[House Report 119-331]
[From the U.S. Government Publishing Office]
119th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 119-331
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HEALTHY START REAUTHORIZATION ACT OF 2025
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October 3, 2025.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
----------------
Mr. Guthrie, from the Committee on Energy and Commerce,
submitted the following
R E P O R T
[To accompany H.R. 3302]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 3302) to amend the Public Health Service Act to
reauthorize the Healthy Start Initiative, having considered the
same, reports favorably thereon without amendment and
recommends that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 1
Background and Need for Legislation.............................. 2
Committee Action................................................. 2
Committee Votes.................................................. 3
Oversight Findings and Recommendations........................... 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 5
Statement of General Performance Goals and Objectives............ 5
Duplication of Federal Programs.................................. 5
Related Committee and Subcommittee Hearings...................... 5
Committee Cost Estimate.......................................... 6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 6
Advisory Committee Statement..................................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 6
Purpose and Summary
H.R. 3302 would reauthorize the Healthy Start Initiative
through Fiscal Year 2030.
Background and Need for Legislation
The Healthy Start Initiative was established during
President George H.W. Bush's term as a presidential initiative
and was later authorized by Congress under the Children's
Health Act of 2000.\1\ There are now 115 federally-funded
Healthy Start projects in the U.S. providing services in 37
states, the District of Columbia, and Puerto Rico, which have
been critical for helping parents foster a healthy environment
so more children can survive infancy and lead more productive
and longer lives.\2\
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\1\National Healthy Start Assoc., Healthy Start Initiative, https:/
/www.nationalhealthystart.org/healthy-start-initiative/ (last visited
Oct. 3, 2025).
\2\Id.
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The Healthy Start Initiative is a comprehensive maternal
and child health program that aims to improve the health
outcomes of mothers and their newborn children, assisting women
from the prenatal to postpartum periods of pregnancy. Healthy
Start prioritizes areas where the infant mortality rates are at
least 1.5 times the U.S. national average or areas with higher
rates of preterm birth, low birth weight, and maternal
illness.\3\ Compared to pregnant women nationally, a higher
percentage of pregnant women enrolled in the program received
early prenatal care, well-woman preventive health care visits,
and screenings for interpersonal violence and depression, all
of which have been found to influence the overall health
outcomes of mothers and their children. The program serves over
85,000 participants annually.\4\
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\3\Id.
\4\Health Resources and Serv. Admin. (HRSA), Maternal & Child
Health, Healthy Start (Feb. 2025), https://mchb.hrsa.gov/sites/default/
files/mchb/about-us/mchb-healthy-start-factsheet.pdf.
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This legislation would continue resources for the Healthy
Start Initiative at the last enacted appropriated level, to
ensure this crucial support reaches communities in need.
Committee Action
On July 16, 2025, the Subcommittee on Health held a
legislative hearing on H.R. 3302. The title of the hearing was
``Legislative Proposals to Maintain and Improve the Public
Health Workforce, Rural Health, and Over-the-Counter
Medicines.'' The Subcommittee received testimony from:
Dr. Jacqueline Corrigan-Curay, JD, MD,
Acting Director for Center for Drug Evaluation and
Research (CDER), U.S. Food and Drug Administration;
Dr. Candice Chen, MD, MPH, Acting Associate
Administrator for Health Workforce, U.S. Health
Resources and Services Administration; and
Tom Morris, MPA, Associate Administrator for
Rural Health Policy, U.S. Health Resources and Services
Administration.
On September 10, 2025, the Subcommittee on Health met in
open markup session and forwarded H.R. 3302, without amendment,
to the full Committee by a voice vote.
On September 17, 2025, the full Committee on Energy and
Commerce met in open markup session and ordered H.R. 3302,
without amendment, favorably reported to the House by a record
vote of 49 yeas and 0 nays.
Committee Votes
Clause 3(b) of rule XIII requires the Committee to list the
record votes on the motion to report legislation and amendments
thereto. The following reflects the record votes taken during
the Committee consideration:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Oversight Findings and Recommendations
Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of
rule XIII, the Committee held a hearing and made findings that
are reflected in this report.
New Budget Authority, Entitlement Authority,
and Tax Expenditures
Pursuant to clause 3(c)(2) of rule XIII, the Committee
finds that H.R. 3302 would result in no new or increased budget
authority, entitlement authority, or tax expenditures or
revenues.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII, at the time this
report was filed, the cost estimate prepared by the Director of
the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974 was not available.
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.
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
reauthorize the Healthy Start Initiative through Fiscal Year
2030.
Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII, no provision of
H.R. 3302 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.
Related Committee and Subcommittee Hearings
Pursuant to clause 3(c)(6) of rule XIII, the following
related hearing was used to develop or consider H.R. 3302:
On July 16, 2025, the Subcommittee on Health
held a legislative hearing on H.R. 3302. The title of
the hearing was ``Legislative Proposals to Maintain and
Improve the Public Health Workforce, Rural Health, and
Over-the-Counter Medicines.'' The Subcommittee received
testimony from:
Dr. Jacqueline Corrigan-Curay,
JD, MD, Acting Director for Center for Drug
Evaluation and Research (CDER), U.S. Food and
Drug Administration;
Dr. Candice Chen, MD, MPH,
Acting Associate Administrator for Health
Workforce, U.S. Health Resources and Services
Administration; and
Tom Morris, MPA, Associate
Administrator for Rural Health Policy, U.S.
Health Resources and Services Administration.
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. At the time this report was
filed, the estimate was not available.
Earmark, 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. 3302 contains no earmarks, limited
tax benefits, or limited tariff benefits.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
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.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 provides a short title of the ``Healthy Start
Reauthorization Act of 2025.''
Section 2. Reauthorization of Healthy Start Initiative
Section 2 reauthorizes the Healthy Start Initiative through
Fiscal Year 2030.
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, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC
HEALTH SERVICE
* * * * * * *
Part D--Primary Health Care
Subpart I--Health Centers
* * * * * * *
SEC. 330H. HEALTHY START FOR INFANTS.
(a) In General.--
(1) Continuation and expansion of program.--The
Secretary, acting through the Administrator of the
Health Resources and Services Administration, Maternal
and Child Health Bureau, shall under authority of this
section continue in effect the Healthy Start Initiative
and may carry out such program on a national basis.
(2) Definition.--For purposes of paragraph (1), the
term ``Healthy Start Initiative'' is a reference to the
program that, as an initiative to reduce the rate of
infant mortality and improve perinatal outcomes, makes
grants for project areas with high or increasing above
the national average annual rates of infant mortality
and that, prior to the effective date of this section,
was a demonstration program carried out under section
301.
(b) Considerations in Making Grants.--
(1) Requirements.--In making grants under subsection
(a), the Secretary shall require that applicants (in
addition to meeting all eligibility criteria
established by the Secretary) establish, for project
areas under such subsection, community-based consortia
of individuals and organizations (including agencies
responsible for administering block grant programs
under title V of the Social Security Act, participants
and former participants of project services, public
health departments, hospitals, health centers under
section 330, State substance abuse agencies, and other
significant sources of health care services) that are
appropriate for participation in projects under
subsection (a).
(2) Other considerations.--In making grants under
subsection (a), the Secretary shall take into
consideration the following:
(A) Factors that contribute to infant
mortality, including poor birth outcomes (such
as low birthweight and preterm birth) and
social determinants of health.
(B) Communities with--
(i) high rates of infant mortality or
poor perinatal outcomes; or
(ii) high rates of infant mortality
or poor perinatal outcomes in specific
subpopulations within the community.
(C) The extent to which applicants for such
grants facilitate--
(i) collaboration with the local
community in the development of the
project;
(ii) a community-based approach to
the delivery of services;
(iii) a comprehensive approach to
women's health care to improve
perinatal outcomes; and
(iv) the use and collection of data
demonstrating the effectiveness of such
program in decreasing infant mortality
rates and improving perinatal outcomes,
as applicable, or the process by which
new applicants plan to collect this
data.
(3) Special projects.--Nothing in paragraph (2) shall
be construed to prevent the Secretary from awarding
grants under subsection (a) for special projects that
are intended to address significant disparities in
perinatal health indicators in communities along the
United States-Mexico border or in Alaska or Hawaii.
(c) Coordination.--
(1) In general.--Recipients of grants under
subsection (a) shall coordinate their services and
activities with the State agency or agencies that
administer block grant programs under title V of the
Social Security Act in order to promote cooperation,
integration, and dissemination of information with
Statewide systems and with other community services
funded under the Maternal and Child Health Block Grant.
(2) Other programs.--The Secretary shall ensure
coordination of the program carried out pursuant to
this section with other programs and activities related
to the reduction of the rate of infant mortality and
improved perinatal and infant health outcomes supported
by the Department.
(d) Rule of Construction.--Except to the extent inconsistent
with this section, this section may not be construed as
affecting the authority of the Secretary to make modifications
in the program carried out under subsection (a).
(e) Funding.--
(1) Authorization of appropriations.--For the purpose
of carrying out this section, there are authorized to
be [appropriated] appropriated--
(A) $125,500,000 for each of fiscal years
2021 through 2025[.]; and
(B) $145,000,000 for each of fiscal years
2026 through 2030.
(2) Allocation.--
(A) Program administration.--Of the amounts
appropriated under paragraph (1) for a fiscal
year, the Secretary may reserve up to 5 percent
for coordination, dissemination, technical
assistance, and data activities that are
determined by the Secretary to be appropriate
for carrying out the program under this
section.
(B) Evaluation.--Of the amounts appropriated
under paragraph (1) for a fiscal year, the
Secretary may reserve up to 1 percent for
evaluations of projects carried out under
subsection (a). Each such evaluation shall
include a determination of whether such
projects have been effective in reducing the
disparity in health status between the general
population and individuals who are members of
racial or ethnic minority groups. Evaluations
may also include, to the extent practicable,
information related to--
(i) progress toward achieving any
grant metrics or outcomes related to
reducing infant mortality rates,
improving perinatal outcomes, or
reducing the disparity in health
status;
(ii) recommendations on potential
improvements that may assist with
addressing gaps, as applicable and
appropriate; and
(iii) the extent to which the grantee
coordinated with the community in which
the grantee is located in the
development of the project and delivery
of services, including with respect to
technical assistance and mentorship
programs.
(f) GAO Report.--
(1) In general.--Not later than 4 years after the
date of the enactment of this subsection, the
Comptroller General of the United States shall conduct
an independent evaluation, and submit to the
appropriate Committees of Congress a report, concerning
the Healthy Start program under this section.
(2) Evaluation.--In conducting the evaluation under
paragraph (1), the Comptroller General shall consider,
as applicable and appropriate, information from the
evaluations under subsection (e)(2)(B).
(3) Report.--The report described in paragraph (1)
shall review, assess, and provide recommendations, as
appropriate, on the following:
(A) The allocation of Healthy Start program
grants by the Health Resources and Services
Administration, including considerations made
by such Administration regarding disparities in
infant mortality or perinatal outcomes among
urban and rural areas in making such awards.
(B) Trends in the progress made toward
meeting the evaluation criteria pursuant to
subsection (e)(2)(B), including programs which
decrease infant mortality rates and improve
perinatal outcomes, programs that have not
decreased infant mortality rates or improved
perinatal outcomes, and programs that have made
an impact on disparities in infant mortality or
perinatal outcomes.
(C) The ability of grantees to improve health
outcomes for project participants, promote the
awareness of the Healthy Start program
services, incorporate and promote family
participation, facilitate coordination with the
community in which the grantee is located, and
increase grantee accountability through quality
improvement, performance monitoring,
evaluation, and the effect such metrics may
have toward decreasing the rate of infant
mortality and improving perinatal outcomes.
(D) The extent to which such Federal programs
are coordinated across agencies and the
identification of opportunities for improved
coordination in such Federal programs and
activities.
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