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115th Congress     }                                          {    Report
                           HOUSE OF REPRESENTATIVES
 2d Session        }                                          {   115-749

======================================================================



 
              TREATING BARRIERS TO PROSPERITY ACT OF 2018

                                _______
                                

 June 12, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Shuster, from the Committee on Transportation and Infrastructure, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 5294]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Transportation and Infrastructure, to whom 
was referred the bill (H.R. 5294) to amend title 40, United 
States Code, to address the impact of drug abuse on economic 
development in Appalachia, and for other purposes, having 
considered the same, report favorably thereon without amendment 
and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose of Legislation...........................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Legislative History and Consideration............................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
New Budget Authority and Tax Expenditures........................     4
Congressional Budget Office Cost Estimate........................     4
Performance Goals and Objectives.................................     5
Advisory of Earmarks.............................................     5
Duplication of Federal Programs..................................     6
Disclosure of Directed Rule Makings..............................     6
Federal Mandate Statement........................................     6
Preemption Clarification.........................................     6
Advisory Committee Statement.....................................     6
Applicability of Legislative Branch..............................     6
Section-by-Section Analysis of Legislation.......................     6
Changes in Existing Law Made by the Bill, as Reported............     7

                         Purpose of Legislation

    H.R. 5294, the Treating Barriers to Prosperity Act, amends 
title 40, United States Code, to address the impact of drug 
abuse on economic development in Appalachia, and for other 
purposes.

                  Background and Need for Legislation

    The Appalachian Regional Commission (ARC) was created in 
the Appalachian Regional Development Act of 1965 (Public Law 
89-4). The primary function of ARC is to provide economic 
development assistance to a 13-state region. The region 
includes all of West Virginia and parts of Alabama, Georgia, 
Kentucky, Maryland, Mississippi, New York, North Carolina, 
South Carolina, Ohio, Pennsylvania, Tennessee, and Virginia. 
ARC is a federal-state governmental agency consisting of the 
governors of the 13 Appalachian states and a federal co-
chairman. Project proposals must originate in, and be approved 
by, a state. The Commission allocates the level of funding to 
each state.
    In 2017, ARC commissioned two reports specifically 
examining potential health challenges to economic development 
in Appalachia. In August 2017, ARC issued ``Health Disparities 
in Appalachia'' and ``Appalachian Diseases of Despair.''\1\ 
These reports detail the health disparities in Appalachia and, 
more specifically, the impact of the opioid crisis in 
Appalachia. Specifically, the reports noted:
---------------------------------------------------------------------------
    \1\See Appalachian Diseases of Despair, Prepared for the 
Appalachian Regional Commission, The Walsh Center for Rural Health 
Analysis, NORC at the University of Chicago (2017); Health Disparities 
in Appalachia, The Cecil G. Sheps Center for Health Services Research, 
the University of North Carolina at Chapel Hill (2017).
---------------------------------------------------------------------------
           The household income in Appalachia is 80 
        percent of the U.S. average, and 17 percent of 
        Appalachians live below the poverty level.\2\
---------------------------------------------------------------------------
    \2\Data Snapshot, Income and Poverty in Appalachia, Appalachian 
Regional Commission.
---------------------------------------------------------------------------
           Nationally, the majority of drug overdose 
        deaths involve opioids and, since 1999, the number of 
        overdose deaths involving opioids has quadrupled.\3\
---------------------------------------------------------------------------
    \3\See Record Overdose Deaths, Opioid Overdose, Centers for Disease 
Control and Prevention: https://www.cdc.gov/drugoverdose/epidemic/
index.html.
---------------------------------------------------------------------------
           Between 1999 and 2014, while the overall 
        mortality rate in non-Appalachian states decreased by 
        10 percent, the overall mortality rate in Appalachia 
        increased by 5 percent. By 2015, the overall mortality 
        rate in Appalachia was 32 percent higher than in the 
        non-Appalachian regions of the United States.
           In 2015, among 15- to 64-year-olds in 
        Appalachia, there were 5,594 overdose deaths--65 
        percent higher in Appalachia than to the rest of the 
        Nation. The disparities were greatest among people 25 
        to 54 years old.
           In 2015, 69 percent of the overdose deaths 
        were caused by opioids.
           In comparing the mortality rates for 
        diseases of despair within states with Appalachian 
        portions and non-Appalachian portions--the differences 
        were stark. For example, in 2015, the mortality rate in 
        Appalachian portions of Maryland were 63 percent higher 
        than in non-Appalachian portions. In Pennsylvania, the 
        difference was 28 percent, and in Kentucky it was 26 
        percent.
    The reports highlight that when examining specifically 
overdose deaths, those individuals who are 25 to 44 years old 
experienced mortality rates 70 percent higher than the non-
Appalachian states. Typically, this group includes those in 
their prime working years which has created a significant 
challenge to economic development in the region. For example, 
the Pennsylvania Chamber of Business and Industry, citing a 
report released in September 2017, noted that opioids are 
responsible for 20 percent of the workforce decline for men and 
25 percent for women.\4\ The Pennsylvania Chamber further noted 
that addressing the opioid epidemic is an integral component of 
workforce strategy.\5\
---------------------------------------------------------------------------
    \4\``Where Have All the Workers Gone?'' Alan B. Krueger, Princeton 
University, September 2017.
    \5\Gene Barr, President and CEO, Pennsylvania Chamber of Business 
and Industry testimony Before the Center for Rural Pennsylvania, 
October 26, 2017.
---------------------------------------------------------------------------
    In testimony before the Subcommittee on Economic 
Development, Public Buildings, and Emergency Management on 
December 12, 2017, the then-Federal Co-Chair Earl Gohl of the 
Appalachian Regional Commission detailed the specific 
impediments to job creation due to opioid and other drug abuse. 
Mr. Gohl noted the impact of opioid abuse on workers in their 
prime productive years and how the abuse is stunting economic 
potential of the region by creating a ``doughnut-hole'' in the 
workforce\6\--people in their prime working years (25 to 54 
years ago) being impacted the most. He further noted the 
challenges are compounded by proportionately fewer health 
professionals in the region.\7\
---------------------------------------------------------------------------
    \6\``Diseases of Despair'' typically refers to drug and alcohol 
abuse, related health concerns, and suicide.
    \7\Statement of Earl Gohl, Federal Co-Chair, Appalachian Regional 
Commission, before the House Subcommittee on Economic Development, 
Public Buildings and Emergency Management, House Committee on 
Transportation and Infrastructure, December 12, 2017.
---------------------------------------------------------------------------
    Because the opioid crisis has created challenges to 
spurring economic development and job creation in already 
distressed communities, positioning economic development 
agencies such as ARC to help overcome these barriers is needed. 
The provisions of the bill ensure funding is specifically 
focused on impediments to job creation and economic 
development, ensures states in the Appalachian region can 
effectively share best practices, and ties in clearer authority 
to attract health-based businesses, workers and technology to 
the region. While the ARC's existing authority has provided ARC 
the ability to support certain efforts to combat the opioid 
crisis, clarifying and strengthening that role is critical to 
economic development in the region.

                                Hearings

    The Subcommittee on Economic Development, Public Buildings, 
and Emergency Management held the following hearing on subjects 
related to matters contained in H.R. 5294:

          ``The Opioid Epidemic in Appalachia: Addressing 
        Hurdles to Economic Development in the Region'' held on 
        December 12, 2017. The purpose of the hearing was to 
        examine the impact of the opioid crisis on efforts in 
        Appalachia to spur economic development and growth in 
        distressed communities, to explore possible solutions 
        to the crisis, and to examine the role of federal 
        economic development programs, such as the Appalachian 
        Regional Commission (ARC), in addressing this epidemic.

                 Legislative History and Consideration

    On March 15, 2018, Representative Lou Barletta (R-PA) 
introduced H.R. 5294 amending title 40, United States Code, to 
address the impact of drug abuse on economic development in 
Appalachia, and for other purposes. The bill was referred 
solely to the Committee on Transportation and Infrastructure.
    On April 12, 2018, the Committee on Transportation and 
Infrastructure met in open session and ordered the bill 
reported favorably to the House by voice vote with a quorum 
present.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires each committee report to include the 
total number of votes cast for and against on each record vote 
on a motion to report and on any amendment offered to the 
measure or matter, and the names of those members voting for 
and against. There were no recorded votes taken in connection 
with consideration of H.R. 5294.

                      Committee Oversight Findings

    With respect to the requirements of clause 3(c)(1) of rule 
XIII of the Rules of the House of Representatives, the 
Committee's oversight findings and recommendations are 
reflected in this report.

               New Budget Authority and Tax Expenditures

    Clause 3(c)(2) of rule XIII of the Rules of the House of 
Representatives does not apply where a cost estimate and 
comparison prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974 has been timely submitted prior to the filing of the 
report and is included in the report. Such a cost estimate is 
included in this report.

               Congressional Budget Office Cost Estimate

    With respect to the requirement of clause 3(c)(3) of rule 
XIII of the Rules of the House of Representatives and section 
402 of the Congressional Budget Act of 1974, the Committee has 
received the enclosed cost estimate for H.R. 5294 from the 
Director of the Congressional Budget Office:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 10, 2018.
Hon. Bill Shuster,
Chairman, Committee on Transportation and Infrastructure,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 5294, the Treating 
Barriers to Prosperity Act of 2018.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Robert Reese.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

H.R. 5294--Treating Barriers to Prosperity Act of 2018

    H.R. 5294 would clarify that the Appalachian Regional 
Commission (ARC) may enter into contracts with and provide 
grants to people and organizations in Appalachia for projects 
and other activities aimed at reducing drug abuse and the 
negative effects of drug abuse, including opioid abuse, in the 
region. Such projects would include facilitating the sharing of 
best practices among states for reducing drug abuse; creating 
programs designed to reduce harm to the workforce from drug 
abuse; attracting relevant health care services, businesses, 
and workers to the region; and developing infrastructure to 
support greater use of telemedicine in Appalachia.
    Under current law, $110 million annually through 2020 is 
authorized to be appropriated to ARC to carry out various 
provisions in law, including the opioid provisions in H.R. 
5294. Because the bill would not increase the amounts 
authorized to be appropriated for those projects, CBO estimates 
that implementing H.R. 5294 would have no budgetary effects. In 
2018, ARC allocated approximately $3 million of the $155 
million provided to ARC to projects addressing the opioid 
crisis and other drug abuse in Appalachia.
    Enacting H.R. 5294 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    CBO estimates that enacting H.R. 5294 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2029.
    H.R. 5294 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The CBO staff contact for this estimate is Robert Reese. 
The estimate was reviewed by H. Samuel Papenfuss, Deputy 
Assistant Director for Budget Analysis.

                    Performance Goals and Objectives

    With respect to the requirement of clause 3(c)(4) of rule 
XIII of the Rules of the House of Representatives, the 
performance goal and objective of this legislation is to amend 
title 40, United States Code, to address the impact of drug 
abuse on economic development in Appalachia, and for other 
purposes.

                          Advisory of Earmarks

    Pursuant to clause 9 of rule XXI of the Rules of the House 
of Representatives, the Committee is required to include a list 
of congressional earmarks, limited tax benefits, or limited 
tariff benefits as defined in clause 9(e), 9(f), and 9(g) of 
rule XXI of the Rules of the House of Representatives. No 
provision in the bill includes an earmark, limited tax benefit, 
or limited tariff benefit under clause 9(e), 9(f), or 9(g) of 
rule XXI.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 5294 establishes or reauthorizes a program of the 
federal government known to be duplicative of another federal 
program, a program that was included in any report from the 
Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

                  Disclosure of Directed Rule Makings

    Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), 
the Committee finds that enacting H.R. 5294 does not direct the 
completion of a specific rulemaking within the meaning of 
section 551 of title 5, United States Code.

                       Federal Mandate Statement

    The Committee adopts as its own the estimate of federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act (Public Law 104-4).

                        Preemption Clarification

    Section 423 of the Congressional Budget Act of 1974 
requires the report of any Committee on a bill or joint 
resolution to include a statement on the extent to which the 
bill or joint resolution is intended to preempt state, local, 
or tribal law. The Committee states that H.R. 5294 does not 
preempt any state, local, or tribal law.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act are created by this 
legislation.

                  Applicability of Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act (Public Law 
104-1).

               Section-by-Section Analysis of Legislation


Section 1. Short title

    Section 1 provides that the Act may be cited as the 
``Treating Barriers to Prosperity Act of 2018.''

Section 2. Drug abuse mitigation initiative

    Section 2 amends Chapter 145 of title 40, United States 
Code, by inserting a new section at the end that authorizes the 
Appalachian Regional Commission to provide technical assistance 
to, make grants to, enter into contracts with, or otherwise 
provide amounts to individuals or entities in Appalachia for 
projects and activities to address drug abuse, including opioid 
abuse, in the region.
    The section also clarifies that the projects and activities 
may include facilitating the sharing of best practices; 
initiating or expanding programs designed to eliminate or 
reduce the harm to the workforce and economic growth of the 
region that results from such abuse; attracting and retaining 
relevant health care services, businesses, and workers; and 
developing relevant infrastructure, including broadband 
infrastructure, that support the use of telemedicine.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italic and existing law in which no change is 
proposed is shown in roman):

                      TITLE 40, UNITED STATES CODE




           *       *       *       *       *       *       *
SUBTITLE IV--APPALACHIAN REGIONAL DEVELOPMENT

           *       *       *       *       *       *       *


               CHAPTER 145--SPECIAL APPALACHIAN PROGRAMS


                         SUBCHAPTER I--PROGRAMS

Sec.
14501. Appalachian development highway system.
     * * * * * * *
14510. Drug abuse mitigation initiative.
     * * * * * * *

SUBCHAPTER I--PROGRAMS

           *       *       *       *       *       *       *


Sec. 14510. Drug abuse mitigation initiative

  (a) In General.--The Appalachian Regional Commission may 
provide technical assistance to, make grants to, enter into 
contracts with, or otherwise provide amounts to individuals or 
entities in the Appalachian region for projects and activities 
to address drug abuse, including opioid abuse, in the region, 
including projects and activities--
          (1) to facilitate the sharing of best practices among 
        States, counties, and other experts in the region with 
        respect to reducing such abuse;
          (2) to initiate or expand programs designed to 
        eliminate or reduce the harm to the workforce and 
        economic growth of the region that results from such 
        abuse;
          (3) to attract and retain relevant health care 
        services, businesses, and workers; and
          (4) to develop relevant infrastructure, including 
        broadband infrastructure that supports the use of 
        telemedicine.
  (b) Limitation on Available Amounts.--Of the cost of any 
activity eligible for a grant under this section--
          (1) not more than 50 percent may be provided from 
        amounts appropriated to carry out this section; and
          (2) notwithstanding paragraph (1)--
                  (A) in the case of a project to be carried 
                out in a county for which a distressed county 
                designation is in effect under section 14526, 
                not more than 80 percent may be provided from 
                amounts appropriated to carry out this section; 
                and
                  (B) in the case of a project to be carried 
                out in a county for which an at-risk 
                designation is in effect under section 14526, 
                not more than 70 percent may be provided from 
                amounts appropriated to carry out this section.
  (c) Sources of Assistance.--Subject to subsection (b), a 
grant provided under this section may be provided from amounts 
made available to carry out this section in combination with 
amounts made available--
          (1) under any other Federal program (subject to the 
        availability of subsequent appropriations); or
          (2) from any other source.
  (d) Federal Share.--Notwithstanding any provision of law 
limiting the Federal share under any other Federal program, 
amounts made available to carry out this section may be used to 
increase that Federal share, as the Appalachian Regional 
Commission determines to be appropriate.

           *       *       *       *       *       *       *