HR-6989-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Melanie Stansbury (D-NM)
What it does
This bill would add a new section to the Public Health Service Act directing the Health and Human Services Secretary to run activities that build and sustain a public health nursing workforce, including grants to state, local, and territorial health departments. Grant money could pay wages, benefits, recruiting, training, medical supplies, and administrative costs for registered nurses working in public health settings or doing home visits. The bill would authorize $5 billion per year for fiscal years 2026 through 2035 ($50 billion total), require grantees to maintain their own prior spending levels, and give priority to high-need areas and to applicants with a collective bargaining agreement or a policy of not interfering with employee labor rights.
Who benefits
Registered nurses who would be recruited, hired, and trained by public health departments. State, local, and territorial health departments that could add staff and supplies. Residents of medically underserved, rural, low-income, and health professional shortage areas, and mothers and infants who may gain more prenatal, postpartum, and home visiting services. Unions and employers with labor-rights policies, which would receive priority in grant selection. Suppliers of medical equipment and protective gear.
Who is hurt
Federal taxpayers, since the bill would authorize $50 billion over ten years that would add to spending unless offset. Health departments with limited budgets that may struggle to meet the maintenance-of-effort requirement or to sustain positions once grants end. Applicants without a collective bargaining agreement or labor-rights policy, which could be disadvantaged in competition for grants. Private and nonprofit health employers that may face wage competition for a limited nurse supply. Jurisdictions with less grant-writing capacity may be outcompeted.
Supporters argue
Supporters argue that public health departments have lost significant staff since the COVID-19 pandemic and that nurses deliver prevention, maternal care, and home visiting services that reduce costly hospitalizations later. They contend that targeting shortage areas, high infant and maternal mortality areas, and rural communities directs money to documented gaps. They also argue the maintenance-of-effort rule keeps federal funds from replacing state spending, and that labor-related priorities support stable, well-paid jobs that help retain nurses.
Opponents argue
Opponents argue that $50 billion over ten years is a large new commitment without identified offsets, and that grants may create staff positions that states cannot afford once federal funding ends. They contend that health care staffing is primarily a state and local responsibility, and that the preference for applicants with collective bargaining agreements or labor-rights policies could disadvantage otherwise qualified departments. They also argue that a nurse shortage is a supply problem that grants for hiring alone may not solve, since departments may simply compete for the same nurses.
Constitutional context
The bill rests on Congress's Spending Clause power (Art. I, §8, cl. 1) to fund state and local programs with conditions. South Dakota v. Dole (1987) allows conditions that are clearly stated and related to the funding's purpose, and NFIB v. Sebelius (2012) bars conditions so coercive that states lack a real choice. Because the grants are voluntary and come with modest conditions such as maintenance of effort, coercion concerns appear limited.
Checks and balances
Congress would authorize the funds but must separately appropriate them each year, while HHS would gain discretion over grant selection and priorities, subject to congressional oversight and judicial review of agency action.
Historical precedent
Title VII of the Public Health Service Act has long funded health workforce training, and the Nurse Corps and nursing workforce development programs under Title VIII provide a similar federal funding approach for nurses.