Critical Waste Issues for the 118th Congress | Citizens Against Government Waste

Critical Waste Issues for the 118th Congress



CAGW’s Critical Waste Issues for the 118th Congress details 13 policy areas that require immediate attention to eliminate government waste, fraud, abuse, and mismanagement. With the national debt reaching $31.5 trillion, and the cost of paying the interest on the debt higher than anticipated due to rising interest rates, these proposals are essential to creating a more effective and efficient government and reining in excessive spending.


Following the enactment of legislation in the 117th Congress that allocated trillions of dollars for COVID “relief,” infrastructure, and “inflation reduction,” the primary focus of the 118th Congress, in which Republicans control the House and Democrats control the Senate, should be to exercise strict oversight on how that money is being spent rather than spending even more money.  The prevailing wisdom is that divided control brings gridlock, but it also brings an opportunity to show which members of Congress are serious about protecting the taxpayers’ money. 

The budget deficit was $2.8 trillion in fiscal year (FY) 2021, the second largest in history, and $1.4 trillion in FY 2022, the fourth largest in history.  The national debt is $31.5 trillion, and the cost of paying the interest on the debt is greater than anticipated due to rising interest rates.  There could not be a more critical time for action to reduce government waste, fraud, abuse, and mismanagement, and rein in the size and scope of the federal government.

Citizens Against Government Waste (CAGW) has been exposing earmarks in the Congressional Pig Book since 1991 and publishing a comprehensive database of recommendations to consolidate and terminate wasteful and inefficient programs in Prime Cuts since 1993.  The publication of Critical Waste Issues for the 118th Congress provides a more concentrated list of some of the most important proposals that CAGW believes will result in a smaller and more efficient government.

CAGW’s Critical Waste Issues for the 118th Congress details 13 policy areas that require immediate attention, including the need for greater accountability and transparency in government, budget reform, entitlements, healthcare, privacy, and telecommunications.  Policymakers have considered but not acted upon many of these recommendations in the past, and completely ignored others.

The adoption of recommendations in Critical Waste Issues for the 118th Congress will repair the damage done by years of runaway spending and government waste and help to create a more effective and efficient government.  Excessive government spending results in greater involvement and interference in the economy and less personal freedom.  Eliminating government waste would help transfer power from Washington bureaucrats back to the states and the people, where there is usually more accountability.

CAGW’s mission reflects the interests of taxpayers.  All citizens benefit when government programs work cost-effectively and provide money to only those who are truly in need.  Duplicative and overlapping programs fail to meet those objectives.  Not only will representative government benefit from the adoption of these policies, but the country will also prosper economically because government mismanagement, fiscal profligacy, and chronic deficits soak up private savings and crowd out the private investment necessary for long-term growth.

Critical Waste Issues for the 118th Congress should be mandatory reading for taxpayers, the media, and all members of Congress as they tackle the biggest issues facing America.

Accountability, Oversight, and Transparency

The Freedom of Information Act (FOIA), enacted in 1967 to codify Americans’ right to request and receive in a timely manner any nonproprietary information that does not compromise national security, has become a black hole for both taxpayers and the media.1 

The Obama administration promised to be “the most transparent administration in history” and set out to reduce the overall FOIA backlog by 10 percent annually.2  Despite that lofty goal, the number of unanswered FOIA requests reached 200,000 in 2015, an increase of 55 percent from the 129,000 in 2014.3  To address the concerns of both news organizations and taxpayers, Congress passed the FOIA Improvement Act, signed into law by President Obama on June 30, 2016.  While the legislation gave requesters a stronger position by codifying presumptions of disclosure, it did little to make the process more substantive and efficient.

The federal government received 838,164 FOIA requests in FY 2021, a 6 percent increase from FY 2020.4  It processed 838,668 of those requests, an increase of 8.5 percent from FY 2020.  However, the Department of Justice reported that the number of backlogged requests grew by 8 percent, from 141,762 in FY 2020 to 153,227 in FY 2021.5  The average processing time increased from 30.23 days in FY 2020 to 32.99 days in FY 2021.6

A March 11, 2020, Government Accountability Office (GAO) report detailed continued delays in response time and a substantial increase in the FOIA backlog.7  The report was requested by a bipartisan group of legislators because some agencies were not fully complying with the FOIA Improvement Act.  In FY 2018, only 27 percent of FOIA requests were fully granted.  The FOIA backlog increased by 97 percent between FY 2012 and FY 2020.8  Costs to litigate FOIA requests also increased by 69 percent since FY 2012. 

The way in which FOIA staffers answer requests is also concerning.  A March 12, 2018, Associated Press analysis stated that out of 823,222 answered requests in FY 2017, 78 percent were answered as censored files or blank.9  In other words, only about one in five FOIA requests was fully answered.

As internal government information is being obscured, the two largest taxpayer watchdogs, the GAO and the 72 federal agency Office of Inspector General (OIG), continue to pay for themselves, while rooting out waste, fraud, and abuse.  A June 2016 Brookings Institution report found that “from 2010–2014, the mean annual return on investment for IGs was 13.41.”10  In other words, for every dollar spent, the OIGs brought in $13.41 in savings. 

In its FY 2023 budget request, GAO stated that since 2002 the watchdog has produced $1.26 trillion in financial benefits, with an average return on investment of $158 to each dollar spent over the previous five years.11  According to the GAO, “We have also identified on average over 1,300 program and operational benefits that produced a more effective and efficient government each year during the same time period.”12

Sufficient support for GAO and the OIGs and further reforms to the FOIA process would help demonstrate that eradicating waste, fraud, abuse, and mismanagement is being taken seriously in Washington.  It would also help overcome the institutional bias on Capitol Hill for solving problems by creating and funding new programs rather than conducting vigorous oversight to determine the effectiveness of existing expenditures.      

Members of the 118th Congress must regain the public’s trust by committing themselves to scrutinizing every corner of the federal budget, reinstating and repairing some of the government’s most powerful waste-fighting tools, and providing complete transparency for all federal government spending in an easily understood and searchable online database accessible to all Americans.    


The 118th Congress will be considering the reauthorization of the Farm Bill, which was last reauthorized in 2018.  There are numerous programs that should be eliminated or reformed during consideration of the Farm Bill or as part of the authorization and appropriations process for the Department of Agriculture (USDA) and related agencies, including the sugar, dairy and peanut programs, the Market Access Program (MAP), and the Rural Utilities Services (RUS).

The U.S. sugar program is an outdated, Soviet-style command-and-control program that uses import quotas, loans, marketing allotments, price supports, and tariffs to artificially inflate the price of sugar.  The federal government establishes a minimum price for sugar in the U.S.  In 2021, the monthly U.S. price for raw sugar price averaged $35.75, while the monthly world price averaged $18.82, making the U.S. price nearly double the world price.13  The government also imposes marketing controls, limiting how much sugar processors are allowed to sell.  These allotments are enforced and administered by a small cartel of sugar processors. 

Consumers are paying between $2 billion and $4 billion more each year in artificially inflated prices for commodities that use sugar, including baked goods, beverages, candy, cereal, dairy products, snack foods, and hundreds of other products.14  The program has been costly to the economy as well, with job losses of 17,000-20,000 annually in sugar-using industries.15  Few examples exist of more conspicuous public regulation for the benefit of entrenched special interests at the expense of taxpayers than the U.S. sugar program. 

The sweet deal for sugar leaves a sour taste for consumers and taxpayers.  The program should be replaced with market-oriented reforms to help consumers, food manufacturers, taxpayers, producers, and the environment.  Eliminating the sugar subsidies would result in a one-year savings of $1.2 billion and a five-year savings of $6 billion.16

The U.S. dairy market is a complex tangle of subsidies and price supports.  Through a series of federal Milk Marketing Orders, which are based historically on the distance from Eau Claire, Wisconsin, to where the milk is produced, the government sets minimum prices that producers must pay for Grade A milk.  These vary from region to region, and milk producers are forbidden to sell their product in another region.  The best solution for taxpayers and consumers is for milk markets to be deregulated and made to resemble other competitive industries.  Eliminating dairy subsidies would save $92.4 million in the first year and $462 million over five years.17

Programs designed to support the peanut industry have existed in some form since the early 1900s.  Originally, peanuts were subsidized with a production quota; only those who owned or leased production quotas from the government were allowed to produce.  These valuable quotas drove the cost of peanuts to nearly twice the world price.  The 2002 Farm Bill eliminated production quotas, but Congress chose to create a new direct payment program in order to compensate farmers for removing this “resource,” costing taxpayers $1.3 billion over five years. 

The direct payment program created a system of payments and counter-cyclical payments to “historic peanut producers,” or those who grew peanuts from 1998-2001.  Unbelievably, the farmers were paid regardless of whether they currently produced peanuts.

The 2014 Farm Bill eliminated direct payments, but greatly expanded crop insurance in an effort to make up for the loss of such payments.  Producers of covered commodities, including peanuts, chose in late 2014 to participate in either the Agriculture Risk Coverage (ARC) program or the Price Loss Coverage (PLC) program.  Under the PLC program, payments are made to farmers when the price for a crop dips below its “reference price.”  The Farm Bill set the reference price for peanuts at $535 per ton.  Under the ARC program, USDA makes a payment for a covered crop in any year that “actual crop revenue” for the commodity is less than its “agriculture risk guarantee.”

Many economists believe that the cost of the expanded crop insurance programs will significantly exceed initial estimates, as crop prices are beginning to fall much sooner than projected.18  On June 28, 2022, the Congressional Research Service (CRS) released a revised baseline that showed annual payments to farmers could average $7.9 billion over the next decade.19  This represents a nearly 50 percent increase over the Congressional Budget Office (CBO) estimate following passage of the 2014 Farm Bill.  Eliminating the peanut subsidies would result in a one-year savings of $53.5 million, and a five-year savings of $267.3 million.20

Formerly known as the Market Promotion Program, MAP is one of the federal government’s most blatant examples of corporate welfare.  Over the past decade, the program has provided nearly $2 billion in taxpayer money to help agriculture trade associations, farmer cooperatives, and individual companies advertise their products overseas.21  Previous beneficiaries have included successful companies like Blue Diamond, Sunkist, Tyson, and Welch Foods. 

President Obama’s FY 2012 budget proposed a 20 percent cut in MAP, but an amendment to achieve even that limited objective was struck down in the Senate.22

A June 2012 report on MAP by former Sen. Tom Coburn (R-Okla.) disclosed that some of the $20 million that was given to the Cotton Council International (CCI) in 2011 was used to create an Indian reality TV show in which designers create clothing made from cotton.  The show was intended to promote the use of cotton generally, not necessarily cotton from the U.S.  Indeed, India does not have any need for U.S. cotton, as it is a net exporter of the product, producing twice the amount of U.S. cotton growers.  MAP has provided more than $169 million to CCI over 10 years.  Eliminating MAP would result in a one-year savings of $200 million and a five-year savings of $1 billion.23

The Rural Electrification Administration (REA) was established in 1935 to bring electricity to America’s rural communities.  By 1981, 98.7 percent electrification and 95 percent telephone service coverage were achieved.  Rather than declaring victory and shutting down the REA, the agency was transformed into the RUS in 1994 and then expanded to provide loans and grants for other utilities including telephone service to underserved areas of the country.  That mission was further expanded under the 2002 Farm Bill to provide broadband services to unserved or underserved rural areas, which are generally defined as communities with populations of less than 20,000.  These services are provided in part through the Rural Broadband Access Loan and Loan Guarantee Program (BAP). 

During debate on the 2018 Farm Bill, the Senate included broadband reforms that sought to correct persistent programmatic weakness by ensuring that RUS grants and loans would not be used to overbuild in areas of the country where broadband already existed.  The Senate also sought to restrict loans to areas with two or fewer existing broadband providers, where 90 percent of households were defined as unserved.24  During the 118th Congress, similar measures should be implemented to restrict taxpayer resources from being used to overbuild existing broadband networks.

Some of the BAP’s wasteful projects include the $667,120 given to Buford Communications of LaGrange, Arkansas, (population 122) in 2009 to build a hybrid fiber coaxial network and a new community center.  This equates to $5,468 per resident of LaGrange.

The BAP program is a prime example of duplication and waste in federal broadband programs.  A May 2022 GAO report noted that despite “numerous programs and federal investment of< $44 billion from 2015 to 2020, millions of Americans still lack broadband, and communities with limited resources may be most affected by fragmentation.”25  

Federal broadband programs are offered through 15 federal agencies and departments including the USDA, the Federal Communications Commission (FCC), the National Telecommunications and Information Administration (NTIA), and the Departments of Education, Commerce, Interior, Health and Human Services (HHS), Housing and Urban Development, Treasury, and Transportation.26 Stringent oversight of not only the BAP but also other broadband programs is essential to ensure that funding is not duplicated and reaches truly underserved areas.  (Broadband programs are discussed in more detail in the telecommunications section of this publication.)

Another RUS program rife with waste is the Water and Waste Disposal System Loans and Grants Program (WWD), which was intended to improve quality of life and create jobs in rural communities.  According to a July 2012 USDA OIG report, “as of September 30, 2011, RUS had obligated $3.3 billion in grants and loans to fund 854 WWD projects throughout the United States.”27  Only three of the 22 projects examined by the OIG were completed on time, and the majority of the projects were started five to 30 months after the funds were obligated.  The RUS created only 415 new jobs through the WWD, which is “less than 20 percent of the actual jobs identified in planning estimates.”28

The OIG’s 2021 semiannual report to Congress cited an ongoing review of the RUS program.  In FY 2022, members of Congress earmarked $397.8 million for drinking water infrastructure and $443.6 million for wastewater infrastructure projects.29  The return of earmarks, as explained in the earmark section of this publication, means that even more taxpayer money will be spent on a program that is rife with waste.

CAGW’s 2021 Congressional Pig Book identified a $10 million earmark for high energy cost grants within the RUS.  Since FY 2002, members of Congress have added six earmarks for high energy cost grants totaling $113.5 million.30  Eliminating RUS would result in a one-year savings of $8.4 billion and a five-year savings of $42.1 billion.31

Budget Reform

The current congressional budget process was established in 1974 by the Congressional Budget and Impoundment Control Act, also known as the Congressional Budget Act (CBA).32  The CBA created the CBO and the budget committees in the Senate and House of Representatives.  Despite Congress’s intent for the CBA to improve the budget process, it has long been broken, and reform is crucial to improve accountability and transparency, and get government spending under control.

According to the CBA, Congress is supposed to agree on a concurrent budget resolution by every April 15 for the coming fiscal year to set spending and revenue levels, covering 21 broadly defined functions of government, and enact all appropriations bills by October 1.  However, this timeline has been mostly ignored by Congress as all appropriations bills have been passed on time since the CBA’s enactment only in four fiscal years – 1977, 1989, 1995, and 1997.  Instead, Congress has resorted to passing continuing resolutions, which provide funding similar to the previous year’s level without regard to the effectiveness of federal spending.33  

Continuing resolutions are a primary example of Congress’s inability to carry out its most fundamental duties.  Short-term spending bills undermine the ability of the government to save money by forcing agencies “to purchase fewer items at a time, rather than paying in advance for bulk orders at lower prices.  They also undermine the effectiveness of agencies by creating delays and raising costs for multi-year projects, as well as disrupting the onboarding of new employees.  Continuing resolutions are particularly problematic for the Pentagon, where multi-year contracts are essential to providing proper and timely procurement for weapons systems and other equipment needed to give warfighters the tools they need to protect national security.”34

In addition to performing the most basic job of members of Congress by simply adhering to the timeline for the budget resolution and appropriations bills, there are several reforms that should be adopted that would improve the process.  Passing biennial budgets that cover two years would bring increased stability and predictability to a chaotic process that has been subject to partisan bickering and grandstanding, last-minute giveaways, and government shutdowns.  Regular, predictable biennial budgeting would enable Congress to enact two-year appropriations in the first year and conduct vigorous oversight hearings and analysis in the second year.

Congress should also adopt zero-based budgeting.  The starting number for any expenditure would be zero, instead of starting the budget at the level spent during the previous year.  Spending on any program would then have to be justified, not merely assumed.  Congress should also enact sunset clauses to ensure that government spending does not outlive its usefulness and future expenditures can be paused.  At the same time, an evaluation of the effectiveness of federal programs can be conducted.  No program that was enacted 20 or 50 years ago should automatically be renewed.

Parallel to sunset clauses to stop the automatic renewal of federal programs is the Unauthorized Spending Accountability (USA) Act, first introduced in 2016 by Rep. Cathy McMorris Rodgers (R-Wash.).35  The objective of the legislation is to eliminate “Zombie” programs that have not been authorized and give members of Congress time to “review, rethink, and possibly eliminate programs that are no longer needed.”36  

An August 2, 2002, CBO report estimated that there are “1,118 authorizations that expired before the beginning of fiscal year 2022.”37  There was “$461 billion in funding for fiscal year 2022 for which authorizations have expired can be attributed to 422 expired authorizations contained in 163 laws—$353 billion for those authorizations with specified amounts and $107 billion for indefinite authorizations.”38  Unauthorized programs were only $35 billion 20 years ago, which at the time represented 10 percent of the discretionary budget; today, they amount to more than 30 percent of total discretionary spending.39

The USA Act requires unauthorized programs to be put on a rolling path to sunset after three years.  Each program would receive 90 percent of funding in the first year after its authorization expired, dropping to 85 percent in the second and third years, and then all funding would be rescinded after the fourth year.  The legislation would also require a sunset clause in future reauthorizations.40  

Unauthorized programs include entire departments, not just small programs.  The State Department has not been reauthorized since 2003 and the Bureau of Land Management has not been reauthorized since 1996.  In the Department of Veterans Affairs (VA), programs costing more than $60 billion annually have not been reauthorized, some dating back to 1998.41 

When a new Congress convenes, the majority party in each chamber decides the rules and procedures that will govern the Senate and House, respectively.  Democrats, who controlled the House during the 117th Congress, revived the “Gephardt Rule,” introduced by former Rep. Dick Gephardt (D-Mo.), which automatically raises the debt ceiling whenever the House passes a budget.  The Gephardt Rule was initially in effect from 1979 to 1995, when it was wisely repealed by the new Republican majority.  Its revival makes it easier to raise the federal borrowing limit, thus reducing the likelihood of cutting spending to help rein in the deficit and debt.

During his last month as House Budget Committee Chairman, Rep. Tom Price (R-Ga.) proposed six principles for budget reform, including strengthening enforcement, increasing transparency and constitutional authority, and changing the built-in bias toward higher spending.  Chairman Price recommended that rather than having the President submit a detailed budget in February, a policy-based budget should be sent to Congress on April 30, which would be after the House and Senate Budget Committees report their budget resolutions no later than April 15.42

Chairman Price’s reforms also required the President’s budget “to include an analysis of the costs of complying with all current and proposed federal regulations, prohibits any agency from adding new regulatory costs without eliminating existing regulations of the same amount, and requires the CBO and the Office of Management and Budget to create a regulatory baseline in order to estimate total regulatory costs.”43  He also suggested uniform budget rules for the House and Senate, full cost estimates prior to committee mark-ups, and an end to “gimmicks” like moving spending into or out of the last and first day of a fiscal year.

Other changes that should be made to the budget process include converting the concurrent budget resolution into a joint resolution that would be signed into law by the President; amending House rules to establish a point of order for a rule waiving applicable spending points of order; limiting the growth of entitlement spending to the current inflationary adjustment for each program and population growth; repealing the Gephardt rule; and enhanced rescission authority that would pass constitutional muster and give the President the power to eliminate wasteful spending in appropriations bills.

Congress’s inability to adhere to the requirements of the budget process proves that the system needs reform.  Following these recommendations would increase accountability, improve oversight, and increase the chances of passing the budget resolution and appropriations bills on time.

Civil Service Reform

The federal government is the largest single employer in the nation with approximately 2.1 million civilian workers.44  Salaries are paid by taxpayers, who should expect full and open accountability for how workers perform on the job and spend their time.

One of the most prominent issues that adversely impacts the effectiveness of the federal civil service is the use of “official time.”  Under the Civil Service Reform Act of 1978, federal employees are allowed to conduct union business during work hours while being paid their full salary.  These taxpayer-funded union duties include negotiating collective bargaining agreements and filing and handling grievances against the agencies where they are employed.  There is no cap on either the number of hours an individual can spend on official time or the total number of hours that can be spent on official time government-wide or within each agency. 

The Office of Personnel Management (OPM) reported that in FY 2019, federal workers used more than 2.6 million hours of official time at a taxpayer cost of $135 million.45  The 2.6 million hours of official time represents a 27.8 percent reduction from the 3.6 million hours in FY 2016, while the $135 million is a 23.8 percent reduction from the $177.2 million in FY 2016.46   The OPM report noted that, “there is no uniform government-wide requirement concerning the degree and specificity of records kept” for official time.47

In a series of executive orders (EO) issued on May 25, 2018, former President Trump attempted to crack down on abuse of official time.  One order instituted a 25 percent cap on the amount of time a federal employee is permitted to spend on union duties.  That order also barred employees from lobbying Congress while on the taxpayers’ dime, stating, “Federal employees should spend the clear majority of their duty hours working for the public.”48  

Another order streamlined the ability of departments and agencies to terminate employees in a more expedited fashion.49  A February 2015 GAO report found that it took an average of a year or longer to fire a lackluster federal worker.50  The EO instituted a 30-day cap on a worker’s mandated “Performance Improvement Plan.” 

Unfortunately, on August 25, 2018, a U.S. District Court struck down nearly all provisions in the orders51 and the U.S. Court of Appeals for the District of Columbia Circuit denied the administration’s request for an expedited appeal on October 19, 2018.52

As the broader effort at civil service reform sputters, a more focused, department-level reform has been enacted.  After the insidious wait times scandal at the VA,53 Congress passed and then-President Trump signed into law the Department of Veterans Affairs Accountability and Whistleblower Protection Act on June 23, 2017.54  The law expedites the process of dismissing an employee to less than a month, shortening a process that previously took several months or years.

The fits and starts of civil service reform make it even more critical for Congress to consider key pieces of legislation that would help accomplish the goal of a leaner and more accountable federal workforce.  On March 16, 2022, then-Rep. Jody Hice (R-Ga.) introduced the Accountable Federal Employees Act, which would have limited the use of official time by federal employees and made it easier for federal agencies to remove or demote employees for poor performance or misconduct.55

Similar legislation has been introduced in previous sessions of Congress.  On June 19, 2019, Rep. Barry Loudermilk (R-Ga.) introduced the Modern Employment Reform, Improvement, and Transformation (MERIT) Act.56  Then-Sen. David Purdue (R-Ga.) introduced companion legislation in the Senate on the same day.57  The bills would give a fired employee 30 days to appeal and double the probationary period for new hires, making it easier to dismiss employees who are not a good fit.

Federal workers who collect paychecks funded with taxpayer dollars should be held to the highest performance and ethical standards.  Any federal employee who breaches the public trust through poor performance or unethical behavior should be subject to a fair but swift termination process.  As the executive branch implements reforms, Congress should also exercise its authority to ensure that the federal bureaucracy is not taking advantage of taxpayers.

Department of Defense

As the federal budget increases every year, the budget for the Department of Defense (DOD), which is the government’s largest discretionary expenditure, could eventually eclipse $1 trillion annually.  Congress approved $782.5 billion in defense spending for FY 2022, $13.5 billion more than was requested by the Biden administration.  It was one of the highest amounts in U.S. history, accounting for approximately one-sixth of federal spending.58  The FY 2023 National Defense Authorization Act raised it to $816.7 billion, $45 billion more than was requested by the Biden administration and $34.2 billion or 4.4 percent more than in FY 2022.

To help ensure the DOD spends this money effectively and efficiently, the 118th Congress should focus on two key areas.

Financial Disarray

The DOD’s financial black hole is nowhere more evident than in its inability to pass a financial review.  It remains the sole federal agency that has not undergone a clean audit under the Chief Financial Officers Act of 1990. 

On November 15, 2021, the DOD announced that, yet again, it failed its financial examination.59  The Pentagon now estimates that its agencies will not be able to pass a clean audit before 2027, or 37 years after it was required to do so by law.  DOD officials have stressed patience, but this is hard to reconcile with the fact that this problem does not exist in any other federal agency.  It is also difficult to imagine members of Congress allowing such persistent financial ineptitude to exist anywhere else. 

The effort to improve the DOD's fiscal situation has been long and arduous.  In 2013, the Pentagon announced with much fanfare that the Marine Corps had become the first military service to attain a clean audit.60  Then-Secretary of Defense Chuck Hagel even held a ceremony on February 6, 2014, stating, “I know that it might seem a bit unusual to be in the Hall of Heroes to honor a bookkeeping accomplishment, but, damn, this is an accomplishment!”

Damn, that celebration was short-lived.  A July 30, 2015, GAO report on the Marine Corps audit stated that the DOD OIG “did not perform sufficient procedures, under professional standards, and consequently did not obtain sufficient, appropriate audit evidence to support the audit opinion.”61

In November 2018, the DOD released the results of its first-ever department-wide financial review.  Speaking to reporters on November 15, 2018, then-Deputy Secretary of Defense Patrick Shanahan stated, “We failed the audit, but we never expected to pass it.”62

The second attempt the following year ended about as poorly as the first.  On November 15, 2019, the Pentagon released its FY 2019 financial report, which provided further evidence of remarkably poor recordkeeping including $280 million in improperly tracked material at the Jacksonville Naval Air Station.63  Amongst this total was $81 million worth of items that the Navy had no idea it possessed.  The service freed up 200,000 square feet of storage space in Jacksonville by clearing out unusable materials. 

While it is highly unlikely that the Internal Revenue Service would allow private citizens to get away unpenalized with more than 30 years of financial ineptitude, legislators have been far more charitable to the Pentagon.

The necessity for the Pentagon to get its financial house in order is revealed on a regular basis.  The Defense Health Agency (DHA) spends approximately $23 billion annually on the Military Health Benefits program, supporting more than nine million active-duty service members, veterans, and their families.  The November 2021 Agency Financial Report for FY 2021 noted that improper payments for the Military Health Benefits program in FY 2021 amounted to $168 million, a 50.4 percent reduction from the $338.9 million in FY 2020.64  It expressed a 95 percent level of confidence in the accuracy of its method for identifying improper payments within the program.

However, these results were called into question by a January 11, 2022, DOD OIG report, which found that the DHA “did not have adequate processes to identify improper payments and produce a reliable improper payment estimate.”65  Because the DHA used inappropriate sampling methodology and did not undertake proper reviews, the agency is “unable to produce a reliable improper payment estimate.”66

The OIG report casts doubt on the veracity of agency-wide improper payment estimates.  The Pentagon reported a total of $2.5 billion in improper payments across nine programs in FY 2021, a decrease of $8.9 billion from the $11.4 reported in FY 2020.67  If auditing standards in these analyses were similarly insufficient, then the true amount of improper payments at the DOD would be far higher than reported.

Financial irregularities at the Pentagon have been on the GAO’s list of programs at high risk for waste, fraud, abuse, and mismanagement since 1990.  The 2021 High-Risk report contains six areas, including weapon systems acquisition, which has been on the list since 1990, and business systems modernization, first added in 1995.68

Taming the bureaucratic beast has always been and will continue to be a challenge because of institutional inertia, contractor resistance, and the Pentagon’s benefactors in Congress.  Results will not change unless legislators hold the DOD’s feet to the fire.

Poor Acquisition Track Record

The acquisition side of defense spending is also a mess, including several infamous procurement disasters that are emblematic of the Pentagon’s systemic problems.  The foremost example is the F-35 Joint Strike Fighter (JSF).

The perennial posterchild of a broken acquisition system, the JSF program has been under continuous development since the contract was awarded in 2001 and has faced innumerable delays and cost overruns.  Total acquisition costs now exceed $428 billion, nearly double the initial estimate of $233 billion.  The total costs for the F-35 are estimated to reach $1.727 trillion over the lifetime of the program, of which $1.266 trillion will be needed for operations and support.69

On April 26, 2016, then-Senate Armed Services Committee Chairman John McCain (R-Ariz.) called the JSF program “both a scandal and a tragedy with respect to cost, schedule, and performance.”70  In February 2014, then-Under Secretary of Defense for Acquisition, Technology, and Logistics Frank Kendall referred to the purchase of the F-35 as “acquisition malpractice,” a description that has yet to be improved upon.71

The JSF has been plagued by a staggering array of persistent issues, many of which were highlighted in the FY 2019 DOD Operational Test and Evaluation Annual Report, which revealed 873 unresolved deficiencies including 13 Category 1 items, involving the most serious flaws that could endanger crew and aircraft.  While this is an overall reduction from the 917 unresolved deficiencies and 15 Category 1 items found in September 2018, the report stated that “although the program is working to fix deficiencies, new discoveries are still being made, resulting in only a minor decrease in the overall number of deficiencies.”72

Cost overruns resulting from the ongoing problems have plagued the F-35.  The first comprehensive cost review of the program since 2012 found a funding gap of $10 billion over the next five years.  On September 11, 2020, Bloomberg reported on an internal DOD review of the JSF program labeled “For Official Use Only.”73  Dated June 17, 2020, the report estimated that $88 billion for research and development, procurement, and operations and maintenance would be needed over the next five fiscal years.  The DOD has officially called for $78 billion for these purposes.

According to the DOD report, much uncertainty exists regarding the final cost of the JSF because the aircraft has only logged about 2 percent of the total flight hours it will accrue over its lifecycle.  In addition, the DOD’s goal to reduce the F-35’s cost per hour of flight by $10,000 to $25,000 over the next five years “is likely to prove unachievable” because of “a lack of defined actions” to cut costs.74

Many of the problems with the F-35 program can be traced to the decision to develop and procure the aircraft simultaneously.  Whenever problems have been identified, contractors needed to go back and make changes to planes that were already assembled, adding to overall costs.  Speaking at the Aspen Security Forum on July 24, 2015, then-Air Force Secretary Deborah Lee James stated, “The biggest lesson I have learned from the F-35 is never again should we be flying an aircraft while we’re building it.”75

The high cost, delays, and underperformance of the JSF has also created a readiness gap, which has forced the Air Force to purchase older aircraft as a stopgap.  The average Air Force fighter is approximately 28 years old.76  The service’s fleet of F-16s, one of the aircraft meant to be replaced by the F-35, is on average more than 30 years old.77

Unsurprisingly, the Air Force’s readiness rates have plummeted in recent years.  Aware of the problem, former DOD Secretary Jim Mattis released a memo in September 2018 directing the Air Force and Navy to increase mission-capable rates of four aircraft (including three Air Force platforms) to at least 80 percent by the close of 2019.78  The initiative failed and was quickly abandoned by the DOD.  The Air Force’s rates have languished in the low 70s in the last four years, including 71.5 percent in 2021.79

Unbelievably, the F-35A, the Air Force’s version of the JSF, has sustained an even lower readiness rate than older service platforms.80  In 2021, 68.8 percent of F-35As were mission-capable on average, down from 76.1 percent in 2020, but a marginal improvement from the 61.6 readiness rate in 2019.81

Of course, the program’s many problems have not stopped the Pentagon from asking for funding, and members of Congress from supplying it, oftentimes exceeding the request from the DOD.  This trend continued in FY 2021, when legislators added $1.7 billion to fund the acquisition of 17 JSFs beyond the amount requested by the Pentagon.82  Upon completion of the development phase, additional funding will be needed to retrofit the JSFs purchased via earmarks, adding to overall program costs.  Since FY 2001, members of Congress have added 34 earmarks for the JSF program, costing $10.6 billion.

An October 20, 2021, letter from 89 members of the congressional JSF Caucus, chaired by Reps. Mike Turner (R-Ohio) and Marc Veasey (D-Texas) argued for even money for the F-35.83  Predictably, the legislators emphasized the importance of maintaining the domestic industrial base, where the JSF supports 1,800 suppliers and 254,000 employees.  Finite defense spending should never be used to support a jobs program.

The deficiencies that have plagued the DOD in recent years have been identified ad nauseum.  The Pentagon’s track record in addressing its financial shortcomings and procurement failures makes it evident that these problems will continue until members of Congress hold the DOD to a much higher standard of effectiveness and efficiency.


Earmarks have returned in a big way.

On February 26, 2021, House Democrats restored an open system of earmarking beginning in FY 2022.84   House Republicans and Senate Democrats followed suit shortly thereafter.85  Senate Republicans retained the moratorium on April 21, 2021, but the agreement was nonbinding, and many received earmarks.86  House Republicans again embraced earmarks by voting 158 to 52 on November 30, 2022, to reject an amendment by Rep. Tom McClintock (R-Calif.) that would have banned earmarks among the conference for the 118th Congress.87

The new earmarks, despite a futile attempt to cover them up by designating them as “Community Project Funding,” are similar to the old earmarks that were included in the appropriations bills passed by Congress during FYs 2008-2010, which required that the names of the members who received earmarks be listed in each bill.  The new rules are as follows:  each Representative is allowed to request up to 10 projects (Senators face no such limitation); requests are posted online; a list of projects funded is published when the subcommittee or committee marked up a bill; for-profit entities are not eligible; and members certify that they, their spouse, and their family have no financial interest in the project.88  Democrats also capped earmark spending at 1 percent of total discretionary spending.89

In order to receive funding, there must be “evidence of community support that were compelling factors” in deciding which projects to request.  This limitation is prima facie absurd, since it includes every expenditure from building a weapons system to programs and projects funded by hundreds of agencies and programs that include community, development, economic, or similar words in their title.90  It also describes the normal system of requesting money from competitive grant programs.  The projects that would be requested as earmarks were by their very nature not funded because the agencies rejected them based on statutory criteria established by Congress.  As a result, the end product looked awfully similar to the old system used by members of Congress prior to the establishment of the earmark moratorium. 

On July 20, 2022, CAGW released the 2022 Congressional Pig Book, which exposed 5,138 earmarks, an increase of 1,702.8 percent from the 285 in FY 2021, at a cost of $18.9 billion, an increase of 18.9 percent from the $15.9 billion in earmarks in FY 2021.  The cost of the FY 2022 earmarks was 14.5 percent higher than the $16.5 billion in FY 2010, the last year prior to the moratorium, and the number of earmarks declined by 43.7 percent from the 9,129 projects in FY 2010.91

Even though members of Congress certified that there were no earmarks in the bills subsequent to the moratorium, CAGW found on average 192 earmarks costing $9.4 billion in the 12 appropriations bills that were passed in the nine years they were enacted.  Nonetheless, the moratorium reduced earmarks under CAGW’s criteria.  In the nine years prior to the earmark moratorium, there were on average added 9,542 earmarks costing $20.9 billion.92

The 2022 Congressional Pig Book also revealed the following:

The new system of earmarking continued to benefit senators far more than representatives, as the top 50 earmark recipients by dollar featured only two legislators from the lower chamber, and Democrats far more than Republicans.  There were 273 Democrats, or 99.3 percent of the 275, who received 5,435 earmarks totaling $8,510,474,770, while 120 Republicans, or 45.8 percent of the 262, received 1,320 earmarks costing $4,952,024,395.  Because multiple legislators often requested the same earmark, the combined individual totals exceed the total number and dollar value of earmarks attributed to members of Congress in the bills.

Like the earmarks prior to the moratorium, states with smaller populations got a disproportionate amount, especially if they had members on powerful committees.  Alaska ($337.07 per resident) received the most pork per capita, calculated as dollars in earmarks relative to population, followed by Vermont ($312.51 per resident), Hawaii ($182.12 per resident), West Virginia ($164.28 per resident) and Maine ($142.38 per resident).  Alaska, Hawaii, and West Virginia were in the top three every year between 2008 and 2010.

While the inclusion of the names of members of Congress is helpful, nearly half of the cost of the earmarks was added without any attribution.  There were 163 such earmarks costing $9.2 billion, or 48.7 percent of the $18.9 billion total.  The Department of Defense (DOD) received by far the most of these earmarks, with 128 costing $8 billion.

Members of Congress will argue that their standards differ from the earmark criteria used in the Pig Book, and that these projects do not count as earmarks according to their definition.  However, the difference in the definition of earmarks between CAGW and Congress has existed since the first Pig Book in 1991.

Beyond the high percentage of anonymous earmarks, larger problems with transparency exist.  The FY 2022 earmarks were again contained in omnibus bills containing thousands of pages, which present their own challenges to determine how money is being spent.  Voting on blocks of spending bills bundled together with minimal time for review is a strong indicator of a poorly functioning legislative process.

Moreover, the earmarks were located in disparate sections of the 12 appropriations bills with varying degrees of legibility.  To undertake this analysis, CAGW staff painstakingly created a searchable database, oftentimes entering by hand information that failed to accurately scan because of blurry, barely discernable text in the legislation.  The state of the data released to the public makes a mockery of the clearly searchable database delineated by the earmark guidelines.  And the earmark requests were also not in a single database.  They can only be found on an individual members’ website.93

Earmarks fundamentally advantage the most influential legislators.  As the late Sen. John McCain (R-Ariz.) explained on May 7, 2014, regarding those making the case for a return to earmarks, “The problem with all their arguments is:  the more powerful you are, the more likely it is you get the earmark in.  Therefore, it is a corrupt system.”94

The latest batch of appropriations bills demonstrated this truth yet again.  In FY 2022, the 89 members of the House and Senate appropriations committees, accounting for just 17 percent of Congress, claimed 41.1 percent of the earmarks and 29.1 percent of the funding.95

Senate Appropriations Committee Ranking Member Richard Shelby (R-Ala.) received by far the highest dollar amount of earmarks.  His 16 earmarks cost $647,936,000, which is $270,437,000 (71.6 percent) more than the legislator in second place, Rep. Brian Mast (R-Fla.), who received six earmarks costing $377,499,000.96

Three more senators were in the top five:  Senate Appropriations Committee member Lindsey Graham (R-S.C.), who received 31 earmarks costing $361,193,000; Senate Majority Leader Chuck Schumer (D-N.Y.), who received 205 earmarks costing $316,024,824; and Senate Appropriations Committee member Roy Blunt (R-Mo.), who received 48 earmarks costing $313,265,000.  These five members of Congress together received $2,015,917,824, or 10.7 percent of the FY 2022 earmarks.97

In their first opportunity in 12 years to request the projects, 393 legislators, or 73.5 percent of Congress, took part.  With nearly three-quarters of the members now participating, it is easy to imagine the scope and cost of earmarks expanding in future years. 

Between FYs 1991 and 2021, excluding FYs 2011 and 2013 when the government ran on full year continuing resolutions, members of Congress on average added 3,851 earmarks costing $13.5 billion.  The 5,138 earmarks costing $18.9 billion added in FY 2022 are $5.4 billion greater than the average earmarks in those years.  If that amount of increase in cost continues, it will take only two more years to exceed the record $29 billion in earmarks set in FY 2006.

The most effective way to limit the cost and impact of earmarks is to ban them entirely, as proposed by members of Congress like Sen. Steve Daines (R-Mont.) and Rep. Ralph Norman (R-S.C.), who introduced, respectively, S. 501 and H.R. 1086, the Earmark Elimination Act.98  Ending the earmark moratorium has opened a can of worms.  The most probable outcome will be a proliferation in number and cost of earmarks over time.

In a September 28, 2022, report, CAGW argued that earmarks are a modern extravagance, not an ancient tradition.99  And the Constitution does not give Congress a blank check to spend tax dollars on any particular local project legislators might favor. 

As Sen. Mike Lee (R-Utah) and former Rep. Jeb Hensarling (R-Texas) wrote in their February 27, 2017, op-ed, “Letting members of Congress take credit for federal money steered to their constituents does not fix the incentive problem at the core of today’s congressional disfunction.  In fact, it would only worsen it.”  They suggested that the best way to strengthen Congress’s Article 1 legislative powers would be to “use the authorization process to reform how federal agencies spend taxpayer dollars to ensure the process for selecting funding priorities and recipients is transparent, merit-based, and consistent with congressional intent.”100  

The case against the projects is clear.  Earmarks create a handful of winners (appropriators, special interests, and lobbyists) and a great many losers (taxpayers).  They contribute to the deficit directly, by tacking on extra funding, and indirectly, by attracting votes to costly legislation that might not otherwise pass.  Earmarks corrupt democracy by eclipsing more important matters in the minds of legislators and voters.

The congressional tug-of-war over agencies’ budgets dilutes the effectiveness of federal programs and impedes progress toward national policy goals.  In the modern era, earmarks were not the last resort for many members of Congress, but rather the primary means to ensure re-election.  These problems might very well become worse in the near future as the open, organized method of earmarking has returned. 

While the earmark moratorium succeeded in significantly diminishing the number and cost of earmarks, transparency and accountability were also reduced.  The new system adds a measure of transparency, but vast improvements are needed to allow the public to meaningfully track earmark requests and recipients.


President Joe Biden made his position on U.S. energy policy clear during his campaign with his support of the Green New Deal as a “crucial framework for meeting the climate challenges we face.”101  His plan included zero emissions through a 100 percent clean energy economy by 2050, rejoining the Paris Climate Agreement, banning all fossil fuel subsidies, recommitting the U.S. to the Green Climate Fund, integrating climate change as part of the government’s strategy on foreign policy and national security, and banning new gas and oil leases on public lands.102  On his first day in office, he took several steps toward achieving these campaign promises by killing the Keystone Pipeline, placing a temporary moratorium on drilling in the Arctic National Refuge, and requiring every federal agency to account for the full cost of greenhouse gas emissions in their policy decisions.103  

He also signed a document that brought the U.S. back into the Paris Climate Agreement, which became official on February 19, 2021.104  A Heritage Foundation analysis found that the Paris Climate Agreement would destroy $2.5 trillion in gross domestic product (GDP) by 2035, waste the taxpayer’s money on the U.S. contribution to a $100 billion annual Green Climate Fund, and hurt American energy competitiveness.105  The Obama administration had already sent $1 billion in taxpayer funds to the Green Climate Fund without congressional authorization.106

After the expansion of oil and gas exploration and development under the Trump administration helped lead to U.S. energy independence and lower gas prices, President Biden undid nearly everything that his predecessor had done.  As a result of his policies, gas prices since he took office doubled to the highest in U.S. history and helped fuel the highest inflation since the 1980s.107 

Then, rather than restoring the policies that would once again make the U.S. energy independent, President Biden asked several foreign countries, including Iran and Venezuela, to supply the U.S. with oil at lower prices, and initiated the largest draw down of the Strategic Petroleum Reserve in history.  The impact of his policies on states like Louisiana, which is the third-largest producer of natural gas, and Texas, which is the largest oil and gas producer in the U.S., has been particularly problematic, since those states and other like them, depend on the income from oil and gas exploration to fund education, healthcare, and conservation programs.108

Rep. Alexandria Ocasio-Cortez (D-N.Y.) and Sen. Ed Markey (D-Mass.) were the primary sponsors of the Green New Deal during the 116th Congress, which would cost Americans as much as $93 trillion, according to the American Action Forum.  Nearly $5.4 trillion would be used for a low-carbon electricity grid, a net zero emissions transportation system would cost anywhere between $1.3 trillion to $2.7 trillion for net zero emissions transportation system; $6.8 trillion to $44.6 trillion would go to guaranteed jobs; $36 trillion would be used to fund universal healthcare; $1.6 trillion to $4.2 trillion would go to guaranteed housing; and $1.5 billion would be used for food security.109

The House of Representatives attempted to add elements of the Green New Deal like clean energy and solar tax credits in COVID-19 stimulus bills, including the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Health and Economic Recovery Omnibus Emergency Solutions Act.110  However, they were not part of the final legislation.

But some of the Green New Deal energy provisions were included in the Inflation Reduction Act (IRA).  There is a new fee on methane emissions that starts at $900 per ton and increases to $1,500 per ton after two years, which CBO estimated would raise $6.35 billion over the next decade.111 The IRA permanently reinstated Superfund excise taxes on domestic crude oil and imported petroleum products and raised the rate to 16.4 cents per barrel in 2023, with adjustments for inflation annually thereafter.112

Energy legislation is likely to be considered in the 118th Congress.  The primary principles for these bills should be to free the energy market from government intervention, ensure a secure supply of energy to meet the needs of a growing economy, and increase domestic production of critical and conventional energy resources through the innovation and creativity of the private sector.  These principles are antithetical to any plans to further advance the Green New Deal and similar proposals.


To paraphrase Willie Sutton, Congress needs to go where the money is to reduce the deficit, and it is in mandatory spending, more commonly called entitlement spending.  In the mid-1960s, discretionary spending was 67.5 percent of the budget and mandatory, or entitlement spending, was 26.1 percent of the budget.  By FY 2027, those figures will essentially be reversed, as entitlement spending is estimated to be 63 percent of the budget and discretionary spending is estimated to be 26.7 percent of the budget.113  While efforts to reduce waste, fraud, abuse, and mismanagement in discretionary spending to help reduce the deficit are always welcome, based on the percentage of the budget those programs represent, cuts in such spending will be insufficient to provide long-term relief from the impact of the continuously growing national debt and the interest payments thereon.

The three largest entitlement programs are Social Security, Medicare, and Medicaid.  Social Security cost $1.84 trillion in FY 2020, $1.23 trillion in FY 2021, and $1.206 trillion in FY 2022.  Medicare, the nation’s health insurance for those 65-plus and younger people with disabilities, cost $773 billion in FY 2020, $692 billion in FY 2021, and $751 billion in FY 2022.  Medicaid, which was expanded under the Patient Protection and Affordable Care Act (ACA), or Obamacare, in 2010, cost $458 billion in FY 2020, $521 billion in FY 2021, and $592 billion in FY 2022.114

Social Security

The 2022 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds (OASDI), stated that, “Under the Trustees’ intermediate assumptions, Social Security’s total cost is projected to be less than its total income in 2022 and all later years.  Total costs began to exceed total income in 2021.  Social Security’s cost has exceeded its non-interest income since 2010.”115

For the long term, “Under the Trustees’ intermediate assumptions, OASDI cost is projected to exceed total income in 2022, and the dollar level of the hypothetical combined trust fund reserves declines until reserves become depleted in 2035.”116

It has been known for some time that retiring Baby Boomers would significantly increase the costs of OASDI.  Through 2040, “the projected cost of Social Security generally increases faster than projected income … because the ratio of workers paying taxes to beneficiaries will decline as the baby-boom generation retires and is replaced at working ages with subsequent lower birth-rate generations.”117

The trustees addressed the size of the 75-year actuarial deficit by noting, “that for the combined OASI and DI Trust Funds to remain fully solvent throughout the 75-year projection period ending in 2096: (1) revenue would have to increase by an amount equivalent to an immediate and permanent payroll tax rate increase of 3.24 percentage points to 15.64 percent beginning in January 2022; (2) scheduled benefits would have to be reduced by an amount equivalent to an immediate and permanent reduction of 20.3 percent applied to all current and future beneficiaries effective in January 2022, or 24.1 percent if the reductions were applied only to those who become initially eligible for benefits in 2022 or later; or (3) some combination of these approaches would have to be adopted. If substantial actions are deferred for several years, the changes necessary to maintain Social Security solvency would be concentrated on fewer years and fewer generations. Significantly larger changes would be necessary if action is deferred until the combined trust fund reserves become depleted in 2035.”118

As they have before, the trustees recommended that Congress take action to “address the projected shortfalls in a timely way in order to phase in necessary changes gradually and give workers and beneficiaries time to adjust to them.  Implementing changes sooner rather than later would allow more generations to share in the needed revenue increases or reductions in scheduled benefits.”119

Social Security, along with the Supplemental Security Income (SSI) program, makes monthly income payments to insured workers and their families at retirement, death, or disability.  Social Security was created in 1935 and is the largest single program in the federal budget, paying monthly benefits to 70.5 million beneficiaries, including SSI, as of October 2022.120  That is equal to 21 percent of the U.S. population of 333,335,803 as of December 13, 2022.121

In 1930, the average life expectancy at birth was 58 for men and 62 for women and the retirement age was 65.  The younger death rate in the early part of the 20th century was due to high mortality rates in infants and children.  While that may have seemed like most people would not have lived long enough to receive Social Security benefits, a better measure for the death rate and its relationship to Social Security is to determine when a person reached adulthood.  In 1940, the percentage of population surviving adulthood from ages 21 to 65 for men was 54 percent and 61 percent for women.  If a man reached 65, he was expected to live an average of 13 years longer to 77 and a woman reaching 65 was expected to live an average of 15 years longer to 80.  If a man reached 65 in 1990, he was expected to live an average of 15 years longer to 80, and a woman an average of 19 years longer to 85.122 

But life expectancy is now higher, as a man turning 65 in 2022 can be expected to live an average of 19 more years to 84 and a woman an average of 22 more years to 87.123  The good news that people are living longer means that improving the long-term financial stability of Social Security is more critical than ever to promoting a sustainable federal budget and ensuring that earned benefits will be paid.  Reforms will entail making sacrifices and tough choices, no matter how politically unpopular, but changes must be made to avoid an even bigger financial crisis.

Currently, the earliest retirement age at which benefits can be paid is 62, but that retiree will receive only 75 to 79.6 percent of his or her full-retirement-age monthly benefit, depending on date of birth.124  The full retirement age was 65 until 1983, when Congress passed the Social Security Amendments of 1983 to gradually raise the full retirement age for people born in 1938 or later.  For example, if someone was born in 1942, the full retirement age is 65 years and 10 months.  If someone was born in 1953, his or her full retirement age is 66.  The full retirement age for those born in 1960 and beyond is 67.125

Because Americans are living longer, Social Security’s normal retirement age (NRA) should continue to be raised.  Additional changes in retirement and benefit structures must be made so the retirement program can be saved for current and future beneficiaries. 

In its July 2022 report, “Summary of Provisions That Would Change the Social Security Program,” the Social Security Office of the Chief Actuary provided a series of policy changes that would close or reduce the long-term financing shortfalls in the program.  They included reducing the Cost-of-Living Adjustment (COLA), changing the level of the monthly benefits, raising the retirement age, setting benefit levels to inflation rather than wage growth, redirecting some of the funds to an individual retirement account, and taxing benefits.126

The most aggressive proposal in COLA adjustments would be to reduce the annual amount by one percentage point for 75 years starting in December 2023.  Doing so would reduce the long-range actuarial balance shortfall by 56 percent.127  That would mean, for example, that the Social Security and SSI benefits for approximately 70 million Americans would increase by 7.7 percent instead of the scheduled 8.7 percent in 2023.128

For the NRA, the actuary suggests that after the NRA reaches 67 for those age 62 in 2022, it should be increased by 2 months per year until it reaches 69 for individuals attaining age 62 in 2034, and thereafter increased by 1 month every 2 years.  This would reduce the long-term shortfall by 57 percent, the most of any proposed change in the NRA.129

In Critical Waste Issues for the 115th Congress, CAGW called for and continues to support eliminating the indexing of Social Security benefits to wage levels and instead base it on price inflation, or Progressive Price Indexing.  Implementing this policy for middle-income and upper income families would eliminate much of Social Security’s increases being driven by higher benefit costs.130

CAGW has also called for several of the changes mentioned in the chief actuary’s report in the 2020 Prime Cuts that would provide $108.5 billion in savings over five years.  These recommendations include raising the retirement age and linking benefits to average prices instead of average earnings.131

Social Security Disability Insurance

SSDI made up 14 percent of Social Security outlays in FY 2021, costing $141 billion, and 13 percent in FY 2022, costing $142 billion.132 

A 2015 GAO report showed widespread fraud and poor oversight of the SSDI program.  From 2005 to 2014, the Social Security Administration overpaid $11 billion in SSDI benefits to beneficiaries who had returned to work and received earnings above program limits.133

GAO’s March 2019 report, “High-Risk Series: Substantial Efforts Needed to Achieve Greater Progress on High-Risk Areas,” revealed that “[m]anagement attention and efforts are needed across the government to ensure that disability programs provide benefits in a timely manner, reflect current ideas about disability, and achieve positive employment outcomes.”134  GAO found that the SSA and the VA, which also manages a disability program, struggle to meet their programs’ needs, mismanage their workloads, especially appealed claims, and rely on outdated criteria to determine whether individuals qualify for benefits.  In 2003, the GAO made 35 recommendations to SSDI and as of December 2018, 10 remained open.135


The 2022 Annual Report of the Boards of Trustees of the Federal Hospital Insurance (HI) and Federal Supplemental Medical Insurance (SMI) Trust Funds stated, “Expenditures from the HI trust fund exceeded income each year from 2008 through 2015.  In 2016 and 2017, however, there were fund surpluses amounting to $5.4 billion and $2.8 billion, respectively.  In 2018, 2019, and 2020, expenditures again exceeded income, with trust fund deficits of $1.6 billion, $5.8 billion, and $60.4 billion, respectively.  The large deficit in 2020 was mostly due to accelerated and advance payments to providers from the trust fund.  In 2021, there was a small surplus of $8.5 billion as these payments began to be repaid to the trust fund, and this continued repayment will result in a larger surplus in 2022.  Deficits are projected to return in 2023 and persist for the remainder of the projection period, requiring redemption of trust fund assets until the trust fund’s depletion in 2028.136

Established in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance to individuals aged 65 and older and those with disabilities.137  In 2021, Medicare served 63.8 million people, include 55.5 million aged and 8.3 million disabled.138  The program is run by the Centers for Medicare and Medicaid Services (CMS), which contracts with private entities to process claims, conduct audits, and oversee quality control. 

Medicare “helps pay for health care services for the aged, disabled, and individuals with end-stage renal disease (ESRD).  It has two separate trust funds, the Hospital Insurance trust fund (HI) and the Supplementary Medical Insurance trust fund (SMI).  HI, otherwise known as Medicare Part A, helps pay for inpatient hospital services, hospice care, and skilled nursing facility and home health services following hospital stays.  SMI consists of Medicare Part B and Part D.  Part B helps pay for physician, outpatient hospital, home health, and other services for individuals who have voluntarily enrolled.  Part D provides subsidized access to drug insurance coverage on a voluntary basis for all beneficiaries and premium and cost-sharing subsidies for low-income enrollees.  Medicare also has a Part C, which serves as an alternative to traditional Part A and Part B coverage.  Under this option, beneficiaries can choose to enroll in and receive care from private Medicare Advantage and certain other health insurance plans.”139

The 2021 GAO High-Risk List included Medicare, which it has since 1990, “[d]ue to its size, complexity, and susceptibility to mismanagement and improper payments,” and noted that the program “continues to challenge the federal government because of (1) its outsized impact on the federal budget and the health care sector as a whole, (2) the large number of beneficiaries it serves, and (3) the complexity of its administration.”140  High-risk areas include payments, provider incentives, and program management under fee-for-service; Medicare Advantage and other Medicare Health Plans; design and oversight of the Medicare program and its effects on beneficiaries; and improper payments. 

According to CMS, improper payments for Medicare Fee for Service (FFS), or Parts A and B, were $31.46 billion in reporting year 2022, an improper payment rate of 7.46 percent.141  For Medicare Part C, it was $13.94 billion, an improper payment rate of 5.42 percent.142  Medicare Part D, which notably is run by the private sector, had $1.36 billion in improper payments, an improper payment rate of 1.54 percent.143  The total amount for improper payments was $46.76 billion.

GAO noted that Medicare improper payments do not yet include “the potential for improper payments that may result from inappropriate use of flexibilities given to providers and patients during the COVID-19 public health emergencies.  These flexibilities included such things as the use of program waivers for telehealth services and waivers of a number of provider enrollment requirements, such as certain background checks.  Many of our recommendations that could further lower improper payment rates remain open.  For example, CMS has not implemented our recommendation from April 2016 that it seek legislative authority to permit payment for recovery auditors to conduct prepayment claims reviews.  Reviewing Medicare claims before payment can prevent improper payment.”144

The “pay and chase” method of sending trillions of dollars out from federal agencies and then going after the money when it is misspent and already in the hands of payees is far less effective than preventing the funds from being paid incorrectly in the first instance.  This is as valid for Medicare as it was for unemployment payments and small business programs under the various COVID-19 “relief” bills.  But agencies cannot conduct prepayment reviews through recovery auditors without congressional authority, which should be granted as soon as possible in the 118th Congress.

The Medicare Trustees 2022 Annual Report noted that the HI trust fund, which is supported by payroll taxes, is subjected to a greater variation in asset growth because the tax rates do not change, unless a law is passed, to meet expenditures.  For SMI, the yearly determination for Parts B and D beneficiary premiums and general revenue financing to cover anticipated costs for the following year is subject to current law.  Even though both funds are vastly different in how they are paid for, the two programs work and rely on one another to provide benefits to millions of beneficiaries.  Thus, any financing changes proposed to one program will affect the other and must be considered before implemented.145

In addition, an increasing number of beneficiaries are participating in Medicare Advantage.  Most beneficiaries can enroll in this program, which utilizes private health insurers that contract with Medicare to provide both Parts A and B, as well as other benefits not provided in traditional Medicare like vision, hearing, and dental coverage.  Use of Medicare Advantage has risen from 12.8 percent in 2004 to 43 percent in 2021.  The Trustees estimate this participation rate will rise to 53 percent in 2031.146

For SMI, the Trustees believe the fund “is expected to be adequately financed over the next 10 years and beyond because income from premiums and general revenue for Parts B and D are reset each year to cover expected costs and ensure a reserve for Part B contingencies.  The monthly Part B premium for 2022 is $170.10.”147

But the HI trust fund is in far worse condition.  The Trustees noted, “In 2021, HI income exceeded expenditures by $8.5 billion due in part to repayments of the accelerated and advance payments that were made in 2020.  These repayments are assumed to continue until September of 2022, when the outstanding balance is expected to be fully repaid, resulting in another surplus in 2022.  After that, the Trustees project deficits in all future years until the trust fund becomes depleted in 2028.”148

In the report, the trustees described their “explicit test for short-range financial adequacy” of the HI trust fund as follows:  (i) if the HI trust fund ratio is at least 100 percent at the beginning of the projection period, then it must remain at or above 100 percent throughout the 10-year projection period; (ii) alternatively, if the fund ratio is initially less than 100 percent, it must reach a level of at least 100 percent within 5 years (with no depletion of the trust fund at any time during this period) and then remain at or above 100 percent through the rest of the 10-year period.”149  The Trustees wrote, “the HI trust fund does not meet this test because estimated assets are below 100 percent of annual expenditures and are not projected to attain this level under the intermediate assumptions.  This outlook indicates the need for prompt legislative action to achieve financial adequacy for the HI trust fund throughout the short-range period.”150

Looking at the 75-year actuarial outlook, the trustees wrote, “financial outcomes are inherently uncertain, particularly over periods as long as 75 years, such estimates are helpful for assessing the trust fund’s long-term financial condition.”151  This is due to comparing dollar values now and into the future.  Also, income levels for determining eligibility for additional HI tax are not indexed, therefore more employees will be subjected to a higher tax of up to 80 percent by the end of the long-range projection period.

The trustees also offered two examples to “illustrate the magnitude of the changes needed to eliminate the deficit.”  For the HI trust fund to remain solvent throughout the 75-year projection period, the Trustees suggested that the two immediate steps to take would be to raise the current 2.9 percent payroll tax to 3.6 percent or cut expenditures by 15 percent.152

The trustees admitted that increasing taxes, cutting benefits, or making any significant reforms to Medicare would likely occur gradually; but, unless lawmakers act soon, more severe adjustments will be necessary in the future.

An October 2017 CBO report, “A Premium Support System for Medicare: Updated Analysis of Illustrative Options,” said such a system could save taxpayers $419 billion between 2022 and 2026, without grandfathering; in other words, requiring all Medicare beneficiaries to move to the premium support program, like Medicare Advantage, once it began.  The savings would come about because competing private insurers would help to drive down premium costs.  As a result, there would be a lower federal contribution compared with FFS costs per capita.153  If grandfathering were allowed, enabling beneficiaries to choose to stay in the current Medicare program after the premium support program began, the CBO found that net federal spending for Medicare would drop by $50 billion between 2022 and 2026.154

Keeping Medicare “off the table” during the 118th Congress will not do any favors for taxpayers, beneficiaries, or future generations.  Decisions need to be made and pushing reforms to future Congresses and administrations will only make it more difficult to maintain the benefits that have helped tens of millions of Americans since Medicare was established in 1965.


Medicaid is the largest public health program serving low-income individuals and families.  In August 2022, Medicaid enrollment was 90.55 million, consisting of 83.94 million in Medicaid and 7.05 million in the Children’s Health Insurance Program (CHIP).  This represents an increase of 19.86 million, or 28.1 percent from the 70.69 million enrolled in February 2020, prior to the onset of the COVID-19 pandemic.155  Medicaid is a jointly funded, federal-state health insurance program.  When the program was created in 1965, it provided health insurance to low-income children, caretaker relatives, the elderly, the blind, and the disabled.  Through the years, other individuals became eligible for Medicaid, especially after it was expanded to include able-bodied adults under Obamacare.156

The federal government matches every dollar spent by the states with a calculated amount dependent on per capita income, called the Federal Medical Assistance Percentage (FMAP), and a multiplier, which can vary from year to year.  The minimum matching rate is 50 percent, which was temporarily increased by 6.2 percentage points to 56.2 percent between 2020-2022 due to the COVID-19 pandemic.157  

Medicaid is not only expensive, but also invites fraud.  In 2021, the HHS OIG was able to obtain 1,105 convictions for Medicaid fraud and patient abuse or neglect, get 716 civil settlements and judgments, ban 540 individuals or entities from federal funded health programs, and recover $1.7 billion in civil and criminal payments, with a return on investment of $5.36 for every dollar spent.158  Improper payments were $80.57 billion for Medicaid in 2022, a rate of 15.62 percent.  CHIP had $4.3 million in improper payments and a rate of 26.75 percent; 71.2 percent greater than the Medicaid rate.159

Obamacare allowed states to expand Medicaid coverage to nearly all low-income people under the age of 65, including able-bodied adults with incomes at or below 138 percent of the federal poverty level.  Medicaid expansion under Obamacare also provides a much larger FMAP payment.  Starting in 2014 and through 2016, the federal government covered 100 percent of Medicaid expansion dollars.  In 2017, that amount dropped to 95 percent, gradually diminishing to 93 percent in 2019 and to 90 percent in 2020 and beyond.160

According to the CBO, about 18 million adults will receive insurance through Medicaid expansion in 2021 at a cost of $22 billion,161 compared with 11.4 million people who obtained private insurance by April 2020 through the Obamacare marketplaces.162  As of January 2023, 12 states have not adopted Medicaid expansion while 39 states and Washington, D.C., have expanded or will soon be implementing expansion.163

According to Brian Blase, a former special assistant to President Trump at the National Economic Council and now a policy consultant, Medicaid enrollment increased by about 13 million people and is the main vehicle that reduced the uninsured in the United States.  He noted that the “massive expansion of Medicaid – a welfare program that traditionally served low-income children, pregnant women, seniors, and individuals with disabilities – is not what the ACA’s proponents talked about when selling the law to the American people.  Medicaid expansion crowds out services for more vulnerable populations on the program and has generally had disappointing health results.  The expansion increased the number of services provided to recipients and generally boosted financial protection, but also let to an increase in unnecessary emergency department use. 

The impact on the health of enrollees is less clear.  One study found that expanding the population of Medicaid enrollees has led to longer waiting times for care.  Another study found that states that expanded Medicaid had a significant slowdown in ambulance response time.  For some people with pressing medical conditions, this slowdown could be life-threatening.”164

A January 23, 2020, Forbes article by Andrew Millsap, “Medicaid Spending is Taking Over State Budgets,” discussed how the program has increased from an average of 12 percent of state budgets in 2000 to an average of 17 percent and is still growing.  States that spent the largest percentage of their state revenue on Medicaid in 2017 were Louisiana, Massachusetts, Missouri, New York, Pennsylvania, and Rhode Island.  New York spent almost 30 percent and Massachusetts spent 22 percent, with the other states’ percentages between these two figures.  Only four states spent less than 10 percent of their budgets on Medicaid in 2017:  Hawaii at 8.2 percent, Idaho at 9.9 percent, Nevada at 9.4 percent, and Utah at 5.8 percent.165

Millsap pointed out that as more of a state’s budget is consumed by Medicaid, there is less money for other government services like education and infrastructure.  For example, Louisiana doubled its share of revenue spent on Medicaid from 2000 to 2017, and its budget for education declined by 16 percent.  Alaska saw a 14 percent decrease in education as Medicaid increased from 3 percent to 13 percent of the budget.166

Like the wildly inaccurate estimates for Medicare, the figures for Medicaid were way off.  In 1965, the House Ways and Means Committee predicted Medicaid would cost $238 million in its first year; its cost was more than $1 billion.  By 1971, Medicaid spending reached $6.5 billion, far more than anyone estimated.  In 1969, the Senate Finance Committee reported the following:  “Expenditures under the Medicaid program have increased much more rapidly than anyone had anticipated.  Between 1965 and 1970, total Federal, State, and local costs will have risen from $1.3 billion to $5.5 billion.”167

It has been said that it will only be a matter of time before Congress looks to decrease the 90 percent FMAP for Medicaid expansion, relying on the states to pick up the remaining cost for the ACA-created program.  In December 2018, the CBO provided this option to reduce the national debt.168  During the deficit reduction talks in 2011, former President Obama offered this option as a budget pay-for, worth $100 billion over 10 years.169

The best way to reform and restrain Medicaid spending while introducing more innovation and oversight and providing better care to beneficiaries is by using federal block grants or per capita allotments while turning over full control of the program to the states.  Enabling patients to use Medicaid funds to obtain private insurance that would compete for their business could be accomplished by adopting the ideas in the Health Care Choices Proposal and the Republican Study Committee’s (RSC), “The RSC Health Care Plan: A Framework for Personalized, Affordable Care,” which are discussed in the healthcare reform section of this publication.

Federal Real Property

The federal government is the most prominent property owner in the United States.  GAO reported that the federal government’s real estate portfolio included “about 130,000 domestic civilian buildings as of fiscal year 2019 that cost billions of dollars annually to operate and maintain.”170  A 2022 CRS report found that, “In FY2021, federal agencies owned 7,697 buildings that were vacant (unutilized), and another 2,265 that were partially empty (underutilized).”171

The federal government has repeatedly shown that it can neither manage its existing properties nor justify the amount of empty land it owns, which are among the reasons why the GAO has had federal real property management on its High-Risk List since 2003.172  The March 2019 High-Risk Series report noted that, despite “high-level attention” to improve real property management, “federal agencies continue to face long-standing challenges, including: (1) effectively disposing of excess and underutilized property, (2) relying too heavily on leasing, (3) collecting reliable real property data for decision making, and (4) protecting federal facilities.”173  The GAO noted that the Federal Real Property Profile (FRPP), which was created in 2004, was unreliable and inaccurate.  While the DOD has almost half of the government’s buildings, the data provided for the FRPP was not dependable.  The GAO suggested that the Office of Management and Budget, which works with GSA to maintain and update the FRPP, should “refocus agency attention on meeting space reduction targets …”174

An October 28, 2022, GAO report found that a lack of proper maintenance of federal real property has led to deferrals and a backlog that may “diminish the performance of these systems and…shorten their useful lives.”175  Between 2017 and 2021, the costs arising from deferred maintenance and repairs increased by $61 billion, or 406 percent, from $15 billion to $76 billion.  The dramatic increase was caused by funding constraints at the agencies responsible for property maintenance, increased costs to repair real property, deliberate deferrals of repairs and maintenance, and changes in data collection.  It clearly demonstrates that federal agencies lack the capacity or willingness to adequately maintain the real property under their control.

The McKinney-Vento Homeless Assistance Act of 1987 (McKinney-Vento Act) requires that excess federal property be offered to states, municipalities, or nonprofit groups that provide services for homeless people before such property can be sold to anyone else.176  In addition, under the status quo, empty office buildings cannot be sold without agencies first undergoing a complex and rigorous review by the General Services Administration (GSA).  When the GSA Public Buildings Service reports a property as excess, that property must first be screened for use by other federal agencies.  If another agency wants it, that agency gets it.  If the property remains unclaimed by every eligible agency, according to Title 40 of the U.S. Code and Title V of the McKinney-Vento Act, it must be screened for use by providers of homeless shelters, who can use the property for free.  A June 2015 GAO report found that only 122 of 40,000 screened federal properties had been transferred to homeless advocacy groups since the law’s enactment in 1987.177

If shelters are not interested, the property is screened for other public uses and sold for up to a 100 percent discount of market value.  Finally, if no public service can be identified, the property is auctioned and sold.178

A February 2016 CRS report found that this requirement can add months or years to the divestment process.179  A month after that report was published, former Rep. Jeff Denham (R-Calif.) told the Los Angeles Times that this existing requirement meant that, “[a] homeless advocacy group could actually put a hold on any property that we were trying to sell.  That created a disincentive for agencies actually trying to sell.”180  

Rep. Denham was the sponsor of the Federal Asset Sale and Transfer Act of 2016 (FASTA), which created the Public Buildings Reform Board (PBRB).  The board was tasked with identifying up to $7.25 billion in potential opportunities to sell, consolidate, dispose of, or redevelop underutilized and vacant federal properties over five years, including $750 million in the first six months after FASTA was signed into law in December 2016.  The law also requires GSA to provide and maintain a public database of federal property assets.181 

A January 29, 2021, GAO report on the PBRB questioned the evaluation process for the sale of these properties as “vague or incomplete” and recommended increased documentation and transparency for future decisions.182  The report noted that even with increased efficacy in the evaluation process, the PBRB’s ability to find appropriate properties would be challenging since there is a lack of reliable data from the FRPP. 

For example, the FRPP listed the GSA Auburn, Washington Complex as being utilized by five agencies, yet a trip to the property revealed that the “warehouses were vacant and few staff were available at the buildings.”183  This report was issued 11 months after a February 2020 GAO report on the accuracy and usefulness of FRPP data, which includes about 398,000 buildings, structures, and land, determined 67 percent of property addresses were incomplete or improperly formatted.184  The GAO cited water towers in Maryland and antennas on top of buildings in Alexandria, Virginia, and Washington, D.C., as among the inaccurately identified properties.185

Another proposal to resolve longstanding issues regarding federal property assets was made by the RSC’s February 6, 2020, Government, Efficiency, Accountability, and Reform (GEAR) Task Force report, which recommended selling excess space that is either unused or underutilized by agencies of the federal government.186  In an effort to turn that proposal into law, in the 116th Congress Rep. Greg Murphy (R-N.C.) introduced H.R. 6128, the Eliminate Excess Space Act.187 

This legislation would streamline the approval process for eliminating excess federal property, including removing the requirement for agencies to have access to them before screening for other potential transactions.  CAGW President Tom Schatz suggested that every member of Congress should support the Eliminate Agency Excess Space Act, since “There is nothing more sensible than getting rid of excess property” … and [t]he legislation will give the tools to identify and eliminate unneeded real estate …”188

The divestiture of federal property should be simple, but instead it has been complex, convoluted, and costly.  Commonsense reforms like those proposed in H.R. 6128, along with the implementation of GAO recommendations, would improve real property maintenance and more efficiently dispose of excess federal property across the country, saving taxpayers $15 billion over fifteen years.189


Healthcare costs have long been a significant concern for taxpayers and voters across the country.  During the 2020 election cycle, it was the number two issue among voters after the economy.190  That sentiment was reflected again in a February 16, 2022, Pew Research poll, which found that reducing healthcare costs was the second biggest concern for voters after strengthening the economy.191

The 117th Congress acted on healthcare through the IRA of 2022.192  The legislation included an extension of Obamacare premium subsidies and the establishment of price controls on pharmaceuticals, the latter of which has been the subject of numerous comments and reports by CAGW.193  The price control provisions will be devastating to patients by stifling the innovation needed to find cures and treatments for deadly diseases.  However, the IRA did not include the Medicare for All Act and similar bills that would have substantially expanded the role of the federal government across the entire healthcare system. 

CAGW has long advocated for comprehensive healthcare reform.  Some of the organization’s key recommendations were laid out in the 1998 investigative report, “Patient-Centered Healthcare:  The Road to Wellville,” which described how patients should be allowed to take control of their healthcare decisions.  The report called for individuals to be given the same tax break that is enjoyed by employers, so they can buy health insurance with pre-tax dollars, which would both increase competition for quality healthcare and give patients more decision-making power.194  CAGW has since promoted similar patient-centered recommendations in many blog posts, op-eds, and publications, including the 2021 issue brief, “Government-Run Healthcare Will Harm Patients and Eliminate Consumer Choice.”195

When politicians discuss healthcare, they conflate healthcare and health insurance.  While these two concepts are interwoven, they are dissimilar.  The United States offers some of the best quality healthcare in the world, yet the arguments surrounding the delivery systems for insurance and who should pay for it vary.  One school of thought demands a national healthcare system riddled with layers of bureaucracy, while the other envisions a patient-centric approach to healthcare reform.

Unfortunately, government bureaucracies, subsidies, and red tape have distorted the medical marketplace, resulting in higher prices and less access for patients.  The artificially lower costs subsidized by the taxpayers are part of an unsustainable system.  Medicare for All and other universal healthcare proposals would shift even more decision-making power to bureaucrats, while the current federal healthcare system, the ACA, is a costly one-size-fits-all approach that provides few options for individual healthcare needs.  America’s healthcare system should promote competition and innovation and give patients more choice and control.

Reform the Affordable Care Act

The establishment of Medicare and Medicaid in 1965 was one of the major milestones promoting a government-run health system in the U.S.196  Coverage was provided for the elderly, disabled, and low-income individuals. 

The passage of the ACA was the next largest government takeover of healthcare in the United States.197  While the ACA increased the number of insured Americans, it also increased costs to taxpayers and left fewer options for patients with private insurance coverage.  As of August 2020, 70 percent of U.S. counties either had no insurer options or only two choices, compared to 36 percent in 2016.198

The national average monthly premium paid by those with private healthcare coverage in 2013 was $244, and by 2019 it increased by 129 percent to $558.199  The negative effects the ACA has had on private coverage could not be clearer.  Nearly doubling the cost of insurance and subsidizing the market through tax dollars for those on government insured plans is not a viable long-term solution.200

Yet, many ACA proponents want to both spend more money and steer all Americans into so-called “free healthcare” through a government-run healthcare system.  The Veterans Health Administration (VHA) is a good example of how a government-run healthcare system that lacks competition and incentives to improve care will fail.  The VHA system has long wait times, price controls that have led to denial of care, bureaucratic inertia, fraud, and abuse.201  A March 7, 2018 VA OIG report found $92 million in overpriced medical supplies, more than 10,000 pending appointments for prosthetics, and a lack of consistently clean storage areas for medical supplies and equipment.202  This is the sad reality for veterans today and a warning sign against further expansion of the government’s responsibility for everyone’s healthcare.

Since its enactment in 2010, several unsuccessful efforts have been made in Congress to repeal the ACA.  During the 117th Congress, Rep. Andy Biggs (R-Ariz.) introduced H.R. 6515, the Responsible Path to Full Obamacare Repeal Act, which would fully repeal the ACA.203  However, the legislation has only six cosponsors, there is no Senate companion bill, and Republican candidates for Congress in 2022 did not call for repeal of the ACA.204

The ACA is also supported by President Biden and enough Senate Democrats that attempts to repeal the program will be ultimately defeated.  The best options are therefore reforming the program and shifting more power over healthcare to the states.  The diversity of the U.S. population requires such state-based options instead of the failed one-size-fits-all approach required by the ACA.

ACA reforms should include lowering out-of-pocket costs, premiums, and deductibles, along with increasing private coverage options.  These reforms would increase patient choice and control and lead to better healthcare outcomes.

Eliminate Price Controls

The price controls on pharmaceuticals that were included in the IRA will devastate future research and development of new life-saving medicines, and significantly reduce future treatments and cures.  CAGW has released numerous reports on the damaging impact of price controls since 2000, including the provisions of the IRA.205 

An August 2021 CBO report on the Simulation Model of New Drug Development projected that H.R. 3, on which the price control provisions of the IRA are based, would decrease the number of new drugs entering the marketplace by 8 percent in the third decade following enactment, resulting in at least 60 lost treatments.206 

Another analysis of government price controls over the pharmaceutical marketplace deemed the CBO projection too conservative, finding the potential loss of future cures to be much greater.207  In a November 29, 2021 issue brief, University of Chicago economists Dr. Thomas Philipson and Troy Durie found that H.R. 5376 would reduce R&D spending by $663 billion and that “188 new indications will not get new prevention, treatment, or cures through 2039 … and lead to 331.5 million fewer life years through 2039 … 31 times as large as the 10.7 million life years lost from COVID-19 to date.208  These estimated effects on the number of new drugs brought to market are 27 times larger than projected by CBO,209 which finds only five drugs will be lost through 2039, equaling a 0.63 percent reduction.”210 

CAGW has long been concerned about the push toward increased government overreach into the medical marketplace and the negative consequences price controls have on research and development.  Congress has continually attempted to implement price control legislation disguised as “negotiations” for Medicare Part D coverage, like the language included in both the H.R. 3 and the Build Back Better Act, and enacted in the IRA during the 117th Congress, which will have a significant negative impact on future cures, leaving “an invisible graveyard of patients.”211  Instead of imposing additional price controls on the innovative biopharmaceutical marketplace, Congress should instead incentivize new drug development by creating an environment that encourages innovation and remove burdensome regulatory barriers, including a more expedited drug approval process that would bring pharmaceuticals to market sooner and at a lower cost. 

Congress should also repeal the price controls that were included in the IRA, as proposed by Sen. Mike Lee (R-Utah) in S. 4953, the Protection Drug Innovation Act.212  Sen. Lee said, “Price controls never work.  Instead, they exacerbate the problems they seek to resolve.  Mandating fixed prescription drug prices will ultimately result in the shortening of American lives.  Instead of repeating past mistakes, it’s time we address what’s driving the cost of prescription medications and adopt a regulatory environment that works to everyone’s advantage.”213  

The negative impact of the IRA on research and development was swift, as less than three months after it was signed into law, Eli Lilly and Company announced that it was stopping research on a $40 million cancer drug, which “in light of the Inflation Reduction Act, … no longer meets our threshold for continued investment,” and research on a drug to treat Stargardt disease, a rare eye disorder, was suspended by Alnylam because the company needed “to evaluate the impact of the Inflation Reduction Act.”214  Passage of Sen. Lee’s legislation would help to eliminate the adverse impact of price controls and ensure continued access to future cures and treatments for all Americans.

Reform the 340B Program

The 340B drug discount program, created in 1992 by Congress, is overseen by the Health Resources and Services Administration (HRSA), an agency within the HHS.  It requires pharmaceutical manufacturers that want to participate in Medicaid to provide heavily discounted outpatient pharmaceuticals (as much as 50 percent) to certain healthcare facilities, called “covered entities,” which include federally qualified health centers; Ryan White HIV/AIDS grantees; children’s, disproportionate share, free standing cancer, and sole community hospitals; and specialized clinics.215  

The covered entity, or its contract pharmacy, is supposed to pass along the savings from the discounted drugs to their low-income patients, but that has not occurred due to vague language in the law and regulations along with other factors.  The abuse of the program accelerated beginning in 2014, after the ACA expanded the type and number of entities that could benefit from the program.

In June 2020, the Drug Channels Institute reported that 340B drug purchases reached $29.9 billion in 2019, an increase of 23 percent over 2018 and more than 232 percent since 2014.216  In 2021, the total was $43.9 billion, a 16 percent increase over 2020.217

A January 2018 House Energy and Commerce Committee report on 340B identified insufficient oversight, unreliable data, and inadequate reporting requirements.  The program’s failures were the result of several factors, including the lack of clear statutory intent and definition of an eligible patient, as well as lax requirements to report savings and how that money is being used.  The committee’s reform recommendations included an increase in HRSA’s regulatory authority and resources to oversee and administer the program, clarification by Congress of the intent of the program, and greater transparency on charity care provided by covered entities.218

A November 2021 Xcenda study found that since 2004, newly registered 340B disproportionate share hospitals tend to be in higher-income communities compared to hospitals that previously joined the 340B program.  The study noted, “Today, there are nearly 30,000 unique 340B contract pharmacy locations compared to just 1,300 in 2010; that was the year when HRSA updated its guidance to allow hospitals and other covered entities to have an unlimited number of contract pharmacies, instead of limiting the program to covered entities with no on-site pharmacy.”219

In a wide-ranging analysis of Richmond Community Hospital, owned by Bon Secours, which was supposed to reinvest profits from 340B drug sales into its facilities and improve patient care, a September 24, 2022, The New York Times article reported that the money was being used instead to invest in facilities in the city’s wealthier neighborhoods.  Dr. Lucas English, who worked in the hospital’s emergency department until 2018, said, “Bon Secours was basically laundering money through this poor hospital to its wealthy outposts … It was all about profits.”220  Dr. Peter B. Bach, who has written about the increased number of clinics opened in wealthier areas using 340B profits, said the hospitals are “nakedly capitalizing on programs that are intended to help poor people.”221

There have been sufficient reports by Congress, the media, and outside organizations about the corruption, cost, failure, and abuse of the 340B program.  All that remains is the will to get the job done, which will both save the taxpayers money and give low-income patients the discounts on drugs that they have long deserved.  Eliminating the horrors that have been exposed about this program should be a top priority for the 118th Congress. 

Stop Overregulation of Pharmacy Benefit Managers

Pharmacy Benefit Managers (PBMs) were established in the 1960s as part of the claims administration process for health insurance companies and employer health plans.  They helped to simplify and reduce the cost of administering benefits through the development of plastic drug benefit cards, pharmacy networks, and mail order/delivery for medications.

PBMs serve more than 266 million Americans nationwide who obtain their health insurance from employers, unions, state governments, insurers, and other entities.  They save an average of $962 per patient annually.222  The number of patients PBMs serve is growing due to the efficiencies and savings that they provide.  

PBMs use a variety of tools like rebates, pharmacy networks, drug utilization review, formularies, specialty pharmacies, mail-order and audits to drive down drug costs, improve quality, increase patient medication adherence, and prevent fraud.  PBMs can negotiate on behalf of large groups to lower prices for their customers.  Employers, governments, and unions looking to offer competitive healthcare insurance packages to their employees and members have the option to use PBMs and voluntarily choose to do so because of the many benefits including cost savings.

A July 2019 GAO report, “Medicare Part D: Use of Pharmacy Benefit Managers and Efforts to Manage Drug Expenditures and Utilization,” examined how PBMs are used in voluntary Medicare Part D drug plans in response to a request for such a study from Sen. Susan Collins (R-Maine) and Rep. Richard Neal (D-Mass.).  GAO examined “1. the extent to which plan sponsors utilize PBMs to deliver drug benefits; 2. how PBMs earn revenue from the services they provide to Part D plan sponsors; 3. trends in rebates and other price concessions obtained by Part D plan sponsors and PBMs from drug manufacturers and others; 4. the extent to which prices for Part D drugs are discounted off of manufacturer list prices; and, 5. what is known about the savings and other effects of utilization management services commonly used in Part D plans.”223

In 2016, which was the most recent year for which GAO could get such information, PBMs were used by drug plan sponsors, like insurers, to provide 74 percent of drug management services, while the sponsors provided the remaining 26 percent.224  Total gross expenditures in Part D were $145 billion, with PBM-negotiated rebates and other price concessions offsetting that amount by $29 billion, or 20 percent, to $116 billion.225

While rebates and other price concessions grew faster than Part D net expenditures from 2014 to 2016, at 66 percent and 13 percent respectively, PBMs retained less than 1 percent of the rebates and passed the rest to their plan sponsors.226  The plans use these savings to help offset the growth in drug costs and keep drug benefit premiums low for Medicare beneficiaries.  GAO also found PBMs are primarily compensated by fees obtained from plan sponsors, not the rebates.

Despite the evidence that PBMs play a valuable role in the pharmaceutical industry, legislation has been introduced in Congress to interfere in these private agreements by imposing price controls and rate regulations in a vibrant and competitive market.  S. 4293, the Pharmacy Benefit Manager Transparency Act of 2022, would have imposed price controls and unnecessary regulations over PBMs and increased drug prices rather than lowered them, and harmed patients.227  While the bill was reported out of the Senate Commerce, Science, and Transportation Committee, it fortunately did not pass in the Senate or House.  Efforts to control PBM private sector negotiations move power away from patients and put it in the hands of government.  Price controls of any kind decrease competition and result in higher costs for all.  

S. 4293 would also give unprecedented power over PBMs to the Federal Trade Commission (FTC).  As CAGW noted in its May 25, 2022, comments to the FTC on the agency’s proposed review of the impact of PBMs’ business practices, “CAGW has for many years been involved in the debate over the regulation of pharmacy benefit managers (PBMs) as part of the effort to lower drug costs.  The organization has consistently argued that government meddling in this area does the exact opposite and raises costs.  … Since PBMs provide benefits for multitudes of employers and millions of patients, they are able to bring to bear increased negotiating power and get substantial price discounts from pharmaceutical companies based on volume.  The savings are passed on to health plan sponsors, like employers, and consumers. … The perceived need for a new review of PBMs is puzzling since the FTC has previously and repeatedly determined that PBMs benefit consumer welfare and that restrictions on PBMs would be anticompetitive and raise prices.  Other government and private sector studies have drawn similar conclusions. ”228

While patients should know what to expect their drugs cost at the pharmacy counter, exposing private negotiated agreements will increase rather than decrease costs.  Price controls and overregulation never reduce costs for any product or commodity.  S. 4293 will further distort the medical marketplace by initiating transparency requirements that would reveal proprietary pricing information among different providers with private contracts.  No other private business is required to disclose detailed financial information of this nature.  Instituting these anticompetitive requirements will prevent PBMs from operating as efficiently as they are today. 

Implementing unnecessary and harmful oversight over PBMs will limit their ability to save money for their customers.  S. 4293 would take power away from patients and give it to government bureaucrats, opening the door to price controls and manipulation.  PBMs provide a valuable service in delivering drug benefits and lower costs to patients.  Instead of interfering in this successful process, Congress should continue to encourage private-sector negotiations to create an environment that will spur competition, innovation, and increase healthcare quality for patients.

Expand Association Health Plans

Expanding the opportunities to shop for and purchase health insurance would improve the healthcare system.  Even though the manner in which Americans work today has evolved with new options to work using the gig economy, contracting, or other self-employment options, attaching health insurance to employment, which was first implemented during the 1940s, remains the primary method.229 

Nearly 80 years later, attaching health insurance to employment is an archaic process that has left millions of Americans with few options.  This issue was exacerbated during the COVID-19 pandemic, when nearly 12 million Americans lost employer-sponsored coverage.230  Linking employment to healthcare no longer makes sense and puts Americans at risk.  Instead, healthcare insurance should be easily shopped and purchased like home and auto insurance, not offered mostly through one’s employer or the government.

One solution to increase marketplace choices for consumers would be to expand association health plans, which allow patients to group as members of an association to access health insurance coverage and care, thus lowering costs and increasing options.  This allows small companies, freelancers (like those engaged in the gig economy), and self-employed individuals to access health insurance savings, like those available to large group medical insurance coverage.231  Sen. Rand Paul (R-Ky.) has long been an advocate of expanding association health plans to grant eligibility to more groups and individuals. 

Expand Health Savings Accounts

Health savings accounts (HSAs) offer tax advantages for healthcare expenses by allowing pre-tax contributions up to $3,650 for individuals and $7,300 for families with high deductible health plans (HDHP).232  HSAs are a great savings tool, but must be coupled with a HDHP, meaning millions of Americans don’t have access to an HSA, including many Medicare patients.  Even though Medicare patients have Medicare Advantage they still don’t have access to the additional benefits of an HSA.  More than 63 million of the patients with HDHP’s and access to HSAs utilize the benefits of their HSAs.233 

Expanding HSAs to all Americans would improve their ability to save and make more affordable healthcare choices available to all.  Eliminating the requirement that HSAs be coupled with HDHPs is a clear and simple fix.  By casting a broader net to include all Americans, especially those who are younger, and allowing them to save and invest in an HSA, patients will be empowered to make their own medical decisions, while pursuing financial independence instead of relying on the government.

Increase the Availability of Telehealth 

Unlike traditional healthcare, telehealth offers alternative means for underserved communities, particularly in rural or remote areas of the country, to access much-needed medical care primarily online using smartphones, computers, or tablets.  Telehealth is not intended as a substitution for in-person care, but it provides an alternative pathway for patients to connect with their doctor and other providers. 

Since the passage of the ACA in 2010, 129 rural hospitals in the United States have closed.234  On August 3, 2020, President Trump issued an EO, “Improving Rural Health and Telehealth Access,” to further expand telehealth services and ensure continued access to healthcare for rural

Americans during the pandemic.235  Following the release of the EO, more than 60 services were added to the Medicare telehealth list.236   

The administration also called upon Congress to further expand telehealth options across the country.  Former Centers for Medicare and Medicaid Services Administrator Seema Verma stated, “Telehealth has long been a priority for the Trump Administration, so we started paying for short virtual visits in rural areas long before the pandemic struck.  But the pandemic accentuated just how transformative it could be.  Several months in, it’s clear that the healthcare system has adapted seamlessly to a historic telehealth expansion that inaugurated a new era in healthcare delivery.”237

The COVID-19 pandemic opened America’s eyes to successes and failures in the medical marketplace, as well as the critical need for alternative healthcare options during times of crisis.  During the height of the pandemic, 41 percent of patients abstained from necessary medical care due to restrictions imposed to help avoid the spread of the disease.238  To help increase access for these patients, the Trump administration expanded coverage for Medicare telehealth services and providers.239  

In April 2020, the Federal Communications Commission launched a program to promote telehealth opportunities in response to the COVID-19 pandemic, providing more than $200 million to providers under the CARES Act to assist in starting up telehealth programs for their patients.240  As of January 26, 2022, 447 awardees had received funding through the program, with commitments totaling $256,378,567.241

H.R. 1332, the Telehealth Modernization Act, introduced by Rep. Buddy Carter (R-Ga.), would expand telehealth services by making certain COVID-19-related telehealth services permanent for Medicare.242  Unleashing American innovation and permanently expanding telehealth will provide better options for far more patients.  Telehealth offers accessible care for patients and should be prioritized as an approach to patient-centered care. 

Increase Patient Choices and Control

Healthcare decisions should be made by individuals along with their healthcare providers, rather than by a cumbersome federal bureaucracy forcing them to rely on programs fraught with waste, fraud, and abuse.  These programs must be reformed and utilized as originally intended for the most vulnerable in society.  Adopting free market reforms that increase competition and spur innovation should be a top priority.

The U.S. healthcare system is at a tipping point.  The recommendations in this report will help to avoid increased government control of the healthcare system and provide patients with greater choice and control

The Health Policy Consensus Group, facilitated by the Galen Institute, and composed of healthcare policy analysts who provide recommendations on a variety of healthcare policy issues released, “Health Care Choices 2020: A Vision for the Future.”243  The plan encompasses free market solutions to healthcare problems including continued use of HRAs; expanding HSAs, building off of the Trump administration’s successful plan to give states more control over federal healthcare dollars by instituting high-risk pools, “invisible risk pools,” reinsurance, and other risk adjustments that provide specialized care for people with chronic or preexisting conditions; more regulatory flexibility for the states; expanding telemedicine; providing an alternative to the No Surprise Billing Act; and lowering federal regulatory burdens that hinder competition and innovation.244

Patients have been stripped of their healthcare choices and left with either a big government socialist program that is failing, or a private coverage market that has been heavily distorted by government manipulation.  If Congress works to unleash the free market, competition will drive down costs, and American ingenuity will bring about the best choices and give more control to patients. 

Intellectual Property Rights

Intellectual property (IP) is the only property right protected in the Constitution, in Article 1, Section 8:

To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries.245

The Founding Fathers understood that the best way to encourage creation and dissemination of new inventions and artistic works to the benefit of both the public good and individual liberty is to protect IP rights.  In his January 8, 1790, State of the Union Address to Congress, President George Washington stated, “nothing … can better deserve your patronage than the promotion of science and literature.”246  The Senate responded on January 11, 1790, noting, “Literature and science are essential to the preservation of a free constitution; the measures of government should, therefore, be calculated to strengthen the confidence that is due to that important truth.” 

On January 12, 1790, the House of Representatives issued its concurrence with the President as well by stating, “the promotion of science and literature will contribute to the security of a free Government; in the progress of our deliberations we shall not lose sight of objects so worthy of our regard.”  Congress then moved forward and passed H.R. 43, the Copyright Act of 1790, which was signed into law on May 31, 1790.247 

The Act established both the U.S. Copyright Office and the U.S. Patent and Trademark Office (USPTO).  These agencies are tasked with cataloguing, analyzing, and protecting IP rights.

IP is not always seen or heard directly, and its value is therefore not as visible as other forms of property.  Most Americans think of property as something they own, meaning personal and real property, but they are likely unaware that someone came up with an idea or an invention to create and build those possessions, and that the protection of IP rights enables the development of new ideas and inventions.

The COVID-19 pandemic demonstrated how critical the protection of IP is to the development of new cures for diseases.  As shutdowns and lockdowns occurred, drug manufacturers stepped up to the plate and developed vaccines to combat the disease and treatments to help mitigate the severity of the illness.  Without IP protection and the full support of the U.S. government, the breakneck speed of developing safe and effective drugs would not have occurred.  These same protections remain critical to future cures and the creation of new technologies that improve everyone’s lives and provide significant economic benefits.  (The devastating impact of price controls on IP rights and pharmaceutical research and development is discussed in the healthcare chapter of this publication.)

According to the USPTO’s 2021 report on intellectual property and the U.S. economy, IP-intensive industries “directly accounted for more than 47 million U.S. jobs,” and “supported an additional 15.5 million jobs in other industries that supply them intermediate goods and services” in 2019.248  The report stated that of the $7.76 trillion contributed to the GDP in 2019 by IP-intensive industries, utility patent-industries contributed $4.43 trillion, design patent-intensive industries provided $4.46 trillion, trademark-intensive industries contributed $6.91 trillion, and copyright-intensive industries contributed $1.29 trillion.249 

In December 2022, the International Intellectual Property Alliance released its study of the impact of copyright-related industries on the U.S. economy between 2019-2021.  Even with pandemic restrictions in place during much of the period the study was conducted, copyright-related industries, including entertainment, gaming, movie, music, and business applications, continued to produce new and innovation products and services.  According to the report, core copyright industries added “more than $1.8 trillion” to the U.S. GDP in 2021, and directly “employed 9.6 million workers in 2021 accounting for 4.88 percent of the entire U.S. workforce.”250

The economic impact of copyright-intensive industries extends well beyond direct employment.  According to the Motion Picture Association (MPA), when the movie Black Panther was filmed in 2018, more than 3,100 local workers in Georgia received more than $26.5 million in wages supporting the local economy.251  The 2022 sequel Black Panther: Wakanda Forever, was filmed in multiple locations in Georgia, contributing more than $314 million in the local economy, and providing 1,885 local workers’ wages totaling more than $88 million.252   In 2020, the industry paid a total of “$49 billion to more than 280,000 businesses in cities and small towns across the country.”253

Given the significant economic benefit demonstrated by these reports, enforcement and protection of IP globally is critical to future innovation and creativity.  The U.S. Chamber of Commerce 2022 International IP Index report, published by the Global Innovation Policy Center (GIPC), focused on how IP was helping promote economic prosperity as the world began to come out of the pandemic.254  Reviewing intellectual property rights and protections across 55 nations, GIPC evaluates how well each country protects overall IP rights, provides copyright protections, and enforces laws against physical IP-infringing goods. 

The United States, with a score of 95.48 percent, ranked first; followed by the United Kingdom (94.14 percent); Germany (92.46 percent); Sweden (92.14 percent); and France (92.10 percent).  The countries with the least IP protections were Venezuela (14.10 percent); Algeria (23.36 percent); Pakistan (27.43 percent); Kuwait (27.92 percent); and Indonesia (30.42 percent).255  The report noted that, “Despite the critical role IP played in response to the pandemic, some World Trade Organization (WTO) members continued to push a proposal to ‘waive’ international IP commitments.”256

CAGW’s 2014 book, Intellectual Property: Making It Personal, cited four myths and realities surrounding IP that remain valid today:

  1. Myth:  The price of information and ideas should be zero because products should be priced at marginal cost.
  2. Reality:  Economists reject marginal cost pricing because such policies destroy investment.
  1. Myth:  Intellectual property rights result in information and ideas being ’locked down’ by their owners.
  2. Reality:  The creators of art, books, movies, and inventions want their creations to reach as many people as possible, so long as they are compensated.
  1. Myth:  Intellectual property rights are monopolies that give their owners too much economic power.
  2. Reality:  Patents or copyrights support competition by encouraging inventors and creators to enter new markets; IP gives its owners no more economic power than any other asset.
  1. Myth:  Intellectual property rights benefit big firms at the expense of ‘the little guy.’
  2. Reality:  Patents are often the best protection that a small inventor has against large firms; copyright benefits creative ventures of many sizes, from solo musicians to big studios.257

Promoting IP in Trade Agreements

The protection of IP should be a key consideration in all trade negotiations.  Although the U.S. has a strong history of IP protection, other countries do not value IP as highly and often seek to diminish its protections. 

The Office of the U.S. Trade Representative (USTR) releases an annual Special 301 Report identifying trading partners that “do not adequately or effectively protect and enforce intellectual property (IP) rights or otherwise deny market access to U.S. innovators and creators that rely on protection of their IP rights.”  The 2022 Special 301 Report identified 27 countries on its Priority Watch List and Watch List out of the 100 countries reviewed.258 

Placement on either of these lists indicates problems with one of more of the following: IP protection, enforcement, and market access.  Countries on the Priority Watch List require greater scrutiny.  The Priority Watch List includes Argentina, Chile, China, India, Indonesia, Russia, and Venezuela.  The Watch List includes Algeria, Barbados, Bolivia, Brazil, Canada, Colombia, Dominican Republic, Ecuador, Egypt, Guatemala, Mexico, Pakistan, Paraguay, Peru, Thailand, Trinidad and Tobago, Turkey, Turkmenistan, Uzbekistan, and Vietnam.259  Due to the conflict in Ukraine, the USTR did not provide an analysis of that country, but it was on the Priority Watch List in 2021.260

While the rest of the world cannot measure up to the protection of IP in the United States, sometimes policies are promoted domestically that threaten those rights.  In an effort to obtain the IP rights to the vaccines that were created for COVID-19 at no cost, India and South Africa proposed a waiver of certain provisions of the WTO Trade-Related Aspects of Intellectual Property Rights Agreement.  Despite objections from IP rights holders throughout the U.S. (and groups like CAGW), the USTR’s press release announcing the issuance of the 2022 Special 301 Report noted that the Biden-Harris administration “supports a waiver of IP protections for COVID-19 vaccines under the World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement).”261 

Waiving licensed vaccinations and medical treatments creates a system of compulsory licensing of COVID-19 vaccines and other treatments and allows governments seeking the waiver to manufacture generic versions of the vaccines and treatments using the research and development of a company for no cost, essentially stealing the IP that is supposed to be protected under U.S. and international laws.  The WTO decided on June 17, 2022, to grant a 5-year waiver for COVID-19 vaccines, which will allow eligible WTO members to use “patented inventions necessary for COVID-19 vaccine production and supply, without the right holder’s consent.”262  The waiver is not only a violation of IP rights, but also unnecessary, since beginning in August 2020, there were 172 countries in discussions to obtain vaccines through COVAX, which is run through the World Health Organization and has for many years provided equitable distribution of vaccines around the world.263

The U.S. should begin negotiations for bilateral and multilateral agreements by insisting the IP rights be protected at the same level they are in America.  Any decisions to depart from those standards on the part of any administration should not be made without the advice and consent of Congress, particularly if those decisions impact the IP rights of individuals and companies within the U.S.  And every nation’s track record on IP should be evaluated using tools provided by the Special 301 report and sources like the GIPC’s Global IP index to ensure that America’s global leadership in creativity, innovation, and technology is enhanced and protected.

The Battle Against Counterfeits and Piracy

In 2016, the Trade Facilitation and Trade Enforcement Act was signed into law, strengthening the ability of federal officials to interdict and seize suspected infringing goods at the border.264  According to the Department of Homeland Security, the number of IP rights seizures decreased from 34,143 in FY 2017 to 33,810 in FY 2018.265  Based on the estimated manufacturer’s suggested retail price, had the seized goods been genuine, they were worth $1.4 billion.266  In FY 2019, there were 27,599 seizures, with an estimated value of more than $1.5 billion.  In FY 2020, there were 26,503 seizures with an estimated manufacturer’s suggested retail value of $1.3 billion.267  There were 27,000 seizures in FY 2021, with an estimated manufacturer’s suggested retail value of more than $3.3 billion, a 152 percent increase over the FY 2020 value.268

However, the value of these seizures does not reflect their full economic impact.  A February 2017 Commission on the Theft of American Intellectual Property report, which is the most recent information available, estimated the economic loss of IP due to counterfeits, trade secret theft, and pirated software is between $225 billion to $600 billion annually.269  The report found that 87 percent of the counterfeit goods came from China.270 

In addition to counterfeit goods, there is a significant threat to IP rights from counterfeit and pirated content online.  According to a June 2019 GIPC report, there were “more video streaming subscribers than paid-TV subscribers worldwide, accessing more than 500 licensed online video portals.”271  The report noted that the online video industry employed “up to 2.6 million workers in the U.S.” and provided “$229 billion in annual economic benefits to the U.S. economy.”272  As legal streaming has increased, so has piracy of digital movies, music, and software applications, which is not only anticompetitive but also often a harbinger of malware and other virtual attacks on unsuspecting businesses and consumers. 

According to the MPA, in 2018 “[t]here were an estimated 32.5 billion visits to streaming piracy sites worldwide across both desktops and mobile devices.  One out of four content theft sites exposed consumers to malicious content.”273  This number is staggering when one considers the number of legitimate sites now available to obtain digital content.  In 2020, GIPC President and CEO David Hirshmann noted that, “Global digital piracy costs the U.S. economy $29.2 billion a year, money that would otherwise be spent to create more, safe access to new content generated by American creators and workers.”274

One of the devices used to download and view illegal contents is the set-top box.  The movie industry has filed several piracy lawsuits against set-top box manufacturers to reduce the availability of pirated digital goods on such devices from being downloaded.  One suit resulted in a $90 million settlement on October 24, 2018, paid to DISH Network by SET TV for damages stemming from allegations that SET TV was using DISH channels and retransmitting them without permission.275  The industry has also implemented various voluntary initiatives to prevent illegal theft and distribution of pirated content. 

During the 116th Congress, two provisions of the Consolidated Appropriations Act, 2021, strengthened the laws against illegal distribution of pirated content.276  The Protecting Lawful Streaming Act eliminates a loophole in criminal copyright law by making it a criminal offense for illegally streaming, downloading and distributing pirated content by large criminal enterprises, with sentences of up to 10 years.277  Prior to enactment, these crimes were considered misdemeanors.278

The second IP provision of the Consolidated Appropriations Act, 2021, is intended to help small creators obtain a remedy for copyright infringement.  Language taken from H.R. 2426, the Copyright Alternative in Small-Claims Enforcement Act of 2019, created a Copyright Claims Board within the U.S. Copyright Office to decide copyright infringement disputes from individual creators and small businesses that would otherwise not be able to afford to defend themselves in federal court.  Awards for damages are capped at $30,000, and participation in the board’s proceedings is voluntary with an opt-out procedure for defendants, while the parties are still able to have their dispute heard in court.279  

During the 117th Congress, legislation was introduced to increase the protection of IP rights in the music industry.  H.R. 4130, the American Music Fairness Act, would have equalized the discrepancies in current law surrounding copyright royalties for recorded performances of music by allowing copyright owners of sound recordings to have effective and enforceable rights to their creative product when it is distributed through terrestrial radio.  Current law gives terrestrial broadcast radio stations the right to broadcast sound recordings without appropriate compensation, even though compensation is provided by other broadcast media, including satellite radio and digital streaming services.  While this legislation was not enacted during the 117th Congress, the 118th Congress has an opportunity to revisit this inequity and protect the copyright ownership of creative performers whose works are played on terrestrial radio.280 

IP rights have been paramount since the Republic was established.  As James Madison noted in Federalist Paper No. 43, referring to the authority to promote science and the arts by providing exclusive rights to authors’ and inventors’ writings and discoveries (which led to Article 1, Section 8 of the Constitution):

The utility of this power will scarcely be questioned.  The copyright of authors has been solemnly adjudged in Great Britain to be a right of common law.  The right to useful inventions seems with equal reason to belong to inventors.  The public good fully coincides in both cases with the claims of individuals.  The States cannot separately make effectual provision for either of the cases, and most of them have anticipated the decision of this point by laws passed at the instance of Congress.281

If the Founding Fathers had not codified IP protection, the light bulb, the telephone, the cell phone, and the microchip might never have been invented.  Continued vigilance by Congress and the executive branch in both domestic policy and trade negotiations is essential to keeping America’s engine of ingenuity and innovation on track and maintaining the nation’s creative and economic advantage over the rest of the world.


Americans have become increasingly concerned about the amount of personal information held by banking institutions, e-commerce sites, internet service providers, online platforms, retailers, and many others, and how such information is being used for data analytics, online advertising, and targeted messaging without adequate transparency or consumer choiceThis concern was underscored following the 2016 elections when it was revealed that Cambridge Analytica used ill-gotten personal data from Facebook for targeted political adsWhile companies have since then been working to strengthen data security and consumer privacy, a national framework defining how consumers should be protected would ensure that businesses and individuals alike understand what their rights and responsibilities are for protecting data and privacy when using online services

The U.S. has enacted several laws that contain provisions governing how personal information should be protected using an industry-by-industry approach, including the Communications Act of 1934, the Electronic Communications Privacy Act, the Children’s Online Privacy Protection Act, the Driver’s Privacy Protection Act, the Family Educational Rights and Privacy Act, the Fair Credit Reporting Act, the Gramm-Leach-Bliley Act, the Health Insurance Portability and Accountability Act, the Wire Act, and the Video Privacy Protection Act.  There is no single law or federal agency for protecting consumer privacyThe most prominent agency entrusted with protecting consumer privacy is the FTC

On April 14, 2016, the European Parliament adopted the General Data Protection Regulation (GDPR)The GDPR entered into force on May 24, 2016, and its provisions became directly applicable to all European Union (EU) member states on May 25, 2018The GDPR imposes onerous and costly requirements for data protection by businesses or other entities that process the personal data of individuals in the member states of the EU, regardless of where the data processing takes place.282  This includes U.S. companies conducting business in the EU. 

On June 28, 2018, the California Consumer Privacy Act (CCPA) was signed into law by Gov. Jerry Brown (D).283  The bill, which was rushed through the legislature in a few days, echoes the GPDR and by imposing extremely burdensome requirements on how companies must store and provide access to consumers’ personal information, as well as harsh restrictions on the types of product and service options and discounts companies may offer to their customers

On November 4, 2020, California voters approved a ballot measure to adopt the California Privacy Rights Act (CPRA).284  The CPRA amends the CCPA to extend employee and business to business exemptions for personal information; create a higher threshold for the definition of a business effective January 1, 2023; create a new definition for “sharing” personal information for “cross-context behavioral advertising,” and provide the right to op-out with a requirement to include a “Do Not Sell or Share My Personal Information” link.  The CPRA also imposes limits on the use of sensitive personal information like that imposed by the GDPR; creates new notice requirements at the point of data collection; imposes new requirements on service provider agreements; expands private rights of action; improves exemptions for clinical trials; and creates a new state agency dedicated to privacy enforcement, funded with $5 million for 2020-2021 and $10 million each following year.285  

Other states have enacted or are reviewing laws that would protect personal information, including children’s online privacy, website privacy policies, and monitoring employee e-mail communicationsWithout the adoption of a consistent national privacy protection regime that preempts state and local laws, more states will continue to enact their own rules, some of which could be as strict as California’s, further complicating the privacy regulatory environment with which companies and individuals must comply.

Michigan voters adopted Proposal 2 on November 3, 2020, by a margin of 89 percent to 11 percentThe proposal amends the state constitution by prohibiting unreasonable searches and seizures of private electronic data and communications and requiring a search warrant before accessing an individual’s electronic data and communicationsThe amendment therefore gives the same protection to these communications as a person’s physical property.286  This was one of many privacy proposals cropping up in statehouses and ballot boxes across the country

As noted by CAGW State Government Affairs Associate Ryan Lanier, “During their 2022 legislative sessions, lawmakers in 35 states considered privacy billsOnly two of them, SB 227 in Utah, and SB 6 in Connecticut, were signed into law, adding to a growing patchwork of such laws in the states.”287  The increasing number of conflicting data privacy rules is creating uncertainty and significant costs for compliance, especially for small businessesAccording to a January 24, 2022, Information Technology and Innovation Foundation report, 50 different state privacy laws could cost $1 trillion more over 10 years than a national standard adopted by Congress.288

The recognition of the problems caused by myriad states laws created some momentum during the 117th Congress toward passing a national privacy framework with the introduction of several bills in the House and Senate. The bill that moved forward more than the others is the American Data Privacy Protection Act, H.R. 8152, which would create a national standard for protecting consumer’s private information and was ordered to be reported by the House Energy and

Commerce Committee on July 20, 2022, by a vote of 53-2.289  The bill would establish requirements for companies, including nonprofits and common carriers, on how to handle personal data, including personal identifying information (PII)It would require companies to limit the collection, processing, and transfer of PII only to that which is strictly necessary to provide a requested product or service and prohibits companies from transferring PII without affirmative consent providedH.R. 8152 also spells out the enforcement authority for the FTC and state attorneys general.

Many provisions in the bill reflect CAGW’s recommendations for greater protection of consumer data privacy, which were provided to the NTIA on November 2, 2018,290 and included in CAGW’s report, “The Path to a National Privacy Framework,” published in March 2022.291  These provisions include transparency, right to consent and object, data security and protection of covered data, and unified opt-out mechanismsHowever, the legislation is not without its flaws

H.R. 8152 includes language that promotes a strong private right of action that would open the door for frivolous lawsuits against companies and individuals who someone deems has violated their privacy.  It includes more than 15 exceptions to the bill’s preemption of state privacy laws including the Illinois biometric law and the CCPA.  In addition, the bill would impose onerous biennial impact statement reporting requirements on all covered entities, including small businesses.292  By allowing this many exceptions to state privacy law preemption, legislators repudiate the idea that there is the need for a national privacy framework and instead encourage more states to draft and enact their own consumer data privacy law, creating more confusion and chaos for consumers and businesses.

While H.R. 8152 goes a long way toward providing a national data privacy framework, the legislation was not enacted prior to the adjournment of the 117th CongressTherefore, it will be up to the 118th Congress to resolve the problems in the bill with the goal of enacting a comprehensive consumer data privacy protection law that addresses the issues related to existing state laws and avoids excessive litigation through private rights of action.

Making matters more complicated, FTC Chair Lina Khan has begun the process of adopting privacy rules for the entire economy through the agency’s August 10, 2022, Advanced Notice of Proposed Rulemaking (ANRPM) on Commercial Surveillance and Data Security.293  There have been strong objections filed with the FTC about the size and scope of the new rules and that it is moving forward beyond the scope of its authority while also usurping Congress’s authority as legislation is moving forward.  CAGW’s comments to the FTC on the ANRPM also noted, “A regulation of this size and scope, absent Congressional authorization, would likely see a successful challenge in the court, pursuant to the U.S. Supreme Court decision in West Virginia vs. Environmental Protection Agency, which sets a precedent for overruling agency regulations that exceed their congressionally delegated authority, under the “major questions” doctrine, wherein a clear statement from Congress is necessary to prove that Congress intended the delegate authority “of this breadth to regulate a fundamental sector of the economy.”294

CCAGW offers the following recommendations to the 118th Congress as guidance for consumer data privacy legislation:

  1. National Privacy Framework:  Because of the unique nature of the internet ecosystem and its presence beyond state borders, a clear and concise national data privacy framework is necessary to provide consistency and certainty for businesses and consumers alike.
  2. Consumer Choice and Control:  Businesses should provide consumers with easy-to-understand privacy choices based on the sensitivity of their personal data and how it will be used or disclosed, consistent with the FTC’s privacy enforcement guidance.  Businesses should provide consumers with an opt-out choice to use their non-sensitive customer information for personalized third-party marketing.  Businesses should be able to continue to rely on implied consent to use customer information for activities such as service fulfillment and support, fraud prevention, market research, product development, network management and security, compliance with the law, and first-party marketing.
  3. Transparency:  Consumers should be provided with clear, comprehensible, accurate, and continuously available privacy notices by businesses collecting, using, or sharing consumer data that describe in detail the information being collected, how that information will be used, and whether the information will be sold or shared with third parties.  Should customer information be sold or shared with a third party, customers must be notified about the types of third parties to whom their information has been given and for what purpose.
  4. Data Minimization and Contextuality: Consumers should expect reasonable limits on the amount of personal data that organizations will collect, use, and disclose, consistent with the context in which that data is provided.  Every effort should be made to de-identify and delete data as promptly as possible when it is no longer necessary.
  5. Flexibility: Different types of data require separate methods and standards of protection. For example, sensitive health care data and financial data require a higher level of security than a social media account or a computer’s Internet Protocol address. Therefore, policies must be consistent with the type of data being collected and how it is to be used.
  6. Data Security and Breach Notification: Consumers should expect that the personal data they share with other entities is maintained in a secure environment.  Information technology systems are under constant attack; breaches have and will continue to occur. In the event of a data breach in which there is a reasonable likelihood of misuse and consumer harm, consumers should expect timely notification of the event, and an offer by the entity breached as to the remedies available to make the consumer as whole as possible, including credit protection services, fraud alerts, and credit monitoring through credit reporting agencies.295

These six recommendations provide the groundwork for a national privacy policy going forward, in a technology- and industry-neutral manner, and should be included in any data privacy legislation that will be considered in the 118th Congress.

Telecommunications Reform

The Communications Act of 1934 was enacted to combine regulation of the radio, telephone, and telegraph industries under the newly created FCC.  The act has been amended to cover new technologies through the Cable Act of 1992, the Telecommunications Act of 1996, the Satellite Television and Localism Act Reauthorization (STELAR) Act of 2014, and the RAY BAUM’s Act of 2018.  However, Congress needs to clarify and update these laws to cover more new technologies and future innovations, which will ensure that the United States remains the global leader in telecommunications and technology.  

Innovation throughout the telecommunications industry has enabled providers of “traditional” services to provide far more than their initial offerings.  Internet service providers (ISPs) continue to expand their broadband offerings to include 10-gigabit networks that will provide symmetrical speeds, lower latencies, enhanced reliability, higher computing capabilities, and improved security.  Cable companies provide more than television services, including Voice over Internet Protocol (VoIP) and broadband services.  Telephone companies provide television services.  Mobile phone communications companies provide mobile broadband solutions.  Satellite companies are beginning to provide broadband services through low orbit satellites that offer low latency upload and download speeds.  New uses of spectrum, including TV white space, are being used to provide broadband to rural Americans where building a cable or fiber network is challenging and expensive. 

During the 113th Congress, the House Energy and Commerce Committee began an effort to modernize telecommunications laws, engaging stakeholders through a series of white papers and meetings to discuss the parameters for change.  Topics included competition policies; interconnection; internet regulations; Universal Service Fund (USF) reforms; and video transmission issues.  However, this effort was mostly set aside, and a greater focus was placed on spectrum management and agency oversight during the 114th, 115th, 116th, and 117th Congresses. 

The 116th and 117th Congresses also focused on broadband deployment, allocating far more money than in any other Congress.  According to FCC Commissioner Brendan Carr, at the beginning of 2022, there was as much as $800 billion that could be used for broadband infrastructure.  More than half of that money was provided between the beginning of 2019 and the end of 2021.  He noted that about $80 billion would be sufficient to connect every American who was not already connected and wished to have broadband access.296

The CARES Act provided $150 billion to state and local governments to use as they wished to mitigate the impact of the COVID-19 pandemic, including broadband; the Consolidated Appropriations Act, 2021 provided $7 billion for various infrastructure initiatives including broadband; and the American Rescue Plan Act (ARPA) included $350 billion for state and local governments, with sufficient flexibility to allow some or all the money to be spent on broadband infrastructure.  Even with many states already using tens of millions of dollars for broadband from those three pots of money, including some that were using enough to be able to connect all unserved and underserved households, the Infrastructure Investment and Jobs Act (IIJA) provided another $65 billion solely for broadband programs including $45 billion for the Broadband Equity, Access, and Deployment (BEAD) funding program, which is the largest single amount ever specifically for broadband.   

While there is clearly more than sufficient funding available to deploy next generation broadband connectivity to the millions of Americans who live in unserved and underserved communities and wish to be connected, there is also confusion and conflict among the requirements of the various funding sources to create significant concerns about whether that objective will be attained.  For example, the funding guidance issued by the Treasury Department, NTIA, and the RUS promotes symmetrical speeds of 100 Mbps upload and 100 Mbps download speeds and sets a preference for government-owned networks.

The broadband speed benchmark of 100/100 creates a preference for fiber-to-the-premises to the exclusion of other technologies that may be better suited for remote or rural areas of the country including cable (which now offers speed thresholds well above 100/100 Mbps, often up to 1000/1000 or Gigabit service), fiber, fixed wireless broadband, mobile broadband, satellite broadband, and the use of TV white space in conjunction with fixed wireless or mobile wireless broadband.  By issuing such restrictive and preferential guidance, agencies are encouraging overbuilding in areas that already have broadband service, but just not at the levels listed in their funding notices.  The 118th Congress should revisit the funding availability guidance agencies have issued, and insist these agencies conform their broadband guidance to a technology and vendor neutral approach, thereby offering every area of the country the flexibility needed to get everyone connected who wishes to be connected.

Another potential misuse of federal dollars for broadband deployment would be to overbuild existing broadband networks or creating a government-owned network in direct competition with existing high-speed broadband providers.  CAGW’s 2014, report, Telecom Unplugged:  Ushering in a New Digital Era, cited numerous examples of wasteful spending under the $831 billion 2009 stimulus bill, including money for government-funded overbuild of networks in areas where it could have been better deployed to unserved communities.297 

The stimulus provided $7.2 billion for broadband, with $2.5 billion going to the RUS Broadband Initiatives Program (BIP) and $4.7 billion to the NTIA for its Broadband Technology Opportunity Program (BTOP).  By comparison, from 2002-2009, BIP funding averaged $13 million annually, and the largest amount received during that time period by BTOP’s predecessor program, the Public Safety Interoperability Program, was $1 billion.298  In his October 29, 2009, testimony before the Senate Commerce, Science, and Transportation Committee, GAO Director of Physical Infrastructure Issues Mark L. Goldstein said that RUS and NTIA would “face the challenge of monitoring these projects with far fewer staff per project than were available for their legacy grant and loan programs,” and that both programs “lack[ed] funding for oversight beyond fiscal year 2010.”299  Since the $7.2 billion in stimulus funds is equal to 11 percent of just the $65 billion for broadband in the IIJA and 0.9 percent of the $800 billion that could be used for broadband infrastructure across federal agencies, the need for stringent oversight could not be more obvious and necessary.

Among the wasteful stimulus projects cited by CAGW was a BTOP award of $100.6 million to Eagle-Net in Colorado to bring high speed broadband services to all schools, libraries, and anchor institutions in underserved areas of the state.  Instead, the company deployed these new fiber optic lines in locations already served by other fiber optic communications providers, including a school of 11 students in Agate, Colorado, which then had three different fiber optic lines running to the school, including those provided through the stimulus funds by Eagle-Net.300   

One of the sources for tracking wasteful stimulus bill spending was, which detailed each project that received stimulus funds and required quarterly reports on the progress of the projects.  This level of accountability was not included in the massive spending bills passed during the 116th and 117th Congresses, which is another reason why oversight hearings will be critical for the 118th Congress.  

CAGW has long been concerned that the federal regulatory structure gives too many federal agencies a part in broadband deployment funding, which could cause resources being devoted toward certain projects at the expense of other broadband deployments being delayed or not initiated.  A May 31, 2022, GAO report on broadband programs found that there are 133 such programs across 15 agencies and there is no national strategy for broadband deployment.  GAO noted that the fragmentation of these programs has had the most negative impact on “communities with limited resources.”301  And despite the expenditure of $44 billion between 2015 and 2020 within those programs, millions of American still do not have access to broadband, which has disproportionately impacted communities with limited resources. 

An example of the duplication cited by GAO can be found in the October 25, 2021, announcement of funding opportunity for the ReConnect program, in which the RUS permitted recipients of the FCC’s Rural Digital Opportunities Fund to apply for ReConnect funding.302  Double-dipping into funding sources means fewer unserved areas could receive funds to help with broadband infrastructure in their communities. 

Taxpayers should be concerned not only about the lack of oversight of all these different federal broadband programs, but also about the conflicting guidance and regulations being issued surrounding the funding applications.  The CARES Act, ARPA, and the IIJA have dissimilar requirements to access the hundreds of billions of dollars that are potentially available under those laws. 

The RUS ReConnect funding notice included preferences for governmental or quasi-governmental entities and entities who agree to unrelated policy requirements like net neutrality.303  The Department of Treasury’s ARPA guidance set preferences for fiber and either government-owned or nonprofit broadband networks.304  Despite Congress establishing a technology neutral requirement in the IIJA, the NTIA guidance in its BEAD notice of funding opportunity encouraged symmetrical 100/100 Mbps speed thresholds for new infrastructure deployment, which preferences one technology over others and may reduce the amount of funding available for unserved communities as efforts are made to bring existing broadband networks “up to speed.”305  It also promotes government-owned networks and preferences for unionized workforces. 

CAGW’s May 2021 report, The Folly of Government-Owned Networks, cited a 2004 letter from the Council for Citizens Against Government Waste regarding a government-owned network (GON) in Concord, Massachusetts, that governments “undertake an enormous amount of financial risk to enter these types of businesses.  The systems end up being far more expensive than originally expected and the towns find it difficult to remain competitive, to upgrade, and to market their product within budgetary constraints.  It is common for municipal electric customers to end up subsidizing broadband customers, causing electric rates and taxes to increase.”306  

Forcing a community to use one or two options, particularly if one of them is a municipal overbuild on existing service, is both costly and anti-competitive.  Every federal agency should be required to provide guidance for an “all-of-the-above” technology and vendor neutral approach to broadband deployment.   

Not only should Congress provide a single standard for all broadband funding, but also federal agencies must not be allowed to promulgate regulations or provide guidance beyond those standards, particularly when they would hinder broadband deployment to unserved and underserved areas.

Achieving greater broadband access is also contingent on accurate maps that show underserved and unserved communities.  On November 18, 2022, the FCC issued its first iteration of updated maps of broadband services provided across the country.307  The maps were required by the Broadband DATA Act and will help determine where broadband funding in the BEAD and other federal programs should be distributed based on the connectivity level in various communities.308 

The Broadband DATA Act requires the FCC to develop and disseminate at a granular level a map demonstrating a true picture of broadband deployment across the country, including whether it is provided from wired, fixed-wireless, satellite, and/or mobile broadband providers.  The bill also requires the GAO to report on identified locations where fixed broadband can be installed. 

Broadband mapping across the country has been hit or miss at best over the past decade.  Maps have indicated a lack of service where it was widely available, and widespread service where it was unserved or underserved.  This created a disparity in the distribution of federal funds for broadband deployment.  Knowing where the holes in broadband deployment are located through improved mapping will help to allocate the funding more accurately.  The 118th Congress should continue to follow the development of the new maps and conduct oversight hearings to ensure they are completed before federal funds are issued to areas for new deployments. 

None of the communications services provided across the country could be provided without spectrum.  It is a limited resource that must be allocated in a balanced manner to allow licensed, unlicensed, and shared use where feasible. 

According to a September 28, 2022, Accenture report, the federal government is one of the largest holders of spectrum allocations, maintaining 3,300 MHz of spectrum in the lower mid-band spectrum range.309  The NTIA manages spectrum allocations for the federal government and provides a chart of spectrum allocations showing the use for each band of spectrum.  However, this chart has not been updated by the federal government since 2016, and since that time, several spectrum reallocations, use cases, and auctions of spectrum have occurred. 

The FCC oversees spectrum auctions, which have since 1994 generated more than $259 billion.310  The agency’s authority to conduct auctions expires on March 9, 2023, and Congress must reauthorize it on or before that date.  It is essential to have a much longer time period, like the more normal 10 years, than the three months for which it was reauthorized on December 16, 2022.

As technology develops, both licensed and unlicensed spectrum are vital for communications in the U.S.  With the advent of fifth generation (5G) networks, mobile communications have improved and increased the ability to connect to the internet remotely.  However, the use cases for unlicensed spectrum are also important with many individuals offloading their mobile services to an unlicensed spectrum Wi-Fi connected network when they are in their homes or workplaces, as well as connecting Bluetooth-enabled devices, and other devices requiring the use of radio frequencies to operate, like baby monitors, security camera systems, garage doors, televisions and other technology using remote controls. 

These are among the many reasons a balanced approach to spectrum policy is in order.   To better prepare for a future spectrum pipeline for licensed, unlicensed, and shared uses, NTIA must update the spectrum allocation chart, examine how agencies are using their spectrum allocations and determine what spectrum can be freed up to be either brought to the market for exclusive licensing, reallocated for unlicensed use, or where feasible, shared between an agency and other users as long as agency mission critical operations are not impacted.

The success of the U.S. telecommunications industry, with the unfortunate exception of the negative impact of the Open Internet Order (net neutrality) under the Obama administration, has been achieved through a light-touch regulatory approach.  As President Bill Clinton said, “The Internet ‘should be a place where government makes every effort ... not to stand in the way, to do no harm.’”311

Yet, as the 118th Congress convenes, there are renewed calls for the FCC to once again impose net neutrality, rather than maintaining the following four principles adopted on August 5, 2005 by the FCC, “to encourage broadband deployment and preserve and promote the open and interconnected nature of public Internet:  1) consumers are entitled to access the lawful Internet content of their choice; 2) consumers are entitled to run applications and use services of their choice, subject to the needs of law enforcement; 3) consumers are entitled to connect their choice of legal devices that do not harm the network; and 4) consumers are entitled competition among network providers, application and service providers, and content providers.”312 

Congress should codify these four essential principles rather than getting in the way and doing harm.  A statutory solution based on these principles would allow companies to create and develop innovative technologies and expand their networks without worrying that a new FCC will change direction and again seek to impose damaging heavy-handed regulations on the services they provide. 

With respect to federally subsidized communications programs, Congress should exercise greater oversight on the RUS broadband grant and loan program, and the USF’s Lifeline program.  While eliminating the RUS would save taxpayers $8.4 billion in one year, and $42 billion over five years, Congress has no intention of eliminating the entire program.313  In the 2018 Farm Bill, Congress increased funding by $350 million annually supposedly to help rural unserved communities bridge the digital divide. 

With the 118th Congress considering the reauthorization of the Farm Bill, the RUS program should be scrutinized to determine its effectiveness, since tens of billions of dollars are already being allocated for broadband deployment across the country.  Congress must continue to provide strict program oversight to ensure that the funding is used for truly unserved communities and not for upgrades or overbuilding existing broadband infrastructure.  The upcoming broadband deployment maps should help to prevent that from occurring.

The USF program should also be scrutinized by the 118th Congress.  The USF is funded by a regressive tax listed as a “fee” on consumer telephone bills, which is adjusted based on the contribution factor (CF) charged to telecommunications providers and passed on to consumers.  In 2000, when the FCC first began to track the USF contribution factor, the CF was set at 5.66 percent.314  Yet, as the number of landlines and paging services decrease and the other services provided to Americans increase, so do the revenues and expenses for the USF fund. 

While it took more than 10 years for the CF to increase from its initial 5.66 percent to 12.9 percent, and then another eight years to increase to 20.1 percent.  The contribution factor for the first quarter of 2023 is now at 32.6 percent.315  The USF provides funding for broadband deployment in high-cost areas of the country through the Connect America Fund and the Mobility Fund; access to schools and libraries through the E-Rate program; telehealth initiatives through rural health program, and low-income support through the Lifeline program. 

Congress should revisit the funding mechanism for the USF, determine whether it is the best method by which to fund the programs, and evaluate each program’s effectiveness in helping to deploy broadband in truly unserved areas of the country at reduced rates, at the least possible cost to taxpayers.  This process should include an assessment of the effectiveness of private sector programs that provide significant broadband access at reduced rates or no cost to the beneficiaries of the USF programs.

With up to $800 billion available for federal broadband programs, there are far too many opportunities to squander billions of dollars in precious taxpayers’ resources unless there is greater coordination of deployment efforts.  The 118th Congress should immediately begin holding joint hearings among committees of jurisdiction in the Senate and House, as well as bicameral hearings, to determine how the responsibility and funding for broadband should be consolidated and wasteful spending avoided.  The two most prominent and experienced agencies are the FCC and the NTIA, and they should be given the most significant responsibility and funding for broadband programs.

The 118th Congress should be vigilant about overseeing and promoting sound and effective telecommunications policy.  If not, taxpayer funds will be wasted, and the leading global position of the United States in telecommunications could be challenged. 


1 Department of Justice, “What is FOIA,”

2 C.J. Ciaramella, “‘The Most Transparent Administration in History’:  A campaign promise becomes a punchline,” Reason, January 18, 2017,

3 Ted Bridis, “US sets new record for denying, censoring FOIA requests,” Federal News Network, March 18, 2015,

4 Department of Justice, “Summary of Annual FOIA Reports for Fiscal Year 2021,”

5 Ibid.

6 Ibid.

7 Michelle Sager, “Freedom of Information Act: Federal Agencies’ Recent Implementation Efforts,” Government Accountability Office (GAO), March 11, 2020,

8 GAO, “Freedom of Information Act Selected Agencies Adapted to the COVID-19 Pandemic but Face Ongoing Challenges and Backlogs,” January 2022,

9 Ted Bridis, “US sets new record for censoring, withholding gov’t files,” AP News, March 12, 2018,

10 John Hudak and Grace Wallack, “Sometimes cutting budgets raise deficits: The curious case of inspectors’ general return on investment,” Center for Effective Public Management at Brookings, April 2015,

11 Gene L. Dodaro, “Fiscal Year 2023 Budget Request, U.S. Government Accountability Office,” GAO, June 22, 2022,

12 Ibid.

13 U.S. Department of Agriculture (USDA) Economic Research Service, “Sugar and Sweeteners Yearbook Table,” Group 2 Tables 3b and 4, Updated January 4, 2023,

14 John Beghin, “Recapping the Effects of the US Sugar Program,” American Enterprise Institute, February 1, 2022,

15 Ibid.

16 Citizens Against Government Waste (CAGW), 2022 Prime Cuts Summary, p. 12,

17 Ibid., p. 13.

18 David Rogers, “Payments to Farmers May Exceed Farm Bill’s Expectations,” Politico, January 29, 2015,

19 Congressional Research Service (CRS), “Farm Bill Primer: What is the Farm Bill?” Updated June 28, 2022,

20 CAGW, 2022 Prime Cuts Summary, p. 14.

21 Ron Nixon, “For Groups That Sell Goods Abroad, Help From U.S. Taxpayers,” The New York Times, February 12, 2011,

22 U.S. Grains Council, “Market Access Program Survives Debate,” Farm Press, June 25, 2012,

23 Ibid., CAGW, 2022 Prime Cuts Summary, p. 26.

24 Council for Citizens Against Government Waste, “CCAGW Urges Conferees to Support Rural Broadband Reforms in Farm Bill,” August 8, 2018,

25 GAO, “Broadband: National Strategy Needed to Guide Federal Efforts to Reduce Digital Divide,” GAO-22-104611, GAO, May 31, 2022,

26 Ryan Lanier, “GAO Report Reveals Significant Duplication and Overlap in Broadband Programs,” CAGW, June 23, 2022,

27 USDA, “Rural Utilities Service’s controls Over Water and Waste Disposal Loan and Grant Program for the Recovery Act,” July 24, 2012,

28 Ibid.

29 CRS, “Federally Supported Projects and Programs for Wastewater, Drinking Water, and Water Supply Infrastructure,” August 2, 2022,

30 CAGW, 2021 Congressional Pig Book, April 15, 2021, p. 8,

32 James V. Saturno, Bill Heniff Jr., and Megan S. Lynch, “The Congressional Appropriations Process:  An Introduction,” CRS, November 30, 2016,

33 Jessica Tollestrup, “Automatic Continuing Resolutions:  Background and Overview of Recent Proposals,” CRS, August 20, 2015,

34 Sean Kennedy, “Congress Must Fulfill its Core Function,” The Hill, October 25, 2022,

35 Rep. Cathy McMorris Rodgers (R-Wash.), “Unauthorized Spending Accountability (USA) Act of 2019,”

36 Ibid.

37 CBO, “Expired and Expiring Authorizations of Appropriations for Fiscal Year 2022” August 2022, p. 2,

38  Ibid.

39 William Christian, “The USA Act(s): A Tale of Two Spending Reform Bills,” The WasteWatcher, CAGW, March 18, 2016,

40 Ibid.

41 Ibid.

42 Rachel Cole, “Power of the Purse and Budget Process Reform,” The WasteWatcher, CAGW, December 20, 2016,

43 Ibid.

44 Julie Jennings and Jared C. Nagel, “Federal Workforce Statistics Sources: OPM and OMB,” Congressional Research Service, October 23, 2020,

45 Office of Personnel Management (OPM), “Taxpayer-Funded Union Time Usage in the Federal Government: Fiscal Year 2019,” October 2020,

47 Ibid.

48 The White House, “Executive Order Ensuring Transparency, Accountability, and Efficiency in Taxpayer Funded Union Time Use,” May 25, 2018,

49 The White House, “Executive Order Promoting Accountability and Streamlining Removal Procedures Consistent with Merit System Principles,” May 25, 2018,

50 GAO, “Improved Supervision and Better Use of Probationary Periods Are Needed to Address Substandard Employee Performance,” Report to the Chairman, Committee on Homeland Security and Governmental Affairs, U.S. Senate, February 2015,

51 Erich Wagner, “Judge Strikes Down Trump Executive Orders Limiting Federal Employee Union Bargaining,” Government Executive, August 25, 2018,

52 Erich Wagner, “Court Denies Trump Administration Request to Expedite Appeal of Workforce EO Decision,” Government Executive, October 19, 2018,

53 Curtis Kalin, “VA Scandal Rages On in 2016,” The WasteWatcher, CAGW, August 18, 2016,

54 Department of Veterans Affairs (VA) Accountability and Whistleblower Protection Act of 2017, Pub. L. No. 115-41, S. 1094, 115th Congress (2017),

55 Accountable Federal Employees Act, H.R. 7095, 117th Congress (2022),

56 MERIT Act of 2019, H.R. 3348, 116th Congress (2019),

57 MERIT Act of 2019, S. 1898, 116th Congress (2019), https://www.congress/gov/bill/116th-congress/senate-bill/1898.

58 Andrew Eversden, “Congress settles on $782.5 billion national defense budget, adds $13.6B in Ukraine aid,” Breaking Defense, March 9, 2022,

59 Courtney Bublé, “The Defense Department Fails Its Audit Again, But Officials Have ‘No Doubt’ It Will Eventually Pass,” Government Executive, November 16, 2021,

60 David Alexander, “Hagel praises U.S. Marines’ progress on readying accounts for audit,” Reuters, February 6, 2014,

61 GAO, “DOD Financial Management:  Actions Are Needed on Audit Issues Related to the Marine Corps’ 2012 Schedule of Budgetary Activity,” GAO-15-198, August 3, 2015,

63 Department of Defense (DOD), “Agency Financial Report: Fiscal Year 2019,” November 15, 2019,

64 DOD, “Agency Financial Report: Fiscal Year 2021,” November 5, 2021,

65 DOD Inspector General, “Audit of the Defense Health Agency’s Reporting of Improper Payment Estimates for the Military Health Benefits Program,” January 11, 2022,

66 Ibid.

67 Ibid., DOD, “Agency Financial Report: Fiscal Year 2021.”

68 GAO, “High-Risk Series,” March 2021,

69 Anthony Capaccio, “F-35’s $10 Billion Funding Gap Hints at a Jet Too Costly to Fly,” Bloomberg, September 11, 2020,

70 Ryan Browne, “John McCain:  F-35 is ‘a scandal and a tragedy,’” CNN, April 27, 2016,

71 Andrea Drusch, “Fighter plane cost overruns detailed,” Politico, February 16, 2014,

72 Robert Behler, “Director, Operation Test and Evaluation: FY 2019 Report,” DOD, December 20, 2019,

73 Capaccio, “F-35’s $10 Billion Funding Gap Hints at a Jet Too Costly to Fly.”

74 Ibid.

75 Richard Sisk, “Air Force Secretary Acknowledges Wide Range of Problems with F-35,”, July 28, 2015,

76 Stephen Losey, “US Air Force warns of aging fighters, poor purchasing efforts,” Defense News, September 12, 2022,

77 Ibid.

78 Stephen Losey, “Here’s how bad the military’s aircraft readiness has gotten,” Air Force Times, November 19, 2020,

79 Rachel S. Cohen and Stephen Losey, “US Air Force fleet’s mission-capable rates are stagnating. Here’s the plan to change that,” Air Force Times, February 14, 2022,

80 John A. Tirpak, “Fighter Mission Capable Rates Fell in 2021,” Air Force Times Magazine, November 22, 2021,

81 Ibid.

82 CAGW, Congressional Pig Book Summary, April 15, 2021, p. 13.

83 Stephen Losey, “Fund the F-35 program, lawmakers tell the White House,” Defense News, October 20, 2021,

84 Jennifer Shutt, “House appropriators officially bring back earmarks, ending ban,” Roll Call, February 26, 2021,

85 Melanie Zanoa and Caitlin Emma, “House GOP votes to embrace the return of earmarks,” Politico, March 17, 2021,; Lindsay Wise, “Senate Earmarks Are Back: Democrats Make It Official,” The Wall Street Journal, April 26, 2021,

86 Lauren Fox and Ted Barrett, “Senate Republicans to keep earmark ban, but GOD conference rules allow some wiggle room,” CNN, April 21, 2021,

87 Aidan Quigley and Lindsey McPherson, “House GOP votes down earmark ban proposal,” Roll Call, November 30, 2022,

88 House Appropriations Committee, “DeLauro Announces Community Project Funding in Fiscal Year 2022,” accessed on June 14, 2022,

89 Shutt, “House appropriations officially bring back earmarks, ending ban.”

90 Tom Schatz, “Earmarks are inequitable, corrupt, and costly – they should not be brought back,” The Hill, January 4, 2021,

91 CAGW, 2022 Congressional Pig Book.

92 Ibid., p. 2.

93 Ibid., pp. 3-4.

94 Burgess Everett, “Earmarks divide Republicans,” Politico, May 7, 2014,

95 CAGW, 2022 Congressional Pig Book, p. 2.

96 Ibid.

97 Ibid., p. 3.

98 Earmark Elimination Act, S. 501, 117th Congress, (2021), and H.R. 1086, 117th Congress, (2021),

99 Sean Kennedy, “All About Earmarks:  A Brief History,” CAGW, September 28, 2022,

100 Sen. Mike Lee and Rep. Jeb Hensarling, “Bringing Back Earmarks Won’t Fix Congress,” The Washington Examiner, February 9, 2017,

101 Biden Harris/Democrats, “The Biden Plan for a Clean Energy Revolution and Environmental Justice,”,

102 Ibid.

103 The White House, “Executive Order on Protecting Public Health and the Environment and Restoring Science to Tackle the Climate Crisis, January 21, 2021,

104 U.S. Department of State, “The United States Official Rejoins the Paris Agreement,” February 21, 2021,

105 Nicolas Loris and Katie Tubb, “4 Reasons Trump Was Right to Pull Out of the Paris Agreement,” The Heritage Foundation, June 1, 2017,

106 Ibid.

107 Thomas Barrabi, “Gas prices have doubled since Biden took office,” New York Post, June 6, 2022,

108 House Republican Whip Steve Scalise (R-La.) and Rep. Beth VanDuyne (R-Texas), “Republican House will work to lower costs by increasing American energy production,” The Houston Chronicle, November 22, 2022,

109 Douglas Holtz-Eakin, Dan Bosch, Ben Gitis, Dan Goldbeck, Philip Rossetti, “The Green New Deal: Scope, Scale, and Implications,” American Action Forum, February 25, 2019,

110 Anthony Adragna, Gavin Bade, Eric Wolff, “Clean energy backers’ anger grows as House ignores aid plea,” Politico, May 21, 2020,

111 Congressional Budget Office (CBO) Cost Estimate, August 5, 2022,

112 CRS, “Tax Provisions in the Inflation Reduction Act of 2022 (H.R. 5376),” August 10, 2022,

113 The Heritage Foundation, “Federal Budget in Pictures,”

114 CBO, “Monthly Budget Review: Summary of Fiscal Year 2022,” November 8, 2022, p. 7,

115 The Board of Trustees, Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds, The 2022 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds,” (Social Security Trustees 2022 Annual Report), June 2, 2022, p. 2,

116 Ibid., p. 3.

117 Ibid., p. 25.

118 Ibid., p. 5.

119 Ibid., p. 6.

120 Social Security Administration (SSA), “Research, Statistics & Policy Analysis,” November 2022,

121 U.S. Census Bureau, “U.S. and World Population Clock,”

122 SSA, “Life Expectancy for Social Security,”

123 SSA, “Retirement & Survivors Benefits: Life Expectancy Calculator,” November 2022,

125 SSA, “Retirement Age Calculator,”

126 SSA, “Summary of Provisions that Would Change the Social Security Program,” July 1, 2020,

127 Ibid., p. 4.

128 SSA, “Cost-of-Living Adjustment (COLA) Information,”

129 Ibid., p. 18.

130 CAGW, Critical Waste Issues for the 115th Congress, p. 25,

131 CAGW, “2020 Prime Cuts Database,”

132 CBO, “The Budget and Economic Outlook: 2022-2032,” May 2022, p. 66,

133 GAO, “Disability Insurance:  SSA Could Do More to Prevent Overpayments or Incorrect Waivers to Beneficiaries,” GAO-16-24, October 2015, p. GAO Highlights,

134 GAO, “High-Risk Series: Substantial Efforts Needed to Achieve Greater Progress on High-Risk Areas,” GAO-19-15751, March 2019 (GAO High-Risk Series 2019), p. 259,

135 Ibid., pp. 259-261.

136 The Board of Trustees, Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds, “The 2022 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds,” (Medicare Trustees 2022 Annual Report), p. 2,

137 CRS, “Medicare Primer,” CRS Report No. R40425, May 21, 2020,

138 Medicare Trustees 2022 Annual Report, p. 8.

139 Ibid., pp. 1-2, 6.

140 GAO High-Risk Series 2019, p. 241.

141 HHS, “2022 Medicare Fee-for-Service Supplemental Improper Payment Data,” p. 1,

142 Centers for Medicare and Medicaid Services (CMS), “Medicare Part C Improper Payment Measurement,”

144 GAO High-Risk Series 2019, p. 252.

145 Medicare Board of Trustees 2022 Annual Report, p. 20.

146 Ibid., p. 22.

147 Ibid., p. 9.

148 Ibid., p. 8.

149 Ibid., p. 60.

150 Ibid., p. 26.

151 Ibid., p. 28.

152 Ibid., pp. 31-32.

153 CBO, “A Premium Support System for Medicare: Updated Analysis of Illustrative Options,” October 2017, p. 1,

154 Ibid.

155 Centers for Medicare and Medicaid Services Center for Medicaid and CHIP Services, “August 2022 Medicaid and CHIP Enrollment Trends Snapshot,” August 2022,

158 Department of Health and Human Services Office of Inspector General, “Medicaid Fraud Control Units Fiscal Year 2021 Annual Report,” p. At a Glance,

160 Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 25, 2013,

161 CBO, “Federal Subsidies for Health Insurance Coverage for People Under 65: 2020 to 2030,” September 20, 2020, p. 7,

162 CMS, “Health Insurance Exchanges 2020 Open Enrollment Report,” April 1, 2020, p. 1,

163 Kaiser Family Foundation, “Status of State Action on the Medicaid Expansion Decision,” November, 9, 2022,

164 Brian Blase, “The Disappointing Affordable Care Act,” Forbes Apothecary, September 23, 2020,

165 Adam Millsap, “Medicaid Spending is Taking Over State Budgets,” Forbes, January 23, 2020,

166 Ibid.

167 John Daniel Davidson, “50 Years Later, Medicaid and Medicare Still Spend Us Into Oblivion,” The Federalist, July 31, 2015,

168 CBO, “Options for Reducing the Debt: 2019–2028,” December 13, 2018,

169 Avik Roy, “Governors’ Worst Nightmare: Obama Proposed Shifting Costs of Obamacare’s Medicaid Expansion to the States,” Forbes, July 19, 2012,

170 GAO, “Managing Federal Real Property,”

171 CRS, “The Federal Assets Sale and Transfer Act: Background and Implementation,November 16, 2022,  

172 GAO High-Risk Series 2019; “High-Risk Series:  An Update,” GAO-03-119, January 2003,

173 GAO High-Risk Series 2019.

174 Ibid., p. 80.

175 GAO, “Federal Real Property: Agencies Attribute Substantial Increases in Reported Deferred Maintenance to Multiple Factors,” GAO-23-106124, October 28, 2022, p. 2,

176 General Services Administration, “Resources for the McKinney-Vento Homeless Assistance Program,” January 23, 2019,

177 GAO, “FEDERAL REAL PROPERTY: Current Efforts, GAO Recommendations, and Proposed Legislation Could Address Challenges,” GAO-15-688T, June 16, 2015,

178 CAGW, Prime Cuts, October 2020,

179 Garrett Hatch, “Disposal of Unneeded Federal Buildings:  Legislative Proposals in the 114th Congress,” Congressional Research Service, February 12, 2016,

180 Sarah D. Wire, “The government spends $1.7 billion a year on 770,000 empty buildings, and one Central Valley congressman is fed up,” Los Angeles Times, March 3, 2016,

181 Federal Asset Sale and Transfer Act, Pub. L. No. 114-287, H.R. 4465, 114th Congress (2016),

182 GAO, “FEDERAL REAL PROPERTY: Additional Documentation of Decision Making Could Improve Transparency of New Disposal Process,” GAO-21-233, January 29, 2021, p. What GAO Found,

183 Ibid., p. 27.

184 GAO, “FEDERAL REAL PROPERTY: GSA Should Improve Accuracy, Completeness, and Usefulness of Public Data,” GAO-20-135, February 2020, pp. What GAO Found, 5,

185 Ibid., p. 13.

186 Republican Study Committee GEAR Task Force, “Power, Practices, Personnel: 100 + Commonsense Solutions To A Better Government,” February, 6, 2020,

187 Eliminate Agency Excess Space Act, H.R. 1254, 117th Congress (2021),

188 Thomas Schatz and Cody Leach, “Reducing the Cost of Government Through Effective Management Reforms,” CAGW, December 2020, p. 3,

189 CAGW, 2022 Prime Cuts, p. 6.

190 Carroll Doherty, Jocelyn Kiley, Nida Asheer, and Calvin Jordan, “Important Issues in the 2020 Election,” Pew Research Center, August 13, 2020,

191 Doherty, Kiley, Asheer, and Jordan, “Public’s Top Priority for 2022: Strengthening the Nation’s Economy,” Pew Research Center, February 16, 2022,

192 Inflation Reduction Act of 2022, Pub. L. No. 117-169, H.R. 5376,

193 Christina Herrin, “The Inflation Reduction Act is a Death Sentence for Patients,” The WasteWatcher, Citizens Against Government Waste (CAGW), August 22, 2022,; Christina Herrin, “The Inflation Reduction Act Will Raise Drug Costs and Reduce Cures,” The WasteWatcher, CAGW, August 5, 2022,; Thomas Schatz, “The Senate Must Reject Price Controls on Pharmaceuticals,” The WasteWatcher, CAGW, July 7, 2022,

194 CAGW, “Citizens Against Government Waste Releases Investigative Report on Patient-Centered Healthcare,” November 3, 1998, CAGW,

195 Elizabeth Wright and Thomas Schatz, “Government-Run Healthcare Will Harm Patients and Eliminate Consumer Choice,” CAGW, September 2021,  

196 Barry M. Strobe, M.D., “A Role for Government,” American Journal of Preventive Medicine, January 3, 2013,

197 Patient Protection and Affordable Care Act, Pub. L. No. 111-148, H.R. 3590,

198 The Heritage Foundation, “Solutions,” 2021,

199 Edmund Haislmaier, “Obamacare Has Doubled The Cost Of Individual Health Insurance,” The Heritage Foundation, March 21, 2021,

200 Ibid.

201 Curtis Kalin, “The VA Scandal Refuses to End,” The WasteWatcher, CAGW, March 9, 2018,

202 Department of Veterans Affairs, Office of Inspector General, “Veterans Health Administration:  Critical Deficiencies at the Washington, D.C. VA Medical Center,” Report #17-02644-130, March 7, 2018,

203 Responsible Path to Full Obamacare Repeal Act, H.R. 6515 (2022),

204 Sahil Kapur, “Republicans abandon Obamacare Repeal,” October 2, 2022, NBC News,

205 Thomas Schatz, “The Senate Must Reject Price Controls on Pharmaceuticals,” The WasteWatcher, CAGW, July 7, 2022,; Christina Smith, “Senators Need to Check Their Conscience Before Voting for Price Controls,” The WasteWatcher, CAGW, July 28, 2022,; Christina Smith, “The Inflation Reduction Act Will Raise Drug Prices and Reduce Cures,” The WasteWatcher, CAGW, July 28, 2022,; Christina Smith, “The House Should Avoid Making the Senate’s Terrible Mistake on Healthcare,” The WasteWatcher, CAGW, August 8, 2022,

206 CBO, “CBO’S Simulation Model Of New Drug Development,” August 2021,

207 Thomas Philipson and Troy Durie, “Issue Brief: The Impact of HR 5376 on Biopharmaceutical Innovation and Patient Health,” The Kenneth C. Griffin Department of Economics, University of Chicago, November 29, 2021,

208 Ibid., pp. 7-8.

209 CBO, “Estimated Budgetary Effects Of Title XIII, Committee On Ways And Means, H.R. 5376, The Build Back Better Act,” November 18, 2021,

210 Ibid., Philipson and Durie, “Issue Brief: The Impact of HR 5376 on Biopharmaceutical Innovation and Patient Health.”

211 Christina Smith, “Price Controls Will Create an Invisible Graveyard of Americans,” The WasteWatcher, CAGW, December 17, 2021,

212 Protect Drug Innovation Act, S. 4953, 117th Congress (2022),

214 Joe Grogan, “The Inflation Reduction Act Is Already Killing Potential Cures,” The Wall Street Journal, November 3, 2022,

215 Health Resources and Services Administration (HRSA), “340B Eligibility,”

216 Adam J. Fein, Ph.D., “New HSRA Data: 340B Program Reached $29.9 Billion in 2019; Now Over 8% of Drug Sales,” Drug Channels Institute, June 9, 2020,

217 HRSA, “2021 340B Covered Entity Purchases,”

218 House Energy and Commerce Committee, “New E&C Report Examines the 340B Drug Pricing Program,” press release, January 10, 2018,

220 Katie Thomas and Jessica Silver-Greenberg, “How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits,” The New York Times, September 24, 2022,

221 Ibid.

222 PCMA, “The Value of PBMs: PBMs Are Committed to Helping Their Patients,” Pharmaceutical Care Management Association,,)%2C%20state%20government%20employee%20plans%2C.

223 GAO, “Medicare Part D: Use of Pharmacy Benefit Managers and Efforts to Manage Drug Expenditures and Utilization,” July 2019, p. 2,

224 Ibid., p. 14.

225 Ibid., p. 18.

226 Ibid.

227 Pharmacy Benefit Manager Transparency Act, S. 4293, 117th Congress (2022),

228 CAGW, “CAGW Provides Comments to FTC on Pharmacy Benefit Managers,” May 25, 2022,

229 Ramtin Arablouei and Rund Abdelfatah, “History of Employer-Based Health Insurance in the U.S.,” National Public Radio,  October 7, 2020,,it%20much%20cheaper%20for%20employers.

230 Annie Nova, “Millions Of Americans Have Lost Health Insurance In This Pandemic-Driven Recession. Here Are Their Options,” CNBC, August 28, 2020,

231 Kev Coleman, “What Is an Association Health Plan?,” Association Health, November 18, 2020,

232 CMS, “Health Savings Account (HSA),” 2022,

233 Devinir, “HSAs gain traction with older and younger Americans alike, covering more than 63 million people across all 50 states at the end of 2020,” June 21, 2021,

234 CMS, “Trump Administration Drives Telehealth Services in Medicaid and Medicare,” October 14, 2020,

235 White House Archives, “President Donald J. Trump Is Expanding Access to Telehealth Services and Ensuring Continued Access to Healthcare for Rural Americans,” The White House, August 3, 2020,

236 CMS, “Trump Administration Finalizes Permanent Expansion of Medicare Telehealth Services And Improved Payment for Time Doctors Spend with Patients,” December 1, 2020,

237 Susan Morse, “Congressional Action Is Needed for Telehealth Not To Return To A Rural Benefit, CMS Administrator Seema Verma Says,” Healthcare Finance News, December 1, 2020,

238 Mark E. Czeisler, Kristy Marynak, MPP, Kristie E.M. Clarke, MD, et al., “Delay or Avoidance of Medical Care Because of COVID-19-Related Concerns – United States, June 2020,” Centers for Disease Control and Prevention, September 11, 2020,

239 CMS, “President Trump Expands Telehealth Benefits For Medicare Beneficiaries During COVID-19 Outbreak,”  March 17, 2020,

240 Federal Communications Commission (FCC), “COVID-19 Telehealth Program (Invoices & Reimbursements),”

241 FCC, “FCC Announces Final Set of Commitments for COVID-19 Telehealth Program,” January 26, 2022,

242 The Telehealth Modernization Act, H.R. 1332, (2021),

243 Health Policy Consensus Group, “Health Care Choices 20/20: A Vision for the Future,” November 2020,

244 Ibid.

245 U.S. Constitution, Article 1, Section 8, National Archives,

246 William F. Patry, Copyright Law and Practice, Bureau of National Affairs, 1994, 2000,

247 Ibid.

248 Andrew A. Toole, Ph.D., Richard D. Miller, Ph.D., and Nicholas Rada, Ph.D., “Intellectual property and the U.S. economy: Third edition,” U.S. Patent and Trademark Office, 2021,

249 Ibid., p. 3, “Figure 1: GDP of the IP-intensive industries, 2019,” (because some industries are cross classified, the individual values do not sum to the total value.)

250 Robert Stoner and Jéssica Dutra, “Copyright Industries in the U.S. Economy,” International Intellectual Property Alliance®, December 2022,

251 Motion Picture Association (MPA), “What We Do:  Driving Economic Growth,” February 25, 2020,

253 Ibid.

254 Global Innovation Policy Center, “2022 International IP Index:  Compete for Tomorrow, U.S. Chamber International IP Index,” 10th ed., U.S. Chamber of Commerce, 2022,

255 Ibid.

256 Ibid.

257 Thomas Schatz and Deborah Collier, Intellectual Property: Making It Personal, CAGW, November 2014, p. 5,

258 Office of the United States Trade Representative (USTR), “2022 Special 301 Report,” April 27, 2022,

259 Ibid.

260 USTR, “USTR Releases Annual Special 301 Report on Intellectual Property Protection and Enforcement,” April 30, 2021,

261 USTR, “USTR Releases 2022 Special 301 Report on Intellectual Property Protection and Enforcement,” April 27, 2022,

262 Sheyerah I. Akhtar, “World Trade Organization: ‘TRIPS Waiver’ for COVID-19 Vaccines,” Congressional Research Service, August 31, 2022,,TRIPS%20Waiver%20Decision%20for%20COVID%2D19%20Vaccines,CLs%20for%20COVID%2D19%20vaccines.

263 World Health Organization, “172 countries and multiple vaccine candidates engaged in COVID-19 vaccine Global Access Facility,” August 24, 2020,

264 Meir Pugatch, Rachel Chu, and David Torstensson, “Create: U.S. Chamber International IP Index, 6th edition,” Global Innovation Policy Center, U.S. Chamber of Commerce, February 2018,

265 Department of Homeland Security (DHS), “Intellectual Property Rights Seizure Statistics, Fiscal Year 2018,” August 9, 2019,

266 Ibid.

269 The Commission on the Theft of American Intellectual Property, “The Theft of American Intellectual Property: Reassessments of the Challenge and United States Policy, Update to the IP Commission Report,” National Bureau of Asian Research, February 2017,

270 Ibid.

271 David Blackburn, Jeffrey A. Eisenach, and David Harrison, “Impacts of Digital Video Piracy on the U.S. Economy,” Global Innovation Policy Center, U.S. Chamber of Commerce, June 2019,

272 Ibid.

273 Motion Picture Association, “Safeguarding Creativity,”

274 U.S. Immigration and Customs Enforcement, “Motion Picture Association signs up to assist the IPR Center with anti-piracy efforts,” September 16, 2020,,the%20U.S.%20Chamber%20of%20Commerce.

275 DISH Network L.L.C. and NagraStar LLC v. Nelson Johnson, Jason Labossiere, Set Broadcast LLC, Streaming Entertainment Technology LLC, Doe 1, as Trustee for Chateau Living Revocable Trust and Doe 2, as Trustee for Macromint Trust, individually and collectively d/b/a, Civil Case No. 8:18-cv-1332-T-33AAS, Final Judgment and Permanent Injunction, October 24, 2018,

276 Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, 116th Congress, (2020),

277 Sen. Tom Tillis, “Protecting Lawful Streaming Act,” Congressional Record, Volume 166, Number 218, U.S. Senate, December 21, 2020, pp. S7931-S7932,

278 U.S. Patent and Trademark Office, “Protecting Lawful Streaming Act of 2020,”

279 Copyright Alternative in Small-Claims Enforcement Act of 2019, H.R. 2426, 116th Congress (2019),

280 Council for Citizens Against Government Waste, “CCAGW Leads Coalition Supporting H.R. 4130, the American Music Fairness Act,” June 8, 2022,

281 James Madison, “Federalist Papers:  Primary Documents in American History, Federalist Paper No. 43, The Same Subject Continued:  The Powers Conferred by the Constitution Further Considered,” For the Independent Journal, The Library of Congress, last updated August 13, 2019,

282 Roslyn Layton, “The GDPR: What It Really Does and How the U.S. Can Chart a Better Course,” Federalist Society Review, Volume 19, October 29, 2018,

283 California Consumer Privacy Act of 2018, SB-1121 (2017-2018), Title 1.81.5 added by Stats. 2018, Ch. 55, Sec. 3),

284 Secretary of State Alex Padillo, “California General Election Results,” Tuesday, November 3, 2020,

285 Steven A. Hengeli, Jr., “California Privacy Rights Act: Latest Update, Impact and Next Steps,” The National Law Review, July 2, 2020,

286 Jocelyn Benson, Secretary of State, Department of State, State of Michigan, “Proposal 20-2, A proposed constitutional amendment to require a search warrant in order to access a person’s electronic data or electronic communications,” November 3, 2020,

287 Ryan Lanier, “State Legislative Sessions Underscore the Need for a National Privacy Framework,” The WasteWatcher, CAGW, June 14, 2022,

288 Daniel Castro, Luke Dascoli, and Gillian Diebold, “The Looming Cost of a Patchwork of State Privacy Laws,” Information Technology & Innovation Foundation, January 24, 2022,,costs%20would%20exceed%20%241%20trillion.

289 American Data Privacy Protection Act, H.R. 8152, 117th Congress (2022),

290 CAGW, “Comments to NTIA on Developing the Administration’s Approach to Consumer Privacy,” November 2, 2018,

291 Deborah Collier and Tom Schatz, “The Path to a National Privacy Framework,” CAGW, March 2022,

292 Amy Olivero, “Reviewing the House Committee changes to the proposed ADPPA,” International Association of Privacy Professionals, September 16, 2022,

293 Federal Trade Commission, “Trade Regulation Rule on Commercial Surveillance and Data Security, Advance notice of proposed rulemaking; request for public comment; public forum,” 16 CFR Part 464, August 10, 2022,

294 Deborah Collier, “FTC Is Invading Privacy by Overreaching on Regulations,” CAGW, August 19, 2022,

295 Ibid., “Comments to NTIA on Developing the Administration’s Approach to Consumer Privacy.”

296 Deborah Collier, “Federal Broadband Funds Must Not Be Wasted,” The WasteWatcher, CAGW, February 7, 2022,

297 Deborah S. Collier and Thomas A. Schatz, Telecom Unplugged:  Ushering in a New Digital Era, CAGW, November 2014, p. 36,

298 Ibid., p. 32.

299  Mark L. Goldstein, Director, Physical Infrastructure Issues, “Recovery Act: Preliminary Observations on the Implementation of Broadband Program,” GAO, Testimony Before the Committee on Commerce, Science, and Transportation, U.S. Senate, October 27, 2009, p. Highlights,

300 Deborah S. Collier and Thomas A. Schatz, Telecom Unplugged:  Ushering in a New Digital Era, Citizens Against Government Waste. 

301 GAO, “Broadband:  National Strategy Needed to Guide Federal Efforts to Reduce Digital Divide,” GAO-22-104611, May 31, 2022,

302 USDA, Rural Utilities Service, Rural eConnectivity Program, Funding opportunity announcement, Federal Register, October 25, 2021, p. 58860,

303 Ibid.

304 Department of the Treasury, “Coronavirus State and Local Fiscal Recovery Funds: Overview of the Final Rule,” January 2022, p. 39,

305 National Telecommunications Information Administration, Broadband Equity, Access, and Deployment Program, “Notice of Funding Opportunity, Executive Summary,”

306 Deborah Collier and Thomas A. Schatz, The Folly of Government-Owned Networks, CAGW, May 2021, p. 5,

307 Federal Communications Commission, “FCC National Broadband Map,” November 2022,

308 Broadband DATA Act, Pub. L. No. 116-113, S. 1822, 116th Congress (2020),

309 Accenture, “Three Mid-band Spectrum Bands Offer Greatest Potential to Meet 5G Demand in the US, Study Finds,” September 28, 2022,

310 Federal Communications Commission, “Auctions Summary,”

311 Sandra Sobieraj, “Clinton Issues ‘Hands-Off’ Policy on Internet Commerce,” The New York Times, July 2, 1997,

312 Federal Communications Commission, “In the Matters of Appropriate Framework for Broadband Access to the Internet over Wireline Facilities (CC Docket No. 02-33); Review of Regulatory Requirements for Incumbent LEC Broadband Telecommunications Services (CC Docket No. 01-337); Computer III Further Remand Proceedings:  Bell Operating Company Provision of Enhanced Services; 1998 Biennial Regulatory Review – Review of Computer III and ONA Safeguards and Requirements (CC Docket Nos. 92-20, 98-10); Inquiry Concerning High-Speed Access to the Internet Over Cable and Other Facilities (GN Docket No. 00-185); Internet Over Cable Declaratory Ruling; Appropriate Regulatory Treatment for Broadband Access to the Internet Over Cable Facilities (CS Docket No. 02-52),” Policy Statement, Adopted August 5, 2005,

314 FCC, “Contribution Factor & Quarterly Filings – Universal Service Fund (USF) Management Support,”

315 Deborah Collier, “Reforms are Needed for Financing the Universal Service Fund,” The WasteWatcher, CAGW, January 25, 2021,