What GAO Found Department of Defense (DOD)-affiliated civilians and families in Japan and Guam may receive health care at military medical facilities only if capacity allows (referred to as care on a space-available basis). As a result, these individuals generally rely on local providers for their health care. From fiscal years 2019 to 2024, the number of space-available visits for DOD-affiliated civilians and families at military medical facilities in Japan remained stable overall but varied by year. Over the same time frame, space-available visits at military medical facilities in Guam were stable after a 20 percent decline between 2019 and 2020. DOD officials attributed the decline to a shortage in enlisted support staff in primary care clinics and challenges related to the COVID-19 pandemic. Space-Available Visits at Military Medical Facilities in Japan and Guam In Japan, DOD-affiliated civilians and families face cultural challenges in accessing care with local providers. Commonly cited challenges include language barriers, complex billing, a different approach to care, and a different emergency care system. DOD has taken steps to address some of these challenges. For example, to make civilians more aware of potential challenges they may face, DOD developed a statement of understanding in April 2024 for prospective employees to sign prior to taking a position in Japan. This statement describes their responsibility for obtaining and paying for health care overseas and how health care services in Japan may not be equivalent to those in the United States. The statement is intended to encourage individuals to assess their personal health needs before accepting a job in Japan, according to DOD officials. The department also began a pilot program in January 2025, which is intended to help DOD civilians find Japanese providers and make required, up-front payments for care. In Guam, DOD-affiliated civilians and families face capacity challenges in accessing care with local providers. Commonly cited challenges include failing infrastructure, limited health care professionals, and geographic remoteness. DOD has worked with Guamanian partners to attempt to lease land to build a new public hospital, has provided funding to upgrade existing public medical facilities, and plans to expand military medical facility capacity as the active-duty population grows on the island. DOD also has a working group to address issues that may continue to arise, given its planned growth of the civilian population on Guam. Why GAO Did This Study DOD relies on thousands of federal civilian employees and contractors in Japan and Guam to accomplish its missions in the increasingly important Indo-Pacific region. However, these individuals face unique challenges accessing health care. In 2022, the Defense Health Agency issued guidance restating that these individuals may receive care at military medical facilities only if capacity allows, because active-duty service members and their families are prioritized. The National Defense Authorization Act for Fiscal Year 2024 includes a provision that GAO review health care available to U.S. civilians and contractors who support U.S. Forces Japan and Joint Region Marianas (Guam) overseas, their dependents, and certain dependents of active-duty service members. This report examines how often these DOD-affiliated civilians and families access health care at military medical facilities in Japan and Guam, the challenges these individuals face accessing health care through local providers in Japan and Guam, and the extent DOD is addressing any challenges. GAO reviewed federal law, DOD documentation, and data on space-available visits from fiscal years 2019 to 2024; interviewed officials; and held five non-generalizable, in-person discussion groups with civilians randomly selected from lists of DOD civilians working in Japan and Guam. For more information, contact Rashmi Agarwal at agarwalr@gao.gov.

What GAO Found The Department of Health and Human Services (HHS) leads the nation's medical and public health preparedness and response to emergencies. In this role, HHS oversees the Medical Reserve Corps (MRC), which provides medical and nonmedical support during and after disasters at the state and local level. MRC volunteers were essential in the COVID-19 pandemic and other emergencies, according to MRC leaders from six states and one territory. For example, in 2021, Colorado deployed volunteers to provide medical care at wildfire shelters and distribute tests for COVID-19. Volunteers in Hawaii had multi-day deployments providing medical support to displaced individuals in the 2023 wildfire response. Examples of COVID-19 Volunteer Emergency Response Activities HHS assisted the MRC by providing funding, technical assistance, training, and guidance. To boost the MRC network after the COVID-19 pandemic response, in 2023, HHS made awards to 33 states and jurisdictions. These awards ranged from $376,000 to $2.5 million. HHS relies on MRC network unit information—such as volunteer data and technical assistance assessments—to maintain situational awareness of its capabilities. However, GAO found that volunteer data were unreliable. For example, as of July 2024, about 70 percent of all MRC units' volunteer counts did not indicate when the data were updated. In addition, units are to update data quarterly. However, 41 percent of MRC units' reported number of volunteers remained unchanged from 2020 to 2023, though MRC leaders from selected states told GAO that the number of volunteers was significantly higher during the height of the pandemic and later declined. In both instances, HHS was unable to confirm whether units were making the required data updates or whether there was no change. Moreover, some of the unit leaders GAO spoke to confirmed they did not update the volunteer counts for their units as required by HHS. GAO also found that HHS staff had not always conducted required annual technical assistance assessments of the capabilities of the MRC units. Without ensuring regular Medical Corps data updates and technical assistance assessments, HHS risks having incomplete situational awareness as the coordinator for public health and medical emergency preparedness and response. Why GAO Did This Study Public health emergencies, such as those resulting from wildfires, hurricanes, and infectious disease outbreaks can be devastating. The MRC is a national volunteer network of medical and other health professionals, comprised of approximately 700 local units. These volunteer resources are accessible to states, territories, and localities for workforce support in emergencies. The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 includes a provision for GAO to review states' use of health care volunteers in public health emergencies. This report is follow-up work to our previous reporting and (1) describes MRC leaders' experiences using volunteers, (2) identifies the assistance HHS provided during emergency response, and (3) assesses information HHS uses to maintain situational awareness. GAO reviewed agency documentation and interviewed department officials on assistance provided during emergency response, and submission of quarterly capability information. GAO also interviewed MRC leaders in six states and Puerto Rico.

What GAO Found Federal police officer primary duties include the preservation of the peace, crime prevention and detection, and responding to emergencies on or near federal property. At the end of fiscal year 2023, 17 agencies, including the Federal Bureau of Investigation, employed approximately 12,600 federal police officers within eight executive branch departments. The majority work for the Departments of Defense (49 percent) and Veterans Affairs (32 percent). Federal Bureau of Investigation Police Officers Seven of 17 federal agencies GAO surveyed stated that federal police officer activities have changed since fiscal year 2014. Agencies cited an increased threat environment, civil unrest, and the need for overtime to address staffing shortages as examples of changes in working conditions for federal police officers. Federal police officers generally do not receive enhanced retirement benefits. These enhanced benefits accrue at a higher rate over a shorter period of time than standard federal employee retirement benefits. However, if a department determines that a group of employees, such as federal police officers, meets certain criteria to receive enhanced retirement benefits, it notifies the Office of Personnel Management (OPM), which will review the decision for statutory compliance. None of the eight executive branch departments GAO surveyed had done so for their federal police officers in the past 10 years. GAO's analysis of OPM data showed that federal police across these departments are on nine different pay plans and various specialized pay rates within some of those plans, creating variation. GAO identified a range of considerations regarding potential changes to federal police officers' retirement and pay provisions. These include whether to account for past service, whether federal police officers need to meet physical suitability standards, and whether to provide opt-in or opt-out options. Additionally, changes regarding retirement or pay could have budgetary effects on departments and agencies. For example, retroactively applying enhanced retirement benefits could be very costly to departments and agencies. Why GAO Did This Study Federal police forces play a key role in maintaining the safety and security of federal property, employees, and the general public. Federal law generally does not consider most of these officers to be law enforcement officers for the purpose of receiving enhanced retirement benefits and pay. However, over time, legislation has provided federal police forces at some agencies enhanced retirement benefits, even when they did not meet the legal statutory and regulatory definitions of a law enforcement officer. Some agencies have cited challenges recruiting or retaining federal police officers because of the difference in retirement benefits and pay compared to statutory law enforcement officers. The Joint Explanatory Statement accompanying the Consolidated Appropriations Act, 2023 includes a provision for GAO to report on considerations regarding retirement and pay issues for federal police officers. This report provides information on (1) characteristics and duties of the federal police officer workforce; (2) changes agencies can make regarding retirement and pay; and (3) considerations regarding implementation, finance, and workforce planning to help inform congressional decision-making regarding changes to retirement and pay. To conduct this work, GAO administered two surveys—one to eight departments and another to 17 components within these departments —to gather their perspectives. GAO analyzed past GAO and OPM studies on this topic and used OPM data to conduct analysis. For more information, contact Gretta L. Goodwin at GoodwinG@gao.gov.

What GAO Found Most lobbyists provided documentation for key elements of their disclosure reports to demonstrate compliance with the Lobbying Disclosure Act of 1995, as amended. For the third and fourth quarters of 2023 and the first and second quarters of 2024, GAO estimates that 97 percent of lobbyists who filed new registrations also filed quarterly lobbying disclosure reports as required for the quarter in which they first registered, 93 percent of lobbyists who filed quarterly lobbying disclosure reports provided documentation for lobbying income and expenses, and 95 percent of semiannual contribution reports included all reportable political contributions. These findings are generally consistent with GAO's findings since 2015. Lobbyists are required to report certain criminal convictions. GAO found that, of the 258 individual lobbyists in its sample, none failed to report a conviction. The figure below describes the typical filing and enforcement processes. Typical Lobbying Disclosure Process GAO found that most lobbyists surveyed reported some level of ease in complying with quarterly disclosure requirements and in understanding the definitions of terms used in quarterly lobbying disclosure reports. However, based on GAO's estimates, 21 percent of quarterly lobbying disclosure reports included individual lobbyists who had not properly disclosed covered positions—certain jobs in the executive and legislative branches—as required. To bring lobbyists into compliance, the U.S. Attorney's Office for the District of Columbia continues to contact lobbyists who have not filed their disclosure reports. From 2015 through 2024, the office received 3,566 referrals from the Secretary of the Senate and the Clerk of the House for failure to file quarterly lobbying disclosure reports. As of December 2024, about 36 percent of these referrals were closed as in compliance, and about 63 percent were pending further action. Why GAO Did This Study The Lobbying Disclosure Act of 1995, as amended, requires lobbyists to file quarterly lobbying disclosure reports and semiannual contribution reports, among other requirements. The law includes a provision for GAO to annually audit the extent of lobbyists' compliance with the act. This report (1) determines the extent to which lobbyists demonstrated compliance with disclosure requirements, (2) identifies challenges or potential improvements to compliance that lobbyists report, and (3) describes the efforts of the U.S. Attorney's Office for the District of Columbia in enforcing compliance. This report is GAO's 18th annual review under the provision. GAO reviewed a stratified random sample of 100 quarterly lobbying disclosure reports filed for the third and fourth quarters of calendar year 2023 and the first and second quarters of calendar year 2024. GAO also reviewed a random sample of 160 contribution reports from year-end 2023 and midyear 2024. This methodology allowed GAO to generalize to the population of 67,577 quarterly disclosure reports with $5,000 or more in lobbying activity and 35,034 contribution reports. In addition, through a survey, GAO obtained the views of 99 different lobbyists on any challenges or potential improvements to aid compliance. GAO also interviewed U.S. Attorney's Office officials. GAO provided a draft of this report to the Department of Justice for review. The Department of Justice provided technical comments, which GAO incorporated as appropriate. For more information, contact Yvonne D. Jones at JonesY@gao.gov.