S-1657-116
Placed on Senate Legislative Calendar under General Orders. Calendar No. 287.
Sponsored by Susan Collins (R-ME)
What it does
The Kay Hagan Tick Act would amend the Public Health Service Act to require the Department of Health and Human Services to develop and implement a national strategy for addressing vector-borne diseases, including Lyme disease. It would authorize grants to universities to establish regional centers of excellence focused on vector-borne disease research, prevention, and workforce training. It would also authorize cooperative agreements with state, tribal, and local health departments in high-risk areas to build capacity for identifying, reporting, preventing, and responding to vector-borne disease outbreaks. The bill authorizes $10 million per year (FY2021–2025) for the research centers and $20 million per year (FY2021–2025) for the cooperative agreements with health departments.
Who benefits
People diagnosed with Lyme disease (estimated 476,000 Americans annually per CDC) and those suffering from other tick-borne illnesses such as Rocky Mountain spotted fever, anaplasmosis, and ehrlichiosis. Residents of high-risk regions, particularly the Northeast, Mid-Atlantic, upper Midwest, and Pacific Coast. Rural and underserved populations who currently have limited access to specialized diagnosis and care. Public health entomologists and researchers who would receive training funding and grants. Universities and academic medical centers eligible for center-of-excellence grants. State and tribal health departments that would receive cooperative agreement funding. Patients who have faced diagnostic delays or misdiagnosis due to inadequate testing tools.
Who is hurt
Taxpayers who bear the cost of the authorized appropriations ($150 million total over five years). Other public health research priorities that may compete for limited HHS discretionary funding. Entities that do not qualify for grants — for example, non-academic organizations are excluded from the centers-of-excellence grants in the amended version, unlike the original draft. Federal agencies that may face new coordination mandates without corresponding resource increases.
Supporters argue
Supporters argue that Lyme disease alone affects an estimated 476,000 Americans annually — more than breast cancer or HIV — yet federal research funding has historically lagged far behind comparable disease burdens. They contend that fragmented federal programs across HHS, the Department of Defense, the EPA, and other agencies have produced duplicative efforts and gaps in surveillance, diagnostics, and treatment, and that a mandated national strategy with biennial updates would impose accountability and coordination that currently does not exist. They further argue that regional centers of excellence would accelerate development of better diagnostic tests, since current two-tier testing misses a significant share of cases, causing delayed treatment and long-term health consequences.
Opponents argue
Opponents argue that the bill authorizes new spending layers — $150 million over five years — without demonstrating that existing CDC and NIH vector-borne disease programs are inadequate or that new bureaucratic structures would outperform them. They contend that restricting center-of-excellence grants exclusively to institutions of higher education excludes experienced non-academic public health organizations and private research entities that may be better positioned to deliver results. They further argue that the bill's national strategy requirement, while well-intentioned, creates reporting obligations without enforcement mechanisms, raising questions about whether the coordination mandate would produce meaningful change or primarily generate paperwork.
Constitutional context
Congress's authority to fund public health research and grant programs rests on the Taxing and Spending Clause (Art. I, §8, cl. 1) and the Commerce Clause (Art. I, §8, cl. 3). Cooperative agreements with state and tribal health departments are a standard exercise of spending power; under NFIB v. Sebelius (2012), such conditions are permissible so long as they do not rise to the level of unconstitutional coercion — a threshold this bill, which offers optional grants rather than conditioning existing funding, would not appear to approach.
Checks and balances
Congress grants HHS new programmatic authority and sets spending ceilings; the Secretary of HHS retains discretion over grant awards and strategy development; Congress receives a progress report within four years, providing a legislative oversight mechanism.
Historical precedent
The 21st Century Cures Act (2016) established the Tick-Borne Disease Working Group, which this bill builds upon; prior vector-borne disease grant programs have operated under the Public Health Service Act without significant constitutional challenge.