HR-3498-118
ASSUMING FIRST SPONSORSHIP - Mr. McGarvey asked unanimous consent that he may hereafter be considered as the first sponsor of H.R. 3498, a bill originally introduced by Representative Higgins (NY), for the purpose of adding cosponsors and requesting reprintings pursuant to clause 7 of rule XII. Agreed to without objection.
What it does
The HELP Act of 2023 would require the Department of Health and Human Services (HHS) to distribute funding to states, tribal nations, and U.S. territories to strengthen two existing phone systems: 2-1-1, which connects callers to health and human services information, and 9-8-8, the National Suicide Prevention Lifeline. Funds could only be used to expand access to these systems or improve community referral services. As a condition of receiving funds, recipients would need to appoint a lead managing entity and create a state-level Human Services Oversight Council. HHS would also be required to establish a new national board to oversee fund allocation and evaluate both systems.
Who benefits
People in mental health or suicide crisis who currently cannot reach 9-8-8 due to coverage gaps. People seeking health and human services referrals through 2-1-1 in underserved or rural areas. Residents of tribal nations and U.S. territories, who may have limited access to either system today. Nonprofit and community organizations that operate or partner with 2-1-1 and 9-8-8 networks, which could receive expanded funding and coordination support. State and local agencies that manage human services referrals.
Who is hurt
Federal taxpayers who would fund the program, with the total cost not specified in the bill text. Organizations or states that currently operate 2-1-1 or 9-8-8 systems independently may face new federal compliance requirements, including mandatory oversight councils and lead entity designations. States or territories that prefer their existing governance structures could find the new mandated bodies duplicative or administratively burdensome. Private or locally funded crisis line operators could face competitive disadvantage if federally funded systems expand into their service areas.
Supporters argue
Supporters argue that 2-1-1 and 9-8-8 are proven, cost-effective systems that millions of people rely on during their most vulnerable moments, yet both suffer from uneven coverage and underfunding — particularly in rural areas, tribal lands, and territories. Dedicated federal funding would close those gaps and ensure that no caller is turned away or left without a referral simply because of where they live. The bill's governance requirements — a lead entity and an oversight council — would bring accountability and coordination to what are currently fragmented, patchwork systems. Supporters also contend that strengthening crisis infrastructure is far less costly than the downstream expenses of emergency room visits, hospitalizations, and law enforcement responses that occur when people in crisis cannot access timely help.
Opponents argue
Opponents argue that the bill creates new layers of federal bureaucracy — a national board, state oversight councils, and mandated lead entities — without specifying a funding amount, making it impossible to assess whether the administrative costs are justified. They contend that 2-1-1 and 9-8-8 systems are inherently local in nature and are better managed by states and communities without federal strings attached. The requirement to establish oversight bodies as a condition of funding could be seen as coercive, pressuring states to restructure existing governance arrangements to qualify for grants. Critics may also question whether adding a new federal program duplicates existing funding streams for mental health and human services infrastructure, potentially creating overlap with programs already administered under the Substance Abuse and Mental Health Services Administration (SAMHSA).
Constitutional context
The bill's funding mechanism would rely on Congress's Taxing and Spending Clause authority (Article I, Section 8). Because funds are conditioned on states meeting specific requirements — appointing lead entities and establishing oversight councils — the bill implicates the spending coercion doctrine established in NFIB v. Sebelius (2012), which held that conditions on federal grants must not be so coercive as to leave states no real choice but to comply. The conditions here appear modest relative to NFIB's Medicaid expansion, but the coercion question remains relevant. The Commerce Clause is less directly implicated, as the bill uses grants rather than mandates. No religious exemption issues analogous to Burwell v. Hobby Lobby (2014) are apparent on the face of the bill.
Checks and balances
The bill would expand executive branch authority by directing HHS to create a new national board and manage a new grant program, giving the executive branch discretion over fund allocation and program evaluation. Congress retains oversight through appropriations — since no specific dollar amount is authorized, future funding levels would be subject to annual appropriations decisions. The new Human Services National Board, which includes both federal and non-federal representatives, introduces a quasi-advisory structure that partially distributes decision-making authority outside of traditional agency hierarchy, which may raise questions under post-Loper Bright standards about the scope of delegated agency authority.
Historical precedent
The 9-8-8 system was established by the National Suicide Hotline Designation Act of 2020. The 2-1-1 system has received periodic federal support through HHS grants but lacks a dedicated statutory funding stream. This bill is analogous to the structure of the Runaway and Homeless Youth Act, which uses conditional federal grants to states for locally operated human services infrastructure.