Thank you for your support and interest in GAO’s WatchBlog. We recently launched a new website and have moved the WatchBlog from this WordPress site to our new site (GAO.gov). As a result, we will no longer be posting new content on this page (blog.gao.gov)
If you would like to continue to receive blog updates, here’s how you can:
Have you ever wondered who checks to make sure that the new toy you bought for your child does not contain a choking hazard or that your child’s car seat meets safety standards?
The Consumer Product Safety Commission (CPSC) is a small agency with the big responsibility of protecting consumers from dangerous and hazardous products. However, in our November 2020 report, we found that CPSC faces challenges that impede its oversight efforts.
In recognition of National Consumer Protection Week, today’s WatchBlog post looks at CPSC’s role and the challenges it faces.
What is the Consumer Product Safety Commission?
The CPSC is a small agency of about 500 full-time employees that has the big responsibility of protecting U.S. consumers from product hazards that could cause injury or death.
CPSC has broad jurisdiction over thousands of types of consumer products that are worth about $1.6 trillion and include everything from off-road recreational vehicles to hazardous substances.
CPSC faces some challenges in monitoring product safety. For example, when recalls do happen, CPSC has 2 key tools to monitor recall implementation. The first is “recall effectiveness checks,” which are conducted by CPSC staff to determine if the recall is being carried out according to an agreed upon corrective action plan. The second is monthly progress reports submitted by manufacturers. In our November 2020 report, we found that CPSC does not have a consistent process for conducting “recall effectiveness checks” and we found that manufacturers did not submit monthly reports consistently.
To mitigate these issues, we recommended that CPSC:
develop procedures to determine how many “recall effectiveness checks” a recall should receive based on risk factors, such as product volume and injuries; and
systematically track recalling firms’ monthly progress reports to better identify and address firms that do not meet the monthly reporting requirement and to improve CPSC’s ability to monitor the status of product recalls.
How does the CPSC identify product safety hazards?
First, CPSC monitors products to identify safety hazards. Monitoring occurs through methods like:
inspecting imported products at ports,
monitoring hospital injury data, and
through consumer-reported safety-related complaints about potentially dangerous products filed through SaferProducts.gov.
After CPSC identifies a hazardous product, it contacts the firm or manufacturer responsible for it and negotiates voluntary corrective actions to fix the issue. Typically, the action is a recall of the product. For example, if a bicycle or a baby stroller had a faulty part, the manufacturer might agree to repair or replace that part for consumers. In other cases, the manufacturer may agree to offer consumers a refund if they return the defective product.
CPSC also has the power to take enforcement action against firms that do not comply with consumer product safety laws. For example, if a firm fails to report a serious product safety hazard, CPSC can impose fines. CPSC imposed 59 civil penalties from 2010 through 2019.
CPSC can also refer product safety hazards to the Department of Justice to pursue criminal penalties. CPSC was involved in 12 criminal penalty cases prosecuted from fiscal years 2007 to 2019.
To learn more about our work on CPSC, check out our November report and listen to our podcast with GAO’s Alicia Puente Cackley.
Questions on the content of this post? Contact Alicia Puente Cackley at CackleyA@gao.gov.
7 Areas Improved; Five Got Worse; 20 Showed Little Change
Today, we post our latest High Risk List, which includes 36 areas across the federal government vulnerable to waste, fraud, abuse, and mismanagement or needing broad-based transformation. Our list includes 2 new high risk areas—emergency loans for small businesses and the federal response to drug misuse. We also saw improvements in 7 areas on our previous (2019) list, and removed 1 area from the list. At the same time, 20 areas showed little change and 5 regressed.
Today’s WatchBlog highlights these changes.
What is the High Risk List?
Every 2 years, at the start of each new session of Congress, we issue an update to our High Risk List—a list of programs and operations that are ‘high risk’ due to their vulnerabilities to fraud, waste, abuse, and mismanagement, or that need transformation. The federal government has accrued nearly $575 billion in financial benefits over the past 15 years by addressing the areas on this list. In fact, we recorded $225 billion in financial benefits just since our last update in 2019.
Our 2021 High Risk List includes 2 new areas:
Emergency Loans for Small Businesses. The Small Business Administration has administered hundreds of billions of dollars in loans and advances to help small businesses recover from the economic impacts of COVID-19. While these loans have helped many small businesses, greater attention and oversight of these funds is needed due to the risks of fraud.
Pregnant women in custody are a vulnerable group with specialized health care needs. Yet, there are gaps in the treatment and care policies used by U.S. Immigration and Customs Enforcement, the U.S. Marshals Service, and the Bureau of Prisons that could potentially expose these women to health risks.
In today’s WatchBlog post, we look at our new report on issues related to pregnant women in custody.
How many pregnant women are in custody?
That answer depends on the federal agency and the type of federal action involved. For example, from 2016 through 2018, U.S. Immigration and Customs Enforcement (ICE), detained pregnant women more than 4,600 times as part of immigration enforcement activities. A majority (68%) of these detentions were for 1 week or less, while 10% were for more than 30 days.
With respect to criminal justice agencies, we found that there were at least 1,220 pregnant women in Marshals Service custody and 524 pregnant women in the Bureau of Prisons’ custody from 2017 to 2019. The figure below provides additional information on the age, race, and length of time in custody for pregnant women in the Marshals Service’s and Bureau of Prisons’ custody during this time.
Federal agency policies on the treatment and care of pregnant women
In a May 2020 report, we found that ICE has policies and detention standards that address a variety of matters regarding the care of pregnant women, such as pregnancy testing requirements. However, we also found that some facilities did not address all of these pregnancy-related topics through their policies and standards, such as guidance on required and recommended vaccines for pregnant women and HIV care. At the time of our reporting, ICE told us they have plans to update its policies and detention standards and these updates will address many of the gaps we identified.
This month, we found that policies at the Marshals Service were not aligned with national guidance in 13 of 16 treatment and care categories, such as providing mental health services and special accommodations, like lower bunk assignments or special clothing. Meanwhile, Bureau of Prison policies were not aligned with national guidance in 8 of 16 categories, such as nutrition modifications for pregnant and postpartum women’s diets. We made recommendations for both agencies to more closely align their policies with national guidelines. Both agencies agreed with our recommendations.
To learn more about our work focusing on pregnant women in custody, check out our May 2020 report on ICE detention centers and our February report on the Marshals Service and the Bureau of Prisons, or listen to our new podcast with GAO’s Gretta Goodwin on pregnant women in custody.
Questions on the content of this post? Contact Gretta Goodwin at GoodwinG@gao.gov.
Did you know Medicaid can be used in times of crisis? From natural disasters to the pandemic, Medicaid has been used to protect groups of people and mitigate damages.
In today’s WatchBlog post, we look at how Medicaid is used during times of crisis, including COVID-19. The blog also highlights new work we are issuing for Congress, a special product line called Health Care Capsules. This first one looks at GAO’s work on Medicaid during times of crisis including Hurricane Katrina, the Great Recession, and today’s pandemic. According to Carolyn Yocom, GAO’s Director for Health Care, “The Health Care Capsule is designed to take multiple GAO products on current issues and package them into an easy-to-understand, visually compelling format for the Congress and the American people.”
What is Medicaid, and how is it used in a crisis?
Medicaid is the single largest source of health coverage in the United States. Medicaid is a federal-state health care financing program and serves more than 70 million Americans—including children, pregnant women, parents, seniors, and individuals with disabilities.
Most Medicaid beneficiaries have limited incomes and resources, so when a crisis hits, Medicaid recipients are particularly vulnerable. However, Medicaid can be used to increase funding to states and provide services to those affected. For instance, in response to the COVID-19 pandemic, federal legislation increased Medicaid funding and allowed states to cover testing for uninsured individuals. Our work found that, as of the end of 2020, COVID-19 related federal Medicaid expenditures totaled about $25 billion, or 7% of total federal spending that year.
Medicaid can also be used during economic recessions, natural disasters, and other crises. For example, states have enrolled individuals into Medicaid who were evacuated from their residences due to natural disasters, like in the aftermath of Hurricane Katrina in 2005. In addition to being displaced, individuals impacted by natural disasters might lose out on paychecks or lose their jobs and need Medicaid assistance. During crises like these, the federal government has waived program restrictions to allow states more flexibility to better serve displaced individuals where they are—for example, by expanding telehealth services when in-person visits were not reasonable.
How can using Medicaid in times of crisis be improved?
More individuals may become reliant on assistance from Medicaid as the pandemic’s effects on public health and the economy continue and as climate-related natural disasters increase in number and scale. As a result, policymakers face a number of considerations when deciding how to use Medicaid in times of crisis. States may need a variety of tools within Medicaid to assist beneficiaries and cope with increased costs. Effective federal oversight may improve outcomes for beneficiaries and help manage risks of payment errors, which were over $85 billion in 2020.
We recommended that Congress consider automatic increases in federal Medicaid spending during recessions. This automatic, temporary change would increase Medicaid support in a timely and targeted fashion, which could help ensure beneficiaries get the support they need in times of crisis.
Questions on the content of this post? Contact Carolyn Yocom at email@example.com.
When Vice President Kamala Harris was sworn in January 20, she became the first candidate elected to President or Vice President to have attended a Historically Black College or University (HBCU). What are HBCUs, and what role have they played in higher education?
HBCUs collectively enrolled more than 226,000 Black students in 2017. These schools can boast that more than one-third of Black Americans who obtained a doctorate degree in STEM fields from 2005-2010 earned their undergraduate degrees from an HBCU. HBCUs also play an important role in their local and regional economies, contributing an estimated $14.8 billion in 2014.
Today’s WatchBlog looks at how the federal government’s Small Business Administration (SBA) has partnered with HBCUs to promote student achievement and entrepreneurship.
Established partnership with SBA
In 1980, an executive order established a White House Initiative to strengthen the capacity of HBCUs to provide quality education and other opportunities for students. Subsequent administrations joined this effort—including a 2017 executive order that, among other things, prioritized increasing the role that the private sector plays in helping HBCUs. As part of these efforts, the SBA must plan for how it intends to identify federal programs and initiatives in which HBCUs are underserved or may have been underutilized.
In its 2018 plan, the SBA set a goal of raising awareness and providing information to help HBCUs compete for federal grants and contracts. The SBA set another goal of promoting collaboration among HBCUs, SBA resource partners, and the agency’s district offices to encourage and support entrepreneurship in underserved markets.
In our 2019 work, we examined this effort, and found opportunities for the SBA to strengthen its partnerships with HBCUs.
Areas of improvement
We found that the SBA failed to communicate with key small business development centers and district offices about its planned efforts to support HBCUs. The SBA did not have annual plans for this initiative from 2013–2017.
There was also a lack of communication between SBA headquarters staff and their HBCU partners regarding the 2018 annual plan. The SBA did not prepare an annual plan until the end of fiscal year 2018. The agency did not share this plan with HBCUs once it was prepared and, instead, decided to focus its efforts on how to support HBCUs during the following fiscal year.
We also found, in 2019, that the SBA did not collect relevant information to develop a baseline and track its ongoing efforts to support HBCUs.
Our report recommended that the SBA define clear roles and responsibilities for its headquarters staff responsible for implementing the White House Initiative on HBCUs. Also, SBA should communicate its plans for the initiative to district offices and HBCUs, and should take steps to collect information needed to monitor and assess its efforts to support HBCUs. To date, our recommendations have not been implemented by the SBA.
Questions on the content of this post? Contact Anna Maria Ortiz at OrtizA@gao.gov.
Rural hospitals provide essential health care to both rural and nearby urban communities, including COVID-19 treatment and services. Yet, more than 100 rural hospitals closed from January 2013 to February 2020. While this number may seem small, it’s having a big impact on the communities that those hospitals served.
In today’s WatchBlog, we look at our new report on how rural hospital closures have increased over the last decade and how those closures affect residents’ access to health care services.
Reduced access to health care services
Rural hospital closures may reduce residents’ access to care in several ways. For example, in our December report, we found that counties with rural hospital closures generally had fewer health care professionals. In 2012, the median number of all physicians in counties with hospital closures was 71.2 per 100,000 residents, compared to 87.5 per 100,000 residents in counties without closures.
This could mean that fewer physicians are available to provide care—such as emergency care for illnesses like COVID-19—to residents in these communities.
We also found that after a rural hospital closed, residents had to travel farther to get the same health care services—about 20 miles farther for common services like inpatient care. Residents had to travel even farther—about 40 miles—for less common services like alcohol or drug abuse treatment at other hospitals, as the graphic below illustrates.
Residents had to travel farther to get health care services after rural hospitals closed in their areas.
Rural hospital closures and COVID-19
While it may be too soon to determine the effects of the COVID-19 pandemic on rural hospital closures, it’s easy to imagine how these closures could affect residents who need treatment for COVID-19. For example, as described above, residents are having to travel farther to receive certain health care services as a result of hospital closures.
In a November 2020 report, we described how—as a result of COVID-19—behavioral health experts expected increases in substance use, mental health disorders, and suicides. Some experts said that these increases are likely to persist after the risk from COVID-19 has decreased. For residents living in areas with a rural hospital closure, it could mean (again) that they will need to travel as much as 40 miles farther to receive these less common treatment services.
Prior to the pandemic, many rural hospitals that closed appeared to be financially distressed in the years leading up to their eventual closure. Research shows that COVID-19 may cause financial burdens for the remaining open rural hospitals. For example, one study shows that rural hospitals may be more financially stressed during the COVID-19 pandemic, as most are operating with a small amount of cash. Specifically, rural hospitals had enough cash on hand to operate a median of less than 80 days without additional revenue.
To learn more about how rural hospital closures have affected residents’ access to health care, tune into our podcast with GAO’s Greg Giusto:
Since November 2020, the number of COVID-19 cases in the U.S. has dramatically increased, further straining health care systems across the country.
Today’s WatchBlog looks at our newest report on the federal pandemic response, which describes the status of ongoing efforts and outlines ways to improve the response and prepare for future challenges caused by COVID-19. The full report covers our work through January 15, 2021, on areas such as vaccines and therapeutics, COVID-19 testing, medical and drug supply shortages, data collection, stimulus payments, drug manufacturing, small business loans, workplace safety, and more.
As of January 15, 27 of our 31 previous recommendations related to the federal response to COVID-19 remained unimplemented. In today’s report, we reiterate some of our previous recommendations, while also making 13 new ones that focus on improving vaccine distribution, creating a national testing strategy, improving data for tracking COVID cases and the impacts on communities, and addressing medical supply shortages. As the new Congress and administration establish their policies and priorities for pandemic response, we urge swift action on our recommendations.
We’ll focus on a few key areas for improvement here. You can also tune in to our latest podcast on this work, which features 3 of the directors leading our pandemic response review.
Vaccine Distribution and Administration Fell Short of Expectations
Operation Warp Speed set a goal of having 300 million vaccine doses available. After emergency use authorizations for 2 vaccines, about 12.4 million doses have been distributed and about 2.8 million initial doses have been administered as of December 30, 2020. These initial numbers have fallen short of expectations set by federal officials, further underscoring the need for careful planning and clear and consistent communication.
In our September report, we stressed the importance of having a vaccination plan that focused on coordination and communication, and recommended documenting and sharing a national strategy. This recommendation has not been fully implemented; we reiterate the importance of doing so.
No National Testing Strategy Yet
Diagnostic testing for COVID-19 is critical to controlling the spread of the virus, according to the Centers for Disease Control and Prevention. With federal, state, and other organizations all involved in the testing process, it’s important to ensure that they all have the information they need to accomplish their shared goals. We recommended developing and publicly releasing a comprehensive national testing strategy that incorporates our 6 characteristics of effective national strategies. Such a strategy could build upon existing strategy documents that the Department of Health and Human Services has produced for the public and Congress to allow for a more coordinated pandemic testing approach.
Data for Allocating Health Resources Is Incomplete and Inconsistent
Incomplete and inconsistent data on the number of COVID-19 cases, ICU headroom, and other indicators of the pandemic has made it difficult for the Department of Health and Human Services and others to prioritize the allocation of health resources. This is especially true in specific geographic areas and among certain populations most affected by the pandemic. A lack of standardized data collection and reporting makes it hard to monitor trends in the burden of the pandemic across states and regions; make informed comparisons between areas; and assess the impact of public health actions to mitigate the spread of COVID-19.
We recommended establishing a committee of professionals from the public, private, and nonprofit sectors as well as academia to focus on addressing this issue.
Agencies Don’t Have Needed Information to Strengthen Medical and Drug Supply Chains
The Department of Health and Human Services and the Federal Emergency Management Agency have made numerous efforts to mitigate supply shortages. But in the national survey we did for our previous report, one-third to one-half of states and territories reported ongoing shortages of some testing-related and other medical supplies.
We made two new recommendations to improve coordination on medical supply chain management and to make drug supply chains more resilient. These are in addition to three previous related recommendations.
Strengthening Program Integrity and Protecting Against Fraud
Among GAO’s many recommendations in this area, of particular concern is the slow response to implementation of GAO’s recommendations to improve program integrity and reduce fraud in the Small Business Administration’s emergency loan programs.
Further information, and our findings in other key areas of federal COVID-19 relief efforts, can be found in the full report.
Questions on the content of this post? Contact Nikki Clowers at firstname.lastname@example.org.
Have you ever been stranded on the side of the road while cars and trucks whiz by? If so, you likely appreciate how dangerous and unnerving it can be. America’s emergency responders – police, firefighters, and EMTs – face this danger every day in the line of duty.
Today’s WatchBlog looks at our new report about “Move Over or Slow Down” laws, how states and the federal government are promoting their awareness and training first responders to better protect themselves from highway dangers, among other actions.
What are “Move Over or SlowDown” laws?
Generally, “Move Over or Slow Down” laws require motorists to move over or, if doing so is unsafe, slow down when approaching an emergency responder on the roadside. All states and D.C. have enacted these laws to protect police officers, firefighters, and emergency medical services personnel. Some states also include protections for drivers of tow trucks, utility service vehicles, or any vehicle using flashing lights.
Promoting public awareness of “Move Over or Slow Down” laws
State transportation and law enforcement officials have used various forms of outreach—such as public service announcements, pamphlets, posters, and social media—to improve public awareness of these laws. Despite these efforts, however, state officials we spoke with for our report said raising public awareness was still a challenge because of limited resources, and that motorists may not understand specific requirements of the law such as what speed limit constitutes “slowing down.”
On the federal government side, the U.S. Department of Transportation’s National Highway Traffic Safety Administration assists states efforts by:
providing states with funding for public awareness activities or enforcement initiatives related to emergency responder safety, and
developing marketing materials that states can distribute via traffic safety campaigns.
Educating emergency responders on safety best practices
The Department of Transportation’s Federal Highway Administration also coordinates with a network of stakeholders across the country to train emergency responders on best practices for traffic incident management. These practices include how to park safely near an incident site and how to restore traffic flow quickly to help prevent additional injuries or delays.
To learn more about our work on “Move Over or Slow Down” laws and emergency responder safety, check out our report and our video on “Move Over” laws and emergency responder safety.
What are some of the most important changes the federal government should make?
Today’s WatchBlog looks at GAO’s priority recommendations for agencies—actions that warrant attention, could save large amounts of money, help Congress make decisions on major issues, and substantially improve or transform government operations.
GAO’s Priority Recommendations
When GAO audits a program or agency, we collect all the facts we can about what’s working, what isn’t, why things aren’t working, and why it’s important to fix them. Then we offer recommendations based on these facts to help guide agency officials and policymakers toward decisions that improve government and promote efficiency and effectiveness.
We notify agencies annually about certain recommendations that warrant priority attention. These recommendations are important because implementing them can save large amounts of money, help Congress make decisions on major issues, and substantially improve or transform major government programs or agencies.
GAO maintains a recommendations database covering every topic we work on. As of January 2, 2021, there were 4,912 open recommendations. Of these, we have designated 467 as priority recommendations.
Recommendations for the Nation’s Most Pressing Issues
We here at GAO have also been tasked with monitoring federal COVID-19 response efforts. As we monitor, we are making recommendations to agencies, including the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Treasury. For example, in our November report, we recommended the CDC clearly disclose scientific rationale for changes to COVID-19 testing guidelines.
In addition to monitoring the COVID-19 response, we have also launched our transition webpage to help Congress and the administration address the country’s most pressing issues. We identified Economic Downturns and Race in America along with the Coronavirus Pandemic as major issues facing the nation. We have recommendations for each of those issues as well.
Why Follow GAO’s Recommendations?
Over the past four years, agencies have implemented about 77% of our recommendations. We outlined the benefits of doing so in our latest Performance and Accountability Report. Specifically, in fiscal year 2020, we reported saving the federal government $77.6 billion by recommending ways to prevent payment errors, improve the efficiency and effectiveness of federal programs, and prevent fraud. That’s $114 for every dollar Congress invests in us! We also tracked more than 1,300 nonfinancial improvements in federal government operations.
Almost Ready to Implement Our Recommendations?
If you’re new to an agency or to Congress and you need some extra help, our experts are available! They can get you a quick answer or a full briefing. Congressional staff can call our Office of Congressional Relations at (202) 512-4400 or email email@example.com , and media can contact our Office of Public Affairs at (202) 512-4800 or email firstname.lastname@example.org. You can also look up senior GAO staff by expertise at Find an Expert.
Questions on the content of this post? Contact Chuck Young at email@example.com.