VA facilities may be seeing as few as six patients per provider per day. 3. Consider a pilot program to extend weekday appointment hours and offer Saturday appointment options to veterans if a facility continues to demonstrate that it has excess capacity and is experiencing delays in the delivery of care for veterans. 4. Identify clinical services that are consistently in high demand but require cost-prohibitive compensation to recruit and retain talent, and examine exceptions for higher competitive pay.

Department of Health and Human Services

Weak
Vector: 58%
Pages: 515-517AI Enhanced

AI Analysis:

"The bill focuses on extending a rural hospital demonstration program, while the Project 2025 HHS section emphasizes caregiver strategy, telehealth licensure, contraceptive mandate rulemaking, and data sharing. There is only a tangential connection through the shared interest in improving rural healthcare access, but no direct policy overlap."

Key themes:rural healthhealthcare accesstelehealth

— 483 — Department of Health and Human Services l Readdress the National Strategy to Support Family Caregivers. While in theory the strategy aims to support family members with duties to care for older family members, the plan is overly focused on racial and “LGBTQ+ equity.” The strategy should be examined to establish an efficient plan to support caregivers and their families. There should also be a review of its COVID-19 policies. 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. Supreme Court’s American Hospital Association v. Becerra decision.69 The legislation should also create penalties for those who do not respond to HRSA’s data collection. l Legally define the locus of service as where the provider is located during the telehealth visit rather than where the patient is. With such a definition, states could continue to reserve their powers to establish the standards for licensure and scope of practice. The providers could ensure continuity and consistency of care no matter where their patients might move while maintaining the licenses that make the most sense for them. Americans are far more mobile and technologically advanced today than they were when most health care laws were written. Telehealth has become increasingly important, particularly during the height of the COVID-19 pandemic. It also has great potential in rural and other areas where there are shortages of health care providers. 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. HRSA does not have the authority through this office to dictate licensure laws; that power has typically been reserved to the states. However, telehealth across state lines, when permitted, is interstate commerce, which can be regulated by the federal government according to the Constitution. l Restore Trump religious and moral exemptions to the contraceptive mandate (also a CMS rule). HHS should rescind, if finalized, the regulation titled “Coverage of Certain Preventive Services Under the Affordable Care Act,” proposed jointly by HHS, Treasury, and Labor.70 This rule proposes to amend Trump-era final rules regarding religious and moral exemptions and accommodations for coverage of certain preventive services under the ACA. Preventive services include contraception, and — 484 — Mandate for Leadership: The Conservative Promise it appears the proposed rule would change the existing regulations for religious and moral exemptions to the ACA’s contraception mandate. There is no need for further rulemaking that curtails existing exemptions and accommodations. l Require HRSA to use rulemaking to update the women’s preventive services mandate. The contraceptive mandate issued under Obamacare has been the source of years of egregious attacks on many Americans’ religious and moral beliefs. The mandate was issued as part of the women’s preventive services guidelines, which were issued without any rulemaking that involved public notice and an opportunity to comment. Instead, HRSA issued and changed the mandate by simply posting changes to its website. HRSA also started off not requiring coverage of fertility awareness–based methods of family planning, then requiring them, and then removing the requirement without notifying the public. A federal judge recently ruled that this failure to undergo notice and comment in issuing the mandate is unlawful. HRSA should be required to repromulgate any women’s preventive services mandates through the notice and comment process that is compliant with the Administrative Procedures Act. Moreover, since the Obama Administration HRSA entered into long- term contracts with the pro-abortion American College of Obstetricians and Gynecologists (ACOG) and related entities to serve as an exclusive adviser with respect to the content of this mandate, HRSA has used this arrangement to ignore comments that members of the public were sometimes able to submit in the process, and ACOG has abused its position to attack HHS’s allowance of religious and moral exemptions to the contraceptive mandate. HHS should rescind these contracts and establish an advisory committee that is compliant with the Federal Advisory Committee Act and has members that are committed to women’s preventive services and are not pro-abortion ideologues. l Expand inclusion of fertility awareness–based methods and supplies to family planning in the women’s preventive services mandate. The ACA requires coverage of and prevents insurance plans from imposing any cost-sharing requirements on women who obtain preventive care and screenings as defined by HRSA. In 2016, HHS included “instruction in fertility awareness-based methods” as part of this requirement. However, in December 2021, HHS removed that language from its list without using the notice-and-comment process or giving any rationale, both of which are mandated by the Administrative Procedures Act. In August

Department of Health and Human Services

Weak
Vector: 57%
Pages: 533-535AI Enhanced

AI Analysis:

"The bill focuses on extending a rural hospital demonstration program to improve healthcare access and financial stability in rural areas, while the Project 2025 HHS section emphasizes civil rights enforcement, abortion-related policies, conscience protections, and nondiscrimination rules—topics not addressed in the bill. There is minimal thematic overlap beyond both involving HHS-administered programs."

Key themes:Department of Health and Human Serviceshealthcare policyMedicare

— 501 — Department of Health and Human Services 54. U.S. 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). 55. H.R. 26, Born-Alive Abortion Survivors Protection Act, 118th Congress, introduced January 9, 2023, https:// www.congress.gov/118/bills/hr26/BILLS-118hr26pcs.pdf (accessed March 17, 2023). 56. H.R. 7, No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2023, 118th Congress, introduced January 9, 2023, https://www.congress.gov/118/bills/hr7/BILLS-118hr7ih.pdf (accessed March 17, 2023). 57. S. 401, Conscience Protection Act of 2021, 117th Congress, introduced February 24, 2021, https://www.congress. gov/117/bills/s401/BILLS-117s401is.pdf (accessed March 17, 2023). 58. U.S. 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. 87, No. 149 (August 4, 2022), pp. 47824–47920, https://www.govinfo. gov/content/pkg/FR-2022-08-04/pdf/2022-16217.pdf (accessed March 17, 2023). 59. Ibid., p. 47916. 60. The regulation was not finalized before the end of the Administration. U.S. Department of Agriculture, Food and Nutrition Services, “Revision of Categorical Eligibility in the Supplemental Nutrition Assistance Program (SNAP),” Proposed Rule, Federal Register, Vol. 84, No. 142 (July 24, 2019), pp. 35570–55581, https:// www.federalregister.gov/documents/2019/07/24/2019-15670/revision-of-categorical-eligibility-in-the- supplemental-nutrition-assistance-program-snap (accessed March 17, 2023). 61. 45 Code of Federal Regulations § 75.300(c) and (d), https://www.ecfr.gov/current/title-45/subtitle-A/ subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.300 (accessed March 17, 2023). 62. H.R. 1750, Child Welfare Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https:// www.congress.gov/117/bills/hr1750/BILLS-117hr1750ih.pdf (accessed March 17, 2023), and S. 656, Child Welfare Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https://www.congress.gov/117/bills/ s656/BILLS-117s656is.pdf (accessed March 17, 2023). 63. S. 3949, Trafficking Victims Protection Reauthorization Act of 2022, Public Law No. 117-348, 117th Congress, January 25, 2023, https://www.congress.gov/117/plaws/publ348/PLAW-117publ348.pdf (accessed March 17, 2023). 64. Kelsey Y. Santamaria, “Child Migrants at the Border: The Flores Settlement Agreement and Other Legal Developments,” Congressional Research Service In Focus No. IF11799, April 1, 2021, https://crsreports.congress. gov/product/pdf/IF/IF11799 (accessed March 17, 2023). 65. Report, Building a Happy Home: Marriage Education as a Tool to Strengthen Families, Social Capital Project Report No. 1-22, March 2022, p. 17, https://www.jec.senate.gov/public/_cache/files/3d102525-6f0d-48ed- 92f4-d71edd468ad6/building-a-happy-home.pdf (accessed March 17, 2023). The cover of the report reflects that the Social Capital Project is “[a] project of the Joint Economic Committee – Republicans.” 66. See, for example, Alan J. Hawkins, “Are Federally Supported Relationship Education Programs for Lower-Income Individuals and Couples Working? A Review of Evaluation Research,” American Enterprise Institute, September 2019, https://www. congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023). 67. H.R. 8404, Respect for Marriage Act, Public Law No. 117-228, 117th Congress, December 13, 2022, https://www. congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023). 68. Madison Marino, “Over 1,000 Safety Violations Mar Head Start. Children Deserve Better,” Heritage Foundation Commentary, November 10, 2022, https://www.heritage.org/education/commentary/over-1000-safety- violations-mar-head-start-children-deserve-better. 69. American Hospital Association v. Becerra, 596 U.S. ___ (2022), https://www.supremecourt.gov/ opinions/21pdf/20-1114_09m1.pdf (accessed March 17, 2023). 70. U.S. Department of the Treasury, Internal Revenue Service; U.S. Department of Labor, Employee Benefits Security Administration; and U.S. 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. 88, No. 22 (February 2, 2023), pp. 7236–7281, https://www. govinfo.gov/content/pkg/FR-2023-02-02/pdf/2023-01981.pdf (accessed March 17, 2023). — 502 — Mandate for Leadership: The Conservative Promise 71. 42 U.S. Code § 238n, https://www.law.cornell.edu/uscode/text/42/238n (accessed March 17, 2023). 72. U.S. 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). 73. American Pregnancy Association, “Having a Doula—What Are the Benefits?” https://americanpregnancy. org/healthy-pregnancy/labor-and-birth/having-a-doula/#:~:text=Other%20studies%20have%20shown%20 that%20having%20a%20doula,massage%20to%20reduce%20stress%20and%20anxiety%20during%20labor (accessed March 17, 2023). 74. S. 2372, VA MISSION [Maintaining Internal Systems and Strengthening Integrated Outside Networks] Act of 2018, Public Law No. 115-182, 115th Congress, June 6, 2018, https://www.congress.gov/115/plaws/publ182/ PLAW-115publ182.pdf (accessed March 17, 2023). 75. U.S. Department of Health and Human Services, “Securing Updated and Necessary Statutory Evaluations Timely,” Final Rule, Federal Register, Vol. 86, No. 11 (January 19, 2021), pp. 5694–5764, https://www.govinfo. gov/content/pkg/FR-2021-01-19/pdf/2021-00597.pdf (accessed March 22, 2023). 76. U.S. 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. 84, No. 42 (March 4, 2029), pp. 7714–7791, https://www.govinfo.gov/content/pkg/FR-2019-03-04/pdf/2019-03461.pdf (accessed March 18, 2023). 77. U.S. 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. 86, No. 192 (October 7, 2021), pp. 56144–56180, https://www.govinfo.gov/content/ pkg/FR-2021-10-07/pdf/2021-21542.pdf (accessed March 18, 2023). 78. S. 624, Title X Abortion Provider Prohibition Act, 118th Congress, introduced March 2, 2023, https://www. congress.gov/118/bills/s624/BILLS-118s624is.pdf (accessed March 18, 2023). 79. 50 U.S. Code Chapter 55, https://www.law.cornell.edu/uscode/text/50/chapter-55 (accessed March 22, 2023). 80. 18 U.S. Code § 13, https://www.law.cornell.edu/uscode/text/18/13 (accessed March 18, 2023). 81. Bowen v. American Hospital Association, 476 U.S. 610 (1986), https://tile.loc.gov/storage-services/service/ll/ usrep/usrep476/usrep476610/usrep476610.pdf (accessed 22, 2023). 82. U.S. 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. 86, No. 99 (May 25, 2021), pp. 27984–27985, https://www.govinfo.gov/content/pkg/FR- 2021-05-25/pdf/2021-10477.pdf (accessed March 18, 2023). 83. U.S. 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). 84. Heckler v. Chaney, 420 U.S. 821 (1985), https://caselaw.findlaw.com/us-supreme-court/470/821.html (accessed March 18, 2022). 85. U.S. 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). 86. H.R. 3103, “Health Insurance and Portability and Accountability Act of 1996, Public Law No. 104-191, 104th Congress, August 21, 1996, https://www.congress.gov/104/plaws/publ191/PLAW-104publ191.pdf (accessed March 18, 2023). 87. U.S. 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). 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).

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About These Correlations

Policy matches are calculated using a hybrid approach: initial candidates are found using semantic similarity between bill summaries and Project 2025 policy text, then an AI model (Llama 3.1 70B) provides detailed alignment ratings and analysis. Ratings range from 1 (minimal alignment) to 5 (very strong alignment). This analysis does not imply direct causation or intent.

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