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Tag: oversight

  • Understanding the Connected MOM Act: Federal Intervention in State Maternal Health Medicaid Coverage

    Understanding the Connected MOM Act: Federal Intervention in State Maternal Health Medicaid Coverage

    Introduction to Medicaid and Maternal Health Coverage

    Medicaid is a healthcare program designed to cover specific medical costs for individuals with lower incomes and limited resources. While the federal government sets baseline regulations and retains oversight authority over Medicaid programs, states maintain primary responsibility for program administration, which leads to variation in Medicaid coverage across the nation. Many state Medicaid programs offer insurance coverage for pregnant individuals through mechanisms such as presumptive eligibility. Presumptive eligibility allows certain vulnerable populations to receive coverage before their application for Medicaid is fully processed. For example, Iowa’s presumptive Medicaid coverage extends Medicaid benefits to all pregnant applicants while their eligibility is being determined, regardless of the final outcome.

    Maternal health remains a critical concern in the United States, where indicators such as preterm births and maternal mortality have continued to rise despite targeted policy interventions. A key factor in improving maternal health outcomes is access to high-quality prenatal care, yet adequate access to prenatal care is declining. A significant reason that many people cannot access adequate prenatal care is a lack of insurance coverage or sporadic insurance coverage during their pregnancy. Research emphasizes that increasing insurance coverage for pregnant people can improve access to prenatal care, which can improve maternal health outcomes.


    While federal regulations mandate certain Medicaid services, including maternal healthcare, the specifics of maternal health coverage are left largely to the discretion of individual states. For instance, Iowa’s presumptive eligibility for pregnant people continues until the applicant receives a determination of full Medicaid eligibility. In contrast, Minnesota’s hospital-based presumptive coverage for pregnant people only lasts for a month. 

    S.141 and the Scope of Federal Intervention

    Introduced on January 16, 2025, S.141—or the Connected MOM Act—aims to identify and address barriers to Medicaid coverage of health monitoring devices in an effort to improve maternal health outcomes. Given that health monitoring devices can expand access to prenatal care by allowing physicians to remotely monitor health metrics, the bill aims to explore how pregnant people might face challenges in obtaining these devices. The bill proposes investigating state-level obstacles to coverage of remote physiologic devices, which include: 

    • Blood pressure cuffs (used to monitor blood pressure)
    • Glucometers (used to assess blood glucose levels)
    • Pulse oximeters (used to measure blood oxygen saturation)
    • Thermometers (used to track body temperature)

    These devices enable at-home monitoring of key health metrics, facilitating earlier intervention for dangerous pregnancy-related conditions. According to legal experts, such investigative efforts generate data that can inform and support future policy development. S.B. 141, which has received bipartisan support, is currently under review by the Senate Finance Committee.

    Perspectives on S.B. 141 and Federal Medicaid Interventions

    Investigative legislation like the Connected MOM Act allocates funding for evidence-gathering to guide future policy decisions. In this case, the bill aims to collect information on how states manage Medicaid coverage for remote physiologic devices that are critical during pregnancy, with the long-term goal of shaping federal Medicaid policies. While supporters of the Connected MOM Act argue that it will provide necessary insights to catalyze Medicaid expansion for pregnant people, others point to the rules and regulations of Medicaid which make it difficult for the federal government to intervene broadly in state Medicaid programs. Given the structural limits on federal influence over state-run Medicaid programs, broad national reforms are often considered too costly or unlikely to yield systemic change. This dynamic was evident in the fate of H.R. 3055—the Black Maternal Health Momnibus Act—which failed to advance beyond the committee stage. Supporters of the Connected MOM Act argue that its incremental, investigative approach will help justify future reforms without being perceived as broad federal overreach. 

    Conclusion

    Each state administers its own Medicaid program, resulting in variations in coverage for certain medical devices, including remote health monitoring devices. Given the importance of these devices in expanding access to prenatal care, S.B. 141 seeks to investigate the best course of action for improving coverage of them across the nation. As it moves through committee, S.B. 141 may give insights on how policymakers can strategically navigate limits on federal power over state health programs.

  • Pros and Cons of California SB-1047: The AI Regulation Debate

    Pros and Cons of California SB-1047: The AI Regulation Debate

    Background

    With the recent emergence of ChatGPT, artificial intelligence (AI) has transformed from an obscure mechanism to a widely-used tool in day-to-day life. Around 77% of devices integrate some form of AI in voice assistants, smart speakers, chatbots, or customized recommendations. Still, while at least half of Americans are aware of AI’s presence in their daily lives, many are unable to pinpoint how exactly it is used. For some, the rapid growth of AI has created skepticism and concern. Between 2021 and 2023, the proportion of Americans who expressed concern about AI increased from 37% to 52%. By 2023, only 10% of Americans were more excited than concerned about AI applications in their day-to-day lives. Today, legislators at the federal and state level are grappling with the benefits and drawbacks of regulating AI use and development. 

    California’s SB-1047: An Introduction

    One of the key players in AI development is the state of California, which houses 35 of the 50 most prominent AI companies in the world. Two cities in California, San Francisco and San Jose, account for 25% of all AI patents, conference papers, and companies worldwide. California has responded to the growing debate on AI use through legislative and governmental channels. In 2023, Governor Gavin Newsom signed an executive order establishing initiatives to study the benefits and drawbacks of the AI industry, train government employees on AI skills, and work with legislators to adapt policies for responsible AI development. 

    One such policy that gained attention is SB-1047, or the Safe and Secure Innovation for Frontier Artificial Intelligence Models Act. The bill passed both chambers of the state legislature, but was vetoed by Governor Newsom in September 2024. Introduced by state senator Scott Weiner of San Francisco, SB-1047 aimed to establish safeguards in the development of large-scale AI models. Specifically, the bill applied to cutting-edge AI models that use a high level of computing power or cost more than $100 million to train. Its key provisions included:

    • Cybersecurity protections: Requires developers to take reasonable cybersecurity precautions to prevent unauthorized access to or unintended use of the AI model
    • Pre-release assessment: Requires developers to thoroughly test their AI model for potential critical harm before publicly releasing it. Establishes an annual third-party audit for all developers
    • “Kill switch”: Requires developers to create a capacity to “promptly enact a full shutdown” of the AI program in the case it risks damage to critical infrastructure
    • Safety protocol: Requires developers to create a written safety and security protocol, assign a senior professional to implement it, publish a redacted version, and send an unredacted version to the U.S. Attorney General upon request
    • Whistleblower protections: Prohibits developers from retaliating against employees who report violations of safety protocol internally or to government officials
    • CalCompute: Establishes a publicly-owned and -operated cloud computing infrastructure to “expand access to computational resources” for researchers and startups

    Pros of SB-1047

    One of the main arguments in favor of SB-1047 was that the bill encouraged responsible innovation. Proponents of the bill emphasized that it aligned with federal policy in targeting large-scale systems with considerable computing power, which pose the highest risk of harm due to their cutting-edge nature. They argued that the bill’s holistic approach to regulation, including preventative standards like independent audits and response protocol like the “kill switch” provision, make it difficult for developers to simply check a box stating they do not condone illegal use of their AI model. 

    Proponents also applauded the bill’s protections for whistleblowers at companies that develop advanced AI models. Given the lack of laws on AI development, general whistleblower protections that safeguard the reporting of illegal acts leave a gap of vulnerability for AI workers whose products are largely unregulated. Supporters say SB-1047 would have filled this gap by allowing employees to report potentially dangerous AI models directly to government officials without retaliation. In September 2024, over 100 current and former employees of major AI companies – many of which publicly advocated against the bill – sent a letter to Governor Newsom in support of the legislation’s protections. 

    Other supporters were enthusiastic about the bill’s establishment of CalCompute, a cloud computing infrastructure completely owned and operated by the public sector. Advocacy group Economic Security California praised CalCompute as a necessary intervention to disrupt the dominance of a “handful of corporate actors” in the AI sector. Other advocates emphasized that CalCompute would complement, rather than replace, corporations in providing supercomputing infrastructure. They argued that the initiative would expand access to AI innovation and encourage AI development for public good. 

    Another key argument in favor of SB-1047 is that the bill would have created a necessary blueprint for AI regulation, inspiring other states and even the federal government to implement similar protections. By signing the bill into law, proponents argue, California would have become the “first jurisdiction with a comprehensive framework for governing advanced AI systems”. Countries around the world, including Brazil, Chile, and Canada, are looking at bills like SB-1047 to find ways to regulate AI innovation as its applications continue to expand. 

    Cons of SB-1047

    SB-1047 received criticism from multiple angles. While some labeled the bill an unnecessary roadblock to innovation, others argued for even stronger regulations.

    On one hand, the bill’s large scope was criticized for focusing too heavily on theoretical dangers of AI, hindering innovation that might lead to beneficial advancements. Opponents contended that some of the language in the bill introduced hypothetical scenarios, such as the creation and use of weapons of mass destruction by AI, with no regard to their low plausibility. Major companies like Google, Meta, and OpenAI voiced opposition to the bill, warning that the heavy regulations would stifle productivity and push engineers to leave the state. 

    Others criticized the bill for its potential impacts on academia and smaller startups. Fei-Fei Li, co-director of Stanford University’s Human-Centered AI Institute, argued that the regulations would put a damper on academic and public-sector AI research. Li also stated that the bill would “shackle open source development” by reducing the amount of publicly available code for new entrepreneurs to build off of – a fear that was echoed by national lawmaker Nancy Pelosi (D-CA).

    On the other hand, some believe the bill did not go far enough in regulating cutting-edge AI. These critics pointed to provisions that exempt developers from liability if certain protocols are followed, which raised questions for them about the bill’s ability to hold developers accountable. They also criticized amendments that reduced or completely eliminated certain enforcement mechanisms such as criminal liability for perjury, stating such changes catered to the interests of large tech corporations. Critics argued that the bill’s vague definitions of “unreasonable risk” and “critical harm” leave ample room for developers to evade accountability. 

    Given the bill’s sweeping language in key areas, critics worried that it could either overregulate, or fail to regulate, AI effectively.

    Recent Developments

    On February 27th, 2025, SB-1047 sponsor Scott Weiner introduced a new piece of legislation on AI safety. The new bill, SB-53, was created with a similar intention of safeguarding AI development, but focuses specifically on the whistleblower protection and CalCompute provisions of the original bill.  

    While California continues to grapple with state-level regulations, the federal government has also taken steps to address AI. The Federal Communications Commission is using the 1980s Telephone Consumer Protection Act to restrict AI-generated human voices. The Federal Trade Commission has warned against AI misuse, including discrimination, false claims, and using AI without understanding its risks. In 2024, the Office of Management and Budget issued AI guidelines for all federal agencies. Later that year, the White House formed an AI Council and the AI and Technology Talent Task Force. Although no federal legislation has been passed, these actions show a growing focus on AI regulation.

    Conclusion 

    California’s Safe and Secure Innovation for Frontier Artificial Intelligence Models Act aimed to regulate AI development through novel safeguards. While it was applauded by some as a necessary response to an ever-evolving technology, others believed its wide regulations would have stifled innovation and entrepreneurship. As AI’s use and applications continue to evolve, new policy solutions are likely to emerge at both a state and federal level in the future. 

  • Protecting Our Democracy Act: Weighing the Pros and Cons

    Protecting Our Democracy Act: Weighing the Pros and Cons

    Background

    The Protecting Our Democracy Act (PODA) is a bill under consideration in Congress that aims to protect the integrity of the democratic process. The bill was originally passed in the House in 2021. It was received in the Senate in late 2021, where it failed to pass due to the use of a filibuster. It was reintroduced to the House in 2023, where it remains.

    PODA’s provisions center around three main goals:

    • Shifting power from the executive to the legislative branch: PODA would limit presidential powers, reassert Congress’s constitutional authority over federal spending decisions, and require congressional approval of presidential emergency declarations. PODA would also codify Congress’s subpoena and investigatory power, giving the legislative branch greater oversight of the executive branch.
    • Preventing corruption: PODA would require greater presidential transparency, enact new protections for both inspectors general and whistleblowers, and codify the Constitution’s Emoluments Clauses, which prevent government officials from receiving profits from foreign officials or states. It would also reinforce the Hatch Act of 1939, which limits the political activities of federal employees and other government officials involved with federally-funded programs.
    • Strengthening election integrity laws: PODA also prohibits foreign election assistance in the form of donations and would require greater transparency in digital political advertisements.

    Arguments in Favor of the Protecting Our Democracy Act

    One of the main arguments in support of PODA is that gradual institutional decay has undermined congressional authority. PODA’s proponents point to resistance to congressional oversight by former Presidents Donald Trump and Barack Obama as evidence of this phenomenon. They argue that the recent growth of the executive branch at the expense of the legislative branch can be mitigated through PODA’s provisions, which give Congress clear authority to enforce subpoenas, reassert congressional power over federal spending, and restrict a president’s use of emergency declarations. Proponents believe that this would effectively reform the balance of power between the two branches and restore the democratic process to the federal government.

    PODA’s supporters also emphasize a need for greater defenses against corruption and abuses of power. They point to the Trump administration’s refusal to disclose tax returns, dismissals of inspectors general, and issuance of pardons for corruption charges against close associates as evidence of the need for greater oversight of the executive branch. They believe that reinforcing the Hatch Act would keep federal programs fair and non-partisan, reduce corruption, and prevent political patronage. Supporters also believe that government whistleblowers need greater protections. A poll conducted by Marist in 2020 found that 86% of American voters agree that there should be more legal protections for federal employees who report fraud. Whistleblower protections are also popular across party lines. Supporters of PODA believe that the bill would provide these popular protections by granting whistleblowers increased anonymity and a private right of action if outed by other government officials.

    Finally, proponents of PODA argue that the bill will prevent foreign interference in elections. The federal ban against foreign interference in national elections has not been updated since the Supreme Court’s 2010 Citizens United v. FEC decision, which allowed corporations and other organizations to spend unlimited amounts of money on campaigns and elections. PODA’s supporters believe that this outdated policy has allowed foreign interests to fund campaigns, pay for digital advertising, and conduct social media campaigns freely, potentially spending almost $1 billion total on U.S. elections in the past decade. If passed, the bill intends to decrease foreign influence by explicitly banning foreign assistance in elections and requiring political groups to report all attempts by foreign actors to influence campaigns or elections.

    Arguments Against the Protecting Our Democracy Act

    The main argument against PODA is that the bill interferes with the separation of power between the three branches of government. Opponents of PODA argue that its provisions diminish the executive branch by requiring congressional oversight of the presidential pardon, a constitutionally-granted presidential power. Critics also believe that PODA would diminish the judicial branch by attaching new definitions to constitutional language that courts have already ruled upon, overriding court decisions and further upsetting the balance of power. Specifically, they point to PODA’s new definition of emoluments, which expands the definition to include payments arising from commercial transactions at fair market value. In light of this, opponents believe that PODA’s passage would upset the American political system of checks and balances by tipping the scales too far in the direction of the legislative branch.

    Opponents of PODA also point to the bill’s protections for whistleblowers and inspectors general as a key reason to oppose the proposal. They believe that the increased protections and anonymity for whistleblowers make it difficult for the federal government to vet claims, shielding poorly-performing employees from scrutiny. They also believe that requiring congressional oversight for firing Inspectors General decreases government efficiency and intrudes on internal operations.

    Critics also believe that PODA is politically-motivated. They argue that the bill specifically targets former President Trump and his administration’s actions. As such, they believe that PODA’s proponents only support it with the intent of politically damaging Trump and that the bill’s provisions are unnecessary.

    Conclusion

    In summary, PODA supporters argue that the bill would restore congressional authority, defend against government corruption and abuses of power, and prevent foreign interference in elections. Critics argue that PODA is a politically-motivated bill that would interfere with the constitutional separation of powers, make it difficult to vet whistleblower claims, and decrease the efficiency of the federal government. 
    After its introduction to the Senate in December 2021, PODA entered committee, where it has remained for the last three years. Even with its recent reintroduction to the House, it is unlikely to pass the Senate in its entirety unless the filibuster is abolished.