S-5292-119
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Sponsored by Edward Markey (D-MA)
What it does
This bill would amend the Public Health Service Act's Hill-Burton program to fund construction and modernization grants for hospitals and other medical facilities to improve resilience to climate disasters and public health crises, authorizing $100 billion for fiscal year 2027. It would also create a new $5 billion Planning and Evaluation Grant Program to help states, tribes, and nonprofit health facility operators develop sustainability and resiliency plans, with at least 50% of funds directed to environmental justice communities, and require grant recipients to meet labor standards including Davis-Bacon prevailing wage requirements and neutrality or collective bargaining agreements regarding unionization.
Who benefits
Hospitals, public health centers, and long-term care facilities that receive grants for energy resilience, air filtration, and green infrastructure; patients in facilities serving low-income, Medicare/Medicaid-heavy, or environmentally burdened populations; construction workers and contractors covered by prevailing-wage requirements; labor unions representing facility employees; and communities near participating facilities that gain green space or improved air quality.
Who is hurt
Federal taxpayers who would bear the $105 billion authorized cost; facilities that lack union agreements or neutrality policies and may be ineligible or deprioritized for funding; hospitals and contractors that do not meet Davis-Bacon wage requirements and face higher labor costs; and facilities in areas not designated as environmental justice communities, which compete for the remaining half of planning funds.
Supporters argue
Supporters argue that hospitals must remain operational during extreme weather events and pandemics, and that recent disasters have shown power outages, flooding, and poor air quality can force facility closures or evacuations at the worst possible time for patients. They contend directing funds toward low-income and environmental justice communities addresses documented disparities in facility infrastructure quality, and that labor standards ensure taxpayer-funded construction supports fair wages and worker rights.
Opponents argue
Opponents argue the $105 billion authorization is a substantial new federal commitment with unclear cost controls, since the Secretary has broad discretion to approve "any other type of plan or project" deemed to advance sustainability. They contend conditioning grants on collective bargaining agreements or neutrality policies toward unionization ties healthcare infrastructure funding to labor relations issues unrelated to patient care, potentially disadvantaging facilities based on their labor practices rather than medical need.
Constitutional context
Congress is exercising its Spending Clause authority (Art. I, §8, cl. 1) to attach conditions to federal grants for health facility construction, similar to the Hill-Burton program conditions upheld for decades; unlike the Medicaid expansion struck down in NFIB v. Sebelius (2012), these are discretionary competitive grants rather than a threat to withdraw existing funding, so the coercion concern from that case is less directly implicated.
Checks and balances
Congress authorizes the appropriation and sets eligibility criteria; the Secretary of Health and Human Services holds broad discretion to define qualifying projects and priorities, with limited built-in checks beyond normal agency rulemaking and oversight.
Historical precedent
The original Hill-Burton Act (1946) established federal grants for hospital construction with facility obligations, and this bill amends that same statutory framework to add climate-resilience criteria.