HR-6238-119
Received in the Senate and Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Sponsored by Lauren Underwood (D-IL)
What it does
This bill would formally establish the IMPROVE Initiative within the National Institutes of Health (NIH), directing the NIH Director to continue a program focused on improving maternal health outcomes. It would authorize NIH to award grants, contracts, and cooperative agreements to advance research on reducing maternal mortality and severe maternal illness, with a focus on health disparities affecting populations with disproportionately high rates of poor outcomes. The bill would authorize $63.4 million per year for fiscal years 2026 through 2030, for a total of $317 million over five years.
Who benefits
Pregnant and postpartum women, particularly those in communities with disproportionately high rates of maternal mortality — including Black women, who die from pregnancy-related causes at roughly three times the rate of white women according to CDC data. Researchers and academic medical centers that would receive NIH grants. Community health organizations that could receive funding for community-based interventions. Rural communities with limited obstetric care access. Hospitals and clinicians who would gain evidence-based guidance from the research produced.
Who is hurt
Competing NIH research programs that may face indirect resource competition if appropriations are constrained. Taxpayers who bear the cost of the $317 million authorization. Research institutions or investigators whose work does not align with the initiative's priorities may find it harder to secure NIH funding in this area. States or localities not identified as high-disparity regions may receive less targeted research attention.
Supporters argue
Supporters argue that the United States has one of the highest maternal mortality rates among high-income nations — approximately 22 deaths per 100,000 live births as of recent CDC data — and that persistent racial and geographic disparities demand a dedicated, evidence-building federal research effort. They contend that codifying the IMPROVE Initiative into statute provides stable, long-term funding that prevents the program from being eliminated through administrative action, and that community-based research is essential to identifying the biological and social factors driving preventable deaths.
Opponents argue
Opponents argue that authorizing $317 million for a single NIH initiative duplicates existing maternal health research programs across NIH institutes and other agencies such as HRSA and CDC, potentially creating bureaucratic overlap without proportional benefit. They contend that authorization does not guarantee appropriation, meaning the bill may set expectations without delivering funding, and that resources would be better directed toward direct care delivery — such as expanding Medicaid postpartum coverage — rather than research infrastructure that takes years to produce actionable results.
Constitutional context
Congress has broad authority to fund biomedical research through the Taxing and Spending Clause (Art. I, §8, cl. 1) and the Necessary and Proper Clause (Art. I, §8, cl. 18). No significant constitutional challenge is apparent here, as the bill funds voluntary grant programs rather than mandating state action or compelling individual behavior. NFIB v. Sebelius (2012) is not directly implicated because no coercive conditions are placed on states.
Checks and balances
Congress gains authority by codifying the initiative in statute and setting spending limits; the NIH Director retains discretion over grant awards; the Appropriations Committees retain the power of the purse, as authorization does not guarantee actual funding.
Historical precedent
The IMPROVE Act builds on the Preventing Maternal Deaths Act of 2018, which funded state maternal mortality review committees, and the Black Maternal Health Momnibus Act provisions incorporated into subsequent legislation — representing a pattern of incremental federal action on maternal health disparities.