On the Silencing and Prosecution of PRC Citizen Journalist Zhang Zhan

Michael R. Pompeo, Secretary of State

The United States strongly condemns the People’s Republic of China’s (PRC) sham prosecution and conviction of citizen journalist Zhang Zhan on December 28. We call on the PRC government to release her immediately and unconditionally. The Chinese Communist Party (CCP) has shown once again it will do whatever it takes to silence those who question the Party’s official line, even regarding crucial public health information.

Lying is a feature, not a bug of authoritarian regimes. The CCP restricted and manipulated information about the COVID-19 outbreak in Wuhan from the start and brutally silenced other brave truth-tellers, such as Dr. Li Wenliang, Chen Qiushi, and Fang Bin. Because of the CCP’s gross malfeasance, the rest of the world relied heavily on uncensored reports from citizen journalists like Zhang to understand the true situation in Wuhan after the CCP-imposed strict media controls were enforced and a controllable outbreak turned into a deadly global pandemic. Her hasty trial, to which foreign observers were denied access, shows how fearful the CCP is of Chinese citizens who speak the truth.

The PRC government’s fear of transparency and its ongoing repression of fundamental freedoms are a sign of weakness, not strength, and a threat to all of us. The United States will always support the right of Chinese citizens to express themselves freely and peacefully.

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    Literature GAO reviewed indicated that private insurance payments for anesthesia services on average were more than 3-1/2 times those of Medicare payments. This payment difference increased from what GAO reported in 2007—average private insurance payments for certain anesthesia services in 2004 were about 3 times those of Medicare. While Medicare rates for anesthesia services are set by the Centers for Medicare & Medicaid Services (CMS), private insurance rates are set through negotiations between providers and private insurers. GAO identified three recent studies with analyses of private insurance and Medicare payments for anesthesia services: Researchers from Yale University calculated that private insurance payments were 3.67 times Medicare payments, on average, for services provided by anesthesiologists for one large private insurer in 2015 operating across all 50 states and the District of Columbia. The Health Care Cost Institute calculated that in 2017 private insurance payments ranged from 2 to 7 times Medicare payments, on average, across six common services provided by anesthesiologists in 33 states. Wide state-to-state variation within specific services was reported. The American Society of Anesthesiologists reported that private insurance payments were 3.46 times Medicare payments, on average, based on a survey of its members in 2019. According to studies GAO reviewed and stakeholders GAO interviewed, market factors likely enhanced anesthesia providers' negotiating position and allowed them to secure higher private payments. For example, several studies and stakeholders cited market concentration as a key factor that increased private payments for anesthesia services. In a market with high provider concentration—or relatively few providers in a given market—there is little competition between providers, enabling the providers within that market to negotiate for higher payments from private insurers. Studies also indicated that specialists, including anesthesia providers, could negotiate higher in-network payment rates because they were able to leave an insurer's network with little risk of losing patients or revenue. In addition, when anesthesia providers are not a part of a private insurer's network, they are typically able to bill for a higher amount than the insurer would pay for an in-network provider, known as out-of-network billing. This dynamic decreases providers' incentives to participate in insurer networks because it creates an attractive alternative to network participation. GAO's interviews with stakeholders, literature review, and review of agency data generally did not indicate that the supply of anesthesia providers was insufficient for Medicare beneficiaries. CMS data indicate that the number of active anesthesia providers per 100,000 Medicare beneficiaries increased from 2010 through 2018 and that a very small number of anesthesia providers opted out of the Medicare program. Furthermore, researchers and stakeholders GAO interviewed were not aware of any issues with access to anesthesia services for Medicare beneficiaries, including those in traditionally underserved rural areas. In 2018, Medicare paid over $2 billion for anesthesia services, such as general anesthesia administered to beneficiaries undergoing surgical or other invasive procedures. The joint explanatory statement for the Further Consolidated Appropriations Act, 2020 included a provision for GAO to update its 2007 report and examine how differences in payment rates for anesthesia services have changed since that time. In 2007, GAO reported that Medicare payments in 2004 for certain anesthesia services provided by anesthesiologists were on average 67 percent lower than private insurance payments in certain geographic areas—indicating that private payments were about 3 times more than Medicare payments at that time. This report describes what is known about (1) recent trends in differences between Medicare and private payments for anesthesia services, and (2) the sufficiency of the supply of anesthesia providers for Medicare beneficiaries. GAO reviewed literature and available published data on payment differences for anesthesia services, published in the United States since 2010. GAO also reviewed data from CMS on the number of anesthesia providers from 2010, 2018, and 2020. GAO also interviewed a nongeneralizable selection of three research groups, two beneficiary advocacy groups, and five stakeholder groups, including those representing anesthesiologists, nurse anesthetists, and hospitals, to obtain their perspectives on these issues. The Department of Health and Human Services provided no comments on this report. For more information, contact Jessica Farb at (202) 512-7114 or farbj@gao.gov.
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  • Elder Justice: HHS Could Do More to Encourage State Reporting on the Costs of Financial Exploitation
    In U.S GAO News
    Most state Adult Protective Services (APS) agencies have been providing data on reports of abuse to the Department of Health and Human Services (HHS), including data on financial exploitation, although some faced challenges collecting and submitting these data. Since states began providing data to HHS's National Adult Maltreatment Reporting System (NAMRS) in 2017, they have been voluntarily submitting more detailed data on financial exploitation and perpetrators each year (see figure). However, some APS officials GAO interviewed in selected states said collecting data is difficult, in part, because victims are reluctant to implicate others, especially family members or other caregivers. APS officials also said submitting data to NAMRS was challenging initially because their data systems often did not align with NAMRS, and caseworkers may not have entered data in the system correctly. HHS has provided technical assistance and grant funding to help states address some of these challenges and help provide a better picture of the prevalence of the various types of financial exploitation and its perpetrators nationwide. Number of States That Provide Data on Financial Exploitation and Perpetrators to NAMRS Studies estimate some of the costs of financial exploitation to be in the billions, but comprehensive data on total costs do not exist and NAMRS does not currently collect cost data from APS agencies. The Consumer Financial Protection Bureau found actual losses and attempts at elder financial exploitation reported by financial institutions nationwide were $1.7 billion in 2017. Also, studies published from 2016 to 2020 from three states—New York, Pennsylvania, and Virginia—estimated the costs of financial exploitation could be more than $1 billion in each state alone. HHS does not currently ask states to submit cost data from APS casefiles to NAMRS, though officials said they have begun to reevaluate NAMRS with state APS agencies and other interested parties, including researchers, and may consider asking states to submit cost data moving forward. Adding cost data to NAMRS could make a valuable contribution to the national picture of the cost of financial exploitation. Recognizing the importance of these data, some APS officials GAO interviewed said their states have developed new data fields or other tools to help caseworkers collect and track cost data more systematically. HHS officials said they plan to share this information with other states to make them aware of practices that could help them collect cost data, but they have not established a timeframe for doing so. Elder financial exploitation—the fraudulent or illegal use of an older adult's funds or property—has far-reaching effects on victims and society. Understanding the scope of the problem has thus far been hindered by a lack of nationwide data. In 2013, HHS worked with states to create NAMRS, a voluntary system for collecting APS data on elder abuse, including financial exploitation. GAO was asked to study the extent to which NAMRS provides information on elder financial exploitation. This report examines (1) the status of HHS's efforts to compile nationwide data through NAMRS on the extent of financial exploitation and the challenges involved, and (2) what is known about the costs of financial exploitation to victims and others. GAO analyzed NAMRS data from fiscal year 2016 through 2019 (the most recent available); reviewed relevant federal laws; and interviewed officials from HHS, other federal agencies, elder abuse prevention organizations, and researchers. GAO also reviewed APS documents and spoke with officials in eight states, selected based on their efforts to study, collect, and report cost data; and reviewed studies on financial exploitation. GAO recommends that HHS (1) work with state APS agencies to collect and submit cost data to NAMRS, and (2) develop a timeframe to share states' tools to help collect cost data. HHS did not agree with the first recommendation, but GAO maintains that it is warranted, as discussed in the report. HHS agreed with the second recommendation. For more information, contact Kathryn A. Larin at (202) 512-7215 or larink@gao.gov.
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  • Intelligence Community: Additional Actions Needed to Strengthen Workforce Diversity Planning and Oversight
    In U.S GAO News
    The Office of the Director of National Intelligence (ODNI) reported that the representation of some demographic groups within the Intelligence Community (IC) workforce increased from fiscal years 2011 through 2019—the latest available data. Over this period, the proportion of women, racial or ethnic minorities, and persons with disabilities changed by .7, 3.3, and 6.2 percentage points, respectively. However, the representation of women, racial or ethnic minorities, and persons with disabilities remained below comparable benchmarks and declined among higher ranks in fiscal year 2019. IC elements report taking steps to address leading practices for managing workforce diversity, but report gaps in diversity planning. GAO found that most IC elements report taking steps to address seven of nine leading practices for diversity management. For the remaining two leading practices—strategic planning and measurement—most elements report taking one or no steps. Number of Intelligence Community (IC) Elements and the Steps They Report Taking to Implement Leading Practices for Workforce Diversity Management, as of August 2020 GAO leading practices Number of IC elements that report taking steps Leadership commitment 17 of 17 IC elements report taking multiple steps Recruitment 14 of 17 IC elements report taking multiple steps, and three IC elements report taking one step Employee involvement 14 of 17 IC elements report taking multiple steps, two IC elements report taking one step, and one IC element reports taking no step Diversity training 14 of 17 IC elements report taking multiple steps, and three IC elements report taking one step Performance 12 of 17 IC elements linked diversity management with enhanced performance while five IC elements did not Succession planning 9 of 17 IC elements report taking multiple steps, and eight IC elements report taking one step Accountability 9 of 17 IC elements report taking multiple steps, seven IC elements report taking one step, and one IC element reports taking no steps Strategic planning 3 of 17 IC elements have current and complete strategic plans Measurement 6 of 17 IC elements have diversity-related performance measures Source: GAO analysis of IC element documents and GAO leading practices for diversity management. | GAO-21-83 Further, while all IC elements report having a process to identify barriers to diversity, nine IC elements report not completing required barrier assessments. Without fully implementing leading practices for managing workforce diversity and conducting routine barrier assessments, the IC may miss opportunities to develop effective and efficient diversity policies and programs. ODNI's Office of Intelligence Community Equal Employment Opportunity and Diversity (IC EEOD) is meeting seven of eight leading practices for enhancing and sustaining the coordination of diversity initiatives across the 17 IC elements. However, IC EEOD partially met the practice to reinforce agency accountability. Specifically, IC EEOD has not established IC-wide implementation objectives and timeframes to demonstrate progress. As a result, IC EEOD risks not holding IC elements accountable for enhancing workforce diversity. The 2019 National Intelligence Strategy states that the IC will recruit, develop, and retain a diverse, inclusive, and expert workforce to enable mission success. ODNI reports that the IC is taking steps to increase the representation of diverse groups, such as issuing new strategies to enhance workforce planning. However, barriers to establishing a diverse workforce exist across the IC, according to an ODNI 2017 analysis. GAO was asked to review the IC's progress in enhancing workforce diversity. This report (1) summarizes ODNI annual demographic reports on the proportion of women, racial or ethnic minorities, and persons with disabilities; and assesses the extent to which (2) IC elements report taking steps to address leading practices for managing workforce diversity and to identify potential barriers to maintaining a diverse workforce; and (3) ODNI is addressing leading practices for coordinating IC workforce diversity initiatives. GAO reviewed IC-wide and IC element specific policies and guidance; interviewed ODNI, and other IC officials; and administered a questionnaire to all 17 IC elements to obtain information on diversity strategies and challenges. GAO is making seven recommendations, including that the Director of National Intelligence issue or update guidance to ensure IC elements maintain diversity strategic plans, assess and take steps to eliminate barriers to diversity, and establish implementation objectives and timeframes to hold IC elements accountable. ODNI agreed with the recommendations. For more information, contact Brian M. Mazanec at (202) 512-5130 or mazanecb@gao.gov.
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  • Science & Tech Spotlight: Agile Software Development
    In U.S GAO News
    Why This Matters Agile software development has the potential to save the federal government billions of dollars and significant time, allowing agencies to deliver software more efficiently and effectively for American taxpayers. However, the transition to Agile requires an investment in new tools and processes, which can be costly and time consuming. The Methodology What is it? Agile is an approach to software development that encourages collaboration across an organization and allows requirements to evolve as a program progresses. Agile software development emphasizes iterative delivery; that is, the development of software in short, incremental stages. Customers continuously provide feedback on the software's functionality and quality. By engaging customers early and iterating often, agencies that adopt Agile can also reduce the risks of funding failing programs or outdated technology. Figure 1. Cycle of Agile software development How does it work? Agile software development is well suited for programs where the end goal is known, but specific details about their implementation may be refined along the way. Agile is implemented in different ways. For example, Scrum is a framework focused on teams, Scaled Agile Framework focuses on scaling Agile to larger groups, and DevOps extends the Agile principle of collaboration and unites the development and operation teams. Scrum, one of the most common Agile frameworks, organizes teams using defined roles, such as the product owner, who represents the customer, prioritizes work, and accepts completed software. In Scrum, development is broken down into timed iterations called sprints, where teams commit to complete specific requirements within a defined time frame. During a sprint, teams meet for daily stand-up meetings. At the end of a sprint, teams present the completed work to the product owner for acceptance. At a retrospective meeting following each sprint, team members discuss lessons learned and any changes needed to improve the process. Sprints allow for distinct, consistent, and measurable progress of prioritized software features. How mature is it? Organizations have used versions of incremental software development since the 1950s, with various groups creating Agile frameworks in the 1990s, including Scrum in 1995. In 2001, a group of software developers created the Agile Manifesto, which documents the guiding principles of Agile. Following this, Agile practitioners introduced new frameworks, such as Kanban, which optimizes work output by visualizing its flow. The Federal Information Technology Acquisition Reform Act (FITARA), enacted in 2014, includes a provision for the Office of Management and Budget to require the Chief Information Officers of covered agencies to certify that IT investments are adequately implementing incremental development. This development approach delivers capabilities more rapidly by dividing an investment into smaller parts. As a result, more agencies are now adopting an incremental, Agile, approach to software development. For example, in 2016, the Department of Homeland Security announced five Agile pilot programs. In 2020, at least 22 Department of Defense major defense acquisition programs reported using Agile development methods.  As the federal government continues to adopt Agile, effective oversight of these programs will be increasingly crucial. Our GAO Agile Assessment Guide, released in 2020, takes a closer look at the following categories of best practices: Agile adoption. This area focuses on team dynamics, program operations, and organization environments. One best practice for teams is to have repeatable processes in place such as continuous integration, which automates parts of development and testing. At the program operations level, staff should be appropriately trained in Agile methods. And at an organizational level, a best practice is to create a culture that supports Agile methods. Requirements development and management. Requirements—sometimes called user stories—are important in making sure the final product will function as intended. Best practices in this area include eliciting and prioritizing requirements and ensuring work meets those requirements. Acquisition strategy. Contractors may have a role in an Agile program in government. However, long timelines to award contracts and costly changes are major hurdles to executing Agile programs. One way to clear these hurdles is for organizations to create an integrated team with personnel from contracting, the program office, and software development. Clearly identifying team roles will alleviate bottlenecks in the development process. Figure 2. Different roles come together to make an Agile software development team. Program monitoring and control. Many Agile documents may be used to generate reliable cost and schedule estimates throughout a program’s life-cycle. Metrics. It is critical that metrics align with and prioritize organization-wide goals and objectives while simultaneously meeting customer needs. Such metrics in Agile include the number of features delivered to customers, the number of defects, and overall customer satisfaction.  Opportunities Flexibility. An Agile approach provides flexibility when customers’ needs change and as technology rapidly evolves. Risk reduction. Measuring progress during frequent iterations can reduce technical and programmatic risk. For example, routine retrospectives allow the team to reflect upon and improve the development process for the next iteration. Quicker deliveries. Through incremental releases, agencies can rapidly determine if newly produced software is meeting their needs. With Agile, these deliveries are typically within months, instead of alternative development methods, which can take years. Challenges GAO has previously reported on challenges the federal government faces in applying Agile methods; for the full report see GAO-12-681. Lack of organizational commitment. For example, organizations need to create a dedicated Agile team, which is a challenge when there is an insufficient number of staff, or when staff have several simultaneous duties. Resources needed to transition to Agile. An organization transitioning to Agile may need to invest in new tools, practices, and processes, which can be expensive and time consuming. Mistrust in iterative solutions. Customers who typically see a solution as a whole may be disappointed by the delivery of a small piece of functionality. Misaligned agency practices. Some agency practices, such as procurement, compliance reviews, federal reporting, and status tracking are not designed to support Agile software development. Policy and Context Questions In what ways can Agile help the federal government improve the management of IT acquisitions and operations, an area GAO has identified as high risk for the federal government? How can policymakers implement clear guidance about the use of Agile software development, such as reporting metrics, to better support Agile methods? How might resources need to shift to accommodate the adoption of Agile in federal agencies? What risks could those shifts pose? What updates to agency practices are worth pursuing to support Agile software development? For more information, contact Tim Persons at (202) 512-6888 or personst@gao.gov.
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  • Defense Reform: DOD Has Made Progress, but Needs to Further Refine and Formalize Its Reform Efforts
    In U.S GAO News
    The Department of Defense (DOD) has made progress in establishing valid and reliable cost baselines for its enterprise business operations and has additional efforts ongoing. DOD's January 2020 report responding to section 921 of the John S. McCain National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2019 addressed most of the key requirements from that section but also had some limitations, which DOD acknowledged. For example, the baselines included only labor and information technology costs because DOD's financial data do not attribute costs to other specific activities required under section 921. However, DOD officials told GAO they have developed and are continuing to refine baselines for all of the department's enterprise business operations, such as financial and human resource management, to enable DOD to better track the resources devoted to these operations and the progress of reform. While still in progress, this effort shows promise in addressing the weaknesses in DOD's section 921 report and in meeting the need for consistent baselines for DOD's reform efforts that GAO has previously identified. GAO found that DOD's reported savings of $37 billion from its reform efforts and a Defense-Wide Review to better align resources are largely reflected in its budget materials; however, the savings were not always well documented or consistent with the department's definitions of reform. Specifically: DOD had limited information on the analysis underlying its savings estimates, including (1) economic assumptions, (2) alternative options, and (3) any costs of taking the actions to realize savings, such as opportunity costs. Therefore, GAO was unable to determine the quality of the analysis that led to DOD's savings decisions. Further, some of the cost savings initiatives were not clearly aligned with DOD's definitions of reform, and thus DOD may have overstated savings that came from its reform efforts rather than other sources of savings, like cost avoidance. For example, one initiative was based on the delay of military construction projects. According to DOD officials, this was done to fund higher priorities. But if a delayed project is still planned, the costs will likely be realized in a future year. Without processes to standardize development and documentation of savings and to consistently identify reform savings based on reform definitions, decision makers may lack reliable information on DOD's estimated reform savings. In coordinating its reform efforts, DOD has generally followed leading practices for collaboration, but there is a risk that this collaboration may not be sustained in light of any organizational changes that Congress or DOD may make. This risk is increased because the Office of the Chief Management Officer (OCMO) and other offices have not formalized and institutionalized these efforts through written policies or agreements. Without written policies or formal agreements that define how organizations should collaborate with regard to DOD's reform and efficiency efforts, current progress may be lost, and future coordination efforts may be hindered. DOD spends billions of dollars each year to maintain key business operations. Section 921 of the NDAA for FY 2019 established requirements for DOD to reform these operations and report on their efforts. DOD has also undertaken additional efforts to reform its operations in recent years. Section 921 called for GAO to assess the accuracy of DOD's reported cost baselines and savings, and section 1753 of the NDAA for FY 2020 called for GAO to report on the OCMO's efficiency initiatives. This report assesses the extent to which DOD has (1) established valid and reliable baseline cost estimates for its business operations; (2) established well-documented cost savings estimates reflecting its reforms; and (3) coordinated its reform efforts. GAO assessed documents supporting costs, savings estimates, and coordination efforts; interviewed DOD officials; observed demonstrations of DOD's reform tracking tools; and assessed DOD's efforts using selected criteria. GAO is making three recommendations—specifically, that DOD establish formal processes to standardize development and documentation of cost savings; ensure that reported savings are consistent with the department's definition of reform; and formalize policies or agreements on its reform efforts. DOD concurred with GAO's recommendations. For more information, contact Elizabeth Field at (202) 512-2775 or fielde1@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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