Imposing Sanctions on Two Burmese State-Owned Enterprises

Antony J. Blinken, Secretary of State

The Burmese military regime continues to ignore the will of the people of Burma to restore the country’s path to democracy. Instead of acceding to the clear aspirations of its citizens, the regime has intensified its violent crackdown, killing more than 650 people, including many children, and detaining more than 3,200 others since February 1.

Today, the United States is taking further action to restrict the regime’s access to key economic resources by designating two state-owned enterprises that benefit the regime as it engages in violence against the people of Burma. Myanma Timber Enterprise (MTE) and Myanmar Pearl Enterprise (MPE) are being designated pursuant to Executive Order 14014, for being a political subdivision, agency, or instrumentality of the Government of Burma.

Our action today reinforces our message to the military that the United States will continue to target specific funding channels and promote accountability for the coup and related violence. We will continue to support the people of Burma in their efforts to reject this coup, and we call on the military regime to cease violence, release all those unjustly detained, and restore Burma’s path to democracy.

For more information about today’s action, see the Treasury Department’s press release .

More from: Antony J. Blinken, Secretary of State

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  • Veterans Community Care Program: Immediate Actions Needed to Ensure Health Providers Associated with Poor Quality Care Are Excluded
    In U.S GAO News
    The Department of Veterans Affairs (VA) has implemented contracts with Optum and TriWest to set up networks of community providers as part of the new Veterans Community Care Program (VCCP). However, the two contractors' processes for implementing eligibility restrictions established by the VA MISSION Act, as outlined in their policies and reflected in their contracts, may not consistently exclude all ineligible providers from participating in the VCCP. The VA MISSION Act prohibits providers from participating in the VCCP if they have lost a state medical license, for example, as a result of revocation or termination for cause or due to concerns about poor quality of care. However, VA's contracts with these contractors do not require the verification of providers' history of license sanctions, including a revoked license, in all states during credentialing. Only one of the two contractors has a process that includes verifying providers' licensure history in all states and neither has a sufficient process for continuously monitoring provider licenses. Contractor Processes for Implementing VA MISSION Act Restrictions on Community Care Provider Eligibility In May 2019, VA began tracking providers who do not meet the eligibility restrictions established by the VA MISSION Act. However, this tracking does not address providers removed from VA prior to this date. As of September 2020, VA had deactivated 136 ineligible VA providers from VCCP participation. GAO reviewed data going back to July 1, 2016 and identified an additional 227 providers that had been removed from VA employment and are potentially providing care in the VCCP. VA stated it has no plans to further review these providers. VA officials said these providers were eligible to participate in the VCCP because they were removed from VA employment before the VA MISSION Act restrictions were effective. Thus, there is a continued risk that former VA providers associated with quality of care concerns are participating in the VCCP. The VA MISSION Act of 2018 established a new community care program, the VCCP, aimed at providing care to veterans when it could not reasonably be delivered by providers at VA medical facilities. The act also requires VA to exclude from participation in the VCCP providers who lost a license for violating medical license requirements in any state or who VA removed from employment for quality of care concerns or otherwise suspended from VA employment. The VA MISSION Act included provisions for GAO to report on the implementation of restrictions on certain health care providers' participation in the VCCP. This report examines, among other issues, VA and contractor processes to implement these eligibility restrictions on provider participation in the VCCP. GAO reviewed VA's contracts and contractor policies related to VCCP provider credentialing, interviewed VA and contractor officials, and assessed the provider credentialing requirements and processes. In addition, GAO collected data on former VA providers and compared these data to the database of VCCP providers. GAO is making three recommendations to VA, including that VA require its contractors to have credentialing and monitoring policies that ensure compliance with VA MISSION Act license restrictions and that it assess the risk to veterans when former VA providers with quality concerns continue to provide VCCP care. VA generally agreed with GAO's three recommendations. For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.
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  • Behavioral Health: Patient Access, Provider Claims Payment, and the Effects of the COVID-19 Pandemic
    In U.S GAO News
    What GAO Found GAO found that there have been longstanding concerns about the availability of behavioral health treatment, particularly for low-income individuals. According to a review of federal data, one potential barrier to accessing treatment has been shortages of qualified behavioral health professionals, particularly in rural areas. Stakeholders that GAO interviewed—officials from the National Council for Behavioral Health (NCBH) and from hospital associations and insurance regulators in four states—cited additional contributing factors such as provider reimbursement rates and health system capacity. Additionally, recent reports from Pennsylvania and Oregon further documented longstanding problems with meeting the need for behavioral health services in their states. Evidence collected during the pandemic suggests the prevalence of behavioral health conditions has increased, while access to in-person behavioral health services has decreased: Centers for Disease Control and Prevention (CDC) survey data collected from April 2020 through February 2021 found that the percentage of adults reporting symptoms of anxiety or depression averaged 38 percent. In comparison, using similar questions, CDC found that about 11 percent of U.S. adults reported experiencing these symptoms from January to June 2019. An analysis of CDC data found that the share of emergency department visits for drug overdoses and suicide attempts were 36 and 26 percent higher, respectively, for the period of mid-March through mid-October 2020 compared to the same time period in 2019. In a February 2021 survey of its members, NCBH found that in the 3 months preceding the survey, about two-thirds of the member organizations surveyed reported demand for their services increasing and having to cancel or reschedule patient appointments or turn patients away. The survey also found that during the pandemic, 27 percent of member organizations reported laying off employees, 45 percent reported closing some programs, and 35 percent decreased the hours for staff. Officials GAO interviewed from provider organizations offered anecdotal examples of problems with payments for behavioral health services, including examples suggesting that denials and delays were more common for these services than they were for medical/surgical services. However, most officials were not aware of published data that could confirm their concerns, and data from reports from two states on claims denials either did not support their concerns or were inconclusive. In addition, a report in one state that examined mental health parity—requirements that behavioral health benefits are not more restrictive than medical/surgical benefits—found that the rate of complaints associated with behavioral health services was notably lower than those for medical/surgical services. The lack of available data confirming stakeholder concerns could be related to potential challenges consumers and providers face in identifying and reporting mental health parity violations, as previously reported by GAO. Specifically, in 2019, GAO found that complaints were not a reliable indicator of such violations, because consumers may not know about parity requirements or may have privacy concerns related to submitting a complaint. GAO recommended that the federal agencies involved in the oversight of mental health parity requirements evaluate the effectiveness of their oversight efforts. As of March 2021, the agencies had not yet implemented this recommendation. Why GAO Did This Study Behavioral health conditions, which include mental health and substance use disorders, affect a substantial number of adults in the United States. For example, in 2019, an estimated 52 million adults in the United States were reported to have a mental, behavioral, or emotional disorder, and 20 million people aged 12 or older had a substance use disorder. Experts have expressed concerns that the incidence of behavioral health conditions would increase as a result of stressors associated with the COVID-19 pandemic. Even before the pandemic, longstanding questions have been raised about whether coverage or claims for behavioral health services are denied or delayed at higher rates than those for other health services. GAO was asked to examine several issues about the demand for behavioral health services, as well as coverage and payment for these services. GAO examined (1) what is known about the need for and availability of behavioral health services, and how these have changed during the COVID-19 pandemic; and (2) what issues selected stakeholders identified regarding the payment of claims for behavioral health services. GAO reviewed survey data and other relevant analyses focused on the need for and availability of behavioral health services prior to and during the COVID-19 pandemic. GAO also reviewed reports from two states that compared claims for behavioral health services with those of other health services; interviewed officials from NCBH; and interviewed officials from hospital associations and insurance regulators in Oregon, Pennsylvania, Texas, and Virginia. For more information, contact John E. Dicken at 202-512-7114 or dickenj@gao.gov.
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  • Aviation Cybersecurity: FAA Should Fully Implement Key Practices to Strengthen Its Oversight of Avionics Risks
    In U.S GAO News
    Modern airplanes are equipped with networks and systems that share data with the pilots, passengers, maintenance crews, other aircraft, and air-traffic controllers in ways that were not previously feasible (see fig. 1). As a result, if avionics systems are not properly protected, they could be at risk of a variety of potential cyberattacks. Vulnerabilities could occur due to (1) not applying modifications (patches) to commercial software, (2) insecure supply chains, (3) malicious software uploads, (4) outdated systems on legacy airplanes, and (5) flight data spoofing. To date, extensive cybersecurity controls have been implemented and there have not been any reports of successful cyberattacks on an airplane's avionics systems. However, the increasing connections between airplanes and other systems, combined with the evolving cyber threat landscape, could lead to increasing risks for future flight safety. Figure 1: Key Systems Connections to Commercial Airplanes The Federal Aviation Administration (FAA) has established a process for the certification and oversight of all US commercial airplanes, including the operation of commercial air carriers (see fig. 2). While FAA recognizes avionics cybersecurity as a potential safety issue for modern commercial airplanes, it has not fully implemented key practices that are necessary to carry out a risk-based cybersecurity oversight program. Specifically, FAA has not (1) assessed its oversight program to determine the priority of avionics cybersecurity risks, (2) developed an avionics cybersecurity training program, (3) issued guidance for independent cybersecurity testing, or (4) included periodic testing as part of its monitoring process. Until FAA strengthens its oversight program, based on assessed risks, it may not be able to ensure it is providing sufficient oversight to guard against evolving cybersecurity risks facing avionics systems in commercial airplanes. Figure 2: Federal Aviation Administration's Certification Process for Commercial Transport Airplanes GAO has previously identified key practices for interagency collaboration that can be used to assess interagency coordination. FAA coordinates with other federal agencies, such as the Departments of Defense (DOD) and Homeland Security (DHS), and with industry to address aviation cybersecurity issues. For example, FAA co-chairs the Aviation Cyber Initiative, a tri-agency forum with DOD and DHS to address cyber risks across the aviation ecosystem. However, FAA's internal coordination activities do not fully reflect GAO's key collaboration practices. FAA has not established a tracking mechanism for monitoring progress on cybersecurity issues that are raised in coordination meetings, and its oversight coordination activities are not supported by dedicated resources within the agency's budget. Until FAA establishes a tracking mechanism for cybersecurity issues, it may be unable to ensure that all issues are appropriately addressed and resolved. Further, until it conducts an avionics cybersecurity risk assessment, it will not be able to effectively prioritize and dedicate resources to ensure that avionics cybersecurity risks are addressed in its oversight program. Avionics systems, which provide weather information, positioning data, and communications, are critical to the safe operation of an airplane. FAA is responsible for overseeing the safety of commercial aviation, including avionics systems. The growing connectivity between airplanes and these systems may present increasing opportunities for cyberattacks on commercial airplanes. GAO was asked to review the FAA's oversight of avionics cybersecurity issues. The objectives of this review were to (1) describe key cybersecurity risks to avionics systems and their potential effects, (2) determine the extent to which FAA oversees the implementation of cybersecurity controls that address identified risks in avionics systems, and (3) assess the extent to which FAA coordinates internally and with other government and industry entities to identify and address cybersecurity risks to avionics systems. To do so, GAO reviewed information on key cybersecurity risks to avionics systems, as reported by major industry representatives as well as key elements of an effective oversight program, and compared FAA's process for overseeing the implementation of cybersecurity controls in avionics systems with these program elements. GAO also reviewed agency documentation and interviewed agency and industry representatives to assess FAA's coordination efforts to address the identified risks. GAO is making six recommendations to FAA to strengthen its avionics cybersecurity oversight program: GAO recommends that FAA conduct a cybersecurity risk assessment of avionics systems cybersecurity within its oversight program to identify the relative priority of avionics cybersecurity risks compared to other safety concerns and develop a plan to address those risks. Based on the assessment of avionics cybersecurity risks, GAO recommends that FAA identify staffing and training needs for agency inspectors specific to avionics cybersecurity, and develop and implement appropriate training to address identified needs. develop and implement guidance for avionics cybersecurity testing of new airplane designs that includes independent testing. review and consider revising its policies and procedures for monitoring the effectiveness of avionics cybersecurity controls in the deployed fleet to include developing procedures for safely conducting independent testing. ensure that avionics cybersecurity issues are appropriately tracked and resolved when coordinating among internal stakeholders. review and consider the extent to which oversight resources should be committed to avionics cybersecurity. FAA concurred with five out of six GAO recommendations. FAA did not concur with the recommendation to consider revising its policies and procedures for periodic independent testing. GAO clarified this recommendation to emphasize that FAA safely conduct such testing as part of its ongoing monitoring of airplane safety. For more information, contact Nick Marinos at (202) 512-9342 or MarinosN@gao.gov, or Heather Krause at (202) 512-2834 or KrauseH@gao.gov.
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  • Automated Technologies: DOT Should Take Steps to Ensure Its Workforce Has Skills Needed to Oversee Safety
    In U.S GAO News
    Stakeholders GAO interviewed said that federal oversight of automated technologies—such as those that control a function or task of a plane, train, or vehicle without human intervention—requires regulatory expertise as well as engineering, data analysis, and cybersecurity skills. Stakeholders also stated that as automated systems become more common across transportation modes, overseeing them will require understanding vehicle operating systems, software code, and the vast amounts of data produced by these systems to ensure their safety. Skills Needed to Oversee the Safety of Automated Technologies, according to Stakeholders The U.S. Department of Transportation's (DOT) Departmental Office of Human Resources Management has identified most skills DOT needs to oversee automated technologies, but it has not fully assessed whether its workforce has these skills. Through its workforce planning efforts, DOT identified many of the skills cited by stakeholders as important for overseeing automated technologies—regulatory expertise, engineering, and data analysis. In 2016 and 2020, DOT surveyed staff in related positions and identified gaps in some of these skills, including regulatory expertise. However, DOT did not survey staff or assess skill gaps in data analysis or cybersecurity positions important to automated technology oversight. As a result, DOT lacks critical information needed to identify skill gaps and ensure key relevant staff are equipped to oversee the safety of these technologies now and in the future. DOT developed strategies to address some but not all gaps in skills needed to oversee automated technologies. For example, DOT implemented some recruiting strategies and established hiring goals as a means of closing gaps identified in the 2016 survey and plans to continue these efforts in light of the 2020 survey. However, DOT has not tracked the progress of strategies implemented to close skill gaps since the 2016 survey, nor has it implemented training strategies. Accordingly, some skill gaps related to overseeing the safety of automated technologies will likely persist in DOT's workforce. Automated technologies in planes, trains, and passenger vehicles are in use today and likely to become increasingly widespread. While these technologies hold promise, accidents involving them demonstrate potential safety challenges. DOT is responsible for overseeing the safety of all modes of transportation. This report addresses: (1) stakeholders' perspectives on the skills required to oversee automated technologies; (2) the extent to which DOT has identified and assessed the skills it needs to oversee these technologies; and (3) the extent to which DOT has developed strategies to address any gaps in skills. GAO reviewed relevant literature and DOT workforce planning documents, and interviewed DOT human capital officials, selected modal administrations, and stakeholders, including transportation associations and technology developers. GAO selected modal administrations based in part on the prevalence of automated technologies. GAO is making four recommendations, including that DOT: (1) assess skill gaps in key occupations involved in overseeing automated technologies and (2) regularly measure the progress of strategies implemented to close skill gaps. DOT concurred with three recommendations and partially concurred with one on measuring progress. GAO clarified this recommendation and believes its implementation is warranted. For more information, contact Heather Krause at (202) 512-2834 or krauseh@gao.gov.
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  • Technology Assessment Design Handbook
    In U.S GAO News
    The Technology Assessment (TA) Design Handbook identifies tools and approaches GAO staff and others can consider in the design of robust and rigorous technology assessments. The handbook underscores the importance of TA design (Chapter 1), outlines the process of designing TAs (Chapter 2), and describes approaches for mitigating select TA design and implementation challenges (Chapter 3). While the primary audience of this handbook is GAO staff, other organizations may also find portions of this handbook useful as they consider or conduct TAs. This is an update to the handbook published in December 2019, based on the experiences of GAO teams and a review of relevant literature and comments submitted by external experts and the public between December 2019 and December 2020. The handbook identifies three general design stages, as shown in the figure below. The handbook also highlights seven cross-cutting considerations for designing TAs: the iterative nature of TA design, congressional and policymakers' interests, resources, independence, engaging internal and external stakeholders, potential challenges, and communication strategy. In addition, the handbook provides a high-level process for developing policy options, as a tool for analyzing and articulating a range of possible actions a policymaker could consider that may enhance the benefits or mitigate the challenges of a technology. Steps in developing policy options include, as applicable: determining the potential policy objective; gathering evidence; identifying possible policy options and the relevant dimensions along which to analyze them; analyzing policy options; and presenting the results of the analysis. Summary of Key Stages of Technology Assessment Design We found that GAO TAs can use a variety of design approaches and methods. The handbook includes TA design and methodology examples, along with example objectives commonly found in GAO TAs, such as: describe a technology, assess opportunities and challenges of a technology, and assess policy implications or options. For example, some GAO TAs include an objective related to describing the status and feasibility of a technology, which GAO teams have addressed by using methodologies such as expert panels, interviews, literature and document reviews, site visits, and determining the technology readiness level. Also included in the handbook are examples of TA design and implementation challenges, along with possible mitigation strategies. We identified four general categories of challenges: (1) ensuring that the design and implementation of TAs result in useful products for Congress and other policymakers; (2) determining the policy objective and measuring potential effects; (3) researching and communicating complicated issues; and (4) engaging relevant stakeholders. For example, allowing sufficient time for writing, review, and any needed revisions is one potential mitigation strategy that could help teams write simply and clearly about technical subjects and ensure that the design and implementation of TAs result in useful products for Congress and other policymakers. In 2019, GAO created the Science, Technology Assessment, and Analytics team to expand its work on cutting-edge science and technology issues, and to provide oversight, insight, and foresight for science and technology. TAs can be used to strengthen decision-making, enhance knowledge and awareness, and provide early insights into the potential effects of technology. Systematically designing a TA can enhance its quality, credibility, and usefulness; ensure independence of the analysis; and ensure effective use of resources. Under Comptroller General Authority, we developed this handbook by generally following the format of the 2012 GAO methodology transfer paper, Designing Evaluations. Below is a summary of the approach we used to affirm and document TA design steps and considerations for this handbook. Reviewed select GAO documents, including Designing Evaluations (GAO-12-208G), published GAO TAs, select GAO products using policy analysis approaches to present policy options, and other GAO reports Reviewed select Office of Technology Assessment reports Reviewed select Congressional Research Service reports Reviewed select English-language literature regarding TAs and related to development and analysis of policy options Consulted with external experts and performed outreach, including holding an expert meeting to gather input on TA design, soliciting comments from external experts who contributed to GAO TAs published since 2015, and soliciting comments from the public Reviewed experiences of GAO teams that have successfully assessed and incorporated policy options into GAO products and TA design, including challenges to TA design and implementation and possible solutions GAO is not making any recommendations. For more information, contact Timothy M. Persons or Karen L. Howard at (202) 512-6888 or personst@gao.gov or howardk@gao.gov.
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  • Countering Violent Extremism: DHS Needs to Improve Grants Management and Data Collection
    In U.S GAO News
    While the Department of Homeland Security (DHS) followed the Office of Management and Budget (OMB) guidance for announcing the 2016 Countering Violent Extremism (CVE) Grant Program and reviewing applications, DHS did not document the basis for its final award decisions. In June 2017, DHS awarded a total of $10 million in CVE grants to 26 grantees for a 2-year performance period (2017 to 2019). Consistent with OMB guidance, DHS included program priorities and eligibility requirements in its grant announcement and described the process for reviewing and selecting grant applications for award. However, after DHS announced its selection of 31 applications for awards, it ran a new process resulting in revised selections, which was based on additional selection criteria not expressly listed in the grant announcement. While DHS officials explained to GAO how these additional criteria aligned with the grant announcement, these explanations do not appear in DHS's award documentation. Without such documentation, DHS cannot clearly demonstrate that its award decisions were based on the process described in the grant announcement. Figure: Location and Number of Deaths Associated with Domestic Extremist Attacks, 2010-2019 DHS did not obtain the necessary data from grantees to evaluate the overall CVE grant program. DHS required grant organizations to develop, collect, and submit their own output and outcome-related information to help enable the department to evaluate individual grantees and the overall grant program. However, a DHS review of four grant projects concluded that the grantees did not collect the type of performance information DHS needed to determine the grants' effectiveness, such as data at various time intervals to assess change in attitudinal behavior. Taking steps to ensure grantees collect and submit appropriate performance data would enable DHS to evaluate the extent that individual grant projects and the overall grant program are achieving results. Such information would help DHS manage the program and make adjustments as warranted. From 2010 through 2019, data collected through the Extremist Crime Database show that 205 deaths resulted from 59 violent extremist attacks in the United States. DHS received funding in 2016 to establish a new CVE Grant Program to support efforts by state and local governments and nongovernmental organizations to reduce risk factors associated with violent extremism. GAO was asked to review management of the CVE Grant Program. This report examines, among other things, the extent to which DHS (1) announced, reviewed, and awarded CVE grants in accordance with OMB guidance and (2) evaluated the performance of CVE grantees and the overall program. GAO reviewed documentation of DHS's actions in announcing, reviewing and awarding CVE grants; and documentation on steps taken to assess the performance of grantees and the overall program; as compared to requirements in key documents, including the CVE grant announcement, elements of internal control, and a DHS 2017 report to Congress. GAO recommends that DHS, for future CVE-related grant programs: (1) develop policy to document the rationale for award decisions, and (2) take steps to ensure that grantees collect and submit data on project performance that enable evaluation of individual grants and the overall grant program toward intended outcomes. DHS concurred with both recommendations. For more information, contact Triana McNeil at (202) 512-8777 or mcneilt@gao.gov.
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  • COVID-19: Brief Update on Initial Federal Response to the Pandemic
    In U.S GAO News
    As of August 20, 2020, the U.S. had over 5.5 million cumulative reported cases of COVID-19, and 158,000 reported deaths, according to federal agencies. The country also continues to experience serious economic repercussions and turmoil. Four relief laws, including the CARES Act, were enacted between March and July 2020 to provide appropriations for the response to COVID-19. The CARES Act includes a provision for GAO to report bimonthly on its ongoing monitoring and oversight efforts related to COVID-19. This second report examines federal spending on the COVID-19 response; indicators for monitoring public health and the economy; and the status of matters for congressional consideration and recommendations from GAO’s June 2020 report (GAO-20-625). GAO reviewed data through June 30, 2020 (the latest available) from USAspending.gov, a government website with data from government agencies. GAO also obtained, directly from the agencies, spending data, as of July 31, 2020, for the six largest spending areas, to the extent available. To develop the public health indicators, GAO reviewed research and federal guidance. To understand economic developments, GAO reviewed data from federal statistical agencies, the Federal Reserve, and Bloomberg Terminal, as well as economic research. To update the status of matters for congressional consideration and recommendations, GAO reviewed agency and congressional actions. In response to the national public health and economic threats caused by COVID-19, four relief laws making appropriations of about $2.6 trillion had been enacted as of July 31, 2020. Overall, federal obligations and expenditures government-wide of these COVID-19 relief funds totaled $1.5 trillion and $1.3 trillion, respectively, as of June 30, 2020. GAO also obtained preliminary data for six major spending areas as of July 31, 2020 (see table). COVID-19 Relief Appropriations, Obligations, and Expenditures for Six Major Spending Areas, as of July 2020 Spending area Appropriationsa ($ billions) Preliminary obligationsb ($ billions) Preliminary expendituresb ($ billions) Business Loan Programs 687.3 538.1 522.2c Economic Stabilization and Assistance to Distressed Sectors 500.0 30.4 19.2c Unemployment Insurance 376.4 301.1 296.8 Economic Impact Payments 282.0 273.5 273.5 Public Health and Social Services Emergency Fund 231.7 129.6 95.9 Coronavirus Relief Fund 150.0 149.5 149.5 Total for six spending areas 2,227.4 1,422.2 1,357.0 Source: GAO analysis of data from the Department of the Treasury, USAspending.gov, and applicable agencies. | GAO-20-708 aCOVID-19 relief appropriations reflect amounts appropriated under the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146; Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178 (2020); CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020); and Paycheck Protection Program and Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020). These data are based on appropriations warrant information provided by the Department of the Treasury as of July 31, 2020. These amounts could increase in the future for programs with indefinite appropriations, which are appropriations that, at the time of enactment, are for an unspecified amount. In addition, this table does not represent transfers of funds that federal agencies may make between appropriation accounts or transfers of funds they may make to other agencies. bObligations and expenditures data for July 2020 are based on preliminary data reported by applicable agencies. cThese expenditures relate to the loan subsidy costs (the loan’s estimated long-term costs to the United States government). The CARES Act included a provision for GAO to assess the impact of the federal response on public health and the economy. The following are examples of health care and economic indicators that GAO is monitoring. Health care. GAO’s indicators are intended to assess the nation’s immediate response to COVID-19 as it first took hold, gauge its recovery from the effects of the pandemic over the longer term, and determine the nation’s level of preparedness for future pandemics, involving subsequent waves of either COVID-19 or other infectious diseases. For example, to assess the sufficiency of testing—a potential indicator of the system’s response and recovery—GAO suggests monitoring the proportion of tests in a given population that are positive for infection. A higher positivity rate can indicate that testing is not sufficiently widespread to find all cases. That is higher positivity rates can indicate that testing has focused on those most likely to be infected and seeking testing because they have symptoms, and may not be detecting COVID-19 cases among individuals with no symptoms. Although there is no agreed-upon threshold for the test positivity rate, governments should target low positivity rates. The World Health Organization recommends a test positivity rate threshold of less than 5 percent over a 14-day period. As of August 12, 2020, 12 states and the District of Columbia had met this threshold (38 states had not). Resolve to Save Lives, another organization, recommends a threshold of less than 3 percent over a 7-day period, and 11 states and the District of Columbia had met this threshold (39 states had not) as of August 12, 2020. GAO also suggests monitoring mortality from all causes compared to historical norms as an indicator of the pandemic’s broad effect on health care outcomes. Mortality rates have tended to be consistent from year to year. This allows an estimation of how much mortality rose with the onset of the pandemic, and provides a baseline by which to judge a return to pre-COVID levels. According to Centers for Disease Control and Prevention data, about 125,000 more people died from all causes January 1–June 13 than would normally be expected (see figure). CDC Data on Higher-Than-Expected Weekly Mortality, January 1 through June 13, 2020 Note: The figure shows the number of deaths from all causes in a given week that exceeded the upper bound threshold of expected deaths calculated by CDC on the basis of variation in mortality experienced in prior years. Changes in the observed numbers of deaths in recent weeks should be interpreted cautiously as this figure relies on provisional data that are generally less complete in recent weeks. Data were accessed on July 16, 2020. Economy. GAO updated information on a number of indicators to facilitate ongoing and consistent monitoring of areas of the economy supported by the federal pandemic response, in particular the COVID-19 relief laws. These indicators suggest that economic conditions—including for workers, small businesses, and corporations—have improved modestly in recent months but remain much weaker than prior to the pandemic. In June and July initial regular unemployment insurance (UI) claims filed weekly averaged roughly 1.4 million (see figure), which was six and a half times higher than average weekly claims in 2019, but claims have decreased substantially since mid-March, falling to 971,000 in the week ending August 8, 2020. Increasing infections in some states and orders to once again close or limit certain businesses are likely to pose additional challenges for potentially fragile economic improvements, especially in affected sectors, such as the leisure and hospitality sector. National Weekly Initial Unemployment Insurance Claims, January 2019–July 2020 Note: See figure 5 in the report. As GAO reported in June, consistent with the urgency of responding to serious and widespread health issues and economic disruptions, federal agencies gave priority to moving swiftly where possible to distribute funds and implement new programs designed to help small businesses and the newly unemployed, for example. However, such urgency required certain tradeoffs in achieving transparency and accountability goals. To make mid-course corrections, GAO made three recommendations to federal agencies: To reduce the potential for duplicate payments from the Paycheck Protection Program (PPP)—a program that provides guaranteed loans through lenders to small businesses—and unemployment insurance, GAO recommended that the Department of Labor (DOL), in consultation with the Small Business Administration (SBA) and the Department of the Treasury (Treasury), immediately provide information to state unemployment agencies that specifically addresses PPP loans, and the risk of improper unemployment insurance payments. DOL issued guidance on August 12, 2020, that, among other things, clarified that individuals working full-time and being paid through PPP are not eligible for UI. To recoup economic impact payments totaling more than $1.6 billion sent to decedents, GAO recommended that the Internal Revenue Service (IRS) consider cost-effective options for notifying ineligible recipients of economic impact payments how to return payments. IRS has taken steps to address this recommendation. According to a Treasury official, nearly 70 percent of the payments sent to decedents have been recovered. However, GAO was unable to verify that amount before finalizing work on this report. GAO is working with Treasury to determine the number of payments sent to decedents that have been recovered. Treasury was considering sending letters to request the return of remaining outstanding payments but has not moved forward with this effort because, according to Treasury, Congress is considering legislation that would clarify or change payment eligibility requirements. To reduce the potential for fraud and ensure program integrity, GAO recommended that SBA develop and implement plans to identify and respond to risks in PPP to ensure program integrity, achieve program effectiveness, and address potential fraud. SBA has begun developing oversight plans for PPP but has not yet finalized or implemented them. In addition, to improve the government’s response efforts, GAO suggested three matters for congressional consideration: GAO urged Congress to take legislative action to require the Department of Transportation (DOT) to work with relevant agencies and stakeholders, such as HHS, the Department of Homeland Security (DHS), and international organizations, to develop a national aviation-preparedness plan to ensure safeguards are in place to limit the spread of communicable disease threats from abroad, while also minimizing any unnecessary interference with travel and trade. In early July 2020, DOT collaborated with HHS and DHS to issue guidance to airports and airlines for implementing measures to mitigate the public health risks associated with COVID-19, but it has not developed a preparedness plan for future communicable disease threats. DOT has maintained that HHS and DHS should lead such planning efforts as they are responsible for communicable disease response and preparedness planning, respectively. In June 2020, HHS stated that it is not in a position to develop a national aviation-preparedness plan as it does not have primary jurisdiction over the entire aviation sector or the relevant transportation expertise. In May 2020, DHS stated that it had reviewed its existing plans for pandemic preparedness and response activities and determined it is not best situated to develop a national aviation-preparedness plan. Without such a plan, the U.S. will not be as prepared to minimize and quickly respond to future communicable disease events. GAO also urged Congress to amend the Social Security Act to explicitly allow the Social Security Administration (SSA) to share its full death data with Treasury for data matching to help prevent payments to ineligible individuals. In June 2020, the Senate passed S.4104, referred to as the Stopping Improper Payments to Deceased People Act. If enacted, the bill would allow SSA to share these data with Treasury's Bureau of the Fiscal Service to avoid paying deceased individuals. Finally, GAO urged Congress to use GAO's Federal Medical Assistance Percentage (FMAP) formula for any future changes to the FMAP—the statutory formula according to which the federal government matches states' spending for Medicaid services—during the current or any future economic downturn. Congress has taken no action thus far on this issue. GAO incorporated technical comments received the Departments of Labor, Commerce, Health and Human Services, Transportation, and the Treasury; the Federal Reserve; Office of Management and Budget; and Internal Revenue Service. The Small Business Administration commented that GAO did not include information on actions taken and controls related to its loan forgiveness program or its plans for loan reviews. GAO plans to provide more information on these topics in its next CARES Act report. For more information, contact A. Nicole Clowers at (202) 512-7114 or clowersa@gao.gov.
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