[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).
---------------------------------------------------------------------------
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\
---------------------------------------------------------------------------
\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]