HR-7198-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Ami Bera (D-CA)
What it does
This bill would amend the Public Health Service Act to require the Health Resources and Services Administration (HRSA) to conduct a study on how to identify and designate areas underserved by general surgeons. Within one year of enactment, HRSA would submit a report to Congress evaluating current shortage designation methods and potential new methodologies — including one based on surgeon-to-population ratios within hospital service areas. Based on the study's findings, the Secretary of Health and Human Services would have discretionary authority to establish, through formal rulemaking, a new system for designating "general surgery shortage areas" and to publish and annually update a list of such areas.
Who benefits
Patients in rural and underserved urban and suburban areas who currently lack adequate access to general surgeons. Rural hospitals and critical access hospitals that could gain recognition as shortage areas, potentially qualifying for federal incentive programs. Medical students and residents considering general surgery who may be directed toward shortage areas through loan repayment or placement programs. Public health researchers and policymakers who would gain better data on surgical workforce distribution. Organizations representing surgeons and surgical facilities that would have a formal consultation role in the rulemaking process.
Who is hurt
Federal agencies — primarily HRSA — that would bear the administrative and financial cost of conducting the study and, if the Secretary proceeds, developing and maintaining a new designation system. General surgeons currently practicing in areas that might be newly designated as shortage areas, who could face increased pressure or competition from incentivized placements. Taxpayers who would fund the study and any downstream designation infrastructure. Existing health professional shortage area (HPSA) designation frameworks could face redundancy or resource competition if a parallel general surgery system is created.
Supporters argue
Supporters argue that the current Health Professional Shortage Area designation system was not designed with surgical specialties in mind and may systematically undercount general surgery shortages — particularly in rural areas, where HRSA data show only 69% of needed surgeons are present. They contend that a specialty-specific, data-driven designation system would allow federal workforce programs to more precisely direct surgeons to communities with the greatest unmet need, and that the bill's study-first approach is fiscally prudent, requiring evidence before committing to a new regulatory framework.
Opponents argue
Opponents argue that the bill creates a new bureaucratic layer — a separate designation system for a single surgical specialty — without guaranteeing any improvement in access, since the Secretary's authority to act on the study's findings is discretionary, not mandatory. They contend that the underlying shortage problem stems from physician training pipeline constraints and reimbursement structures that a designation study cannot fix, and that resources spent on a new classification system might be better directed toward Graduate Medical Education funding or rural recruitment incentives that have a demonstrated track record.
Constitutional context
Congress has broad authority to fund and direct studies through the Taxing and Spending Clause (Art. I, §8, cl. 1) and to regulate healthcare workforce programs under the Commerce Clause (Art. I, §8, cl. 3). The bill's delegation of rulemaking authority to the HHS Secretary is standard administrative practice, though post-Loper Bright v. Raimondo (2024), any regulations the Secretary ultimately issues would face independent judicial review rather than deferential review of the agency's statutory interpretation.
Checks and balances
The Executive Branch (HHS/HRSA) gains discretionary authority to create a new shortage designation system through notice-and-comment rulemaking; Congress retains oversight through the mandatory report requirement, and courts would independently review any resulting regulations under post-Loper Bright standards.
Historical precedent
The existing Health Professional Shortage Area (HPSA) designation system, established under Section 332 of the Public Health Service Act, provides a direct structural analogue — this bill would create a parallel, specialty-specific track modeled on that framework.