Getting in Fiscal Shape — How Changing Future Spending and Revenue Could Improve Government Finances (interactive graphic)

Posted on December 17, 2020 by

The COVID-19 pandemic has caused economic turmoil and resulted in unprecedented federal spending to address the public health and economic crisis. However, even before the pandemic, the federal government was on an unsustainable fiscal path caused by an imbalance in revenue and spending.

As a result, debt held by the public is now projected to reach the highest point in U.S. history – 107% of gross domestic product (GDP) – in 2023. GDP is the total value of the goods and services made in the country. Being highly leveraged in debt could impact the federal government’s ability to meet it security and social needs, as well as its flexibility to address unforeseen events.

In today’s WatchBlog, we explore our work on how to tackle the debt after public health and the economy have recovered from the pandemic. Specifically, we look at the potential effect of changes in future spending and revenue and what Congress should consider when designing, implementing, and enforcing new laws to limit spending or increase revenue.

Tough decisions ahead

Policymakers will have tough decisions to make to get the federal government on a sustainable fiscal path. These decisions may include cutting program spending, increasing revenue, or a combination of both.

Setting a target amount for future debt can help frame fiscal decision making. The magnitude of these changes will depend on which debt-to-GDP targets policymakers want to achieve. But other factors—like discretionary spending and GDP—can also affect the federal debt.

To help Congress visualize all the moving pieces, we developed a tool that examines how changes in spending and revenue could help reach some specific debt targets at the end of a 30-year period. This tool also allows policymakers to test out how changes to different factors could affect the spending and revenue changes needed to reach specific debt targets.

The image below is a snapshot of the interactive tool showing the effects of changes in GDP growth rate. Click the image to go to the interactive tool for more.

Snapshot of Tool – GDP Growth Rate

Setting targets for spending and revenue

The information in the tool above can be used to help develop fiscal rules and targets. Other countries use these constraints and benchmarks to promote fiscal responsibility and sustainability, but the federal government has faced challenges doing so here.

We suggested that Congress consider developing a long-term plan that includes fiscal rules and targets, like a debt-to-GDP target, to manage the federal government’s fiscal outlook. We also identified 7 key considerations for establishing new, effective fiscal rules and targets that Congress could consider when doing so. These include steps such as weighing various design features and tradeoffs, and including flexibility for events like national emergencies.

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What is 5G and Why Does It Matter?

Posted on December 14, 2020 by

Billed as the next generation of wireless technology, 5G has the potential to transform industries and society now and in the years to come. But what is 5G and what does it make possible?

Today’s WatchBlog explores the latest in our series of reports on 5G and the capabilities and challenges this technology presents.

What is 5G?

5G promises to provide significantly greater speeds and accommodate more devices than current 4G networks. 5G networks also aim to be more flexible, reliable, and secure than existing cellular networks. The figure below compares 4G and 5G on these measures.

What will 5G make possible?

Because 5G will allow for faster communication among more devices, it will enable applications such as 3D video, extended reality—an umbrella term that includes virtual, augmented, and mixed reality—and smart cities (meaning cities that are using data to improve energy use, transportation efficiency, and more). Extended reality applications are expected to impact a wide range of industries, including healthcare, education, transportation, and military. For example, researchers are developing extended reality applications to help fighter pilots maneuver better in poor visibility or darkness. The figure below shows some of the technical advances and anticipated applications of 5G networks.

5G will also allow companies to serve a larger number of more diverse customers and applications over the same network. One way it can do so requires more radio spectrum to be available to 5G. Another way is with a technology known as end-to-end network slicing, which divides network infrastructure into “slices,” with each slice tuned to meet the needs of a particular set of users.

For example, network slicing would allow a wireless carrier to efficiently and simultaneously support connected vehicles, extended reality applications, videoconferencing, and automated industrial machines—above and beyond basic voice or internet access—using the same underlying network. 

What challenges do 5G networks present?

Several challenges can arise with the use of 5G, including cybersecurity risks, privacy issues, and concern from members of the public over possible health effects.

For instance, 5G potentially introduces new modes of cyberattack and opens up new points of attack. 5G networks may also exacerbate existing privacy concerns in so far as 5G introduces new kinds of user data to be collected, including more precise location metrics.

Deployment of 5G may also raise new concerns about the effects of radio frequency exposure on public health. Although there is no consistent evidence of the health risks related to radio waves used for 5G, responding to public concerns remains a challenge, in part due to the unknown long-term health effects.

What’s next?

To address these challenges, policymakers could support nationwide, coordinated cybersecurity monitoring of 5G networks, adopt cybersecurity requirements for 5G networks, and put uniform privacy practices in place for user data, among other policy options.

We discuss these options in some of our recent work examining national security considerations surrounding 5G and the challenges to deploying 5G technology.

5G has the potential to connect many more users and devices, but reaching its full potential will require new technologies and cooperation over the next decade.

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Why Do Banks Share Your Financial Information and Are They Allowed To?

Posted on December 9, 2020 by

In a word: yes.

If you’ve ever applied for a loan, you know that banks and credit unions collect a lot of personal financial information from you, such as your income and credit history. And it’s not uncommon for lenders to then share your information with other vendors, such as insurance companies after the loan is finalized. But why do banks and credit unions share your information and what protections are available to consumers to ensure their privacy?

Today’s WatchBlog explores our new report on this issue. You can also tune in to our new podcast with GAO consumer protection and privacy experts Alicia Puente Cackley and Nick Marinos to learn more.

What types of information do banks collect and why?

Banks and credit unions collect and use many types of personal information to conduct everyday business activities and to market products and services. The information banks collect may be used to create bank statements, monitor for fraud, and determine credit eligibility.

Banks and credit unions also gather information about consumers’ online activities. This information may not identify an individual, but can be used for marketing. For example, when consumers access a financial institution’s website and use mobile or online services, banks and credit unions collect information about their social media and browsing activities, type of computer or mobile device, and network address. Banks mainly use this information to ensure their websites function properly, detect and prevent fraud, and per our report, to tailor advertisements.

Why do banks share your information?

The personal information banks collect and share helps them approve customers for services like loans and set up accounts. But it is also helps them and their marketing partners determine whether they should offer other products and services. Banks share information with various types of third-party vendors including:

  • financial companies like mortgage bankers, securities brokers-dealers, and insurance agents;
  • retailers (for example, home improvement stores), magazine publishers, airline companies, and direct marketers;
  • companies that deliver services on behalf of the lender (for example, mortgage servicers), and government agencies and nonprofits.

Are they allowed to share your information?

Again, the answer is yes. But, banks and credit unions are also required to have processes in place to protect the personal information they collect, use, and share with third parties. Also, customers can opt out of having their information shared under certain conditions. The primary law that governs how financial institutions can use or share personal information about consumers is the Gramm-Leach-Bliley Act of 1999. This law prohibits a financial institution from disclosing a consumer’s nonpublic personal information like your Social Security number, income, and outstanding debt to companies that are not related to the financial institution. Consumers have the right to opt out of some, but not all, sharing of their personal information. There are exceptions. For example, banks don’t have to let you opt out when transferring your information to their loan servicer.

To learn more about this topic and consumer protections, check out our report. And to learn more about our portfolio of work on this topic check out our key issues page on Consumer Financial Protections.

 

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Why is CDC Screening Fewer People for Breast and Cervical Cancer?

Posted on December 8, 2020 by

About 265,000 women in the U.S. were diagnosed with breast or cervical cancer in 2017, according to the most recently available data from the Centers for Disease Control and Prevention. Early screening and detection of cancer, followed by prompt treatment, can save lives. But what happens when people can’t afford such medical care?

For many people in need of breast or cervical cancer screening, the answer has been the CDC’s National Breast and Cervical Cancer Early Detection Program. It has provided cancer screening and diagnostic services to millions of low-income people without health insurance for nearly 30 years. However, the number of people receiving screenings through this program has declined dramatically in recent years.

Today’s WatchBlog explores our new report about this decline. Also, tune in to our podcast with GAO’s John Dicken—a health care policy expert and director in our Health Care team— to learn more.

Less uninsured people = less screenings

In recent years, the number of people screened for breast or cervical cancer annually through the CDC’s Early Detection Program decreased by about 46%—from about 550,000 people in 2011 to just under 300,000 people in 2018.

What’s the cause for such a dramatic drop? CDC officials told us that health insurance coverage expansions under the Affordable Care Act, including Medicaid expansion beginning in 2014, were a major factor. Because the Early Detection Program serves people who lack health insurance coverage, a reduced uninsured population means less people are eligible. Sure enough, a CDC-funded study that estimated program eligibility showed decreases by 48% and 49% (for each type of cancer) between 2011 and 2017.

Figure: People Screened by CDC’s National Breast and Cervical Cancer Early Detection Program, 2011-18

Why the Early Detection Program is still needed

While the Early Detection Program has seen a decrease in demand, there are still millions of people eligible for and in need of the services it offers. A recent study estimated that, as of 2017, about 2.8 million people were eligible for breast cancer screening and about 5.3 million were eligible for cervical cancer screening through the program.

Additionally, declines in demand for the program were not equally shared. Hispanic people and non-Medicaid expansion states have more need for the program than other groups. For example, while the number of Hispanic people screened for breast cancer each year decreased by just 3.3%, the number of non-Hispanic people screened decreased by 66.3%. By 2017, the percentage of Hispanic women eligible for the program was estimated to be about 2 times as high as the percentage of non-Hispanic Black women eligible and about 4 times as high as the percentage of non-Hispanic White women eligible.

How is the CDC responding to program changes?

In response to these trends, the CDC began making some changes to its program. In 2017, the program began focusing more on evidence-based strategies to help people overcome barriers that may prevent them from seeking screening in the first place—things like lack of trust in health care providers or language and cultural barriers.

The CDC also started collecting data related to these changes, but it is still too early to know the effects.

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How GAO Can Help in a Congressional and Presidential Transition

Posted on December 1, 2020 by

The 117th Congress and the incoming Presidential administration will be taking office in a time that presents significant challenges to the government. These include the coronavirus pandemic and its far-reaching public health and economic effects; the evolving issues around race relations; and government readiness to meet these challenges and others on the horizon.

Today’s WatchBlog looks at resources GAO makes available to Congressmembers, the incoming administration, their staffs, the media, and the public—all to help the government prepare for and respond to these pressing concerns.

Transition resources on GAO.gov

GAO provides information on the key challenges facing the nation, as well as our recommendations in these areas to improve government services or save taxpayer dollars. As a trusted source for fact-based, nonpartisan information about government agencies and programs, GAO is well-positioned to help elected and federal officials and their staff prioritize policy matters and develop oversight agendas.

Today, we launched a new webpage with information on major issues facing the nation and the federal government’s ability to meet strategic challenges. There are also links to GAO’s priority recommendations for improving vital government services or achieving significant savings.

U.S. Comptroller General and head of GAO, Gene Dodaro, talks about the resources available on the Transition page in this video:

Continue reading →

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Continued Surge in COVID Cases Highlights Need for Urgent Federal Action

Posted on November 30, 2020 by

COVID-19 cases have been increasing since mid-September, further highlighting the importance of federal public health and economic response efforts.

Today’s WatchBlog looks at our fourth report on the federal pandemic response, which describes the status of ongoing efforts and outlines ways to improve the response and prepare for future challenges in these areas:

  • medical supply shortages
  • vaccines and therapeutics
  • COVID-19 testing guidance
  • unemployment insurance
  • stimulus payments
  • nursing home care

Read on to learn more about what we recommended. You can also tune in to our latest podcast on this work, which features two of the directors leading our pandemic response review.

Medical Supply Shortages

The Department of Health and Human Services (HHS) and FEMA have made numerous efforts to mitigate supply shortages. But in our national survey, one-third to one-half of states and territories reported ongoing shortages of some testing-related and other medical supplies.

Most states reported certain PPE supplies (e.g., nitrile gloves) remain scarce, and about one-third of respondents were “greatly” or “completely” concerned about having enough supplies to administer vaccines in the future. Given the surge of COVID-19 cases and these reported medical supply shortages, we believe it is critically important that our previous recommendations on better managing the supply chain be implemented.

Safety and Effectiveness of Vaccines and Therapeutics

Through Operation Warp Speed, the federal government has made a concerted effort to speed the development of vaccines and therapeutics, which we detailed in our November 17 report. The FDA’s Emergency Use Authorizations allow for the emergency use of medical products without full FDA approval or licensure. As of November 9, FDA had used that approach to make four COVID-19 treatments available.

But there are concerns about the safety and effectiveness of these treatments and vaccines. We recommended that the FDA find ways to be more transparent about its scientific safety and effectiveness reviews when issuing Emergency Use Authorizations for therapeutics and vaccines.

Changes in CDC Guidance on COVID-19 Testing

Guidance on COVID-19 testing is expected to evolve as new information about the coronavirus emerges—and it has, frequently. For example, in August, the Centers for Disease Control and Prevention (CDC) changed its stance on the testing of asymptomatic people who had close contact with an infected person.

Changes like these, however, haven’t always been communicated with a scientific explanation—which increases the risk of confusion and could affect public trust in government. We recommended that HHS ensure that the CDC clearly discloses the scientific rationale for any change to testing guidelines at the time the change is made.

Unemployment Insurance and the Economy

The Department of Labor’s weekly news releases don’t accurately estimate the number of individuals actually relying on unemployment insurance. To better understand the role unemployment insurance benefits are playing in the economy, reliable data are needed on both the number of new claimants each week and the number of claimants who continue to rely on unemployment insurance benefits. We recommend that DOL consider options to report the actual number of distinct individuals claiming benefits.

Stimulus Payments

As of September 30, the Department of the Treasury and IRS had disbursed $274.7 billion worth of economic impact payments to individuals. However, not everyone received a payment who was supposed to. Starting in September, IRS sent notices to nearly 9 million people who had not yet received a payment. Treasury and IRS did not plan to track and analyze the results of that mailing effort until next year. We recommend that they do so promptly and publicly report that information.

Nursing Home Care

In September, the Coronavirus Commission on Safety and Quality in Nursing Homes made 27 recommendations to the Centers for Medicare & Medicaid Services (CMS) in such areas as testing, PPE, and visitation. We recommend that CMS quickly develop a plan that more completely explains how it intends to respond to and implement the commission’s recommendations.

In March, VA instructed its contractor to stop in-person inspections due to concerns about COVID-19. We recommend the VA develop a plan to resume inspections of state veterans’ homes, which may include using in-person, a mix of virtual and in-person, or fully virtual inspections. 

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Mapping Global Food Insecurity (Interactive Map)

Posted on November 23, 2020 by

Nearly 690 million people in the world are undernourished. Poor nutrition can cause a number of health complications including stunting—a condition where poor nutrition in-utero or in early childhood causes a child to be too short for their age. Stunting affected more than 140 million children under the age of 5 globally in 2019.

Today’s WatchBlog explores our new report on efforts to achieve global food security and improved nutrition around the world. The report also provides an interactive map showing how global food security assistance funds were disbursed throughout the world from 2014-2018.

What causes global food insecurity?

Conflict, climate variability, and economic downturns are just some of the factors that may contribute to global levels of food insecurity. For example, climate-related disasters such as floods, droughts, and tropical storms have increased food insecurity by undermining food production.

The economic impacts of the COVID-19 pandemic is expected to further exacerbate global hunger. The pandemic has increased the risk of poverty and therefore hunger and malnutrition for families around the world. The UN estimates that 83 million to 132 million people could become undernourished in 2020 due to the pandemic.

How is the world addressing global food insecurity?

From 2014 through 2018, the United States and other international donors spent an estimated $75 billion to combat global food insecurity. The United States accounted for more than $22 billion of this total. Other major bilateral or country donors included Germany, the United Kingdom, Japan, Canada, France, and the United Arab Emirates.

Figure: Estimated Bilateral Disbursements for Global Food Security Assistance, 2014 through 2018

Multilateral donors (including international organizations and institutions with government membership) such as the World Bank, the Asian Development Bank, World Food Program, and Food and Agriculture Organization provided more than $13 billion of this assistance from 2014 through 2018.

Which sectors and recipients have received global food security assistance?

Donors have provided funding to 8 sectors that directly support global food security, including agriculture, agro-industries, nutrition, developmental food security assistance, emergency food assistance, fishing, school feeding, and food security and safety management.

For example, donors have spent an estimated $37 billion in agriculture assistance, such as supplying seeds and conducting land surveys, and about $5 billion on nutrition activities, which include, for example, managing acute malnutrition.

We developed an interactive map that shows how global food security assistance funds from donors around the world were disbursed from 2014-2018. The figure below demonstrates how the graphic works. Access the complete interactive graphic at GAO.gov or by clicking on the below image.

https://www.gao.gov/multimedia/GAO-21-47R/interactive/

As the largest bilateral donor of this assistance, the United States uses various programs to administer its food assistance. These programs have supported emergencies, for example, by providing food assistance to populations living in or displaced from conflicts like those in Syria and South Sudan. The United States has also supported nonemergency development activities with programs related to agriculture and water, sanitation, and hygiene, among others.

Warehouse Workers Packaging Food Aid for Beneficiaries in Haiti

Want to learn more about our work on global food security? Check out our key issues page on International Food Assistance.

  • Questions on the content of this post? Contact Chelsa Kenney Gurkin at GurkinC@gao.gov.
  • Comments on GAO’s WatchBlog? Contact blog@gao.gov.

 

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Operation Warp Speed—Federal Efforts to Accelerate COVID-19 Vaccine and Therapeutic Development

Posted on November 17, 2020 by

Note: This blog was updated on December 7 to clarify some references to the distribution and licensing aspects of a COVID-19 vaccine.

Developing a vaccine can take 10 years or longer. However, as COVID-19 cases rapidly rose during the early stages of the pandemic, and with no vaccines or therapeutics available at that point to prevent or treat COVID-19, the federal government partnered with private industry to accelerate the development and manufacturing of vaccines and therapeutics to prevent and treat COVID-19.  

Today’s WatchBlog explores our new report on the status of this effort. You can also tune in to our new podcast with GAO health care experts Mary Denigan-Macauley and Alyssa Hundrup to learn more:

Operation Warp Speed

The federal government created Operation Warp Speed in response to the COVID-19 pandemic. Under Operation Warp Speed, vaccine developers are starting to manufacture their COVID-19 vaccines before testing has been completed. Consequently, Operation Warp Speed intends to be ready to distribute any vaccine as soon as it is authorized or licensed by the Food and Drug Administration (FDA).

Under Operation Warp Speed, the federal government has publicly announced financial support for the development and manufacturing of six COVID-19 vaccine candidates totaling more than $10 billion in obligations. Its goal is to produce 300 million doses of a vaccine, with initial doses available in January 2021.

Many of Operation Warp Speed’s vaccine candidates are in the final stage of the development process—i.e., conducting large-scale clinical trials.

However, there are important challenges to consider. For example, ramping up manufacturing of COVID-19 vaccines depends on the manufacturing supply chain. Before the pandemic began, most manufacturing resources were being used for other vaccines, and private industry representatives working on COVID-19 vaccines have told us they’ve had trouble obtaining these resources.

Emergency Use Authorizations

The federal government can issue emergency use authorizations, which temporarily allow the use of unapproved products—such as vaccines or therapeutics—or unapproved uses of approved products during emergencies, such as COVID-19. So far, it has issued 4 of these “EUAs.” For example, remdesivir—a drug previously developed to treat Ebola—has been authorized to treat COVID-19 in certain patients.

These authorizations can provide the federal government with flexibility and help make treatments available more quickly during an emergency, but an EUA allows for less certainty of effectiveness than is required to approve therapeutics or license vaccines. FDA has revoked emergency authorizations for some drugs, namely chloroquine and hydroxychloroquine, because they later found they were not effective at treating COVID-19.

Additionally, making a therapeutic or vaccine widely available through emergency use authorization could negatively affect participation in further clinical trials. Such trials, or studies of the drug’s effectiveness and safety in humans, are necessary to support any eventual approval. In addition, if a drug originally used to treat a different disease is used to treat COVID-19, it can result in a shortage of that drug, potentially impacting patients who need it for the original use. 

Moving forward

As the federal government moves forward in its efforts to support the development of vaccines and therapeutics for COVID-19, it’s important for the FDA to be transparent about the safety and effectiveness data it uses when deciding whether to authorize a vaccine or therapeutic.

However, we’ve found that FDA has not uniformly disclosed information about its decisions on COVID-19 therapeutics. This lack of transparency could erode the public’s trust in FDA’s decisions about COVID-19 vaccines or therapeutics.

Want to know more? Check out our new report.

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GAO’s Scorecard—How we saved the federal government $77.6 billion this year

Posted on November 16, 2020 by

GAO audits federal programs and spending to ensure that taxpayer dollars are protected and that programs operate effectively and efficiently. While we share our findings with Congress and the public through hundreds of reports and testimonies issued throughout the year, we also publish an annual report summarizing that year’s efforts to improve federal performance and accountability.

So, what did we find during our audits this year?

In our new Performance and Accountability Report, we highlight the $77.6 billion we saved in federal spending. That’s $114 dollars for every dollar Congress invests in us!

Today’s WatchBlog explores some of the ways we have helped save money and other ways we helped improve government operations, all in our FY2020  Performance and Accountability Report.

Saving money

We helped federal agencies save money in FY 2020 by making recommendations to increase oversight, reduce fraud, and make better use of federal funds.

For instance:

  • The construction of the Mixed Oxide Fuel Fabrication Facility (MOX)—initially estimated to cost about $4.8 billion—was to be a key part of the Department of Energy’s approach to dispose of surplus weapons-grade plutonium. We recommended that DOE conduct more oversight reviews of such complex projects—which helped DOE to detect that the project would cost an extra $3 billion. DOE identified a less costly alternative and terminated the MOX project, saving about $13 billion.
  • States may test new approaches for delivering Medicaid services—with the approval of the Department of Health and Human Services (HHS)— but these projects must be budget-neutral. We’ve reported that HHS has allowed states to use questionable methods that resulted in inflated demonstration spending limits and increased the federal government’s fiscal liability. In response, HHS issued a new policy to better ensure that these demonstration projects are budget-neutral—which reduced the government’s fiscal liability in 10 states by an estimated $29.4 billion.
  • Identity theft tax refund fraud is a threat to taxpayers and tax administration. We found that IRS could help address this by matching wage information that employers report on the W-2 tax form to individuals’ tax returns before issuing refunds. However, employers’ wage data were not available until months after IRS issued most refunds. In response, Congress advanced the deadline for employers to file W-2s—which helped IRS prevent about $906.7 million in fraudulent payments.

Improving federal operations

We also reported on other benefits resulting from our work—i.e., benefits that can’t be measured in dollars but led to improvements in federal programs and operations. We helped federal agencies make 1,332 of these improvements in FY 2020.

For example:

  • The Federal Aviation Administration (FAA) oversees compliance with unmanned aircraft systems (UAS or “drones”) regulations, including those prohibiting small UAS from endangering lives and property. However, we reported in 2019 that FAA did not consistently communicate to law enforcement partners on their expected role in UAS safety. FAA also had not determined what data it needed to assess its efforts. We made recommendations to improve FAA’s small UAS oversight. FAA has taken some steps in response, such as improving communication with law enforcement partners. This will better inform law enforcement about what information to share with FAA on unsafe UAS operations.
  • Customs and Border Protection (CBP) apprehended over 850,000 noncitizens along the southwest border in FY 2019. CBP is required to track any family separations, but we found that these separations were not always accurately tracked. We also made a number of recommendations to improve CBP’s oversight of funds, medical care, and the reporting of deaths. In response, CBP plans to improve its guidance for processing family separations, and develop oversight mechanisms for medical care.
  • We’ve reported that inadequate oversight practices at the Veterans Health Administration (VHA) resulted in the agency not reporting medical providers with serious quality and safety concerns to the National Provider Data Bank or state licensing boards. In response, VHA implemented a new tool to ensure that provider concerns are appropriately reported in a timely manner.

Assisting Congress

Our legislative impact was also significant. We received 550 requests for work from 90% of Congress’s standing committees in FY 2020. We issued 586 reports and made 1,459 new recommendations. We were also asked to testify 59 times on topics including COVID-19, disaster preparedness, the 2020 U.S. Census, and the nation’s fiscal health.

Additionally, Congress enacted the CARES Act in 2020, which includes provisions for GAO to monitor the nation’s pandemic response and recovery, track how funds are spent, and report bimonthly on our findings. We issued our first three bimonthly reports, and made 19 recommendations to federal agencies to enhance the nation’s response to the COVID-19 pandemic.

These included:

  • Addressing medical supply shortages and improving the medical supply chain
  • Improving data collection on COVID-19 to better understand health outcomes
  • Improving outreach to eligible recipients of economic impact payments

To learn more about our accomplishments, check out our FY 2020 Performance and Accountability Report.

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The Risks of Lead Paint and How Lead is Detected in Blood

Posted on October 29, 2020 by

Lead exposure poses significant health risks—particularly to children whose growing bodies absorb more lead than adults. In recognition of Lead Poisoning Awareness Week, the WatchBlog is highlighting the dangers of lead poisoning.

On Tuesday, we looked at the risk that lead in water poses to children at their schools and child care centers. The most common source of lead exposure for children, however, actually comes from lead paint hazards in homes and buildings (including schools) built before 1978—the year the government restricted lead-based paint sales.

Today’s WatchBlog explores our work on lead-based paint and how elevated lead levels in blood can be detected in those who have been exposed to it.

Lead paint in schools

In schools, lead dust usually comes from lead-based paint that’s disturbed during renovations, deteriorating paint, and lead-contaminated soil.

In a 2019 report, we surveyed schools about how they’ve dealt with lead paint. We found that about 12% of school districts nationwide inspected for lead-based paint in 2016-2017. About half of those districts found lead-based paint, and all of them took action to reduce or eliminate it or had plans to do so.

Lead paint in homes

In homes, infants and young children are particularly at risk of lead exposure because they frequently crawl on the floor and more often ingest nonfood items.

For a 2018 report, we reviewed the Department of Housing and Urban Development’s efforts to reduce lead exposure in housing, including its lead-reduction grants to state and local jurisdictions. From 2013-2017, HUD awarded over $500 million in these grants—71% of which went to locations in the Northeast and Midwest, which are known to have a high prevalence of lead paint hazards.

We found that HUD could improve its processes for identifying high risk areas for lead paint hazards and recommended, among other things, that it strengthen its oversight of public housing authorities’ compliance with lead paint regulations. In November 2019, we updated these recommendations in a statement for the record to Congress.

Lead safety in your home

If you think your home has lead-based paint, the Environmental Protection Agency (EPA) recommends a number of steps you can take to protect your family from lead hazards, including:

  • Keep painted surfaces in good condition to minimize deterioration
  • Clean floors, window sills, and other surfaces where lead dust can collect regularly
  • Talk to your landlord about fixing surfaces with peeling or chipping paint if you rent
  • Hire only EPA- or state-approved Lead-Safe certified renovation firms when renovating, repairing, or repainting if you own
  • Consult your healthcare provider about testing your children for lead exposure. Your pediatrician can conduct a simple blood test.

In January, EPA issued a new brochure about protecting your family from lead at home. Click here to find out more.

Screening for elevated lead levels in young Medicaid beneficiaries

Blood lead screenings are important for identifying children with elevated blood lead levels, as lead exposure can harm and affect nearly every system of the body and cause developmental delays.

According to the Centers for Disease Control and Prevention, a simple blood test is the best readily available way to measure for lead exposure. But, we found that data from the Centers for Medicare & Medicaid Services on blood lead screenings is incomplete and inaccurate for children enrolled in Medicaid—which provides health care for low-income and medically needy people. This could mean that the number of children not receiving these potentially lifesaving screenings may be higher. And since no one knows how many young children enrolled in Medicaid were actually screened, we recommended improving the collection of such data.

Want to know more about this issue and other health issues facing children? Check out our Children’s Health and Safety page.

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