HR-10640-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Maxine Waters (D-CA)
What it does
This bill would appropriate $10 billion for each of fiscal years 2027 through 2031 for CMS to give allotments to states, DC, and territories that apply and are approved. States would have to use the money for at least 3 listed activities, such as technology for chronic disease care, payments to providers, clinician recruitment, behavioral health access, and "right-sizing" urban health systems. Half of each year's money would be split equally among approved states, and the other half would be set by CMS using urban population and facility factors, with at least one quarter of states receiving a share. States could not use the money as their share of Medicaid or CHIP costs, no state match would be required, no more than 10% could go to administration, and unused funds would return to the Treasury by October 1, 2033 (CMS would redistribute some unspent funds before then). It would also appropriate $200 million for CMS implementation costs, and CMS may withhold or recover money from states that misuse it.
Who benefits
Safety-net and urban hospitals, community health centers, behavioral health clinics, and opioid and substance use treatment programs that could receive state-distributed funds. Low-income, uninsured, and Medicaid patients in large metro areas (1 million or more people) who rely on those facilities. State governments, which would receive money with no matching requirement. Health care workers who might receive recruitment or training support, and health technology vendors that could supply software, hardware, or remote monitoring tools.
Who is hurt
Federal taxpayers, because the bill would add up to $50 billion in spending plus $200 million for implementation, with no offsets stated in the text. Rural and smaller-city communities and facilities, since funds target metro areas of 1 million or more, though every approved state gets an equal share of half the money. Hospitals in states that do not apply or are not approved. Providers that might be consolidated or reduced under "right-sizing" plans, and the communities that rely on them. States with limited administrative capacity, which must meet application, reporting, and certification requirements.
Supporters argue
Supporters argue that stand-alone urban safety-net hospitals serve large numbers of low-income, uninsured, and Medicaid patients and face rising risk of closure, conversion, or service cuts, which the bill's application requirements ask states to identify and address. They contend that flexible, no-match funding tied to prevention, technology, workforce, and behavioral health activities, with annual reporting and clawback authority for misuse, targets stability where need is concentrated. They also point to the equal-share half of the formula as ensuring every approved state participates.
Opponents argue
Opponents argue that $50 billion in new direct appropriations with no offsets adds to federal deficits, and that the bill gives CMS broad discretion over allotment factors, permitted uses, and terms, with little statutory guidance. They contend the urban-only focus leaves out rural and smaller-city hospitals with similar financial strain, and that half the money is split equally regardless of need. They also argue that "right-sizing" and short-term grants may not fix underlying payment problems and could leave facilities reliant on funding that ends after 2031.
Constitutional context
The bill rests on Congress's Spending Clause power (Art. I, §8, cl. 1) and its appropriations power. Conditions on state funds are limited by South Dakota v. Dole (1987) and the coercion limit in NFIB v. Sebelius (2012), though this program is voluntary, new money with no match, so coercion concerns appear modest.
Checks and balances
Congress sets the funding and the broad purposes, while CMS gains substantial discretion over allotments, terms, and approvals; checks include annual reporting, clawback authority, congressional oversight, and judicial review of agency actions.
Historical precedent
The Rural Health Transformation Program, enacted in 2025, similarly provided $10 billion per year for five years in state allotments for rural health care, and this bill closely parallels its structure for urban areas.