H.R. 3812, Stop Troubling Retroactive Invoices for Veterans Expenses Act of 2025

Source: US Congressional Budget Office

Bill Summary

H.R. 3812 would generally prohibit the Department of Veterans Affairs (VA) from collecting copayments more than two years after a veteran receives health care services. The bill also would extend a temporary limitation on certain pension payments through February 29, 2032.

Estimated Federal Cost

The estimated budgetary effects of H.R. 3812 are shown in Table 1. The costs of the legislation fall within budget functions 550 (health) and 700 (veterans benefits and services).

Table 1.

Estimated Budgetary Effects of H.R. 3812

 

By Fiscal Year, Millions of Dollars

   
 

2026

2027

2028

2029

2030

2031

2032

2033

2034

2035

2026-2030

2026-2035

 

Increases in Spending Subject to Appropriation

   

Estimated Authorization

1

1

1

1

1

1

1

1

1

1

5

10

Estimated Outlays

1

1

1

1

1

1

1

1

1

1

5

10

 

Decreases (-) in Direct Spending

   

Estimated Budget Authority

0

0

0

0

0

0

-12

0

0

0

0

-12

Estimated Outlays

0

0

0

0

0

0

-12

0

0

0

0

-12

Basis of Estimate

For this estimate, CBO assumes that H.R. 3812 will be enacted near the beginning of fiscal year 2026 and that outlays will follow historical spending patterns for affected programs.

Spending Subject to Appropriation

H.R. 3812 would reduce VA’s collections of copayments and thereby increase spending subject to appropriation. Copayments are deposited into the Medical Care Collections Fund and are classified as discretionary offsetting collections (that is, as reductions in discretionary spending).

The bill would prohibit VA from collecting copayments more than two years after a veteran receives care if the department fails to provide timely notification of the veteran’s obligation or if their outstanding balance exceeds $2,000. According to VA, most copayments are billed and paid within two years. On the basis of information about annual collections of copayments, CBO estimates that, under H.R. 3812, those collections would decrease by $1 million annually.

Those forgone copayments, which would be recorded as increases in discretionary spending, would total $10 million over the 2026-2035 period. The authority to collect copayments is subject to the enactment of appropriation legislation.

Direct Spending

H.R. 3812 would extend a temporary limitation on certain VA pension payments. CBO estimates that enacting the bill would decrease net direct spending by $12 million over the 2026-2035 period.

Under current law, VA reduces pension payments to veterans and survivors who reside in Medicaid nursing homes to $90 per month. That required reduction expires November 30, 2031. The bill would extend that reduction for three months, through February 29, 2032. CBO estimates that extending that requirement would reduce VA benefits by $10 million per month. As a result of that reduction in beneficiaries’ income, Medicaid would pay more of the cost of their care, increasing spending for that program by $6 million per month. Thus, enacting the bill would reduce net direct spending by $12 million over the 2026-2035 period.

Pay-As-You-Go Considerations

The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. The net changes in outlays that are subject to those pay-as-you-go procedures are shown in Table 1.

Increase in Long-Term Net Direct Spending and Deficits

CBO estimates that enacting H.R. 3812 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2036.

Mandates

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.

Estimate Reviewed By

David Newman
Chief, Defense, International Affairs, and Veterans’ Affairs Cost Estimates Unit

Kathleen FitzGerald
Chief, Public and Private Mandates Unit

Christina Hawley Anthony
Deputy Director of Budget Analysis

Phillip L. Swagel

Director, Congressional Budget Office

H.R. 3668, Improving Interagency Coordination for Pipeline Reviews Act

Source: US Congressional Budget Office

H.R. 3668 would specify timeframes and procedures for the Federal Energy Regulatory Commission (FERC) and other affected agencies to follow when conducting environmental reviews of natural gas pipelines. In particular, the bill would exempt interstate natural gas pipeline projects from the requirement to obtain water quality certifications from states under section 401 of the Clean Water Act. Instead, affected states would coordinate with FERC on water quality issues as part of the environmental review process.

Under the Natural Gas Act, FERC is the lead federal agency involved in approving and regulating interstate pipelines that carry natural gas. Such projects are subject to a variety of federal and nonfederal permits and authorizations related to a range of issues, particularly environmental matters. Under current law, FERC coordinates those efforts and is ultimately responsible for granting the certificate of public convenience and necessity required to construct or expand interstate natural gas pipelines.

CBO expects that implementing H.R. 3668 could streamline the permitting process and as a result accelerate the production of natural gas on federal lands. Because CBO does not expect that the changes under the bill would significantly affect the time needed to construct natural gas pipelines and related infrastructure, CBO estimates that any increases in offsetting receipts from royalty payments from increased natural gas production (which are recorded in the budget as reductions in direct spending) would total less than $500,000 over the 2026-2035 period.

Using information from FERC and other federal agencies that regulate aspects of interstate natural gas pipelines, CBO estimates that implementing the bill would have no significant net effect on spending subject to appropriation. The bill would not significantly affect the scope of federal agencies’ responsibilities in overseeing such pipelines, and CBO expects that meeting the timeframes specified in the bill would not require a significant change in the level of discretionary funding provided to those agencies. Further, because FERC is authorized to collect fees to recover its costs (which are controlled through annual appropriation acts), CBO estimates that net costs for FERC would be negligible.

If FERC increases their fees to offset the costs of implementing the bill, H.R. 3668 would increase the cost of an existing mandate on public and private entities, such as electric utilities, that are required to pay those fees. CBO estimates that the additional amounts collected would be small and fall well below the thresholds established in the Unfunded Mandates Reform Act for intergovernmental and private-sector mandates ($103 million and $206 million in 2025, respectively, adjusted annually for inflation).

The CBO staff contacts for this estimate are Aaron Krupkin (for the Federal Energy Regulatory Commission), Lilia Ledezma (for onshore gas), and Brandon Lever (for mandates). The estimate was reviewed by H. Samuel Papenfuss, Deputy Director of Budget Analysis.

Phillip L. Swagel

Director, Congressional Budget Office

S. 714, Critical Mineral Consistency Act of 2025

Source: US Congressional Budget Office

S. 714 would require the U.S. Geological Survey (USGS) to update its list of minerals essential to the United States’ economy or national security to include any materials that the Department of Energy (DOE) has designated as critical for energy technologies.

Currently, there are six materials designated as critical by DOE that are not included in the USGS’s list of critical minerals. If those materials were added to the list, the agency would be required to identify all known sources of each material and annually report on each material’s projected supply and demand. Using information from the USGS about the costs of its current assessments, CBO estimates that listing and assessing the six additional materials would cost $2 million over the 2026-2030 period.

If DOE designates new materials after enactment, the USGS would be required to include them on its list and in subsequent annual reports. Using information about the timing of past updates to DOE’s list and the costs of the USGS’s current assessments, CBO estimates that listing and reporting on any new DOE designations would cost $1 million over the 2026-2030 period.

CBO expects that the $50 million that is authorized to be appropriated each year over the 2026-2029 period under current law would be sufficient to cover the costs of those activities through 2029. CBO estimates that there would be insignificant costs to implement the bill in 2030; any related spending would be subject to the availability of appropriated funds.

The CBO staff contact for this estimate is Emma Uebelhor. The estimate was reviewed by H. Samuel Papenfuss, Deputy Director of Budget Analysis.

Phillip L. Swagel

Director, Congressional Budget Office

S. 323, PLAN for Broadband Act

Source: US Congressional Budget Office

Bill Summary

S. 323 would require the National Telecommunications and Information Administration (NTIA) to develop a plan for improving coordination among federal agencies to expand access to broadband Internet and to submit that plan to the Congress. The bill also would direct several federal agencies to report to the NTIA and the Congress on efforts to track broadband construction and to assist the Federal Communications Commission (FCC) with filling in its map that depicts national access to broadband. In addition, the bill would require the Government Accountability Office (GAO) to study and report on the plan’s effectiveness.

Under the bill, agencies specified in the bill would be required to track processing times for permit applications to install, construct, modify, or maintain communications facilities on federal land. (Under current law, such applications must be processed within 270 days.) The bill would require those agencies to analyze any delays, expedite processing, and report annually to the Congress.

Finally, S. 323 would amend title 41 of the Fixing America’s Surface Transportation (FAST) Act to expand the types of projects that are eligible for coverage under the FAST-41 program, which was established in 2015 to streamline federal permitting and environmental review for large energy and infrastructure projects. The bill would lower the cost threshold at which covered broadband construction projects that are subject to review under the National Environmental Policy Act (NEPA) qualify for the FAST-41 program from $200 million to $5 million.

Estimated Federal Cost

The estimated budgetary effect of S. 323 is shown in Table 1. The costs of the legislation primarily fall within budget function 370 (commerce and housing credit).

Table 1.

Estimated Increases in Spending Subject to Appropriation Under S. 323

 

By Fiscal Year, Millions of Dollars

 
 

2026

2027

2028

2029

2030

2026-2030

Estimated Authorization

3

2

1

*

*

6

Estimated Outlays

3

2

1

*

*

6

Basis of Estimate

CBO assumes that S. 323 will be enacted by the end of 2025.

Spending Subject to Appropriation

Using information from the NTIA, CBO estimates that implementing S. 323 would cost $6 million over the 2026-2030 period. Any related spending would be subject to the availability of appropriated funds.

CBO estimates that the costs for employee compensation and contracting to develop a plan to improve coordination among federal broadband programs would total $5 million over the 2026-2030 period. Among other responsibilities, the NTIA would be directed to coordinate the work of federal agencies to establish a strategy, identify potential funding caps for certain broadband subsidies, and create benchmarks for the performance of federal broadband programs.

Using information about the cost of similar reports, CBO estimates that the cost for GAO to complete its study, for 15 federal agencies to report to the NTIA within 60 days of enactment, and for federal agencies to report on delays in processing permits for communications facilities would total $1 million over the 2026-2030 period.

CBO estimates that it would cost the FCC less than $500,000 over the 2026-2030 period to consult with and report to the NTIA and to the Congress about broadband projects. However, because the FCC is authorized to collect fees each year that are sufficient to offset the appropriated costs of its regulatory activities, CBO estimates that the net cost to the agency would be negligible, assuming appropriation actions consistent with that authority.

Direct Spending

S. 323 would authorize certain broadband construction projects to participate in the FAST-41 permitting program, which is administered by the Federal Permitting Improvement Steering Council. To participate in FAST-41 under current law, a project must require an investment of more than $200 million and be subject to NEPA review. S. 323 would reduce that cost threshold to $5 million for broadband projects. CBO expects that under the bill many broadband construction projects that will be funded through the NTIA’s Broadband Equity, Access, and Deployment (BEAD) Program would be newly eligible for FAST-41 coverage. The Infrastructure Investment and Jobs Act provided $42 billion in 2021 for the BEAD Program, which is designed to increase high-speed Internet access across the United States by funding planning, mapping, and deployment of broadband networks. CBO expects that funds for some BEAD projects that would participate in the FAST-41 program could be spent more quickly under S. 323 than under current law. Thus, net direct spending would increase over the 2026-2035 period for those projects.

CBO expects that the increase in direct spending under the bill would be insignificant for three reasons. First, participation is voluntary, so many projects may not choose to participate in FAST-41 even if they are newly eligible under the bill. Second, because most broadband projects are categorically excluded from NEPA’s documentation requirements, CBO expects that very few broadband projects would benefit from FAST-41 participation. Only projects that require an environmental impact statement (EIS) or environmental assessment under NEPA would be eligible for FAST-41.

Third, CBO is uncertain about the extent to which any BEAD projects that newly participate in FAST-41 under the bill would spend funds more quickly than under current law. The Permitting Council’s fiscal year 2024 report to the Congress shows that FAST-41 projects completed their environmental impact statements 23 percent faster than all projects requiring an EIS in that year. However, the NTIA is also streamlining requirements for permitting and environmental review, which reduces the effect of FAST-41 on the permitting process. Certain large, complex projects could benefit by using FAST-41, but those projects would still need to adhere to federal, state, and local permitting and environmental requirements, which all serve to delay project timelines regardless of FAST-41 participation.

Pay-As-You-Go Considerations

The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. CBO estimates that enacting the bill would increase direct spending by less than $500,000 over the 2026-2035 period.

Increase in Long-Term Net Direct Spending and Deficits

CBO estimates that enacting S. 323 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2036.

Mandates

If the FCC increases annual fees to offset the costs of implementing provisions in the bill, S. 323 would increase the cost of an existing private-sector mandate as defined in the Unfunded Mandates Reform Act (UMRA) on private-sector entities required to pay those fees. CBO estimates that the incremental cost of the mandate would be small and would fall well below the annual threshold established for private-sector mandates ($206 million in 2025, adjusted annually for inflation).

S. 323 contains no intergovernmental mandates as defined in UMRA.

Estimate Reviewed By

Justin Humphrey
Chief, Finance, Housing, and Education Cost Estimates Unit

Kathleen FitzGerald 
Chief, Public and Private Mandates Unit

H. Samuel Papenfuss 
Deputy Director of Budget Analysis

Phillip L. Swagel

Director, Congressional Budget Office

Testimony on Growth in the 340B Drug Pricing Program and Its Implications for the Federal Budget

Source: US Congressional Budget Office

Chairman Cassidy, Ranking Member Sanders, and Members of the Committee, thank you for inviting me to testify today. My remarks summarize the Congressional Budget Office’s recent report about the 340B Drug Pricing Program. That report examines trends in drug purchases through the program from 2010 to 2021, the factors driving those trends, and the implications for the federal budget.

H.R. 2294, a bill to reauthorize the Integrated Coastal and Ocean Observation System Act of 2009

Source: US Congressional Budget Office

H.R. 2294 would authorize the appropriation of $56 million annually from 2026 through 2030 for the Integrated Ocean Observing System. The National Oceanic and Atmospheric Administration uses that system, which is composed of buoys, ships, radar, autonomous vessels and other coastal observation devices, to continually monitor and report on marine conditions. The bill also would make administrative and conforming changes to the Integrated Coastal and Ocean Observation System Act of 2009.

Based on historical spending patterns, CBO estimates that implementing the bill would cost $244 million over the 2026-2030 period and $33 million after 2030; such spending would be subject to the appropriation of the specified amounts.

The costs of the legislation, detailed in Table 1, fall within budget function 300 (natural resources and environment).

Table 1.

Estimated Increases in Spending Subject to Appropriation Under H.R. 2294

 

By Fiscal Year, Millions of Dollars

 
 

2026

2027

2028

2029

2030

2026-2030

Estimated Authorization

56

56

56

56

56

280

Estimated Outlays

34

46

54

55

55

244

The CBO staff contact for this estimate is David Rafferty. The estimate was reviewed by Christina Hawley Anthony, Deputy Director of Budget Analysis.

Phillip L. Swagel

Director, Congressional Budget Office

H.R. 740, Veterans’ Assuring Critical Care Expansions to Support Servicemembers Act of 2025

Source: US Congressional Budget Office

Bill Summary

H.R. 740 would extend the deadline for community health care providers to submit claims for payment from the Department of Veterans Affairs (VA). The bill also would require VA to establish a three-year pilot program to allow veterans to access outpatient mental health and substance-use treatment through community providers without prior approval from the department.

In addition, the bill would direct VA to develop an online health care portal to allow veterans to schedule appointments, track referrals, and appeal denials of requests for care. H.R. 740 would require VA to notify veterans of their eligibility for community care and notify veterans in writing when the department denies requests for community care.

The bill also would require VA to report on the clinical appeals process and utilization of community care and would direct the Government Accountability Office to study the department’s ability to use opioid alternatives for pain management and rehabilitation. Finally, the bill would extend the higher rates for fees that VA charges borrowers for home loan guarantees.

Estimated Federal Cost

The estimated budgetary effects of H.R. 740 are shown in Table 1. The costs of the legislation fall within budget function 700 (veterans benefits and services).

Table 1.

Estimated Budgetary Effects of H.R. 740

   

By Fiscal Year, Millions of Dollars

   
   

2026

2027

2028

2029

2030

2031

2032

2033

2034

2035

2026-2030

2026-2035

 

Increases or Decreases (-) in Direct Spending

   

Estimated Budget Authority

 

5

10

11

14

7

7

7

8

-239

-120

47

-290

Estimated Outlays

 

5

10

11

14

7

7

7

8

-239

-120

47

-290

 

Increases in Spending Subject to Appropriation

   

Estimated Authorization

 

22

41

38

40

19

19

21

20

19

21

160

260

Estimated Outlays

 

22

40

38

40

20

19

21

20

19

21

160

260

Basis of Estimate

For this estimate, CBO assumes that H.R. 740 will be enacted near the beginning of fiscal year 2026 and that outlays will follow historical spending patterns for affected programs.

Provisions that Affect Spending Subject to Appropriation and Direct Spending

CBO expects that some of the costs of implementing the provisions of the bill that affect VA health care benefits would be paid from the Toxic Exposures Fund (TEF) established by Public Law 117-168, the Honoring our PACT Act. The TEF is a mandatory appropriation that VA uses to pay for health care, disability claims processing, medical research, and IT modernization that benefit veterans who were exposed to environmental hazards.

Additional spending from the TEF would occur if legislation increases the costs of similar activities that benefit veterans with such exposure. Thus, in addition to increasing spending subject to appropriation, enacting the bill would increase amounts paid from the TEF, which are classified as direct spending. CBO projects that the proportion of costs paid by the TEF will grow over time based on the amount of formerly discretionary appropriations that CBO expects will be provided through the mandatory appropriation as specified in the Honoring our PACT Act.

CBO estimates that over the 2026-2035 period, implementing the health care-related provisions of H.R. 740 would increase spending subject to appropriation by $258 million and direct spending by $87 million.

Claims Submission Deadline. Section 105 would extend by six months the deadline for community health care providers to submit claims for payment to VA. Through the Veterans Community Care program, VA pays for veterans to receive health care from providers in their communities, outside of VA facilities, when the department cannot provide such care according to certain standards for availability, timeliness, and quality. CBO estimates that payments to community health care providers totaled $23 billion in 2025.

Under current law, those community providers must submit claims for payment to VA within 180 days of providing the care. Using information from VA about the reasons that claims are denied, CBO estimates that, although most providers will submit claims within the 180-day limit, extending the filing deadline to one year would increase the number of claims paid by 0.1 percent annually.

CBO estimates that implementing section 105 would cost $228 million over the 2026‑2035 period. Of that amount, $170 million would be spending subject to appropriation, and $58 million would be direct spending from the TEF.

Mental Health and Substance Use Treatment. Section 202 would require VA to allow veterans to receive outpatient mental health and substance use treatment from community providers without prior approval from the department. That requirement would expire after three years.

On the basis of information from VA about projected participation and the average cost of outpatient mental health visits, CBO expects the department would pay for roughly 10,000 patients to receive 10 appointments annually at an average cost of $245 per visit.

In total, CBO estimates that implementing section 202 would cost $75 million over the 2026–2035 period. Of that amount, $58 million would be spending subject to appropriation, and $17 million would be direct spending from the TEF.

Online Health Care Portal. Section 201 would require VA to develop an online system to allow veterans to manage the health care they receive from the Veterans Health Administration, both directly from the department and through the Veterans Community Care program. The system would enable veterans to request appointments, track referrals, receive reminders, and appeal denials of requests for care. VA also would be required to provide an implementation plan and quarterly progress reports to the Congress for two years.

On the basis of information from VA about the costs to develop and maintain new information technology systems, CBO estimates that implementing section 201 would cost $30 million over the 2026-2035 period. Of that amount, $21 million would be spending subject to appropriation, and $9 million would be direct spending from the TEF.

Community Care Notifications. Sections 102 and 103 would require VA to notify veterans about their eligibility for community care and to notify veterans in writing when it denies requests for community care. Section 103 would require VA to include the reason for the denial and instructions on how to appeal the denial when it notifies veterans that their requests for care have been denied. CBO expects that VA would need to develop an electronic system to ensure eligibility notifications are sent to veterans and that managing that system would increase the department’s workload by the equivalent of two full-time employees.

Using information from VA about mailing expenses and staffing costs, CBO estimates that implementing those provisions would cost $12 million over the 2026-2035 period. Of that amount, $9 million would be spending subject to appropriation, and $3 million would be direct spending from the TEF.

Direct Spending

In addition to expanding benefits that would partly be covered by the TEF, enacting section 205 of the bill would affect direct spending by extending higher fees for VA home loan guarantees. In total, CBO estimates that enacting H.R. 740 would decrease net direct spending by $290 million over the 2026-2035 period (see Table 2).

Table 2.

Estimated Increases in Direct Spending Under H.R. 740

 

By Fiscal Year, Millions of Dollars

   
 

2026

2027

2028

2029

2030

2031

2032

2033

2034

2035

2026-2030

2026-2035

Claims Submission Deadline

                       

Estimated Budget Authority

4

4

5

5

6

6

6

7

7

8

24

58

Estimated Outlays

4

4

5

5

6

6

6

7

7

8

24

58

Mental Health and Substance Use Treatment

                       

Estimated Budget Authority

0

5

6

6

0

0

0

0

0

0

17

17

Estimated Outlays

0

5

6

6

0

0

0

0

0

0

17

17

Online Health Care Portal

                       

Estimated Budget Authority

1

1

*

1

1

1

1

1

1

1

4

9

Estimated Outlays

1

1

*

1

1

1

1

1

1

1

4

9

Community Care Notifications

                       

Estimated Budget Authority

*

*

*

2

*

*

*

*

*

1

2

3

Estimated Outlays

*

*

*

2

*

*

*

*

*

1

2

3

Home Loan Fees

                       

Estimated Budget Authority

0

0

0

0

0

0

0

0

-247

-130

0

-377

Estimated Outlays

0

0

0

0

0

0

0

0

-247

-130

0

-377

Total Changes

                       

Estimated Budget Authority

5

10

11

14

7

7

7

8

-239

-120

47

-290

Estimated Outlays

5

10

11

14

7

7

7

8

-239

-120

47

-290

Home Loan Fees. The bill would extend—for about six months—the higher fees that VA charges borrowers for its loan guarantees.VA provides loan guarantees to lenders that allow eligible borrowers to obtain better loan terms—such as lower interest rates or smaller down payments—to purchase, construct, improve, or refinance a home. VA typically pays lenders up to 25 percent of the outstanding mortgage balance if a borrower’s home is foreclosed upon. Those payments, net of fees paid by borrowers and recoveries by lenders, constitute the subsidy cost for the loan guarantees.[2]

Under current law, the rates for most of the fees that borrowers pay to VA for loans guaranteed after June 9, 2034, will drop from a weighted average of about 2.4 percent to about 1.2 percent of the loan amount. The bill would extend the higher rates through November 29, 2034, thereby reducing the subsidy cost of loans guaranteed during that period. Using its forecast of loan volume based on data provided by VA, CBO estimates that extending the higher rates would decrease direct spending by $377 million over the 2026‑2035 period.

Spending Subject to Appropriation

The discussion above in “Provisions That Affect Both Spending Subject to Appropriation and Direct Spending” describes the costs of changes to the VA health care programs. Implementing those provisions would increase spending subject to appropriation by $258 million over the 2026-2035 period, CBO estimates.

In addition, the bill would require VA to report to the Congress on several issues related to veterans’ use of community care and would direct the Government Accountability Office to study VA’s ability to provide pain management therapy without using opioids. On the basis of the costs of similar reports and studies, CBO estimates that satisfying those requirements would cost $2 million over the 2026-2035 period; such spending would be subject to the availability of appropriated funds.

In total, CBO estimates that implementing H.R. 740 would increase spending subject to appropriation by $260 million over the 2026–2035 period (see Table 3).

Table 3.

Estimated Increases in Spending Subject to Appropriation Under H.R. 740

 

By Fiscal Year, Millions of Dollars

   
 

2026

2027

2028

2029

2030

2031

2032

2033

2034

2035

2026-2030

2026-2035

Claims Submission Deadline

                       

Estimated Budget Authority

17

17

17

17

17

17

17

17

17

17

85

170

Estimated Outlays

17

17

17

17

17

17

17

17

17

17

85

170

Mental Health and Substance Use Treatment

                       

Estimated Budget Authority

0

20

19

19

0

0

0

0

0

0

58

58

Estimated Outlays

0

19

19

19

1

0

0

0

0

0

58

58

Online Health Care Portal

                       

Estimated Budget Authority

3

2

2

2

2

2

2

2

2

2

11

21

Estimated Outlays

3

2

2

2

2

2

2

2

2

2

11

21

Community Care Notifications

                       

Estimated Budget Authority

2

2

*

*

*

*

2

1

*

2

4

9

Estimated Outlays

2

2

*

*

*

*

2

1

*

2

4

9

Reports and Studies

                       

Estimated Budget Authority

*

1

*

1

*

*

*

*

*

*

2

2

Estimated Outlays

*

1

*

1

*

*

*

*

*

*

2

2

Total Changes

                       

Estimated Budget Authority

22

42

38

39

19

19

21

20

19

21

160

260

Estimated Outlays

22

41

38

39

20

19

21

20

19

21

160

260

Pay-As-You-Go Considerations

The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. The net changes in outlays that are subject to those pay-as-you-go procedures are shown in Table 2.

Increase in Long-Term Net Direct Spending and Deficits

CBO estimates that enacting H.R. 740 would not increase net direct spending by more than $2.5 billion in any of the four consecutive 10-year periods beginning in 2036.

CBO estimates that enacting H.R. 740 would not increase on‑budget deficits by more than $5 billion in any of the four consecutive 10-year periods beginning in 2036.

Mandates

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.

Estimate Reviewed By

David Newman
Chief, Defense, International Affairs, and Veterans’ Affairs Cost Estimates Unit

Kathleen FitzGerald 
Chief, Public and Private Mandates Unit

Christina Hawley Anthony
Deputy Director of Budget Analysis

Phillip L. Swagel

Director, Congressional Budget Office

Revised Estimate of Changes Under the 2025 Reconciliation Act for Exemptions From Medicare Price Negotiations for Orphan Drugs

Source: US Congressional Budget Office

In CBO’s current assessment, the new law will affect price negotiations for several orphan drugs not originally included in the estimates of budgetary effects of section 71203 of the 2025 reconciliation act. After incorporating those drugs into its analysis, CBO now estimates that the 10-year cost of the section will be $8.8 billion.

H.R. 3613, Streamlining Foreign Military Sales Act of 2025

Source: US Congressional Budget Office

H.R. 3613 would raise the thresholds at which the Administration must notify or report to the Congress on foreign military sales and direct commercial sales of defense articles and services to foreign countries. Notifications of proposed sales typically include a waiting period for Congressional review. Raising the thresholds would eliminate the waiting period for some sales, which could affect their timing and thus the timing of the collection and spending of associated fees. CBO estimates that the change in direct spending would be less than $500,000.

Both types of sales affect direct spending. U.S. defense articles and services are exported or transferred to foreign countries through the Foreign Military Sales (FMS) program, which is managed by the Department of Defense. Those countries pay all costs associated with such sales, and the amounts received in the FMS trust fund are available for obligation without further appropriation. Cash flows to and from that trust fund are classified as direct spending. The Department of State manages the Direct Commercial Sales program and requires defense manufacturers, exporters, and brokers of defense articles and services to register with its Directorate of Defense Trade Controls. The directorate charges registration fees and can spend those fees without further appropriation.

In addition, raising the threshold for notifying and reporting to the Congress would reduce the workloads of the agencies responsible for submitting that information. On the basis of information from the Administration, CBO estimates that implementing H.R. 3613 would reduce administrative costs by less than $500,000 over the 2026‑2030 period. Spending for some of those activities is subject to the availability of appropriated funds.

The CBO staff contact for this estimate is Caroline Dorminey. The estimate was reviewed by Christina Hawley Anthony, Deputy Director of Budget Analysis.

Phillip L. Swagel

Director, Congressional Budget Office

A Qualitative Analysis of the Effects of the Government Shutdown on the Economy as of October 17, 2025

Source: US Congressional Budget Office

CBO was asked for information about the effects on the economy of the lapse in discretionary appropriations (often called a government shutdown) that began on October 1, 2025. The analysis in this letter is based largely on the framework CBO developed in 2019 after the five-week partial shutdown that lasted from December 22, 2018, to January 25, 2019. CBO will continue to analyze the budget and economic effects of the government shutdown and will publish additional information when it is available.

The magnitude of the effects of the shutdown will depend on the Administration’s decisions regarding which executive branch activities continue and which are halted. The Administration has paid active-duty members of the military (including the Coast Guard) this week, and it has stated it will pay certain federal law-enforcement officers. Some agencies, such as the Internal Revenue Service, were able to continue to pay workers during the initial days of the shutdown. In addition, any federal employment that ends because of a reduction in force that would not have occurred in the absence of a shutdown would reduce outlays for federal employees’ compensation beyond the shutdown period.

The magnitude of the effects of the shutdown will also depend on its duration. In CBO’s assessment, the negative effects of the shutdown on the economy will grow the longer the shutdown is in effect. In addition, the economic effects will vary slightly each week, in part because many federal employees are paid every two weeks.