Mandatory Vaccinations: Precedent and Current Laws

Kathleen S. Swendiman
Legislative Attorney

Historically, the preservation of the public health has been the primary responsibility of state and local governments, and the authority to enact laws relevant to the protection of the public health derives from the state’s general police powers. With regard to communicable disease outbreaks, these powers may include the enactment of mandatory vaccination laws. This report provides an overview of the legal precedent for mandatory vaccination laws, and of state laws that require certain individuals or populations, including school-aged children and health care workers, to be vaccinated against various communicable diseases. Also discussed are state laws providing for mandatory vaccinations during a public health emergency or outbreak of a communicable disease.

Federal jurisdiction over public health matters derives from the Commerce Clause of the United States Constitution, which states that Congress shall have the power “[t]o regulate Commerce with foreign Nations, and among the several States ... ” Congress has enacted requirements regarding vaccination of immigrants seeking entry into the United States, and military regulations require American troops to be immunized against a number of diseases. The Secretary of Health and Human Services has authority under the Public Health Service Act to issue regulations necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the states or from state to state. Current federal regulations do not include any mandatory vaccination programs; rather, when compulsory measures are needed, measures such as quarantine and isolation are generally utilized to halt the spread of communicable diseases.


Date of Report: March 10, 2011
Number of Pages: 12
Order Number: RS21414
Price: $29.95

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Medical Malpractice Liability Reform: Legal Issues and 50-State Surveys on Tort Reform Proposals

Vivian S. Chu
Legislative Attorney

Medical malpractice liability is governed by state law, but Congress has the power, under the Commerce Clause of the U.S. Constitution (Art. I, § 8, cl. 3), to enact tort reform laws that would affect actions for medical malpractice liability brought under state law. In the 112th Congress, H.R. 5, the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act was introduced by Representative Phil Gingrey on January 24, 2011, and was marked up on February 9 and 16, 2011, by the House Committee on the Judiciary. This bill would preempt state law with respect to certain aspects of medical malpractice lawsuits. Past Congresses have considered similar measures.

This report does not examine the effects of medical malpractice litigation or medical malpractice liability reform on the health care system or on the cost of liability insurance premiums; rather, it explains specific tort reform proposals that are commonly included in medical malpractice liability reform bills, and discusses the individual arguments in favor of and against such proposals from a legal perspective. These proposals include imposing caps on noneconomic damages and punitive damages; permitting defendants to be held liable for no more than their share of responsibility for a plaintiff’s injuries; requiring that damage awards be reduced by amounts plaintiffs receive from collateral sources such as health insurance; limiting lawyers’ contingent fees; creating a federal statute of limitations; and requiring that awards of future damages in some cases be paid periodically rather than in a lump sum. It also includes, where appropriate, a description of H.R. 5’s provisions with respect to these categories.

An Appendix to this report includes five tables. The first table (Table A-1) is a 50-state survey of definitions of a medical malpractice action or to whom state medical malpractice statutes apply. The second table (Table A-2) is a 50-state survey of caps on noneconomic and punitive damages. The third table (Table A-3) is a 50-state survey of the burden of proof standards for punitive damages and whether a state requires a separate proceeding to determine such damages. The fourth table (Table A-4) is a 50-state survey of whether the doctrine of joint and several liability applies to malpractice actions in a state and whether periodic payment of damages is to be considered in an award for a medical malpractice action. The fifth table (Table A-5) is a 50-state survey of limits on attorneys’ contingency fees.


Date of Report: March 14, 2011
Number of Pages: 76
Order Number: R41661
Price: $29.95

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Public Health and Emergency Preparedness: CRS Experts

Sarah A. Lister
Specialist in Public Health and Epidemiology

The following table provides access to names and contact information for CRS experts on policy concerns relating to public health and emergency preparedness. Policy areas identified include 

• public health and medical system preparedness and response; 
• legal issues in preparedness and response; 
• medical countermeasures; 
• homeland security research and development; and 
• health effects of threat agents.

Date of Report: March 17, 2011
Number of Pages: 4
Order Number: R40904
Price: $19.95

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Authority of the Secretary of HHS To Waive the Maintenance of Effort Requirements in Section 2001(b) of PPACA

TO: Senate Finance Committee

FROM: Legislative Attorney

This responds to your request for a legal analysis of the authority of the Secretary of Health and Human Services {“Secretary”} to waive the maintenance of effort requirements of Section 2001(b) of P.L. 111-148, the Patient Protection and Affordable Care Act (“PPACA”), under the demonstration project waiver authority of Section 1115(a) of the Social Security Act.


Date of Report: March 3, 2011
Number of Pages: 5
Order Number: M-030311
Price: $19.95

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The Americans with Disabilities Act: Legislation Concerning Notification Prior to Initiating Legal Action

Nancy Lee Jones
Legislative Attorney

The Americans with Disabilities Act (ADA) provides broad nondiscrimination protection in employment, public services, and public accommodation and services operated by private entities. Since the 106th Congress, legislation has been introduced to require plaintiffs to provide notice to the defendant prior to filing a complaint regarding public accommodations. In the 112th Congress, H.R. 881 was introduced by Representative Hunter to amend Title III of the ADA to require notification.


Date of Report: March 17, 2011
Number of Pages: 9
Order Number: RS22296
Price: $19.95

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The National Institutes of Health (NIH): Organization, Funding, and Congressional Issues

Judith A. Johnson
Specialist in Biomedical Policy

Pamela W. Smith
Analyst in Biomedical Policy

The National Institutes of Health (NIH) is the focal point for federal health research. An agency of the Department of Health and Human Services (HHS), it uses its $31 billion budget to support more than 325,000 scientists and research personnel working at over 3,000 institutions across the U.S. and abroad, as well as to conduct biomedical and behavioral research and research training at its own facilities. The agency consists of the Office of the Director, in charge of overall policy and program coordination, and 27 institutes and centers, each of which focuses on particular diseases or research areas in human health. A range of basic and clinical research is funded through a highly competitive system of peer-reviewed grants and contracts.

Congress doubled the NIH budget over a five-year period from its FY1998 base of $13.7 billion to the FY2003 level of $27.1 billion. Since then, the growth rate of the NIH budget has been below the rate of inflation, which for biomedical research in FY2011 is estimated to be 2.9%. The American Recovery and Reinvestment Act (ARRA ) provided NIH with an additional $10.4 billion to be spent over the two-year period of FY2009 through FY2010. The Continuing Appropriations Act, 2011 (P.L. 111-242), as amended, provides temporary FY2011 funding through March 18, 2011, at the FY2010 rate of operations. H.R. 1, the Full Year Continuing Appropriations Act, 2011, would provide funding for NIH for the remainder of the fiscal year. According to the House Appropriations Committee, the bill would reduce the NIH budget by $1.63 billion compared to the FY2010 level and by $1.57 billion compared with the FY2011 request. For FY2012, the Obama Administration has requested $32 billion for NIH, an increase of $745 million (2.4%) over FY2010.

Appropriators and authorizers face many issues in working with NIH to set research priorities in the face of tight budgets. Congress accepts, for the most part, the priorities established through the agency’s complex process of weighing scientific opportunity and public health needs. While the Public Health Service Act (PHSA) provides the statutory basis for NIH programs, it is primarily through appropriations report language, not budget line items or earmarks, that Congress gives direction to NIH and allows a voice for advocacy groups. Challenges facing the agency and the research enterprise, all aggravated by restrained budgets, include attracting and keeping young scientists in research careers; improving the translation of research results into useful medical interventions through more efficient clinical research; creating opportunities for transdisciplinary research that cuts across institute boundaries to exploit the newest scientific discoveries; and managing the portfolio of extramural and intramural research with strategic planning, openness, and public accountability.

The last time Congress addressed NIH with comprehensive legislation was in December 2006 when it passed the NIH Reform Act (P.L. 109-482). Congressional oversight of NIH activities may focus on pending financial conflicts of interest regulations and proposals to reorganize the institutes and centers, such as the new National Center for Advancing Translational Sciences (NCATS). Also, health reform legislation (P.L. 111-148) requires NIH to implement the Cures Acceleration Network (CAN). The purpose of CAN is to support revolutionary advances in basic research and facilitate FDA review of CAN-funded cures. However, although P.L. 111-148 authorizes $500 million for CAN in FY2010, CAN would be funded via a specific appropriation—not through the general NIH appropriation. If CAN receives an appropriation, NIH would determine which medical products are “high need cures,” and then make awards to research entities or companies in order to accelerate the development of such high need cures.


Date of Report: March 16, 2011
Number of Pages: 47
Order Number: R41705
Price: $29.95

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Answers to Questions on P.L. 111-347, the James Zadroga 9/11 Health and Compensation Act of 2010

TO: Honorable Carolyn Maloney
Attention: Elizabeth Darnall

FROM: Scott Szymendera
Analyst in Disability Policy

Vivian S. Chu
Legislative Attorney

This memorandum provides answers to the questions on P.L. 111-347, the James Zadroga 9/11 Health and Compensation Act of 2010, that you submitted to the Congressional Research Service (CRS) on January 12, 2010 and January 14, 2010. Each answer includes a citation, in brackets, to one of the following authorities:

• The Public Health Service Act (42 U.S.C. §§ 201 et. seq.), as amended by P.L. 111-347 (referred to as PHSA); or
• The Air Transportation Safety and System Stabilization Act (49 U.S.C. § 40101 note), as amended by P.L. 111-347 (referred to as ATSSSA).

Responses to these questions should not be construed as providing advice concerning possible individual claimant cases.


Date of Report: January 20, 2011
Number of Pages: 14
Order Number: M-012011
Price: $29.95

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