Reports & Testimonies
GAO’s reports and testimonies give Congress, federal agencies, and the public timely, fact-based, non-partisan information that can improve government operations and save taxpayers billions of dollars.
Most Recent Reports
1 - 20 of 332 Reports
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Medicaid: COVID-19 Vaccination Data Access and Strategies Used to Improve Immunization Rates
Medicaid needs to ensure that its beneficiaries receive COVID-19 vaccines to prevent hospitalizations and deaths. But during the public health emergency, COVID-19 vaccines were provided to the public for free, and not by state Medicaid programs. Consequently, Medicaid didn't always know which of its beneficiaries had received the vaccines. We reviewed 6 state Medicaid programs and found that 4 of them got vaccination data on...
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Maternal and Infant Health: HHS Should Strengthen Processes for Measuring Program Performance
The U.S. has the highest rates of maternal and infant death of developed countries. The Healthy Start program tries to address this with 3 goals: Reduce infant death rates Improve maternal health Reduce racial and ethnic disparities in health outcomes The Department of Health and Human Services collects data to measure the program's progress on reducing infant deaths and improving maternal health. HHS said it...
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Commercial Aviation: Key Lessons from COVID-19 Preparedness and Emergency Financial Assistance to the Industry
Airlines saw a dramatic, sudden decrease in passengers due to the COVID-19 pandemic. The federal government responded—providing billions in financial assistance. What are the lessons learned from the assessment of this response? Our pandemic-related work and information from agencies and industry showed: Greater federal leadership in preparedness and disease mitigation research could better address future communicable disease threats while minimizing aviation disruptions Key lessons, such...
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Veterans Health: VA Should Improve Its Monitoring of Severe Maternal Complications and Mental Health Screenings
Pregnant veterans are more likely to have physical and mental health conditions that may lead to adverse maternal outcomes or complications. The Department of Veterans Affairs currently monitors maternal deaths and screens pregnant and postpartum veterans for mental health conditions. But VA hasn't said when it will start reviewing screening results or what demographic data it will use when monitoring severe maternal complications to address...
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Biodefense: National Biosurveillance Integration Center Has Taken Steps to Address Challenges, but Could Better Assess Results
The Department of Homeland Security's National Biosurveillance Integration Center identifies and tracks biological events—such as avian flu—from thousands of data sources. This data helps to provide early warning and situational awareness about biological events to federal, state, and other partners. NBIC has been working to address data access and other challenges. But several milestones in its strategic plans are broad and there aren't clear timeframes...
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Public Health Preparedness: Building and Maintaining Infrastructure beyond the COVID-19 Pandemic
The COVID-19 pandemic demonstrated the need for strong public health infrastructure—including a skilled workforce and physical infrastructure—to prepare for and respond to threats. The Centers for Disease Control and Prevention annually supports such infrastructure in states, localities, and territories through 2 programs. These jurisdictions also received billions of dollars in supplemental funding to respond to the pandemic. But state officials and others involved in preparedness...
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Zoonotic Diseases: Federal Actions Needed to Improve Surveillance and Better Assess Human Health Risks Posed by Wildlife
There are more than 200 known zoonotic diseases—those caused by pathogens that spread between animals and humans. Domestically, zoonotic disease risks can come from U.S. wildlife and animals imported from abroad. While federal agencies are developing a surveillance system to detect zoonotic diseases in U.S. wildlife, they could also do more to improve collaboration—including sharing information on emerging diseases. Some of the federal regulations on...
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Health Care Capsule: Accessing Health Care in Rural America
This Health Care Capsule summarizes our work on health care access in rural areas. Rural residents face several access challenges, including: Fewer health care providers, which limits access to specialized services Longer travel distances to get to health care and fewer transportation options than urban areas Less broadband internet, which limits access to telehealth services We've recommended that federal agencies learn more about the needs...
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Antibiotic Resistance: Federal Agencies Have Taken Steps to Combat the Threat, but Additional Actions Needed
Antibiotic-resistant infections can be difficult or impossible to treat. This testimony covers our work on federal efforts to address the following challenges: Surveillance—CDC doesn't have enough data on antibiotic-resistant infections in health care settings Diagnostics—More studies are needed to help develop and promote the use of tests to diagnose resistance New treatments—The pipeline of new antibiotics is inadequate and not fully federally incentivized Antibiotic use—Federal...
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Adult Drug Court Programs: Factors Related to Eligibility and Acceptance of Offers to Participate in DOJ Funded Adult Drug Courts
Adult drug courts are specialized courts for criminal offenders with substance use disorders. They work to divert individuals from the criminal justice system by offering drug treatment and rehabilitation services and incentives like reduced jail time. We looked at reasons why some individuals may not participate in these programs. We found that some people may not be eligible because of violent criminal records or mental...
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COVID-19: HHS Funds Allocated to Support Disproportionately Affected Communities
Some U.S. communities suffered more from COVID-19 than others. For example, Latinos, Blacks, and American Indian or Alaska Natives have been hospitalized at 2 or more times the rate of Whites. People over age 65, rural communities, and others also fared worse. We reviewed how Health and Human Services (HHS) allocated certain pandemic relief funds to support disproportionately affected communities. HHS provided $75 billion to...
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COVID-19 in Nursing Homes: Outbreak Duration Averaged 4 Weeks and Was Strongly Associated with Community Spread
From June 2020 through December 2021, nursing homes faced many separate COVID-19 outbreaks, with the average outbreak lasting 4 weeks. We found that certain factors increased the likelihood that a nursing home would have a longer outbreak. Specifically, transmission of COVID-19 in the community surrounding a nursing home had the strongest association, with nursing homes located in areas with high transmission more likely to have...
CARES Act: Structural Characteristics That Can Help Insulate HHS Agencies against Potential Political Interference
Four HHS agencies had key roles in the federal COVID-19 response. Our prior reports noted shortcomings to that response, including possible political interference. Some characteristics of an agency's structure may affect how insulated it is from potential political interference, including How many political appointees it has Whether it has active advisory committees with experts to guide decisions If agency officials have fixed terms These characteristics...
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Maternal Health: Outcomes Worsened and Disparities Persisted During the Pandemic
Hundreds of women in the U.S. die each year from complications related to pregnancy and childbirth. Pregnant women with COVID-19 are more likely to experience complications. We analyzed CDC data and found: Maternal deaths increased during the pandemic compared to 2018 and 2019 COVID-19 contributed to 25% of maternal deaths in 2020 and 2021 The maternal death rate for Black or African-American women was disproportionally...
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Federal Research: Information on Funding for U.S.-China Research Collaboration and Other International Activities
The U.S. government sometimes supports international research collaborations by providing funding to foreign entities—such as universities and public health organizations. This also gives U.S. researchers access to global scientific resources. From FY 2015 to 2021, federal agencies provided $28.9 million directly to Chinese entities for research and development activities. For example, the Centers for Disease Control and Prevention and National Institutes of Health awarded funds...
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Persistent Chemicals: Technologies for PFAS Assessment, Detection, and Treatment
A group of synthetic chemicals called per- and polyfluoroalkyl substances—PFAS, for short—are used in a wide range of consumer, manufacturing, and fire safety products. But these chemicals contaminate the environment and some are linked to health problems in people. More information is needed to help government agencies and others address PFAS-related risks. But this group of chemicals is large, diverse, hard to study, and difficult...
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Older Adults and Adults with Disabilities: Federal Programs Provide Support for Preventing Falls, but Program Reach is Limited
The CDC reported falls were the leading cause of death from unintentional injury among older adults in 2020. Nine federal programs specifically aim to help prevent falls or improve accessibility for older adults or adults with disabilities. They do so by providing home safety assessments, ramps, exercise programs, and more. But the programs need to share more information with one another. We also found that...
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Contact Tracing for Air Travel: CDC's Data System Needs Substantial Improvement
The U.S. Centers for Disease Control and Prevention collects information on air passengers to help local public health authorities trace the potential spread of communicable diseases (e.g., COVID-19). But some of the ways in which CDC collects and manages passengers' information make it harder to effectively facilitate contact tracing. For example, the outdated data management system CDC uses doesn't allow it to connect related cases...
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Drug Policy: Preliminary Observations on the 2022 National Drug Control Strategy
Federal efforts to prevent, respond to, and recover from drug misuse have been on our High Risk list since 2021. We testified about our preliminary observations on the Office of National Drug Control Policy's 2022 National Drug Control Strategy. The strategy is intended to reduce illegal drug supplies and demand; and promote prevention, early intervention, treatment, and recovery. Our preliminary review of the available documents...
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Scientific Integrity: HHS Agencies Need to Develop Procedures and Train Staff on Reporting and Addressing Political Interference
Public health agencies regularly use scientific methods and evidence to inform decisions. How do they protect scientific decision-making from interference for political purposes? We testified that the policies and procedures for ensuring scientific integrity at 4 agencies we reviewed do not define political interference or describe how it should be reported and addressed. Employees said they observed potential political interference but didn't report it because...