HR-8074-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Alma Adams (D-NC)
What it does
This bill would create several federal grant programs administered by HHS: grants to community-based organizations working on maternal health equity, grants for bias/racism training for all employees in maternity care settings, grants for "respectful maternity care compliance programs" at hospitals, and a National Academies study on reducing bias in maternity care. It would authorize roughly $525 million over five years plus unspecified additional amounts, and require periodic reports to Congress and GAO oversight reports.
Who benefits
Community-based organizations and midwifery practices that would receive grant funding, particularly those serving populations with elevated maternal mortality rates; pregnant and postpartum patients, especially in communities with historically worse maternal health outcomes; perinatal health workers (doulas, community health workers, lactation counselors); hospitals and health systems that establish compliance programs; historically Black colleges and universities and minority-serving institutions that develop training programs; researchers studying maternal health disparities.
Who is hurt
Taxpayers who fund the roughly $525 million-plus in authorized spending; hospitals and health systems that must implement mandatory reporting and compliance infrastructure without dedicated funding for the compliance-program requirements in some cases, raising administrative costs; organizations not selected for "special consideration" under the eligibility criteria who may find themselves at a competitive disadvantage in the grant process; hospitals in regions without robust community-based organizations may struggle to access outreach and technical assistance during the initial planning year.
Supporters argue
Supporters argue that the U.S. has the highest maternal mortality rate among wealthy nations, with Black women dying from pregnancy-related causes at roughly three times the rate of white women according to CDC data, and that community-based, culturally congruent interventions and bias training have shown promise in improving outcomes and patient trust. They contend that targeted funding for community organizations and standardized training addresses documented, measurable gaps in current hospital-based care that federal health policy has largely failed to address.
Opponents argue
Opponents argue that directing federal grant "special consideration" toward entities based on the racial or demographic composition of their leadership or client base raises legal risk following recent equal-protection rulings restricting race-conscious government decision-making, even where race is one factor among several. They contend that mandating extensive bias and antiracism training curricula for all hospital employees imposes compliance costs and content requirements that may not have demonstrated evidence of improving clinical outcomes, and that the $525 million-plus authorization adds new federal spending without offsetting cuts.
Constitutional context
This bill relies on Congress's Taxing and Spending Clause power to create grant programs, similar to the ACA's spending-based approach upheld in NFIB v. Sebelius (2012); because participation by hospitals and organizations is voluntary and non-coercive, the spending-clause coercion concerns raised in NFIB's Medicaid holding are less directly implicated. The provisions giving "special consideration" to entities based on race or demographic leadership could raise equal-protection questions under the reasoning of SFFA v. Harvard (2023), though that case addressed university admissions rather than federal grant criteria, so its direct applicability here is uncertain.
Checks and balances
Congress would authorize and appropriate funding while delegating grant design and award discretion to the HHS Secretary, with congressional reporting requirements and GAO oversight serving as accountability checks, though courts could review specific grant criteria if challenged as exceeding statutory authority or raising equal-protection concerns.
Historical precedent
Congress has previously funded maternal health initiatives such as the Preventing Maternal Deaths Act (2018) and MOMMIES Act proposals, which similarly used HHS grants to address maternal mortality disparities, though this bill's bias-training mandates and compliance-program structure go further than prior maternal health legislation.