79–006 

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 

2 

1See 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). 2Data Snapshot, Income and Poverty in Appalachia, Appalachian Regional Commission. 

3See Record Overdose Deaths, Opioid Overdose, Centers for Disease Control and Prevention: 

https://www.cdc.gov/drugoverdose/epidemic/index.html. 

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: 

• The household income in Appalachia is 80 percent of the 

U.S. average, and 17 percent of Appalachians live below the 

poverty level.2

• Nationally, the majority of drug overdose deaths involve 

opioids and, since 1999, the number of overdose deaths involving opioids has quadrupled.3

• 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. 

3 

4 ‘‘Where Have All the Workers Gone?’’ Alan B. Krueger, Princeton University, September 

2017. 5Gene Barr, President and CEO, Pennsylvania Chamber of Business and Industry testimony 

Before the Center for Rural Pennsylvania, October 26, 2017. 6 ‘‘Diseases of Despair’’ typically refers to drug and alcohol abuse, related health concerns, and 

suicide. 7Statement 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. 

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

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

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 

4 

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. 

5 

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. 

6 

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. 

7 

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 

* * * * * * * 

§ 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; 

8 

(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. 

* * * * * * * 

Æ