[House Report 117-184]
[From the U.S. Government Publishing Office]


117th Congress    }                                   {      Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                   {      117-184

======================================================================



 
        SOCIAL DETERMINANTS OF HEALTH DATA ANALYSIS ACT OF 2021

                                _______
                                

 November 30, 2021.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 4026]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 4026) to require the Comptroller General of the 
United States to submit to Congress a report on actions taken 
by the Secretary of Health and Human Services to address social 
determinants of health, having considered the same, reports 
favorably thereon without amendment and recommends that the 
bill do pass.

                                CONTENTS

                                                                   Page
   I. Purpose and Summary.............................................2
  II. Background and Need for the Legislation.........................2
 III. Committee Hearings..............................................3
  IV. Committee Consideration.........................................3
   V. Committee Votes.................................................3
  VI. Oversight Findings..............................................4
 VII. New Budget Authority, Entitlement Authority, and Tax Expenditure4
VIII. Federal Mandates Statement......................................5
  IX. Statement of General Performance Goals and Objectives...........5
   X. Duplication of Federal Programs.................................5
  XI. Committee Cost Estimate.........................................5
 XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits.....5
XIII. Congressional Budget Office Estimate............................4
 XIV. Advisory Committee Statement....................................5
  XV. Applicability to Legislative Branch.............................5
 XVI. Section-by-Section Analysis of the Legislation..................6
XVII. Changes in Existing Law Made by the Bill, as Reported...........6

                         I. PURPOSE AND SUMMARY

    H.R. 4026, the ``Social Determinants of Health Data 
Analysis Act of 2021,'' requires the Comptroller General of the 
United States to submit to Congress within two years of 
enactment a report on the actions taken by the Secretary of 
Health and Human Services (HHS) to address social determinants 
of health.

                II. BACKGROUND AND NEED FOR LEGISLATION

    Social determinants of health impact the quality of 
everyone's life and are the primary drivers of health outcomes, 
along with health behaviors like smoking, diet, and 
exercise.\1\ Generally, social determinants of health are 
defined as the medical, economic, educational, environmental, 
and social conditions affecting individuals as they live and 
age.\2\ Examples of social determinants of health include 
income, housing, transportation, safety, literacy, language, 
and access to clean water, nutritious food, and quality health 
care.\3\ Data indicate that discrimination plays a significant 
factor in underlying health inequities\4\. While the health 
care delivery system addresses health during episodes of injury 
or illness, the social determinants (or as referred to in 
recent literature\5\ as ``influencers or predictors'') interact 
with health much earlier, and on a daily basis. These factors 
can impact health directly and indirectly affect an 
individual's access to appropriate health care. The World 
Health Organization's Commission on the Social Determinants of 
Health published a report in 2008\6\ urging all governments to 
lead global action on the social determinants of health with 
the aim of achieving health equity.
---------------------------------------------------------------------------
    \1\Kaiser Family Foundation, Beyond Health Care: The Role of Social 
Determinants in Promoting Health and Health Equity (May 10, 2018) 
(www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-
care-the-role-of-social-determinants-in-promoting-health-and-health-
equity/).
    \2\Department of Health and Human Services, Office of Disease 
Prevention and Health Promotion, Social Determinants of Health 
(health.gov/healthypeople/objectives-and-data/social-determinants-
health) (accessed Sept. 2, 2021).
    \3\See note 1.
    \4\American Public Health Association, Structural Racism is a 
Public Health Crisis. (https://www.apha.org/policies-and-advocacy/
public-health-policy-statements/policy-database/2021/01/13/structural-
racism-is-a-public-health-crisis) (accessed June 14, 2021).
    \5\Zachary Wortman, Elizabeth Cuervo Tilson, and Mandy Krauthamer 
Cohen, Buying Health For North Carolinians: Addressing Nonmedical 
Drivers Of Health At Scale, Health Affairs (Apr. 2020) 
(www.healthaffairs.org/doi/10.1377/hlthaff.2019.01583).
    \6\World Health Organization, Closing the gap in a generation: 
health equity through action on the social determinants of health--
Final report of the commission on social determinants of health (Aug. 
27, 2008) (www.who.int/publications/i/item/WHO-IER-CSDH-08.1).
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    Although these markers are the most important indicators of 
health-related risks, individual-level social determinants of 
health are not routinely collected or systematically utilized 
by healthcare providers to address the health conditions of 
individuals most in need. While health insurance providers are 
increasingly investing in innovative solutions that address 
social determinants of health, public health information 
systems are unable to fully capture the data describing these 
key demographics with adequate fidelity to effectively inform 
public health interventions designed to advance health 
equity.\7\\8\
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    \7\Carl G. Streed Jr, Chris Grasso, Sari L. Reisner, and Kenneth H. 
Mayer, Sexual Orientation and Gender Identity Data Collection: Clinical 
and Public Health Importance, American Journal of Public Health (Apr. 
13, 2020) (ajph.aphapublications.org/doi/10.2105/AJPH.2020.305722).
    \8\Elissa V Klinger et al., Accuracy of race, ethnicity, and 
language preference in an electronic health record, Journal of General 
Internal Medicine (Dec. 20, 2014) (pubmed.ncbi.nlm.nih.gov/25527336/).
---------------------------------------------------------------------------
    H.R. 4026 would require a Government Accountability Office 
(GAO) report to Congress assessing the actions taken by HHS to 
address, capture, and improve social determinants of health 
within two years of enactment.

                        III. COMMITTEE HEARINGS

    For the purposes of section 3(c) of rule XIII of the Rules 
of the House of Representatives, the following hearing was used 
to develop or consider H.R. 4026:
    The Subcommittee on Health held a hearing on June 22, 2021. 
The hearing was entitled ``Empowered by Data: Legislation to 
Advance Equity and Public Health.'' The subcommittee received 
testimony from the following witnesses:
           Romilla Batra, M.D., M.B.A., Chief Medical 
        Officer, SCAN Health Plan;
           Beth Blauer, Executive Director, Johns 
        Hopkins University Centers for Civic Impact;
           Karen DeSalvo, M.D., M.P.H, M.Sc., Chief 
        Health Officer, Google Health;
           Faisel Syed, M.D., National Director of 
        Primary Care, ChenMed; and
           Kara Odom Walker, M.D., M.P.H., M.S.H.S., 
        Executive Vice President and Chief Population Health 
        Officer, Nemours Children's Health System.

                      IV. COMMITTEE CONSIDERATION

    Representatives Michael C. Burgess (R-TX) and Lisa Blunt 
Rochester (D-DE) introduced H.R. 4026, the ``Social 
Determinants of Health Data Analysis Act of 2021,'' on June 22, 
2021, which was referred to the Committee on Energy and 
Commerce. Subsequently, on June 23, 2021, H.R. 3743 was 
referred to the Subcommittee on Health. A legislative hearing 
was held on the bill on June 22, 2021.
    On July 15, 2021, the Subcommittee on Health met in open 
markup session, pursuant to notice, to consider H.R. 4026 and 
18 other bills. No amendments were offered during consideration 
of the bill. Upon conclusion of consideration of the bill, the 
Subcommittee on Health agreed to report the bill favorably to 
the full Committee, without amendment, by a voice vote.
    On July 21, 2021, the full Committee met in open markup 
session, pursuant to notice, to consider H.R. 4026 and 23 other 
bills. No amendments were offered during consideration of the 
bill. Upon conclusion of consideration of the bill, the full 
Committee agreed to a motion on final passage offered by 
Representative Pallone (D-NJ), Chairman of the Committee, to 
order H.R. 4026 reported favorably to the House, without 
amendment, by a voice vote.

                           V. COMMITTEE VOTES

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
4026, including a motion by Mr. Pallone ordering H.R. 4026 
favorably reported to the House, without amendment.

                         VI. OVERSIGHT FINDINGS

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.

               VIII. CONGRESSIONAL BUDGET OFFICE ESTIMATE

                                     U.S. Congress,
                               Congressional Budget Office,
                                  Washington, DC, October 18, 2021.
Hon. Frank Pallone, Jr.,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 4026, the Social 
Determinants of Health Data Analysis Act of 2021.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Madeleine 
Fox.
            Sincerely,
                                         Phillip L. Swagel,
                                                          Director.
    Enclosure.

    
    
    	[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    

    H.R. 4026 would direct the Government Accountability Office 
(GAO) to report on actions taken by the Department of Health 
and Human Services to address social determinants of health and 
to submit their findings within two years of enactment.
    Based on the cost of similar GAO reports, CBO estimates 
that implementing H.R. 4026 would cost less than $500,000 over 
the 2022-2026 period; any such spending would be subject to the 
availability of appropriated funds.
    The CBO staff contact for this estimate is Madeleine Fox. 
The estimate was reviewed by H. Samuel Papenfuss, Deputy 
Director of Budget Analysis.

                     IX. FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

        X. STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to require 
the Comptroller General of the United States to submit a report 
to Congress on actions taken by HHS to address social 
determinants of health.

                  XI. DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 4026 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XII. COMMITTEE COST ESTIMATE

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

   XIII. EARMARKS, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 4026 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIV. ADVISORY COMMITTEE STATEMENT

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XV. APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

          XVI. SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``Social Determinants of Health Data Analysis Act of 
2021.''

Sec. 2. Report on the actions taken by the Secretary of Health and 
        Human Services to address social determinants of health

    Section 2 requires the Comptroller General of the United 
States to submit a report to Congress on the actions taken by 
the Secretary of HHS to address social determinants of health 
within two years of enactment. The report will require: an 
analysis of how any data collection undertaken by the Secretary 
complies with Federal and state privacy laws and regulations; a 
description of any coordination undertaken by the Secretary 
with other relevant Federal agencies and state and local 
authorities; an identification of any potential for duplication 
of such actions or other barriers; and recommendations on how 
to foster private public partnerships, as well as how best to 
leverage private sector efforts, to address social determinants 
of health.

      XVII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    There are no changes to existing law made by the bill H.R. 
4026.

                                  [all]