HR-5378-119
Referred to the House Committee on Ways and Means.
Sponsored by Jimmy Gomez (D-CA)
What it does
The bill would amend section 2008 of the Social Security Act, which authorizes the health profession opportunity grant program, to reserve 15 percent of the program's funds each fiscal year for grants to Indian tribes, tribal organizations, and Tribal Colleges and Universities. It would also require the Secretary of Health and Human Services to award at least 10 grants to these entities, but only to the extent enough of their applications meet the program's requirements. The changes would take effect October 1, 2025.
Who benefits
Indian tribes, tribal organizations, and Tribal Colleges and Universities, which would have a guaranteed share of grant funds and a minimum number of awards. Low-income tribal members seeking training for health care jobs, who might gain access to more training programs. Tribal and Indian health care facilities, which often face workforce shortages and could draw on a larger local pipeline of trained workers.
Who is hurt
Other eligible grant applicants, such as state agencies, community colleges, workforce boards, and nonprofits, which would compete for the remaining 85 percent of funds and could receive fewer or smaller awards. Low-income non-tribal people served by those grantees may see fewer program slots, depending on total funding. The Department of Health and Human Services would take on added administrative work to track and apply the set-aside and minimum-grant rules.
Supporters argue
Supporters argue that tribal communities face long-standing health care workforce shortages and that tribal entities have had trouble winning grants in open competition against larger institutions. They contend a fixed 15 percent share and a 10-grant minimum would give tribes predictable access, consistent with the federal government's trust responsibility and its existing practice of tribal set-asides in other programs. They add that the minimum applies only where applications meet program requirements, so quality standards stay in place.
Opponents argue
Opponents argue that fixed set-asides limit the Secretary's ability to fund the strongest applications and may leave money unused or lower-quality awards if too few tribal applications qualify. They contend the 15 percent share is not tied to measured need or to tribal population shares, and that it reduces funds for other low-income applicants and regions with comparable workforce shortages. They add that the program's modest total funding means any carve-out would shrink awards to other grantees.
Constitutional context
Congress's authority over Indian affairs under the Indian Commerce Clause (Art. I, §8, cl. 3) and the Spending Clause supports the set-aside. Morton v. Mancari (1974) held that preferences for tribal members and tribes are political rather than racial classifications, so they receive rational-basis review rather than strict scrutiny under the Fifth Amendment's equal protection component. The bill's preference for tribal entities, rather than individuals based on race, fits that framework.
Checks and balances
Congress directs a minimum share of funds, which narrows the discretion of the executive branch (HHS) in awarding grants; Congress retains control through appropriations and oversight, and courts can review any challenge to implementation.
Historical precedent
Congress has previously set aside funds or guaranteed eligibility for tribes in other programs, such as tribal set-asides in various HHS and education grant programs, though no specific analogue is identified here.