[Senate Report 117-65]
[From the U.S. Government Publishing Office]


                                                  Calendar No. 224

117th Congress}                                           { Report
                                 SENATE
  2d Session  }                                           { 117-65

======================================================================
 
                  DATA MAPPING TO SAVE MOMS' LIVES ACT

                               __________

                              R E P O R T

                                 OF THE

           COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION

                                   ON

                                 S. 198

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


                February 3, 2022.--Ordered to be printed
                
                              __________

                  U.S. GOVERNMENT PUBLISHING OFFICE                    
                           WASHINGTON : 2022                       
                
                
                
       SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION
                    one hundred seventeenth congress
                             second session

                   MARIA CANTWELL, Washington, Chair
AMY KLOBUCHAR, Minnesota             ROGER WICKER, Mississippi
RICHARD BLUMENTHAL, Connecticut      JOHN THUNE, South Dakota
BRIAN SCHATZ, Hawaii                 ROY BLUNT, Missouri
EDWARD MARKEY, Massachusetts         TED CRUZ, Texas
GARY PETERS, Michigan                DEB FISCHER, Nebraska
TAMMY BALDWIN, Wisconsin             JERRY MORAN, Kansas
TAMMY DUCKWORTH, Illinois            DAN SULLIVAN, Alaska
JON TESTER, Montana                  MARSHA BLACKBURN, Tennessee
KYRSTEN SINEMA, Arizona              TODD YOUNG, Indiana
JACKY ROSEN, Nevada                  MIKE LEE, Utah
BEN RAY LUJAN, New Mexico            RON JOHNSON, Wisconsin
JOHN HICKENLOOPER, Colorado          SHELLEY MOORE CAPITO, West Virginia

RAPHAEL WARNOCK, Georgia             RICK SCOTT, Florida
                                     CYNTHIA LUMMIS, Wyoming
                 
                 Melissa Porter, Acting Staff Director
                  John Keast, Minority Staff Director
                  

                                                  Calendar No. 224

117th Congress}                                           { Report
                                 SENATE
  2d Session  }                                           { 117-65

======================================================================                  
 
                  DATA MAPPING TO SAVE MOMS' LIVES ACT

                                _______
                                

                February 3, 2022.--Ordered to be printed

                                _______
                                

      Ms. Cantwell, from the Committee on Commerce, Science, and 
                Transportation, submitted the following

                              R E P O R T

                         [To accompany S. 198]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Commerce, Science, and Transportation, to 
which was referred the bill (S. 198) to require the Federal 
Communications Commission to incorporate data on maternal 
health outcomes into its broadband health maps, having 
considered the same, reports favorably thereon without 
amendment and recommends that the bill do pass.

                          PURPOSE OF THE BILL

    S. 198 would require the Federal Communications Commission 
(FCC or Commission) to incorporate data from the Centers for 
Disease Control and Prevention (CDC) on maternal health 
outcomes into its most recently available broadband health 
mapping tools.

                          BACKGROUND AND NEEDS

    According to the CDC, severe complications related to 
pregnancy, known as severe maternal morbidity (SMM), impacted 
over 50,000 women in the United States in 2014.\1\ In 2019, a 
CDC study found that SMM causes approximately 700 deaths in the 
United States each year.\2\ After evaluating 232 of these 
deaths, the CDC determined that 139 were preventable (60 
percent of those evaluated).\3\
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, ``Reproductive 
Health: Severe Maternal Morbidity in the United States,'' last reviewed 
June 1, 2021 (https://www.cdc.gov/reproductivehealth/
maternalinfanthealth/
severematernalmorbidity.html#::text=The%20overall%20rate%20of%20
SMM,1993%20to%20122.3%20in%202014) (accessed June 1, 2021).
    \2\Emily E. Petersen et al., Vital Signs: Pregnancy-Related Deaths, 
United States, 2011-2015, and Strategies for Prevention, 13 States, 
2013-2017, Centers for Disease Control and Prevention, Morbidity and 
Mortality Weekly Report, p. 425, May 7, 2019 (https://www.cdc.gov/mmwr/
volumes/68/wr/mm6818e1.htm?s_cid=mm6818e1_w) (accessed June 1, 2021).
    \3\Ibid.
---------------------------------------------------------------------------
    The CDC determined that there are a number of factors 
contributing to maternal deaths, including the following:
   limited access to transportation;
   health facilities' limited experience with obstetric 
        emergencies and a lack of appropriate personnel or 
        services;
   lack of patient knowledge of warning signs;
   missed or delayed diagnoses;
   a lack of continuity of care; and
   inadequate access to care.\4\
---------------------------------------------------------------------------
    \4\Ibid.
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Researchers believe that these factors are more prevalent in 
rural areas, in part due to rural hospitals closing their 
obstetric services or shutting down entirely, rural workforce 
shortages, and other systemic issues.\5\ Poverty also has been 
cited as a contributing factor for maternal mortality.\6\
---------------------------------------------------------------------------
    \5\Centers for Medicare and Medicaid Services, Improving Access to 
Maternal Health Care in Rural Communities, p. 1, Sep. 3, 2019 (https://
www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-
health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf) 
(accessed June 1, 2021).
    \6\J. Phillip Gingrey, ``Maternal Mortality: A US Public Health 
Crisis,'' American Journal of Public Health, volume 110, issue 4 (April 
2020) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067092/) (accessed 
June 1, 2021).
---------------------------------------------------------------------------
    In an effort to prevent maternal deaths, the CDC recommends 
providing telehealth technologies to health facilities lacking 
on-site obstetric services. Telehealth enables collaboration 
between health facilities with obstetric services and health 
facilities that lack on-site obstetric services.\7\ It can also 
help facilitate the transportation of patients to other 
hospitals, clinics, or health centers that offer obstetric 
services or make locally provided care as safe as possible when 
transport is not an option.\8\ There are real-world examples 
supporting the CDC's recommendations. For example, telehealth 
is being successfully utilized to treat SMM in rural areas of 
America, including in Minnesota and South Dakota.\9\ Indeed, 
the National Institutes of Health reports that telehealth 
resources have become crucial to obstetric care during the 
COVID-19 pandemic.\10\
---------------------------------------------------------------------------
    \7\Supra note 5 at 20.
    \8\For a case study concerning the use of telehealth in addressing 
maternal health issues, see Susan Mann, M.D., Kimberly McKay, M.D., and 
Haywood Brown, M.D., ``NEJM: The Maternal Health Compact,'' New England 
Journal of Medicine, April 5, 2017 (https://obgyn.duke.edu/news/nejm-
maternal-health-compact) (accessed June 1, 2021).
    \9\Ibid.
    \10\Kimberly Fryer et al., ``Implementation of Obstetric Telehealth 
During COVID-19 and Beyond,'' Maternal and Child Health Journal, June 
20, 2020 (https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC7305486/) (accessed June 1, 2021).
---------------------------------------------------------------------------
    However, telehealth requires access to broadband. 
Unfortunately, many rural areas lack broadband,\11\ just as 
they lack on-site obstetric services, thus preventing the 
widespread use of telehealth by both patients and healthcare 
providers. The CDC also has documented various structural 
barriers to the adoption of telehealth to combat maternal 
health issues, pointing in particular both to broadband 
availability issues, as well as the cost of service and 
equipment.\12\ In addition, while some low-income Americans may 
have access to broadband, the cost of broadband service may 
pose a barrier.\13\
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    \11\Federal Communications Commission, Inquiry Concerning 
Deployment of Advanced Telecommunications Capability to All Americans 
in a Reasonable and Timely Fashion, 2020 Broadband Deployment Report, 
GN Docket No. 19-285, Fig. 1, released April 24, 2020 (https://
docs.fcc.gov/public/attachments/FCC-20-50A1.pdf) (accessed June 1, 
2021).
    \12\Supra note 5 at 20.
    \13\Pew Research Center, Internet/Broadband Fact Sheet (https://
www.pewresearch.org/
internet/fact-sheet/internet-broadband/?menuItem=480dace1-fd73-4f03-
ad88-eae66e1f4217) (accessed June 1, 2021).
---------------------------------------------------------------------------
    Broadband mapping could lead to better maternal health 
outcomes. The FCC, through its Connect2Health Task Force, 
already maps information related to broadband availability and 
diabetes, obesity, physician access, poor health, preventable 
hospitalization, and sick days.\14\ These maps help show the 
intersection between connectivity (or lack thereof) and health 
outcomes in these areas at granular levels,\15\ which helps 
policymakers, medical professionals, and State and local 
communities make more efficient, data-driven decisions.\16\
---------------------------------------------------------------------------
    \14\Federal Communications Commission, Connect2Health Task Force, 
``Mapping Broadband Health in America 2017'' (https://www.fcc.gov/
reports-research/maps/connect2health/#ll=18.562942,-
112.529295&z=3&t=health&hhm=hh_diabetes_rate&advbb=in_bb_access$60_80&
dmf=none) (accessed June 1, 2021).
    \15\Federal Communications Commission, ``Mapping Broadband Health 
in America'' (https://www.fcc.gov/health/maps) (accessed June 1, 2021).
    \16\Federal Communications Commission, Office of Media Relations, 
``FCC's Connect2Health Task Force Announces Data Update for Broadband 
Health Mapping Platform,'' June 8, 2017 (https://docs.fcc.gov/public/
attachments/DOC-344778A1.pdf) (accessed June 1, 2021).
---------------------------------------------------------------------------
    The FCC, however, does not map the intersection of maternal 
health outcomes and broadband availability. S. 198 would 
require the FCC to incorporate data on maternal health outcomes 
into its most recently available broadband health mapping tools 
for no less than 1 year postpartum. Such a map could help 
increase the quality of maternal care and reduce the prevalence 
of poor maternal health outcomes. For example, creating such a 
map could establish a picture of where maternal mortality rates 
are especially high and identify areas where critical 
telehealth resources need to be deployed.

                          LEGISLATIVE HISTORY

    S. 198 was introduced on February 3, 2021, by Senator Rosen 
(for herself and Senators Fischer, Young, and Schatz), and was 
referred to the Committee on Commerce, Science, and 
Transportation of the Senate. Senators Markey, Blumenthal, 
King, Van Hollen, Klobuchar, Braun, Peters, Sinema, Capito, and 
Hirono are additional cosponsors. On April 28, 2021, the 
Committee met in open Executive Session and, by voice vote, 
ordered S. 198 reported favorably without amendment.
    S. 198 is substantially similar to H.R. 1218, a bill 
introduced on February 23, 2021, by Representative G.K. 
Butterfield (for himself and Representatives Gus Bilirakis and 
Lisa Blunt Rochester) and referred to the Committee on Energy 
and Commerce in the House of Representatives. Representative 
Gwen Moore is an additional cosponsor.

116th Congress

    S. 198 is substantially similar to another bill, S. 3152, 
previously reported favorably by the Committee. S. 3152 was 
introduced on January 7, 2020, by Senator Rosen (for herself 
and Senators Fischer, Young, and Schatz) and was referred to 
the Committee on Commerce, Science, and Transportation of the 
Senate. Senators Jones, Markey, Collins, Smith, King, Braun, 
Van Hollen, Blumenthal, Klobuchar, and Peters were additional 
cosponsors to S. 3152. On July 22, 2020, the Committee met in 
open Executive Session and, by voice vote, ordered S. 3152 
reported favorably with an amendment (in the nature of a 
substitute) and an amendment from Senator Rick Scott. On 
December 15, 2020, S. 3152, as amended, passed the Senate by 
unanimous consent.
    S. 3152 was substantially similar to H.R. 5640, a bill 
introduced on January 16, 2020, by Representative G.K. 
Butterfield (for himself and Representatives Greg Gianforte, 
Susan W. Brooks, Robin L. Kelly, and Lisa Blunt Rochester) and 
referred to the Committee on Energy and Commerce in the House 
of Representatives.

                            ESTIMATED COSTS

    In accordance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate and section 403 of the 
Congressional Budget Act of 1974, the Committee provides the 
following cost estimate, prepared by the Congressional Budget 
Office:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 14, 2021.
Hon. Maria Cantwell,
Chairwoman, Committee on Commerce, Science, and Transportation, U.S. 
        Senate, Washington, DC.
    Dear Madam Chairwoman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 198, the Data 
Mapping to Save Moms' Lives Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is David Hughes.
            Sincerely,
                                         Phillip L. Swagel,
                                                          Director.
    Enclosure.

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    

    S. 198 would require the Federal Communications Commission 
(FCC) to incorporate data on maternal health outcomes into its 
most recently available broadband health mapping tools. In 
addition, the bill would require the Government Accountability 
Office (GAO) to report to the Congress on the effectiveness of 
Internet connectivity in reducing maternal morbidity rates.
    Using information about the cost of broadband mapping, CBO 
estimates that it would cost the FCC less than $500,000 to 
update its broadband health maps to incorporate maternal health 
outcomes. However, because the FCC is authorized to collect 
fees each year sufficient to offset the appropriated costs of 
its regulatory activities, CBO estimates that the net cost to 
the FCC would be negligible, assuming appropriation actions 
consistent with that authority. CBO estimates that it would 
cost GAO less than $500,000 to complete the required report; 
such spending would be subject to the availability of 
appropriated funds.
    If the FCC increases annual fee collections to offset the 
costs of implementing provisions in the bill, S. 198 would 
increase the cost of an existing private-sector mandate on 
entities required to pay those fees. CBO estimates that the 
incremental cost of the mandate would be small and would fall 
well below the annual threshold established in the Unfunded 
Mandates Reform Act for private-sector mandates ($170 million 
in 2021, adjusted annually for inflation).
    The bill contains no intergovernmental mandates.
    The CBO staff contacts for this estimate are David Hughes 
(for federal costs) and Rachel Austin (for mandates). The 
estimate was reviewed by H. Samuel Papenfuss, Deputy Director 
of Budget Analysis.

                      REGULATORY IMPACT STATEMENT

    In accordance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the Committee provides the 
following evaluation of the regulatory impact of the 
legislation, as reported:

Number of Persons Covered

    S. 198 would have no further effect on the number or types 
of individuals and businesses regulated.

Economic Impact

    S. 198 would not have a negative impact on the Nation's 
economy.

Privacy

    S. 198 would not impact the personal privacy of affected 
individuals.

Paperwork

    S. 198 would direct the Government Accountability Office 
(GAO) to submit a report to Congress on the relationship 
between internet connectivity and maternal morbidity.

                   CONGRESSIONALLY DIRECTED SPENDING

    In compliance with paragraph 4(b) of rule XLIV of the 
Standing Rules of the Senate, the Committee provides that no 
provisions contained in the bill, as reported, meet the 
definition of congressionally directed spending items under the 
rule.

                      SECTION-BY-SECTION ANALYSIS

Section 1. Short title.

    This section would provide that the bill may be cited as 
the ``Data Mapping to Save Moms' Lives Act''.

Section 2. Mapping broadband connectivity and maternal health outcomes.

    Subsection (a) of this section would require the FCC to 
incorporate data on maternal health outcomes, for no less than 
1 year postpartum, into its most recently available broadband 
health mapping tools. Subsection (b) of this section would 
direct the Commission to consult with the CDC regarding the 
maternal health outcomes it should incorporate into its most 
recently available broadband health mapping tools.
    The Committee is aware that the FCC's Connect2Health Task 
Force has developed other maps displaying certain health 
outcomes overlaid against data on the availability of 
broadband. In some cases, those maps have been developed in 
coordination with the CDC and use CDC data. The Committee 
intends for the map required by this section to be developed 
using the same coordination processes. It also intends that the 
directive to the FCC to coordinate its actions with the CDC be 
interpreted to direct the FCC to use the CDC-developed 
categories and data related to maternal health outcomes and not 
to develop its own categories or data. Additionally, the 
Committee intends that the FCC utilize its Connect2Health Task 
Force to the greatest extent possible in its execution of its 
responsibilities under this section. Finally, the Committee 
intends for the FCC to maintain the map required by this 
section (and any other maps it has developed relating broadband 
availability and health outcomes) as a publicly available map 
posted to the FCC website, and for those maps to be updated and 
upgraded as data on broadband or health outcomes warrant.

Section 3. GAO study.

    Section 3 would require the GAO to study and submit a 
report to Congress not later than 1 year after enactment of 
this bill on the following two issues: (1) the effectiveness of 
internet connectivity in reducing maternal morbidity rates; and 
(2) who is best suited to take responsibility for ensuring 
better internet connectivity to reduce maternal morbidity 
rates.

                        CHANGES IN EXISTING LAW

    In compliance with paragraph 12 of rule XXVI of the 
Standing Rules of the Senate, the Committee states that the 
bill as reported would make no change to existing law.

                                  [all]