[House Report 117-30]
[From the U.S. Government Publishing Office]
117th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 117-30
======================================================================
PROTECTING MOMS WHO SERVED ACT
_______
May 12, 2021.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Takano, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 958]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 958) to codify maternity care coordination
programs at the Department of Veterans Affairs, and for other
purposes, having considered the same, reports favorably thereon
without amendment and recommends that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 7
Advisory Committee Statement..................................... 7
Constitutional Authority Statement............................... 7
Applicability to Legislative Branch.............................. 7
Statement on Duplication of Federal Programs..................... 7
Disclosure of Directed Rulemaking................................ 7
Section-by-Section Analysis of the Legislation................... 8
Changes in Existing Law Made by the Bill as Reported............. 8
PURPOSE AND SUMMARY
H.R. 958 was introduced by Representative Lauren Underwood
of Illinois on February 8, 2021. H.R. 958, requires the
Department of Veterans Affairs (VA) to implement the maternity
care coordination program, and provide community maternity care
providers (i.e., non-VA maternity care providers) with training
and support with respect to the unique needs of pregnant and
postpartum veterans, particularly regarding mental and
behavioral health conditions in relation to the service of the
veterans in the Armed Forces.
Additionally, HR 958 requires the Government Accountability
Office to report on maternal mortality and severe maternal
morbidity among pregnant and postpartum veterans, with a focus
on racial and ethnic disparities in maternal health outcomes
for veterans.
BACKGROUND AND NEED FOR LEGISLATION
Women veterans aged 18-44 represent more than 40 percent of
women veterans using VA for their healthcare and represent the
fastest-growing cohort of veterans. The Department of Veterans
Affairs was authorized by Congress to provide reproductive
health services to women beginning in 1992, and the services
provided have expanded since then. Women veterans' service,
including deployment to conflict zones, as well as environment
and occupational hazards, may specifically impact reproductive
health, as well as increase the risk of PTSD. Furthermore, the
experiences of military sexual trauma (MST) and intimate
partner violence (IPV) are high in the women veterans
population. More than a quarter of women veterans report
surviving MST and more than a third have experienced IPV. In
fiscal year 2020, 44 percent of women veteran Veterans Health
Administration (VHA) users had a confirmed mental health
diagnosis. Therefore, it is critical to also consider the
mental and behavioral health needs of pregnant veterans.
The United States is the only industrialized nation with a
maternal mortality rate that is on the rise, increasing 26
percent between 2000 and 2014 and more than half of these
deaths are preventable. Currently, VA does not report any
disparities regarding maternal health (morbidities and
mortality) based on race or ethnicity. However, Black women are
three times more likely to die in childbirth than white women
in the United States. In addition, Black women serve in the
military in greater numbers than to their proportion to the
U.S. population. Black women represent 12 percent of all women
nationwide, and more than 30 percent of women using VHA. In
addition, American Indian and Alaska Native (AI/AN) women are
2.5 times more likely to die from pregnancy-related
complication than white women. AI/AN women are also heavily
represented in the women veteran population.
Due to the large proportion of women veterans who are
Black, indigenous, and women of color, VA must pay special
attention to disparities in maternal mortality and morbidity.
As nearly all women veterans receive maternity care in the
community, women veterans likely experience institutionalized
racism in civilian hospitals as much as non-veteran women,
regardless of whether VA is paying for their care.
Sec. 2. Support for maternity care coordination
VA covers maternity care for women veterans, and in 2020,
VHA paid for approximately 6000 deliveries. VHA does not have
perinatal care infrastructure, and therefore all prenatal care
after 12 weeks, as well as labor and delivery, occurs in the
community. Maternity Care Coordinators (MCCs) play a vital role
in care coordination. MCCs are at every facility and support
pregnant Veterans through pregnancy and postpartum. However,
many MCCs are serving in that position part-time. In addition,
as all pregnant veterans receive care in the community,
community providers may not be familiar with circumstances
unique to women veterans. This section would codify the
existing maternity care coordination and ensure it is in
statute. It would also provide community providers with
training and support regarding the needs of pregnant and
postpartum veterans, particularly related to mental and
behavioral health. This section also authorizes $15,000,000 as
additional resources for Fiscal Year 2022 to improve maternity
care coordination.
Sec. 3. Report on maternal mortality and severe maternal morbidity
among pregnant and postpartum veterans
The veteran population has characteristics that may put
them at higher risk of severe maternal morbidity and mortality.
Nearly half of women veterans are also a racial or ethnic
minority, and more than a third are Black. In addition, mental
health comorbidities, older maternal age, and hypertension
create a higher risk for pregnancy complications. In addition
75% of women veterans do not use VHA for their healthcare.
This section mandates that the Comptroller General of the
United States submit to the Committees on Veterans' Affairs of
the Senate and the House of Representatives, and make publicly
available, a report on maternal mortality and severe maternal
morbidity among pregnant and postpartum veterans, with a
particular focus on racial and ethnic disparities in maternal
health outcomes for veterans. This section also mandates that
veterans who are uninsured, are enrolled in private insurance,
or are enrolled in Tribal health programs or other Federal
programs besides VA are also included in this study.
The Committee expects that this study will help identify
disparities not only in infertility, maternal mortality and
morbidity among pregnant veterans, but also identify how types
of healthcare coverage may impact mortality or morbidity,
either positively or negatively.
This section also instructions the Comptroller General to
include any other identified at-risk populations in the study
in addition to defined racial and ethnic minority groups. For
example, veterans of Ashkenazi Jewish descent may experience
unique pregnancy risks, but are not specifically considered
part of a racial or ethnic minority.
HEARINGS
H.R. 958 was examined at a legislative hearing by the
Subcommittee on Health on April 15, 2021. The following
witnesses testified at the hearing: The Honorable Mark Takano,
U.S. House of Representatives, 41st Congressional District of
California; The Honorable Lauren Underwood, U.S. House of
Representatives, 14th Congressional District of Illinois; The
Honorable Steve Stivers, U.S. House of Representatives, 15th
Congressional District of Ohio; The Honorable Cynthia Axne,
U.S. House of Representatives, 3rd Congressional District of
Iowa; The Honorable Brenda L. Lawrence (MI14), U.S. House of
Representatives, 14th Congressional District of Michigan; The
Honorable Hakeem S. Jeffries, U.S. House of Representatives,
8th Congressional District of New York; Mr. Marquis Barefield,
Assistant National Legislative Director, Disabled American
Veterans; Mr. Brian Dempsey, Government Affairs Director,
Wounded Warrior Project; Ms. Lindsay Church, Executive
Director/Co-Founder, Minority Veterans of America; Dr. Clifford
A. Smith, Director, Analytics, Innovations and Collaborations
Veterans Health Administration, U.S. Department of Veterans
Affairs; Dr. Amanda Johnson, Director, Women's Reproductive
Health Veterans Health Administration, U.S. Department of
Veterans Affairs.
SUBCOMMITTEE CONSIDERATION
H.R. 958 was considered before the Subcommittee on Health
on April 15, 2021.
COMMITTEE CONSIDERATION
On May 4, 2021, the full Committee met in an open markup
session, a quorum being present, and ordered H.R. 958, as part
of an en bloc package, favorably reported to the House of
Representatives by a roll call vote.
COMMITTEE VOTES
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the recorded
votes on the motion to report the legislation and amendments
thereto. The results of the record vote on the motion to
transmit, together with the names of those voting for and
against, are printed below.
Veterans' Affairs Committee record vote No. 3
A Motion to favorably report the en bloc bills to the U.S.
House of Representatives was agreed to by roll call vote.
Passed: 22-6. The vote was as follows:
----------------------------------------------------------------------------------------------------------------
Majority Members Vote Minority Members Vote
----------------------------------------------------------------------------------------------------------------
Mr. Takano...................................... Aye Mr. Bost.......................... Aye
Ms. Brownley.................................... Aye Ms. Radewagen..................... ............
Mr. Lamb........................................ Aye Mr. Bergman....................... ............
Mr. Levin....................................... Aye Mr. Banks......................... Nay
Mr. Pappas...................................... Aye Mr. Roy........................... Nay
Ms. Luria....................................... Aye Mr. Murphy........................ Aye
Mr. Mrvan....................................... Aye Mr. Mann.......................... Nay
Mr. Sablan...................................... Aye Mr. Moore......................... Nay
Ms. Underwood................................... Aye Ms. Mace.......................... Aye
Mr. Allred...................................... Aye Mr. Cawthorn...................... Aye
Ms. Frankel..................................... Aye Mr. Nehls......................... Nay
Mr. Brown....................................... Aye Mr. Rosendale..................... Nay
Ms. Slotkin..................................... Aye Ms. Miller-Meeks.................. Aye
Mr. Trone....................................... Aye
Ms. Kaptur...................................... Aye
Mr. Ruiz........................................ Aye
Mr. Gallego..................................... Aye
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COMMITTEE OVERSIGHT FINDINGS
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to improve resources and benefits for
women veterans and other underserved veterans.
NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES
In compliance with clause 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.
EARMARKS AND TAX AND TARIFF BENEFITS
H.R. 958 does not contain any Congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9 of rule XXI of the Rules of the House of
Representatives.
COMMITTEE COST ESTIMATE
The Committee adopts as its own the cost estimate on H.R.
958, prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 958, provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 10, 2021.
Hon. Mark Takano,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 958, the
Protecting Moms Who Served Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Etaf Khan.
Sincerely,
Phillip L. Swagel,
Director.
Enclosure.
H.R. 958 would direct the Department of Veterans Affairs
(VA) to provide coordinators to support veterans through every
stage of their pregnancies. The bill also would require VA to
deliver training on the unique needs of pregnant and postpartum
veterans to maternity-care professionals in medical facilities
that are not operated by the department.
Currently, VA provides coordinators through its Maternity
Care Coordination Program, and it also trains maternity-care
workers in nondepartmental facilities through the Women's
Health Education team.
H.R. 958 would authorize the appropriation of $15 million
for 2022 for those purposes. CBO estimates that those
activities included in the bill would cost $15 million over the
2021-2026 period. Assuming appropriation of the specified
amount, CBO estimates that VA spending would increase by that
amount.
H.R. 958 also would require the Government Accountability
Office to report to the Congress on maternal mortality and
morbidity among pregnant and postpartum veterans. Using
information on similar reports, CBO estimates that satisfying
the reporting requirement would cost $1 million.
In total, CBO estimates that implementing H.R. 958 would
cost $16 million over the 2021-2026 period; such spending would
be subject to the availability of appropriated funds.
The costs of the legislation, detailed in Table 1, fall
within budget function 700 (veterans' benefits and services).
TABLE 1.--ESTIMATED INCREASES IN SPENDING SUBJECT TO APPROPRIATION UNDER H.R. 958
----------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
----------------------------------------------------------
2021 2022 2023 2024 2025 2026 2021-2026
----------------------------------------------------------------------------------------------------------------
Coordination Program:
Estimated Authorization.......................... 0 15 0 0 0 0 15
Estimated Outlays................................ 0 13 1 1 0 0 15
Report:
Estimated Authorization.......................... 0 0 0 1 0 0 1
Estimated Outlays................................ 0 0 0 1 0 0 1
Total Changes:
Estimated Authorization...................... 0 15 0 1 0 0 16
Estimated Outlays............................ 0 13 1 2 0 0 16
----------------------------------------------------------------------------------------------------------------
The CBO staff contact for this estimate is Etaf Khan. The
estimate was reviewed by LeoLex, Deputy Director of Budget
Analysis.
FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 958 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
958.
STATEMENT OF CONSTITUTIONAL AUTHORITY
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 958 is authorized by Congress' power to
``provide for the common Defense and general Welfare of the
United States.''
APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that H.R. 958 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.
STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 958 establishes or reauthorizes a program of the
Federal Government known to be duplicative of another Federal
program, a program that was included in any report from the
Government Accountability Office to Congress pursuant to
section 21 of Public Law 111-139, or a program related to a
program identified in the most recent Catalog of Federal
Domestic Assistance.
DISCLOSURE OF DIRECTED RULEMAKING
Pursuant to clause 3(c)(5) of rule XIII, the Committee
estimates that H.R. 958 contains no directed rule making that
would require the Secretary to prescribe regulations.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Sec. 1. Short title
Section 1 names the Act the ``Protecting Moms Who Served
Act''
Sec. 2. Support for maternity care coordination
Section 2 permanently codifies in statutes the existing
maternity care coordination program at VA, requires training of
community maternity care providers, and authorizes for
appropriations $15,000,000 for fiscal year 2022 for maternity
care coordination.
Sec. 3. Report on maternal mortality and severe maternal morbidity
among pregnant and postpartum veterans
Section 3 mandates that the Comptroller General of the
United States publish through the Government Accountability
Office a publicly-available study on maternal mortality and
severe maternal morbidity among pregnant and postpartum
veterans, with a particular focus on racial and ethnic
disparities in maternal health outcomes for veterans. This
section also outlines the additional parameters of the report.
Sec. 4. Definitions
Section 4 defines ``maternal mortality'', ``postpartum and
postpartum period'', ``pregnancy-associated death'', ``racial
and ethnic minority group,'' and ``severe maternal morbidity.''
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, this bill makes no changes in
existing law.