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Here's a look at documents from all members of the U.S. House and the U.S. Senate
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Chairman Smith: Hospital at Home Program Is a Proven Success for Getting More Americans the Health Care They Need
WASHINGTON, Dec. 2 -- Rep. Jason Smith, R-Missouri, chairman of the House Ways and Means Committee, issued the following news release on Dec. 1, 2025:* * *
Chairman Smith: Hospital at Home Program Is a Proven Success for Getting More Americans the Health Care They Need
Today, Ways and Means Committee Chairman Jason Smith (MO-08) delivered the following remarks during debate in the U.S. House of Representatives on H.R. 4313, the Hospital Inpatient Services Modernization Act.
As prepared for delivery.
"I rise in support of the Hospital Inpatient Services Modernization Act introduced by Ways ... Show Full Article WASHINGTON, Dec. 2 -- Rep. Jason Smith, R-Missouri, chairman of the House Ways and Means Committee, issued the following news release on Dec. 1, 2025: * * * Chairman Smith: Hospital at Home Program Is a Proven Success for Getting More Americans the Health Care They Need Today, Ways and Means Committee Chairman Jason Smith (MO-08) delivered the following remarks during debate in the U.S. House of Representatives on H.R. 4313, the Hospital Inpatient Services Modernization Act. As prepared for delivery. "I rise in support of the Hospital Inpatient Services Modernization Act introduced by Waysand Means Health Subcommittee Chairman Buchanan and Congressman Dwight Evans.
"I think one of the health care related conversations that frustrates a lot of us around here is the typical year-end health care policy extenders mess. The legislation in front of us takes the successful Hospital at Home program and removes it from that chaos by providing it with a renewed five year authorization so more Americans can receive care in the comfort and convenience of their own home.
"Hospital at Home has become embedded in the fabric of our health care system. More than 400 hospitals in nearly 40 states have participated in the program, which has built a track record of improved patient outcomes. In Health Subcommittee Chairman Buchanan's home state of Florida alone, there are 23 hospitals participating in this program.
"Hospital care provided at home cuts mortality rates, reduces the risk of falls and infections, and lowers recovery times. It also can save costs versus expensive in-person hospital visits. It's no wonder that 99 percent of patients said they were satisfied with the program.
"At a Ways and Means Committee hearing we heard the incredible story of a Hospital at Home patient from North Carolina named Roy who was diagnosed with sepsis and initially treated in a hospital. There, he was disturbed by beeping sounds, uncomfortable in his hospital gown, and alone with no one able to visit.
"His recovery was much better at home. He was able to sleep in his own bed and visit with friends and family. He also continued to receive the same level of care he would have otherwise received at the hospital. His recovery at home was rapid, complete, and without any infections.
"I represent one of the most rural districts in America. The long drives to a hospital faced by people living in small towns and remote areas can make seeking care prohibitive. Hospital at Home shrinks the physical distance stopping rural patients from getting care.
"Hospital at Home has been a proven success for getting more Americans the health care they need."
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Original text here: https://waysandmeans.house.gov/2025/12/01/chairman-smith-hospital-at-home-program-is-a-proven-success-for-getting-more-americans-the-health-care-they-need/
Chairman Jordan and Rep. Hageman Probe Cartel Activity on Tribal Lands Fueled by Biden-Harris Border Crisis
WASHINGTON, Dec. 2 -- Rep. Jim Jordan, R-Ohio, chairman of the House Judiciary Committee, issued the following news release on Dec. 1, 2025:* * *
Chairman Jordan and Rep. Hageman Probe Cartel Activity on Tribal Lands Fueled by Biden-Harris Border Crisis
Today, House Judiciary Committee Chairman Jim Jordan (R-OH) and Rep. Harriet Hageman (R-WY) sent a letter to Federal Bureau of Investigation Director Kash Patel requesting data regarding how the Biden-Harris Administration's open border policies led to violent crime and the presence of transnational drug cartels in Indian Country.
The complex ... Show Full Article WASHINGTON, Dec. 2 -- Rep. Jim Jordan, R-Ohio, chairman of the House Judiciary Committee, issued the following news release on Dec. 1, 2025: * * * Chairman Jordan and Rep. Hageman Probe Cartel Activity on Tribal Lands Fueled by Biden-Harris Border Crisis Today, House Judiciary Committee Chairman Jim Jordan (R-OH) and Rep. Harriet Hageman (R-WY) sent a letter to Federal Bureau of Investigation Director Kash Patel requesting data regarding how the Biden-Harris Administration's open border policies led to violent crime and the presence of transnational drug cartels in Indian Country. The complexjurisdictional authority for tribes to prosecute certain criminal offenses on reservations and the shortage of tribal law enforcement officers make Indian reservations prime locations for dangerous cartel operations. Criminal aliens who illegally entered the country under the Biden-Harris Administration work alongside dangerous cartels to smuggle drugs, including fentanyl and methamphetamine, and perpetuate an opioid epidemic and violent crime in Native American communities.
In Indian Country, cartel operatives recruit and take advantage of vulnerable tribal members and offer these individuals quick cash to transport or distribute narcotics. Jurisdictional limitations--tribal law enforcement can only prosecute tribal members and state/local law enforcement often lack authority on reservation land--leave tribal communities vulnerable to rapid cartel infiltration and little proactive federal assistance.
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December 1, 2025
To: The Honorable Kash Patel, Director, Federal Bureau of Investigation, 935 Pennsylvania Avenue NW, Washington, D.C. 20535
Dear Director Patel:
The Committee on the Judiciary is conducting oversight of the Biden-Harris Administration's open-borders policies, including how these policies led to violent crime and the presence of transnational drug cartels in Indian Country. You testified earlier this year that addressing crime on tribal lands is a priority for the Federal Bureau of Investigation (FBI).1 We support your commitment to addressing safety and security in Indian Country and we respectfully write to request information to advance the Committee's oversight.
For four years, the Biden-Harris Administration abandoned America's borders and failed to enforce immigration laws. As a result, eight million illegal aliens entered the country, including at least six million illegal aliens who were released into American communities and nearly two million illegal alien "gotaways" who evaded U.S. Customs and Border Protection at the southwest border.2 Although the Trump Administration has secured the border and prioritized immigration enforcement, national security risks from the Biden-Harris border crisis remain a threat to U.S. communities, including in Indian Country.3
The complex jurisdictional authority for tribes to prosecute certain criminal offenses on reservations and the shortage of tribal law enforcement officers make Indian reservations prime locations for dangerous cartel operations.4 Criminal aliens who illegally entered the country under the Biden-Harris Administration work alongside dangerous cartels to smuggle drugs, including fentanyl and methamphetamine, and perpetuate an opioid epidemic and violent crime in Native American communities.5
In Indian Country, cartel operatives recruit and take advantage of vulnerable tribal members--those facing unemployment, addiction, or financial strain--and offer these individuals quick cash to transport or distribute narcotics.6 Over time, drugs take hold in the community as addiction spreads. Violence often follows. When someone reports drug cartel activity to the tribal police or refuses to cooperate with the cartels' demands, the cartel responds with threats, intimidation, and violence to maintain control.7 The effects on the community include more overdoses, more missing persons, rising fear, and resources stretched thin.8 Meanwhile jurisdictional limitations--tribal law enforcement can only prosecute tribal members and state/local law enforcement often lack authority on reservation land--leave tribal communities vulnerable to rapid cartel infiltration and little proactive federal assistance.9 The cartels exploit these vulnerabilities intentionally, leaving tribal communities to bear the consequences.10
On April 1, 2025, the Department of Justice (DOJ) launched Operation Not Forgotten to address unresolved cases of violent crime in Indian Country.11 DOJ announced that it would "surge resources," including 60 FBI personnel to 10 FBI field offices to support these pending investigations.12 For the past six months, FBI personnel have rotated in 90-day temporary duty assignments to help resolve cases.13 The FBI concluded the operation on October 1, 2025.
On September 17, 2025, you testified before the Committee that of the reported 1,900 open cases in Indian Country, the FBI already helped to issue "600 indictments this year alone."14 Now that Operation Not Forgotten has concluded, we write to request the following documents and information:
1. Data relating to the number, location, and assignment of FBI personnel deployed or reassigned to Indian Country to work pending violent crime investigations from April 1, 2025, to the present;
2. Data relating to violent crime rates in Indian Country, including but not limited to statistical data of case openings and case resolutions, for the period of January 20, 2025, to the present;
3. Data relating to violent crime rates in Indian Country, including but not limited to statistical data of case openings and case resolutions, for the period of January 20, 2021, to January 20, 2025; and
4. Data reflecting the types and categories of violent crime that the FBI has addressed on tribal reservations where it has allocated investigative or enforcement resources. This request includes, but is not limited to, data on drug trafficking, homicide, missing persons, assault, and other violent crimes.
5. An explanation of the budgetary resources that the FBI has dedicated to addressing violent crime on tribal lands, and how that allocation has changed over time.
We respectfully ask that you produce the requested materials by December 15, 2025. The Committee is authorized to conduct oversight of the FBI pursuant to the Rules of the House of Representatives.15 If you have questions about this matter, please contact Committee staff at (202) 225-6906.
Thank you for your prompt attention to this matter.
Sincerely,
Jim Jordan, Chairman
Harriet M. Hageman, Member of Congress
cc: The Honorable Jamie Raskin, Ranking Member
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1 Oversight of the Federal Bureau of Investigation, Hearing Before H. Comm. on the Judiciary, 119th Cong. at 183 (2025) (testimony of the Hon. Kash Patel, Dir., Fed. Bureau of Investigation).
2 Info. provided to the H. Comm. on the Judiciary by U.S. Dep't of Homeland Sec., Table 1: Detention Histories of CBP Encounters, January 20, 2021 - March 31, 2024 (Aug. 16, 2024); U.S. Customs and Border Prot., Custody and Transfer Statistics, U.S. DEP'T OF HOMELAND SEC. (last accessed Jan. 6, 2025); Camilo Montoya-Galvez, Biden administration has admitted more than 1 million migrants into U.S. under parole policy Congress is considering restricting, CBS NEWS (Jan. 22, 2024); Latest UC Data, Total Monthly Discharges to Individual Sponsors Only, U.S. DEP'T OF HEALTH AND HUMAN SERVS. (last accessed Mar. 22, 2024); Off. of Refugee Resettlement, Unaccompanied Children Released to Sponsors by State, U.S. DEP'T OF HEALTH AND HUMAN SERVS. (last accessed Jan 15, 2025); U.S. Customs and Border Prot., CBP Releases December 2024 Monthly Update, U.S. DEP'T OF HOMELAND SEC. (Jan. 14, 2025); Immigr. and Customs Enf't, Daily SWB Placemat, U.S. DEP'T OF HOMELAND SEC. (May 2024-Jan. 2025) (on file with Comm.); Off. of Homeland Sec. Statistics, Immigr. Enf't and Legal Processes Monthly Tables - Apr. 2024, U.S. DEP'T OF HOMELAND SEC. (last accessed Aug. 19, 2024); Casey Harper, Border crisis creates national security threat for U.S., observers say, WASH. EXAM'R (Aug. 7, 2023); Bill Melugin (@BillMelugin_), X (June 20, 2024, 10:22 AM).
3 Jessica M. Vaughn, Tribal Leaders Seek Help to Oust Mexican Drug Cartels, CENTER FOR IMMIGR. STUDIES (Apr. 16, 2024).
4 Bennett Watts and Wilson Beaver, Drug Cartels 'Are Winning': Border Crisis Ravaging Arizona, Montana Indian Reservations, DAILY SIGNAL (Oct. 31, 2024); Emma Jane, Crow Tribe Chairman testifies about cartel threat in Indian Country, EASTERN PROG. (July 25, 2025); Lisa Cavazuti et al., Mexican drug cartels are targeting America's 'last best place', NBC NEWS (Feb. 10, 2024).
5 Clair McFarland, FBI, ICE Nab Suspected Mexican Cartel Member Working on Wyoming Reservation, COWBOY STATE DAILY (Feb. 26, 2025); Press Release, U.S. Drug Enf't Admin., Mexican National With Ties to the Jalisco Cartel Sentenced to 19 Years in Federal Prison for Trafficking in Hundreds of Pounds of Fentanyl, Heroin, Meth, and Cocaine in Eastern Washington and Montana (July 18, 2025).
6 Drug Enforcement Administration, 2025 National Drug Threat Assessment, U.S. Dep't of Justice (May 13, 2025), https://www.dea.gov/sites/default/files/2025-07/2025NationalDrugThreatAssessment.pdf.
7 Press Release, U.S. Drug Enf't Admin., Mexican National With Ties to the Jalisco Cartel Sentenced to 19 Years in Federal Prison for Trafficking in Hundreds of Pounds of Fentanyl, Heroin, Meth, and Cocaine in Eastern Washington and Montana (July 18, 2025).
8 Emma Jane, Crow Tribe Chairman testifies about cartel threat in Indian Country, EASTERN PROG. (July 25, 2025).
9 Bennett Watts and Wilson Beaver, Drug Cartels 'Are Winning': Border Crisis Ravaging Arizona, Montana Indian Reservations, DAILY SIGNAL (Oct. 31, 2024).
10 Id.
11 Press Release, U.S. Dep't of Justice, Justice Department to Surge Resources to Indian Country to Investigate Violent Crimes (Apr. 1, 2025); Louis Casiano, FBI to increase personnel in field offices to address violent crimes in Native American communities, FOX NEWS (Apr. 1, 2025).
12 Press Release, U.S. Dep't of Justice, Justice Department to Surge Resources to Indian Country to Investigate Violent Crimes (Apr. 1, 2025); Louis Casiano, FBI to increase personnel in field offices to address violent crimes in Native American communities, FOX NEWS (Apr. 1, 2025).
13 Id.
14 Oversight of the Federal Bureau of Investigation, Hearing Before H. Comm. on the Judiciary, 119th Cong. at 184 (2025) (testimony of the Hon. Kash Patel, Dir., Fed. Bureau of Investigation).
15 See Rules of the U.S. House of Representatives, R. X., cl.1(7) (2025).
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Original text here: https://judiciary.house.gov/media/press-releases/chairman-jordan-and-rep-hageman-probe-cartel-activity-tribal-lands-fueled
Chairman Hill, Oversight Chair Meuser Issue Final Staff Report on Biden's Debanking of Digital Assets
WASHINGTON, Dec. 2 -- Rep. French Hill, R-Arkansas, chairman of the House Financial Services Committee, issued the following news release on Dec. 1, 2025:* * *
Chairman Hill, Oversight Chair Meuser Issue Final Staff Report on Biden's Debanking of Digital Assets
House Committee on Financial Services Chairman French Hill (AR-02) and Oversight Subcommittee Chairman Dan Meuser (PA-09) today released a final staff report titled "Operation Choke Point 2.0: Biden's Debanking of Digital Assets."
Beginning in the 118th Congress, Committee Republicans have been investigating coordinated efforts by the ... Show Full Article WASHINGTON, Dec. 2 -- Rep. French Hill, R-Arkansas, chairman of the House Financial Services Committee, issued the following news release on Dec. 1, 2025: * * * Chairman Hill, Oversight Chair Meuser Issue Final Staff Report on Biden's Debanking of Digital Assets House Committee on Financial Services Chairman French Hill (AR-02) and Oversight Subcommittee Chairman Dan Meuser (PA-09) today released a final staff report titled "Operation Choke Point 2.0: Biden's Debanking of Digital Assets." Beginning in the 118th Congress, Committee Republicans have been investigating coordinated efforts by theBiden Administration to debank digital asset businesses and individuals. In the report, Republican Committee staff detail how Biden Administration regulators used vague rules, excessive discretion, informal guidance, and aggressive enforcement actions to pressure banks away from serving digital asset clients, resulting in at least 30 digital asset entities or individuals losing access to financial services.
Click here (https://financialservices.house.gov/UploadedFiles/2025-11-30_--_FSC_Debanking_Report_FINAL_1.pdf) to view the debanking report.
"Targeting Americans over their political views erodes trust in the financial system and undermines the core freedoms our nation was founded on," said Chairman Hill. "The staff report released today summarizes Committee Republicans' work and details how the Biden Administration's regulators worked to debank the digital asset ecosystem. Under the leadership of President Trump, we've ushered in a new era for digital assets and look forward to reversing the damage done by the Biden Administration to prevent unlawful debanking."
Subcommittee Chair Meuser said "This report documents how Obama-era practices were revived and expanded under President Biden--through pause letters, informal pressure campaigns, and regulation-by-enforcement that forced U.S. companies offshore. It also highlights the early leadership of President Trump, Secretary Bessent, Vice Chair Bowman, Comptroller Gould, and Acting Chair Hill in reversing this hostility and restoring fairness and clarity to bank supervision. Now Congress must codify these protections into law so that an Operation Choke Point 3.0 can never happen."
Financial Institutions Subcommittee Chairman Andy Barr (KY-06) added "The committee's report makes clear that Chokepoint 2.0 - an explicit, politically motivated attack on digital assets - under the Biden Administration was real and unacceptable. I commend Chairman Hill for spotlighting this issue in this report. I'll keep working to advance my bill that will permanently enshrine President Trump's Executive Order protecting digital assets, Christian nonprofits, firearms manufacturers, energy producers, and other politically targeted industries from being de-banked."
Digital Assets, Financial Technology, and Artificial Intelligence Subcommittee Chairman Bryan Steil (WI-01) stated "Today's report confirms what has been clear for years: the Biden-Harris Administration ran a targeted campaign to debank individuals in the digital asset ecosystem who were engaged in legal business activity the administration simply did not favor. Operation Choke Point 2.0 stalled Web3 innovation, drove jobs overseas, and needlessly politicized access to the banking system. I look forward to working with Chairman Hill, Subcommittee Chairman Meuser, and our colleagues to ensure this regulatory abuse cannot happen again."
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Original text here: https://financialservices.house.gov/news/documentsingle.aspx?DocumentID=410927
Chairman Guthrie Celebrates President Trump's Signing of SUPPORT Act
WASHINGTON, Dec. 2 -- Rep. Brett Guthrie, R-Kentucky, chair of the House Energy and Commerce Committee, issued the following news release on Dec. 1, 2025:* * *
Chairman Guthrie Celebrates President Trump's Signing of SUPPORT Act
Today, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, issued the following statement after President Trump signed H.R. 2483, the SUPPORT for Patients and Communities Reauthorization Act, into law.
"Today, America celebrates the passage of the SUPPORT for Patients and Communities Reauthorization Act--legislation that takes ... Show Full Article WASHINGTON, Dec. 2 -- Rep. Brett Guthrie, R-Kentucky, chair of the House Energy and Commerce Committee, issued the following news release on Dec. 1, 2025: * * * Chairman Guthrie Celebrates President Trump's Signing of SUPPORT Act Today, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, issued the following statement after President Trump signed H.R. 2483, the SUPPORT for Patients and Communities Reauthorization Act, into law. "Today, America celebrates the passage of the SUPPORT for Patients and Communities Reauthorization Act--legislation that takessignificant steps toward reducing the toll illicit fentanyl and fentanyl-related substances take on our communities. As the Chairman of the House Committee on Energy and Commerce, I'm proud of the bipartisan work that has been done through this important legislation to continue empowering first responders, supplying recovery resources, and increasing access to treatment options for individuals with substance use disorders," said Chairman Guthrie. "I want to thank President Trump for his continued commitment to combatting the opioid crisis, and the reauthorization of this legislation ensures continued investment in prevention, recovery, and hope for families nationwide."
Background:
* H.R. 2483, the SUPPORT for Patients and Communities Reauthorization Act of 2025, was reported to the full House from the Committee on Energy and Commerce by a roll call vote of 36 yeas - 13 nays and passed the full House by a vote of 366 yeas - 57 nays.
* The Senate passed the legislation by unanimous consent on September 18.
* The SUPPORT Act:
* Ensures first responders can access and administer naloxone;
* Allows for enhanced SUD treatment options for pregnant and postpartum women;
* Strengthens state PDMP systems;
* Encourages individuals in recovery to participate in the workforce; and
* Continues the supply of resources for Comprehensive Opioid Recovery Centers, which provide a full spectrum of treatment and recovery support services.
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Original text here: https://energycommerce.house.gov/posts/chairman-guthrie-celebrates-president-trump-s-signing-of-support-act
Chairman Guthrie Celebrates House Passage of Mikaela Naylon Give Kids A Chance Act
WASHINGTON, Dec. 2 -- Rep. Brett Guthrie, R-Kentucky, chair of the House Energy and Commerce Committee, issued the following news release on Dec. 1, 2025:* * *
Chairman Guthrie Celebrates House Passage of Mikaela Naylon Give Kids A Chance Act
Today, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, issued a statement following the House passage of H.R. 1262, the Mikaela Naylon Give Kids a Chance Act--a bipartisan piece of legislation which reauthorizes the FDA's Rare Pediatric Disease (RPD) Priority Review Voucher (PRV) Program to incentivize the development ... Show Full Article WASHINGTON, Dec. 2 -- Rep. Brett Guthrie, R-Kentucky, chair of the House Energy and Commerce Committee, issued the following news release on Dec. 1, 2025: * * * Chairman Guthrie Celebrates House Passage of Mikaela Naylon Give Kids A Chance Act Today, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, issued a statement following the House passage of H.R. 1262, the Mikaela Naylon Give Kids a Chance Act--a bipartisan piece of legislation which reauthorizes the FDA's Rare Pediatric Disease (RPD) Priority Review Voucher (PRV) Program to incentivize the developmentof treatments for rare pediatric diseases, and authorizes the FDA to direct companies to study a combination of cancer drugs and therapies in pediatric trials.
"H.R. 1262, the Mikaela Naylon Give Kids a Chance Act, builds on current programs to accelerate research and drug development for rare pediatric diseases, including cancer," said Chairman Guthrie. "The reauthorization of the Rare Pediatric Disease Priority Review Voucher Program has led to over 50 new treatment approvals for nearly 40 different rare pediatric diseases, many of which had no options prior. The impact of this program is profound for patients, and I am grateful to the sponsors of this legislation and their commitment to promoting research and addressing gaps in pediatric therapeutics."
Background on H.R. 1262:
* H.R. 1262, the Mikaela Naylon Give Kids a Chance Act, is a comprehensive piece of legislation that increases access to innovative treatments for children by:
* Reauthorizing the FDA Rare Pediatric Disease (RPD) Priority Review Voucher (PRV) Program through Fiscal Year 2029 and clarifies that orphan drug exclusivity applies to the approved indication, rather than the potentially broader designation;
* Providing the Food and Drug Administration (FDA) with additional authority to require pediatric cancer trials for new combinations of drug therapies;
* Authorizing the FDA to take enforcement action against companies that fail to meet pediatric study requirements under the Pediatric Research Equity Act (PREA);
* Directing the FDA to establish an office in an Abraham Accord country to enhance facilitation with the agency; and
* Requiring FDA to disclose to certain generic drug applicants if any ingredients cause a drug to be quantitatively or qualitatively different from the listed drug, speeding up patients access to more affordable medications.
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Original text here: https://energycommerce.house.gov/posts/chairman-guthrie-celebrates-house-passage-of-mikaela-naylon-give-kids-a-chance-act
Big, Beautiful Success Story: Working Families Tax Cuts Spur $500 Bonuses
WASHINGTON, Dec. 2 -- Rep. Jason Smith, R-Missouri, chairman of the House Ways and Means Committee, issued the following news release on Dec. 1, 2025:* * *
Big, Beautiful Success Story: Working Families Tax Cuts Spur $500 Bonuses
A national printing company headquartered in Texas is passing tax savings from the working families tax cuts to workers and their families. Ennis Incorporated recently gave each worker a $500 bonus as a direct result of the new tax relief law. As one employee put it in a news interview, "It was unexpected, but it was very well received."
Under the working families ... Show Full Article WASHINGTON, Dec. 2 -- Rep. Jason Smith, R-Missouri, chairman of the House Ways and Means Committee, issued the following news release on Dec. 1, 2025: * * * Big, Beautiful Success Story: Working Families Tax Cuts Spur $500 Bonuses A national printing company headquartered in Texas is passing tax savings from the working families tax cuts to workers and their families. Ennis Incorporated recently gave each worker a $500 bonus as a direct result of the new tax relief law. As one employee put it in a news interview, "It was unexpected, but it was very well received." Under the working familiestax cuts, the average American family with two children will take home up to an additional $10,900 each year. Provisions like the 20 percent small business deduction as well as permanent 100 percent immediate expensing, immediate expensing for research & development, and the deduction for interest expenses will help American businesses invest more in growth, hiring, and their local communities.
"Workers across the country are already starting to get more money in their pocket thanks to the working families tax cut," said Ways and Means Committee Chairman Jason Smith (MO-08). "Bigger paychecks and bonuses make a real difference for working families who were pummeled by sticker shock at the grocery store and gas pump. Pro-growth tax policies that reward investing, hiring, and manufacturing in the United States will support local small businesses to bring more prosperity and opportunity to main streets across the country."
The company in Texas - along with providing their employees with new bonus checks - also plans to join other American businesses in expanding and investing in their facilities because of the pro-growth tax policies made permanent in the working families tax cut. According to the company's president, the business plans to use tax relief from the working families tax cuts to also purchase more equipment or acquire more printing companies, noting that "...all of the companies that we end up buying would have gone out of business if we hadn't purchased them."
In the wake of the 2017 Trump tax cuts, companies used tax relief to provide bonuses for workers and purchase more productive equipment. The recently enacted working families tax cuts are similarly projected to increase annual real workers' wages by up to $7,200 - providing an average $600 tax cut beyond what families pay today - while protecting or creating up to 7.2 million jobs, including 1.4 million manufacturing jobs.
READ: The Working Families Tax Cuts Put American Workers First (https://waysandmeans.house.gov/theonebigbeautifulbill/fact-sheets/put-american-workers-first/)
READ: The Working Families Tax Cuts Fuel America's Economic Growth (https://waysandmeans.house.gov/theonebigbeautifulbill/fact-sheets/fuels-americas-economic-growth/)
Read more about the working families tax cuts here (https://waysandmeans.house.gov/theonebigbeautifulbill/).
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Original text here: https://waysandmeans.house.gov/2025/12/01/big-beautiful-success-story-working-families-tax-cuts-spur-500-bonuses-in-texas/
Associated General Contractors General Counsel Pilconis Testifies Before Senate Environment & Public Works Committee
WASHINGTON, Dec. 2 -- The Senate Environment and Public Works Committee released the following written testimony by Leah Pilconis, general counsel for the Associated General Contractors of America, from a Nov. 19, 2025, hearing entitled "Future of PFAS Cleanup and Disposal Policy." PFAS stands for per- and polyfluoroalkyl substances.* * *
Chairman Capito, Ranking Member Whitehouse, and members of the Environment and Public Works Committee, thank you for the opportunity to testify before you today. My name is Leah Pilconis, and I serve as General Counsel for the Associated General Contractors ... Show Full Article WASHINGTON, Dec. 2 -- The Senate Environment and Public Works Committee released the following written testimony by Leah Pilconis, general counsel for the Associated General Contractors of America, from a Nov. 19, 2025, hearing entitled "Future of PFAS Cleanup and Disposal Policy." PFAS stands for per- and polyfluoroalkyl substances. * * * Chairman Capito, Ranking Member Whitehouse, and members of the Environment and Public Works Committee, thank you for the opportunity to testify before you today. My name is Leah Pilconis, and I serve as General Counsel for the Associated General Contractorsof America (AGC).
AGC is the leading association in the construction industry, representing more than 28,000 firms.
This includes America's leading general contractors and specialty-contracting firms, many of which are small businesses. Many of the nation's service providers and suppliers are also associated with AGC through a nationwide network of 87 state and local chapters. AGC contractors are both union and open shop and are engaged in the construction of the nation's highways, bridges, tunnels, airports, transit systems, waterworks facilities, waste treatment facilities, levees, locks, dams, multifamily housing projects, commercial buildings, and more.
In my role as general counsel for AGC, I lead the association's legal, regulatory, and risk management work to support contractors across all sectors of the construction industry. I focus on contract administration, environmental and safety compliance, insurance coverage, and the operational risks facing construction firms nationwide. I work closely with AGC's advocacy and legal teams--along with outside counsel--on federal regulatory and judicial matters affecting the industry, including litigation in federal and state courts. I was invited to testify in front of this venerable committee to explain the challenges contractors face under EPA's current approach to per- and polyfluoroalkyl substances (PFAS) regulation.
Contractors are on the front lines of constructing, maintaining, and improving the nation's infrastructure and routinely encounter emerging contaminants and pollutants in the field, including PFAS. The construction industry does not manufacture or intentionally use PFAS, but contractors build and repair projects in every community across the country and can encounter PFAS wherever they work and in some products. Some of the most common occurrences arise during infrastructure work, including the construction of roads, water infrastructure, airports, and projects on or near military facilities.
AGC supports congressional efforts to modernize environmental liability laws. Doing so allows the construction of our nation's infrastructure to continue without unfairly penalizing those who did not cause the PFAS pollution problem. To be clear, AGC is not wading into the debate about the science or safety of PFAS. Our message is straightforward: contractors need reasonable liability protections and a meaningful path to compliance when they encounter PFAS.
In 2024, the EPA designated two types of PFAS as hazardous substances under the Comprehensive Environmental Response, Compensation, and Liability Act (CERLCA). As this Committee knows, liability under CERCLA is strict, retroactive, and joint and several./1
It is triggered regardless of fault or intent. This approach exposes contractors to liability for any interaction with PFAS - even in situations where the work was completed decades ago, and the contractor had no way of knowing what they were dealing with. It's an untenable status quo and one we felt compelled to challenge in court./2
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1 Under CERCLA, cleanup liability is strict, retroactive, and joint and several, which means a contractor can be held responsible for the entire cost of cleanup, even if they did not know about or cause the contamination and even if others contributed more.
2 Chamber of Commerce of the United States of America, et al. v. U.S. Environmental Protection Agency, et al., No. 24-1193 (D.C. Cir. 2024).
* * *
PFAS is creating significant costs now, even without federal cleanup orders under CERCLA. Looking at what is happening on the ground today, AGC members say the uncertainty and potential liabilities associated with PFAS are discouraging bidders, shrinking the pool of qualified contractors, and increasing overall project costs. (See Appendix for AGC member examples.) These increased costs, as explained in more detail throughout this statement, include:
* Increased Trucking and Handling Costs - Hauling away contaminated debris requires more testing and training for drivers and special protocols. This increases costs significantly./3
* Increased Disposal Costs -Some landfills are refusing waste with trace levels of PFAS, forcing contractors to haul waste longer distances to specially designated hazardous waste landfills, which are limited, more expensive, and often further away than traditional landfills. This drives up construction costs and causes delays while contractors stop work, test and store materials, locate alternative disposal sites, and renegotiate with owners for compensation.
* Increased Consulting, Testing, and Insurance Costs - Site investigations, testing, and engaging qualified environmental legal professionals are costly, coupled with diminished insurance coverage.
* Reduced Use of Recycled Construction Materials - The construction industry relies heavily on recycling to reduce costs and environmental impacts. However, with the increased PFAS liability, contractors will be limited in the material (reclaimed aggregate, soil, asphalt) they can recycle. This reduces recycling options and increases reliance on costlier virgin materials.
The EPA's "direct-to-Superfund" designation of PFOA and PFOS as hazardous substances under CERCLA exposes contractors to significant legal and financial risk without providing a clear compliance path for the construction industry. EPA has not set background levels or soil or groundwater thresholds (concentration limits) that would indicate when materials have restricted or unrestricted uses. Nor has EPA issued clear standards for the management or disposal of PFASimpacted soil or water encountered during routine work./4
In this vacuum, project owners are choosing not to test materials for PFAS. As a result, contractors performing excavation, trenching, and dewatering activities are stuck with the risk of unknowingly handling PFAS and face cleanup liability or private-party litigation for contamination they did not create, could not reasonably detect, and have received no federal direction on how to manage. EPA would ask our contractors to ignore the specter of that liability and to trust in EPA's discretion. We cannot do so.
In addition to a lack of guidance, EPA's PFAS rule creates substantial uncertainty in contract negotiations - sometimes pushing contractors to absorb increased transportation, testing, and disposal costs without a contractual avenue for recovery. At the same time, the industry is seeing more insurers carve out PFAS exclusions and limitations from environmental and general liability policies. These policies are either excluding PFAS outright or undergoing heightened levels of underwriting scrutiny, often leading to very tight conditions, high deductibles, and low sublimits for PFAS. Faced with these uncertainties, many contractors are forced to price potential PFAS risks into their bids--driving up the cost of public infrastructure projects and ultimately increasing costs for taxpayers.
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3 CERCLA mandates that the Secretary of Transportation must regulate all listed "hazardous substances" as hazardous materials under federal transportation law; the Hazardous Materials Transportation Act (42 USC Sec.9656). Even though the U.S. Department of Transportation (DOT) has not yet issued PFAS-specific hazardous-materials rules, construction companies hauling away debris containing PFAS will eventually need specialized truck drivers who have a Commercial Driver's License (CDL) and a Hazardous Materials Endorsement on their CDL.
4 EPA's Interim Guidance on the Destruction and Disposal of Perfluoroalkyl and Polyfluoroalkyl Substances and Materials Containing Perfluoroalkyl and Polyfluoroalkyl Substances--2024 states: "It does not establish what concentrations of PFAS in wastes, spent products, or other materials or media would necessitate destruction or disposal.
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All of this uncertainty and the inability to fairly allocate and/or transfer PFAS risk limit competition.
Contractors are increasingly hesitant to bid on PFAS-suspect projects, decreasing the pool of qualified bidders for public and large infrastructure projects (such as airports and military bases) and increasing the cost of such projects.
In EPA's statement from September 17 announcing that PFOA and PFOS will remain classified as hazardous substances under CERCLA, Administrator Lee Zeldin acknowledged that new statutory language from Congress is needed to fully address the Agency's concern with passive receiver liability. AGC of America agrees. We urge Congress to use its authority to establish protections for contractors who incidentally encounter PFAS during construction infrastructure activities.
AGC has consistently advocated for a measured approach to environmental challenges such as PFOA and PFOS. PFAS is commonly referred to as ubiquitous, and as such, its regulation under CERCLA raises equally ubiquitous liability concerns for public and private entities. Given the decades of historic uses of PFAS, as well as current uses, AGC has repeatedly shared concerns that taking the right regulatory approach to the PFAS challenge is critical. Yet EPA has not acknowledged or addressed the significant impact of its CERCLA action on the construction industry. The construction industry is poised to be part of the solution, but the industry cannot play that role effectively unless Congress and the Administration recognize and mitigate the unprecedented liability risks created by this rule./5
My testimony will outline AGC's concerns on PFAS liabilities and issue AGC's Call to Action, which asks the Committee to do the following:
1. Ensure CERCLA liability is not transferred to contractors who do not manufacture or knowingly encounter PFAS.
2. Direct EPA to establish clear PFAS waste disposal/reuse standards to provide the clarity industry needs to manage this waste stream.
3. Reduce risk around cost estimates and schedules due to the discovery of PFAS.
4. Take actions to ensure PFAS enforcement does not drive up the costs of road, bridge, and other infrastructure construction.
A. CERCLA Creates Unique and Disproportionate Liability Risks for Contractors
Strict, retroactive liability under CERCLA means a contractor could be held responsible for PFAS cleanup costs even if the contractor did not know about the contamination. EPA's enforcement discretion/6 does not protect contractors from third-party lawsuits (e.g., cost contribution claims or actions under common law for negligence). For example, if a contractor disposes of construction debris at a landfill, the contractor could still face liability if, decades later, that debris was found to contribute to PFAS contamination. Contractors could even face liability for moving material from one part of the job site to another - a daily occurrence in construction - if they unknowingly spread contamination./7
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5 As discussed in this statement, CERCLA Sec.119 protects contractors from cleanup liability only when they are performing an EPA- or state-directed response action. It does not protect contractors doing ordinary construction work where PFAS is encountered incidentally. 42 U.S.C. Sec. 9619.
6 EPA's current enforcement discretion policy is a policy choice, not a legal exemption. EPA or a future administration may withdraw that discretion. Available online at: https://www.epa.gov/enforcement/pfas-enforcement-discretion-andsettlement-policy-under-cercla.
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Unlike a fixed facility with a known waste stream, a construction firm's work spans hundreds of sites, stretching over decades of operations that may involve moving dirt, dewatering, demolishing older structures, and placing recycled fill materials. The work does not involve just one landfill, offsite property, or active site, but countless numbers of sites--not a singular facility. While testing may be required in the future, environmental site assessments and clean-fill tests have not historically included PFAS, generally leaving contractors with no way to know whether their past projects involved PFAS-impacted materials.
When EPA finalized the hazardous substance designation, it threw the entire construction industry into immeasurable liability for past projects and left them without a means or compliance path to manage PFAS risk on future projects. PFAS has become the "hot potato" of our childhood games with real-world consequences on who gets stuck with the risk and pays the "PFAS premium" on public and private projects. AGC maintains that it should not be the contractor who pays.
Under current law, only those performing EPA- or state-directed cleanups qualify as Response Action Contractors (RACs) under CERCLA Sec.119 and receive liability protection. A construction firm that incidentally disturbs PFAS-contaminated soil during normal work does not. This leaves wellintentioned contractors vulnerable to potential CERCLA liability as "operators" or "arrangers" or "transporters." The protection offered to response action contractors,/8 or those who are retained specifically for hazardous substance clean-up work,/9 does not apply to the overwhelming majority of contractors that encounter PFAS in the ordinary course of their business.
Lastly, contractors face exposure to future CERCLA liability when historic Superfund sites are reopened for PFAS. For example, if a contractor was brought in as a de minimis contributor to a landfill cleanup, that site could be reopened now for PFAS.
Congress can help by clarifying that contractors performing construction are not potentially responsible parties (PRPs) under CERCLA and extending Response Action Contractor (Sec.119)-type liability protections.
B. PFAS Magnifies Contractual Risk and Is Disrupting Insurance Markets
Because EPA has not set background levels or soil or groundwater thresholds (concentration limits) for PFAS--nor provided disposal or management standards for PFAS-impacted materials--there is no clear framework for how construction firms should comply. In the absence of federal direction, many owners are opting not to test, which pushes the liability and financial exposure onto contractors who may unknowingly encounter PFAS during routine excavation or dewatering, for example. The lack of a federal directive and the lack of innocent contractor and passive receiver protections are complicating contract negotiations and disrupting insurance markets.
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7 If PFAS contamination is released, spread, or transported offsite during the work, that contractor could technically meet CERCLA's broad definition of a potentially responsible party (PRP) even though the contractor had no knowledge of the contamination and no ability to prevent encountering it.
8 42 U.S.C. Sec. 9619.
9 42 USC Sec. 9619(e)(2).
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PFAS risk is increasingly being pushed onto contractors through contract language that holds them responsible for managing and disposing of waste. Even with due diligence ahead of bidding for a project, the contractor will likely not have the opportunity (or permission) to test in advance to know whether PFAS is present. This is exacerbated by the fact that PFAS is not identifiable via a sheen like oil or an odor like other types of contamination. Without testing, it is unlikely the contractor will know it is present. This means a contractor can encounter PFAS in water, soil, concrete, or other paving materials on a project without forewarning.
Owners themselves often avoid PFAS discussions, which enables them to shift risks on a project to the contractor. Many contracts assign contractors all "risk" for "unknown" contamination, defined as any contamination not disclosed by the owner or reasonably ascertainable by the contractor's due diligence, often while providing the contractor no schedule or cost relief for managing site contamination. This trend leaves contractors with unbounded liability risks when PFAS is present.
(See Appendix for AGC member examples.)
In order to help its member companies plan for PFAS risk, AGC has released a "questions and considerations" document that looks at potential pitfalls before and after work starts on a project./10
The document by necessity addresses contractual risks, noting key site documentation to consider, siting, testing, and whether the contract states who is responsible for what and any compensation to the contractor for differing site conditions. Other factors a contractor must consider are hazardous materials restrictions and liabilities governed by insurance and indemnity clauses.
Given this environment, AGC urges Congress to require public owners to:
* Retain CERCLA liability (CERCLA Section 107);
* Test for the presence of PFAS prior to project construction;
* Develop cost-sharing mechanisms to compensate for known and unknown contamination; and
* Allow PFAS storage on site or designate disposal facilities that knowingly permit the material.Insurance Coverage Is Collapsing Under PFAS Pressure PFAS-related liability risk cannot simply be transferred through insurance. Many insurers are now imposing PFAS exclusions, restrictions, or heightened underwriting requirements across environmental and general liability policies. AGC members and news sources report:
* PFAS exclusions added to commercial general liability (CGL) and contractor's pollution liability (CPL) policies;
* Coverage denials or nonrenewals for contractors working near PFAS-suspect sites;
* Special PFAS riders, high deductibles, and low sublimits where coverage is offered at all;
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10 AGC of America, General Contractors: Questions and Considerations Related to PFAS, October 2025 (available online at: https://news.agc.org/wp-content/uploads/2025/10/PFAS-Questions-and-Considerations-Final.pdf).
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* Exclusions for "emerging contaminants" now being used to capture PFAS; and
* PFAS exclusions increasingly added at renewal, even if not present in prior years./11
Some larger insurers may continue offering limited PFAS-related coverage, but contractors-- especially small and mid-sized firms--purchase a wide range of policies across the insurance market, and many do not carry all coverage types. Whether past work is covered depends entirely on the historic policy period, and even then, the dollar limits reflect outdated market prices and are inadequate for PFAS cleanup.
This insurance uncertainty mirrors the regulatory uncertainty. Without clear federal guidance on how PFAS must be handled, transported, or disposed of, insurers cannot reliably underwrite the risk, and contractors cannot know whether their normal operations could trigger future liability.
Critical to the solution moving forward is for EPA to expedite the issuance of clear PFAS waste disposal and reuse standards, along with PFAS concentration thresholds that distinguish between restricted and unrestricted reuse. This would provide the certainty to justify testing and to plan for the added costs of managing PFAS-impacted materials.
Congress can help by directing EPA to establish disposal/reuse standards to provide the clarity industry needs to manage this waste stream. This would reduce risk around cost estimates and schedules due to the discovery of PFAS.
But EPA action alone is not enough. As explained above, AGC urges Congress to enact innocent contractor and passive receiver protections and to require public owners to test for PFAS during the project planning stage for federally funded projects. Early testing ensures contaminated sites are identified before bidding, allowing contractors to price the work accurately and avoid unexpected liability going forward.
C. PFAS Liability Is a Direct Threat to Infrastructure Affordability
While contractors are accustomed to handling hazardous materials such as asbestos or lead, those substances come with established standards: clear exposure thresholds, procedures for removal, and designated disposal facilities. None of this exists for PFAS. The absence of EPA standards leaves contractors with no clear path to compliance. As explained above, when PFAS is discovered during excavation, soil movement, or dewatering, contractors face significant risk of unknowingly disturbing contamination and triggering liability.
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11 "Many carriers seek to exclude PFAS exposures ... we are seeing this on both Pollution placements as well as General Liability and Excess placements." https://www.rpsins.com/learn/2025/mar/pfas-forever-chemicals-and-constructionpollution-liability-risks/. "PFAS exclusions continue to be added by more markets, while some exclude PFAS for only certain classes of business." https://rtspecialty.com/wp-content/uploads/2025/02/2025-Market-Update.pdf. "New ISO PFAS exclusion available; many carriers adopting ... environmental policies can be scheduled or sub-limited for PFAS ..." https://inszoneinsurance.com/blog/pfas-exclusions-in-insurance. "A drawback to modern-day CGL policies is that they almost always contain some form of pollution exclusion ... [and] standard forms may not respond to PFAS ..." https://www.pillsburylaw.com/a/web/168966/Insurance-Coverage-for-PFAS-Liability-Lexis-Practical-Guidance-d.pdf.
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This uncertainty is already affecting the marketplace. Some contractors are walking away from highrisk projects, narrowing the bidding pool for public infrastructure work. The risk also leaves few "liability-proof" options for disposal, other than limited hazardous waste facilities. At the same time, PFAS concerns are disrupting recycling markets and beneficial-reuse practices that traditionally reduce project costs.
AGC members report a range of cost and delay impacts, including:
* Delays in negotiating contracts due to liability concerns;
* Long-term liability risk from work on high-risk sites;
* Increased consulting costs;
* Increased sampling fees and wait times;
* Higher landfill and transportation fees;
* Additional compliance and training costs under hazardous materials rules;
* Increased risk for acquiring laydown yards and other temporary property; and
* Loss of beneficial-use markets for soil, aggregate, and reclaimed asphalt pavement (RAP).The High Cost of Disposal One AGC member example shows a potential 5,000% increase in soil management costs when PFAS-suspect materials had to be shipped to specialized hazardous-waste landfills rather than local facilities. Moreover, hazardous waste capacity is insufficient to handle the volumes of soil associated with infrastructure work. Several AGC members report being forced to ship soil hundreds of miles, sometimes across state lines, increasing transportation costs, project delays, fuel consumption, and emissions. (See Appendix for more examples.)The Cost of Materials - Implications for Recycling and Reuse Higher disposal costs are compounded by the loss of recycling and reuse options that help keep infrastructure affordable. Contractors routinely reuse soil, aggregate, and asphalt to manage costs, particularly in low-bid environments. When PFAS uncertainty prevents material from being recycled, contractors must purchase more expensive virgin materials--costs ultimately borne by project owners and taxpayers.
AGC members report that EPA's CERCLA designation already affects the viability of reclaimed asphalt pavement (RAP). RAP sourced from airports, military bases, and certain highways may contain PFAS, eliminating a revenue stream for contractors and raising material costs.
Contractors also face liability when importing soil to a project. Without PFAS soil standards, contractors cannot know whether imported fill is clean or whether today's conditions will meet future regulatory thresholds. Soil sourced from agricultural land where biosolids were applied presents another new liability risk. With increasing concerns over PFAS contamination at very low thresholds, the cost of earthwork goes up. If contractors cannot use the soil onsite or offsite locally due to the potential for spreading contamination, and the landfills will not take the soil, then a licensed facility is the only option. However, there is not enough hazardous landfill space to accommodate large amounts of soil.
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Public Owners Need to Plan for PFAS Costs
The implications for infrastructure projects become clear when you consider that public owners are not prepared to manage PFAS on their projects. A 2024 Iowa State University study on PFAS policies across state Departments of Transportation (DOT) found that only 39% of state DOTs have policies for identifying PFAS; only three states have established procedures for handling PFAS on construction projects; only seven states require special management or disposal protocols; and only four states currently test for PFAS on construction and maintenance projects. The study notes that this lack of standardized testing and disposal guidance increases the likelihood of unexpected PFAS discovery, delays, cost overruns, and liability exposure for contractors./12
D. PFAS Enforcement Discretion, Settlements and Cost Recovery
EPA's current enforcement discretion policy focuses on chemical manufacturers and large industrial users. But like any policy, that discretion is temporary and does not shield contractors from thirdparty cost recovery suits. At the same time, major PFAS manufacturers are entering into large settlement agreements with EPA and states that could take away downstream cost-recovery rights, shifting future liability to contractors.
More specifically, the problem is that EPA's settlement approach may remove the primary sources of PFAS contamination from the legal chain of cost allocation, exposing downstream parties, such as contractors, to retroactive, joint, and several liability./13
Broad settlement language can bar contribution claims industry-wide, even for sites beyond those captured by the settlement. PFAS regulation is about pathways, and EPA's approach would foreclose future enforcement against what EPA concedes is the primary path to exposure.
As a result, contractors could face disproportionate cleanup costs for PFAS contamination tied to legacy products and historic uses, with no clear mechanism to recover those costs. This outcome undermines CERCLA's "polluter pays" principle and discourages investment in infrastructure development, including redevelopment and public-works projects.
One approach Congress could take to protect innocent contractors is to expand the use of de micromis and de minimis settlements./14
Unfortunately, this exemption is available only for work done on National Priority List sites prior to April 2001 and is subject to Presidential approval that cannot be challenged in court./15
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12 J. Charbonnet and R. Sturgill, Jr., Iowa State University, Practices to Identify and Mitigate PFAS Impacts on Highway Construction Projects and Maintenance Operations, National Cooperative Highway Research Program, 2024. Available online at the National Academies Press: https://nap.nationalacademies.org/read/27843/chapter/5.
13 42 U.S.C. Sec. 9613 makes clear that "A person who has resolved its liability to the United States or a state in an administrative or judicially approved settlement shall not be liable for claims for contribution regarding matters addressed in the settlement. Such settlement does not discharge any of the other potentially liable persons unless its terms so provide."
14 CERCLA provides an exemption for non-owners/operators whose actions caused a relatively small amount of exposure and did not contribute towards response costs in a meaningful way. See 42 U.S.C. Sec. 107(o).
15 Id.
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If Congress and EPA are serious about protecting passive receivers and innocent contractors, you should consider expanding this exemption to work done at any site, during any year, and allowing judicial review of any Presidential veto.
The other lever EPA might pull to protect contractors is the expansion of de minimis settlements under CERCLA 122(g). Under this provision, EPA can settle with parties who don't qualify for the de micromis exemption but, for case specific reasons, still warrant a settlement./16
For example, situations where a party's contribution is still a minute percentage of the total waste volume sent to the site, despite exceeding the thresholds in 107(o).
This provision could be used to protect contractors, but certainly there is no guarantee of protection. And like the de micromis exemption, this provision is subject to ambiguous Presidential determinations that can often cut either way. To allow contractors to rely on de minimis settlements, Congress should establish, or direct EPA to establish, an objective standard for determining whether a contribution is "minimal in comparison to other hazardous substances at the facility."/17
Congress can take actions to ensure PFAS enforcement does not negatively impact critical infrastructure construction, such as:
* Requiring EPA to narrowly define "matters addressed" in PFAS settlements so they resolve only specific site liabilities and do not eliminate the ability of downstream parties to recover PFAS cleanup costs from manufacturers or other responsible parties.
* Clarifying that non-manufacturing PRPs retain cost-recovery rights under CERCLA Sec.107(a) when they incur PFAS cleanup costs unrelated to manufacturing or intentional use.
* Expanding use of the de micromis exemption and de minimis settlements.
E. Conclusion
PFAS presents a real environmental challenge--but without clear statutory and regulatory guardrails, the current CERCLA framework exposes contractors to unlimited, retroactive liability, which is increasingly becoming uninsurable, for contamination they did not create and cannot reasonably detect. This is already driving up bid prices, reducing competition, slowing federal projects, and ultimately increasing costs for taxpayers.
AGC respectfully urges Congress to act. Addressing PFAS must not unintentionally undermine the very infrastructure programs Congress has invested in so heavily. Contractors want to be part of the solution, but they cannot take on open-ended liability for historic PFAS pollution.
We look forward to working with the Committee to modernize CERCLA, establish clear standards for PFAS disposal and reuse, protect innocent contractors and passive receivers, and ensure that PFAS enforcement does not jeopardize the delivery of critical infrastructure.
Thank you for the opportunity to testify. I welcome your questions.
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16 42 U.S.C. Sec. 9622(g).
17 In the past, the Department of Justice used .002% of total volume as a threshold for enforcement. Congress should direct EPA to conduct a rulemaking to develop a legally sufficient standard. That figure was found at the bottom of page three of DOJ's November 2002 CERCLA policy memo.
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APPENDIX
AGC Member Examples - Increased Contract Risk
An example shared by an AGC member relates to another chemical yet demonstrates the problem of risk shifting. On a public project, the owner told the contractor that the soil was not contaminated and was safe for disposal. The contractor tested, and the levels of the chemical in question required remediation. The contractor pursued a change order because of the change in conditions. However, the public owner resisted taking on the additional costs, leading to a delay in the project of over 500 days. As the PFAS issue develops, some states may require testing on sites where there was a known use or manufacturing of PFAS containing materials. These types of requirements will vary by state, and members have shared an overall resistance on the part of project owners to test.
One member mentioned experience with sending waste to qualified landfills that later went out of business - three different times with three different landfills. They had done due diligence to check or verify the landfills' qualifications in advance. Each of the landfills wound up requiring remediation. The member was brought into negotiations as a de minimus contributor on each - paying into the settlement agreements. In each case, insurance did not provide coverage. There is a concern that PFAS will exacerbate existing risks associated with landfill cleanups.
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AGC Member Examples - Increased Disposal and Transport Costs
Contractors are already seeing specific instances where the potential for PFAS has increased costs and transport times. For example:
* In California, an AGC member was turned away from a landfill that previously accepted Department of Defense (DoD) waste, as the landfill now refuses to accept waste from DoD facilities due to the risk of PFAS. This forced the AGC member to pay significantly more to haul the waste to other facilities, with some being located out of state. This member anticipates that, as a direct result of this rule, disposal options for the soil and effluent waste from the above-referenced projects will be limited to hazardous landfill.
* On another project in California, a member company that is dealing with the export of 10,000 to 20,000 yards of soil waste believes that under this same scenario, their disposal costs increased from $40 per yard to $200-$300 per yard.
* In New England, an AGC member was turned away from disposing of materials in landfills multiple times due to trace amounts of PFOA and PFOS. Depending on the project location, disposal options will be very limited, meaning soil may need to be hauled 100 miles or more.
* A study in New England found that trace amounts of PFOA and POFS exist in areas well removed from any development, making removal and disposal more difficult due to the wide range of potentially impacted sites. A member company has shared that disposal costs per ton in Massachusetts were between $15 and $60, not including shipping, for landfilling or a soil reclamation facility. For a hazardous waste landfill, tipping costs increase to $300-$400, not including shipping.
* In Texas, a member company shared their estimate from a jobsite to the nearest disposal option as compared to the nearest hazardous waste landfill. The round-trip miles for the local disposal site were 20 miles, multiplied by 750 loads of soil. For a hazardous landfill, the round-trip was 800 miles. Even if just a small fraction of the 750 loads of soil needed to be transported to the hazardous landfill, the cost of transport, including fuel, would quickly add up. This example does not consider the increased disposal fees and tipping fees when switching to a hazardous waste landfill, which, as we see from the examples above, can be steep.
Other AGC members have reported experiences with demolishing, restoring, and constructing airport hangars equipped with Aqueous Film Forming Foam (AFFF) fire suppression systems, which are known to have PFAS. Many existing hangars, built in the past 70 years, have "charged" systems that require testing (the AFFF is discharged through devices such as sprinklers, nozzles, hoses, and chambers), cleaning, dismantling, and disposal. When demolishing or renovating an existing hangar, the contractor must address the existing AFFF system (drain the system before work and test/charge the new fire suppression system components) as well as the surrounding areas.
In general, the construction process requires demolishing asphalt/concrete pavement, digging soil out two to ten feet below the surface, and disposing of the asphalt/concrete and soil waste in a landfill.
Numerous AGC members also report that the PFAS rule has led to increased consulting, transportation, and disposal costs for contractors handling PFOA- and PFOS-containing hazardous substances. A member shared an example of how the presence of these chemicals in pooled stormwater on a normal project turned an otherwise simple cleanup of a minor spill of hydraulic fluids into a lengthy remediation process, adding at least $88,300 in disposal and consultant fees to the price tag.
In another instance, landfill costs for an AGC member increased tenfold, causing months-long project delays and adding to operational expenses.
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AGC Member Examples - Bidding Impacts and Walking Away from Projects
Due to the increased liability related to PFAS, AGC members have experienced delays and/or declines in business and/or an increase in operating expenses. To comply with the rule and avoid liability, AGC members now face delays in contract negotiations for airport and federal DoD work to assess potential contamination risks, sometimes resulting in a decision not to bid on projects due to liability concerns. In the Northeastern United States, a wetland remediation project downstream from a firefighting academy is removing contaminated soil at a cost to taxpayers.
This is not limited to projects with a history of AFFF use onsite. Other AGC members are seeing similar situations arise throughout the country. For example:
* In the Western United States, one AGC member company was interested in pursuing a 99-year lease project to develop and construct on county-owned property. When the member company undertook due diligence on the subject property, they discovered a record of PFAS contamination at relatively high levels and believed that the site could have had groundwater discharge into a nearby body of water. The project owner indicated that the developer and contractor would be responsible for the handling and disposing of PFAS impacted materials, and after asking about ongoing obligations associated with this PFAS impact, the owner did not have enough information to respond, causing the member company to believe they would be held responsible for the cleanup of PFAS both on the property and potentially off property if the release had spread. The member company ended its pursuit of this project. No other construction companies or contractors responded to the owner's RFP. And despite the owner issuing a new one in the intervening months, intended to clarify uncertainty around RFP, no companies have responded to the updated guidance.
* In the Southwestern United States, a separate AGC member declined to bid on a project to conduct maintenance work downstream of an airport due to a documented spill of PFAS materials six months prior. While the contractor asked about the spill and PFAS testing during the project bid process, the project owner indicated that the spill did not contain known PFAS, and they did not conduct any testing, putting the soil disposal risk directly onto the contractor.
In addition to the above examples, contractors and AGC members are also voicing concerns about conducting PFAS-related cleanup projects within waterworks systems. AGC members often replace contaminated pipes and will install water filtration systems to remove PFAS from water systems.
Liability concerns are starting to be voiced among contractors doing this type of work, leading to some questions about whether some contractors will continue to bid on this type of work.
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The Associated General Contractors of America (AGC) is the leading association in the construction industry, representing more than 28,000 firms, including America's leading general contractors and specialty-contracting firms. Many of the nation's service providers and suppliers are associated with AGC through a nationwide network of chapters. AGC contractors are engaged in the construction of the nation's commercial buildings, shopping centers, factories, warehouses, highways, bridges, tunnels, airports, waterworks facilities, waste treatment facilities, levees, locks, dams, water conservation projects, defense facilities, multi-family housing projects, and more.
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Original text here: https://www.epw.senate.gov/public/_cache/files/b/2/b2821d31-175f-4c08-81cd-faadd9cf5d2e/0D4DED018780A80BDB8CE656099EA3088C399CEE9C2D3D1611D31CF59178FCC5.11-19-2025-pilconis-testimony.pdf
American Action Forum President Holtz-Eakin Testifies Before Senate Finance Committee
WASHINGTON, Dec. 2 -- The Senate Finance Committee released the following testimony by American Action Forum President Douglas Holtz-Eakin from a Nov. 19, 2025, hearing entitled "The Rising Cost of Health Care: Considering Meaningful Solutions for All Americans":* * *
Chairman Crapo, Ranking Member Wyden and members of the committee, thank you for the privilege of appearing today. In what follows, I wish to make to make three main points:
* The Affordable Care Act was, and remains, a flawed policy that affects health insurance, the labor market, and economic growth;
* In the immediate term, ... Show Full Article WASHINGTON, Dec. 2 -- The Senate Finance Committee released the following testimony by American Action Forum President Douglas Holtz-Eakin from a Nov. 19, 2025, hearing entitled "The Rising Cost of Health Care: Considering Meaningful Solutions for All Americans": * * * Chairman Crapo, Ranking Member Wyden and members of the committee, thank you for the privilege of appearing today. In what follows, I wish to make to make three main points: * The Affordable Care Act was, and remains, a flawed policy that affects health insurance, the labor market, and economic growth; * In the immediate term,there are limited options to rework the premium tax credits, although these improvements would be a welcome change; and
* Over the longer term, broad reforms will be needed to achieve the goals of highervalue care and affordable insurance.
Let me discuss each in turn.
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Problems With the Affordable Care Act
The Patient Protection and Affordable Care Act (Affordable Care Act or ACA) has been a problematic policy program since its inception. Even at the time it was debated, the primary policy challenge facing the United States was the unsustainable growth of federal debt - the source of which was, and remains, spending commitments that rise above any reasonable metric of taxation for the indefinite future.
The fiscal future outlined at the time of the ACA's enactment was a direct impediment to job creation and growth. The best way to eliminate deficits is to keep taxes low and reduce public-employee costs and transfer payments. But the ACA moved in precisely the wrong direction. It contained trillions of dollars of new transfer spending, combined with hundreds of billions of dollars in new taxes. It was the wrong economic policy at a pivotal moment.
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Employer Mandate and Tax Impacts on Jobs and Growth
A goal of U.S. economic policy should be to maximize the pace of economic growth. More rapid growth is essential to the labor market futures of the millions of Americans without work. It will generate the resources needed to meet our obligation to provide a standard of living for the next generation that exceeds the one this generation inherited.
Yet key provisions of the ACA - mandate costs, administrative burdens, and new taxes - remain inconsistent with strong, pro-growth policies. Among the key aspects of the ACA is its mandate to cover employees with health insurance. Larger employers, those with more than 50 workers, are faced with employer shared responsibility provisions - so-called "pay or play" - which, beginning in 2014, required them to pay a penalty if any of their full-time workers receive subsidies for coverage through the ACA exchange. The penalty for 2025 is equal to the lesser of $4,350 for each full-time worker receiving a premium credit, or $2,900 for each full-time worker, excluding the first 30 full-time workers. The fees are calculated on a monthly basis. Firms with fewer than 50 employees are exempt from the "play or pay" penalties if they do not offer coverage and their workers receive a subsidy to purchase insurance on the exchange.
As employers sought to avoid penalties, the plans they offered became more generous and more expensive. From the perspective of economic performance, the best-case scenario was that the firm was already offering adequate insurance coverage, with no employee receiving subsidies and triggering penalties, and thus costs were unaffected. In every other instance, renegotiating health insurance coverage created competition with hiring and growth for the scarce resources of those firms.
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Tax Increases
The ACA, as passed, was projected to raise more than $700 billion in tax revenue from an excise tax on high-premium plans; reinsurance and risk adjustment collections; penalty payments by employers and uninsured individuals; fees on medical device manufacturers, pharmaceutical companies, and health insurance providers; and other revenue provisions.
Many of these taxes have not survived to the present, however - evidence of their poor design and interference with the economy.
There are two Medicare taxes in the ACA. Section 9015 increased the Medicare hospital insurance (HI) tax by 0.9-percentage points on wages in excess of $200,000 ($250,000 for couples filing jointly, $125,000 for married individuals filing separately). The tax also applies to self-employed earnings.
Sec. 1402 of the Health Care and Education Reconciliation Act of 2010 (HCERA) - the follow-on law that made technical corrections to the ACA (among other things) - imposed a 3.8-percent Medicare contribution tax on individuals, estates, or trusts of the lesser of net investment income or the excess of modified adjusted gross income over the threshold amount. The threshold amount is $250,000 for joint returns, $125,000 for married filing separately, or $200,000 for any other case.
The first point to note is that these taxes have nothing to do with Medicare finance. While gross inflows may be credited to the HI trust fund, these dollars financed the expansion of the new insurance subsidy entitlement program - the premium tax credits. The second is that these taxes fell predominately on business income and distorted the decisions of these pass-thru entities.
A final tax impact of the ACA is that the impact of the professed refundable credits may have even more perverse growth consequences. As noted in Brill and Holtz-Eakin, the phase-outs in insurance subsidies contribute to high effective marginal tax rates. The effect is to raise to as high as 41 percent the effective marginal tax rate on some lower-income U.S. workers. As evidenced by the discussion that we are having today, there was little to no intention of letting these end. Of the 24.3 million Americans that selected an ACA plan in 2025, 22.4 million qualify for premium tax credits. Thus, the impending effective tax rate has made it necessary to reform them to avoid a tax increase on those purchasing ACA plans.
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ACA and Health Insurance Premiums
Health care reform was presumed to encompass both expansion of affordable insurance options and provision of quality medical care at lower costs. The reality of the ACA could not be more different. The law has raised - and continues to raise- national health care spending. The rising bill for national health care spending has, in turn produced sustained upward pressures on health insurance premiums.
These features of the law are increasingly well understood, much to the dismay of insurance consumers. In short, all insurers - for profit and non-profit alike - will seek to restructure as necessary in an attempt to ensure profitability, with the main opportunity lying in the area of labor compensation costs. To the extent possible, firms will either reduce compensation growth, squeeze labor expansion plans (or even lay off workers), or both. There are, however, sharp limits on the ability of companies to shift the effective burden of excise taxes onto either shareholders (capital) or employees (labor). Moreover, their ability to do so diminishes over time as capital and labor seek out better market opportunities.
The only other place to shift the tax cost is to customers - i.e., families and small businesses.
First, if an aggregate fee on the industry were recognized as any sort of tax that carried incentives to shift some of the burden via lower dividends, capital gains, and wages, then the aggregate fee will overstate the net budget receipts and underestimate net budget costs.
The second implication is that the remainder of such a tax is passed on to consumers. If market conditions make it impossible for insurers to absorb the economic burden of any tax (explicit or implicit), they will have no choice but to build the new, higher costs into the pricing structure of policies. In this way, the economic burden of the tax is shifted to the purchasers of health insurance. In particular, the more competitive markets are for equity capital and hired labor, the greater the fraction of the burden that will be borne by consumers.
The implications for purchasers of health insurance are obvious and unambiguously negative. In addition, as employers pay more for health insurance, they will have to shave back cash wage increases and taxable compensation. The health insurance fee will likely quickly and almost completely be incorporated, resulting in higher insurance premiums.
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ACA and Employer-sponsored Insurance
The basic design of the ACA is an impediment to employer coverage. At the time of passage, about 163 million workers and their families received health insurance coverage from their employers. As of 2023, that number was estimated to be 178 million covered lives.
Proponents of the ACA insisted that one of its key tenets was to build on the system of employer-sponsored insurance (ESI) coverage. The ACA failed to achieve this purported aim; instead, it continued to provide market-distorting support to marketplace plans.
In the ACA's first 10 years, roughly one-half its $900 billion in spending was devoted to subsidies for individuals who did not receive health insurance from their employers. These subsidies were remarkably generous, even for those with relatively high incomes. For example, in 2014 a family earning about $59,000 a year would receive a premium subsidy of about $7,200; a family making $71,000 would receive about $5,200; and even a family earning about $95,000 would receive a subsidy of almost $3,000.
By 2018, subsidy amounts and the income levels to qualify for those subsidies grew substantially: a family earning about $64,000 would receive a subsidy of over $10,000; a family earning $77,000 would receive a subsidy of $7,800; and a family earning $102,000 would receive a subsidy of almost $5,000.
The total federal spending on these subsidies has risen drastically. In 2014, the gross cost of these subsidies was $18 billion. In 2025, these costs are estimated to reach $138 billion. If these subsidies continue to be provided at the same rate, modeling estimates that next year's subsidies could total over $150 billion.
An obvious question is how employers have reacted to the continued presence of an alternative, highly subsidized source of insurance for their workers. Although the number covered through ESI has trended upwards since 2014, the ongoing reorientation of the labor market (through trade disruptions, artificial intelligence, etc.) may result in employers determining that they are better off reducing costs by dropping coverage for their employees. The simplest calculation focuses on the tradeoff between employer savings and the $2,900 penalty (per employee) imposed by the ACA on employers whose employees move to subsidized exchange coverage. Consider a policy with the average premium ($9,325) in 2025. The average covered worker contributes 16 percent of the premium and the employer bears the other 84 percent or $7,833. A simple comparison of $7,833 in savings versus a $2,900 penalty would seemingly suggest large-scale incentives to drop insurance.
The economics of the compensation decision are more nuanced than this simple calculation, however. Health insurance is only one portion of the overall compensation package that employees receive as a result of competitive pressures. Evidence suggests that if one portion of that package is reduced or eliminated - health insurance - another aspect - wages - will ultimately be increased as a competitive necessity to retain and attract valuable labor. Thus, the key question is whether the employer can keep the employee "happy" - appropriately compensated and insured - and save money.
As Table 1 outlines, the answer at the time was frequently "yes" - thanks to the generosity of federal subsidies. To see the logic, consider the first row of the table, which shows the implications for a worker at 133 percent of the federal poverty level (FPL) or $31,521 in 2014. I projected that this worker will be in the 15 percent federal tax bracket, which means that $100 of wages (which yields $85) is needed to offset the loss of $85 of employer-provided health insurance (which is untaxed). Consider now a health insurance policy worth $15,921, of which the employer picks up 75 percent of the cost. The employer's contribution to health insurance of $11,941 is the equivalent of a wage increase of $14,048 to the worker.
Did the economics of ACA ever suggest that employers could drop their insurance offer?
Yes. The employee would receive $14, 176 in subsidies - more than the value of the lost health insurance. On paper, they could take a pay cut and be better off. Clearly, the employer comes out way ahead - $11,941 less the penalty. Obviously, there is room for the employer to improve the worker's life by having a small pay raise and the same insurance and still save money. This is a powerful, mutual incentive to eliminate employer-sponsored insurance.
The remaining rows of Table 1 repeat this calculation for workers at ascending levels of affluence. For example, at 200 percent of the FPL, the "surplus" between the pay raise required to hold a worker harmless ($4,936) and the firm's cash-flow benefit from dropping coverage ($9,941) has narrowed, but the bottom-line decision in the final column is the same. Indeed, the incentives are quite powerful, up to 250 percent of FPL, or $59,250.
Only for higher-income workers do the advantages of untaxed health insurance make it infeasible to drop insurance and re-work the compensation package.
At the time of passage, there was legitimate concern over the loss of ESI. There were 123 million Americans under 250 percent of the FPL. Roughly 60 percent of Americans worked and about 60 percent of those received employer-sponsored insurance. That math suggested that there were about 43 million workers for whom it made sense to drop insurance.
As fate would have it, the failure of healthcare.gov and the botched rollout of the ACA put a stigma on switching to the ACA and reduced the projected immediate dropping of insurance. The incentives reflected in the table have remained embedded in the ACA, and since its inception have been a headwind to the growth of ESI.
This is a real issue, as ESI not only provides health insurance, it also promotes work. As a general matter, policies should support work and the ACA is in contradiction to this objective.
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Table 1: Health Care Reform and Employer-sponsored Insurance in 2014 (Employer Health Plan = $11,941)
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Potential Reforms to the ACA Premium Tax Credits
In the near term, options are quite limited. Given that policy design, premium decisions, and policy selection are already underway, there is little that Congress can do for plan year 2026. The first possibility is simply to send funds to each ACA beneficiary to offset an appropriate part of the cost of premiums and cost-sharing. This has a number of drawbacks, with the obvious being that there is no way to ensure taxpayer funds are used for health purposes. Much like the stimulus checks sent throughout the pandemic, the sharp increase in money supply could result in a surge of inflation through consumers' increased spending power.
A second possibility is to provide the additional subsidy in the form of cost-sharing reductions (CSRs) in the ACA. This has precedent, but has the drawback that it cannot be provided to those ACA purchasers that elected zero-dollar premium Silver plans, since there is no cost to share.
A third possibility is to deliver the subsidy as a contribution to the Health Savings Accounts (HSAs) of those beneficiaries that have HSA-eligible policies. Since not all policies are eligible for HSAs, this is very narrowly targeted and would not help the majority of ACA policyholders.
Of course, the possibilities are not mutually exclusive and could be combined to achieve the desired level and mix of subsidies.
In plan year 2027 and beyond, reforms can both target subsidies and affect the purchase decisions of beneficiaries and pricing by insurers. Broadly, the subsidies may be channeled through CSRs, HSAs, Flexible Spending Accounts (FSAs), and enhanced medical deductions to achieve financial relief and policy objectives. (See Addendum 1 for a brief summary of health-related, tax-preferred accounts.)
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Comprehensive Reforms in the Long term
Over the longer term, it is imperative that federal health policy supports higher-value care - better outcomes at reasonable cost - and affordable insurance.
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Principles for Comprehensive Health Care Reforms.
In my experience, health policy is too often divorced from the principles that broadly guide economic policy making. This is a mistake.
Principle 1: The delivery of health care is an economic activity; health care policy should be good economic policy. It should be built on a small, contained government; light touch regulation; low and efficient taxation; and stable, predictable policies.
Principle 2: High prices are a supply problem and cannot be solved by more government subsidies to demand. As it relates to the topic of this hearing, the enhanced ACA subsidies are a classic case of making a high-price problem worse by subsidizing demand.
Principle 3: Reforms should focus on outputs - quality outcomes and high-value - and permit the health sector to flexibly pursue these goals. The basic ingredients will be capitated payments (a preset payment per patient) and a rigorous quality metric. Failure to hit the metric should mean loss of the payment.
Fixing Federal Insurance Subsidies. (This section draws on my contribution to the Grand Bargain project.) Taxpayers subsidize nearly every health insurance policy in the United States. For example, Medicare, Medicaid, and the ACA receive direct subsidies and ESI is exempt from taxation. (See the Congressional Budget Office.) Excessive subsidies incentivize the overuse of health care. The level and distribution of subsidies across types of insurance and households is an arbitrary accident of history, leading to unfairness and inefficiency. A goal for reform would be to rationalize subsidies to make the insurance system more efficient and less unfair.
Employer-sponsored insurance is subsidized by non-taxation of this form of employee compensation. The subsidy is open-ended and regressive, getting larger with the employee's income tax rate. ACA individual-market policies - the subject of this hearing - are subsidized in a progressive fashion. These subsidies compete with ESI subsidies for many of the same individuals in an inefficient and unfair manner. Medicaid is a sharply progressive subsidy but varies across states and is available only to those of very limited means.
The existence of this array of subsidies supports the notion that Americans have decided that health insurance should be subsidized. To the extent possible, the existing system of subsidies should be reformed to deliver the same federal subsidy to a family of a certain size and income, regardless of the source of their insurance. For example, the ESI subsidy could be changed from an exclusion to a tax credit, and the credit amounts set to reflect the same schedule as in the ACA individual markets. Similarly, one could choose a level (e.g., 133 percent of the federal poverty level) below which insurance is entirely subsidized - whether it be Medicaid or any other source.
A side benefit of this process is that it would generate a debate that would force a consensus decision on the "right" level of subsidy from an overall budget perspective and health policy objective. For example, at present the standard, non-enhanced ACA subsidies phase out at 400 percent of the federal poverty level. Matching this policy in the employer setting immediately raises the question of how large the subsidy should be and how broad the population of recipients is.
Providing Incentives for High-Value Care. The most pressing policy problem facing the federal government is the unsustainable fiscal trajectory. Medicare is a central feature of this outlook, and delivers low-value care in the process. A goal of reform is to place an overall budget constraint on Medicare, improve incentives to control costs, and provide a subsidy to Medicare coverage consistent with the discussion above. When combined with appropriate quality metrics, the outcome will be higher-value Medicare practices. Since Medicare practice patterns contribute significantly to the patterns of care delivery in the United States, this will contribute to a more efficient delivery system overall.
The starting point is to put Medicare on a budget. The current system was never designed to be financially self-sufficient, with Parts B, C, and D having an open-ended draw on the Treasury. This is bad budgeting (or non-budgeting); it also creates bad health policy incentives. Only when there are finite resources will stakeholders have a common interest in providing a quality outcome with the resources available. The central concept is a riskadjusted, capitated subsidy for care. Under this strategy, each senior will receive a fixed subsidy, which will be larger for those who have greater health and/or financial needs.
Medicare Advantage (MA) is the best vehicle for the transition, as more than 50 percent of beneficiaries are now in MA and the evidence is that future retirees will prefer it as well. It is geographically diverse, with care tailored to meet the local population's health characteristics. There is significant health plan competition in most areas, so plans that do not provide high quality care can be permitted to - and should - fail.
There will have to be extensive improvement in measuring the quality of MA plans. Plans should be rated on the quality of beneficiary outcomes and not what services are provided or the location of delivery. This can be a flexible vehicle for delivering increasing elder care as well as acute health care.
At the same time, fee-for-service traditional Medicare should be relegated to history. It is widely recognized as having incentivized excessive medical consumption, contains no attempt to verify the quality of care, and suffers from a lack of coordinated care delivery.
I look forward to your questions.
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Addendum 1
GLOSSARY OF SELECT TAX-ADVANTAGED HEALTH ACCOUNT TERMS
Cost-Sharing Reductions (CSRs)
Cost-sharing reductions are extra subsidies that lower out-of-pocket costs (like deductibles, copayments, and coinsurance) for certain people who buy health insurance through the Affordable Care Act (ACA) marketplaces.
* Only available on Silver-level marketplace plans.
* Eligibility is based on income, generally for lower- to moderate-income enrollees.
* Instead of lowering monthly premiums, CSRs make it cheaper to use care--such as doctor visits, prescriptions, and hospital services.
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Health Savings Accounts (HSAs)
A Health Savings Account (HSA) is a tax-advantaged savings account used to pay for qualified medical expenses.
* A person must be enrolled in a High-Deductible Health Plan (HDHP) to contribute.
* Contributions are tax-deductible, growth is tax-free, and withdrawals for qualified medical expenses are tax-free (a "triple tax advantage").
* Funds roll over from year to year - unused money is not lost at the end of the year.
* After a certain age, HSA funds can be used more flexibly, similar to retirement funds, subject to specific tax rules.
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Flexible Spending Accounts (FSAs)
A Flexible Spending Account (FSA) is an employer-based account that lets a person set aside pre-tax money to pay for eligible out-of-pocket health care expenses.
* Contributions reduce a person's taxable income.
* Commonly used for copayments, deductibles, prescriptions, and other eligible health expenses.
* Most FSAs are "use it or lose it" within the plan year, though some plans allow a small carryover or a brief grace period.
* FSAs are generally tied to a specific employer and usually cannot be taken with an individual if they leave the job.
* Unlike HSAs, an individual typically does not need a high-deductible health plan to participate.
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Enhanced Medical Deductions
"Enhanced medical deductions" is a general term that describes policy changes making it easier or more generous for taxpayers to deduct medical expenses on their income taxes.
* May involve lowering the threshold at which medical expenses become deductible (for example, allowing deductions above a smaller percentage of adjusted gross income).
* Can expand the list of expenses that qualify as deductible medical costs.
* Often refers to temporary or targeted expansions, such as for older adults, people with disabilities, or during a public health emergency.
* Overall, these policies increase the likelihood that taxpayers can reduce their tax burden based on health care spending.
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Health Reimbursement Accounts (HRAs)
A Health Reimbursement Account or Arrangement (HRA) is an employer-funded benefit that reimburses employees for certain medical expenses on a tax-free basis.
* Only the employer contributes; employees do not fund the account themselves.
* Employers may define which expenses are eligible for reimbursement within IRS rules (for example, deductibles, copayments, or premiums in some designs).
* Reimbursements are generally tax-free to the employee.
* Whether unused funds roll over from year to year depends on the employer's specific plan design.
* HRAs are often paired with a group health plan but can also be structured to reimburse individual coverage under specific federal rules.
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Medicare Medical Savings Accounts (MSAs)
A Medicare Medical Savings Account (MSA) is a type of Medicare Advantage plan that combines a high-deductible health plan with a medical savings account funded by Medicare.
* The plan includes a high deductible that must be met before most covered services are paid by the plan.
* Each year, Medicare deposits a set amount of money into a special MSA account in the beneficiary's name.
* Funds can be used tax-free for qualified medical expenses, including those incurred before meeting the deductible.
* Beneficiaries generally cannot contribute their own money to a Medicare MSA; only Medicare makes deposits.
* These plans are relatively niche and have limited availability; a person must enroll in a Medicare MSA plan to have an associated account.
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Original text here: https://www.finance.senate.gov/imo/media/doc/11192025_holtz_eakin_testimony.pdf
