Green New Deal for Health Act
- Sponsor
- Rep. Khanna, Ro [D-CA-17]
- Committees
- Science, Space, and Technology Committee (primary)
- Last action
- Jul 27, 2026
Bottom line
The Green New Deal for Health Act is a sweeping legislative proposal designed to transform the U.S. health care system's relationship with climate change, both by adapting to its impacts and by reducing the sector's own environmental footprint.
What it actually does
This bill establishes a comprehensive 'Green New Deal for Health' by creating new federal offices and programs within the Department of Health and Human Services (HHS) and other agencies. It aims to prepare the health care sector for climate change impacts, decarbonize health care operations, build a climate-resilient health workforce, and strengthen community health in environmental justice communities through significant grant funding, new regulations, and research initiatives. Key provisions include requirements for hospitals regarding service discontinuation, substantial investments in green health care infrastructure, and mandates for climate risk disclosure in medical supplies.
Proponents argue
Proponents argue that the bill is a necessary and urgent response to the growing health threats posed by climate change, which disproportionately affect vulnerable populations. They contend that it will create a more resilient, equitable, and sustainable health care system, protect essential workers, and foster community well-being while simultaneously addressing the health care sector's significant contribution to greenhouse gas emissions. Supporters emphasize the 'whole-of-government' approach and the focus on environmental justice communities.
Opponents contend
Opponents might argue that the bill represents an overreach of federal authority into the health care sector and private industry, imposing burdensome regulations and significant costs that could strain health care providers and manufacturers. Concerns could be raised about the scale of new spending authorizations, potential impacts on health care access or innovation due to new disclosure and manufacturing requirements, and the integration of labor policy into health and climate legislation. Critics may also question the feasibility and administrative complexity of implementing such a broad initiative.
The bill is lengthy and dense, requiring significant time for a thorough review. The estimated reading time is substantial, indicating that a casual reader would struggle to grasp its full implications without dedicated effort.
Title I, Sec. 102
Office of Climate Change and Health Equity and National Strategic Action Plan
This section establishes the Office of Climate Change and Health Equity within HHS to coordinate the federal response to climate change's health impacts. It also mandates the creation of a national strategic action plan within one year to prepare health care systems for climate change, including strategies for identifying vulnerable communities, reducing health sector emissions, and improving disease surveillance for climate-related health issues. The plan requires consultation with various federal agencies, tribal governments, and public stakeholders.
Supporters argue
Supporters argue that a dedicated federal office and a coordinated national plan are essential to effectively address the complex and growing health challenges posed by climate change, ensuring a unified and proactive response across government and the health sector.
Critics contend
Critics might contend that establishing new offices and plans could lead to bureaucratic bloat and inefficient use of resources, potentially duplicating existing efforts or diverting funds from direct health care services.
Tradeoffs
The provision balances the need for centralized coordination and strategic planning against concerns about creating new federal bureaucracy and the potential for overlap with existing climate or health initiatives.
Title II, Sec. 201
Hospital Discontinuation of Services or Closure Requirements
This section amends the Social Security Act to require hospitals participating in Medicare to provide at least 90 days' notice before discontinuing essential services or closing entirely. During this 'notification period,' essential services cannot be discontinued unless there's a clear harm to patient or employee safety. Hospitals must submit mitigation plans if essential services are impacted, which are subject to public comment and potential alternative mitigation plans developed by the Secretary of HHS. Violations can lead to a prohibition on Medicare/Medicaid enrollment for up to three years.
Title II, Sec. 202
Empowering Community Health in Environmental Justice Communities
This section significantly increases funding for community health centers under the Patient Protection and Affordable Care Act, authorizing $130 billion for fiscal years 2027 through 2031, plus an additional $2 billion annually for the same period. It mandates that at least 50% of these funds be awarded to entities for projects or sites located in or serving environmental justice communities. The section also includes a prohibition on using these funds for any activity subject to the Labor-Management Reporting and Disclosure Act of 1959, effectively preventing funds from being used for anti-union activities.
Title III, Sec. 301
Green Hill-Burton Funds for Climate-Ready Medical Facilities
This section amends the Public Health Service Act to authorize $100 billion for fiscal year 2027 for grants to construct or modernize medical facilities. Priority is given to projects that enhance resilience against natural disasters and climate change, including installing onsite renewable energy, high-efficiency HVAC systems, green infrastructure (like wetlands and green rooftops), and protecting access routes. The provision also adds requirements for facilities to have collective bargaining agreements or explicit policies not to interfere with employee union rights as a condition for receiving grants.
Title III, Sec. 302
Planning and Evaluation Grant Program for Sustainability and Resiliency
This section establishes a $5 billion grant program for fiscal year 2027 to help eligible entities (states, tribal governments, nonprofits) develop 'sustainability and resiliency plans' for medical facilities and surrounding infrastructure. Grants are capped at $500,000. Priority is given to facilities serving low-income patients (Medicare/Medicaid beneficiaries, uninsured) and those in environmental justice communities. Grant recipients must ensure Davis-Bacon prevailing wages for laborers and have collective bargaining agreements or non-interference policies regarding unions. It also prohibits the use of training repayment agreements by grant recipients and their contractors.
Title IV, Sec. 401
Office of Sustainability and Environmental Impact within CMS
This section establishes an Office of Sustainability and Environmental Impact within the Centers for Medicare & Medicaid Services (CMS) with $2 million authorized annually from 2027-2036. The Office's purpose is to support health care decarbonization, sustainability, and environmental efforts. Its priority goals include developing regulations for climate-informed care and decarbonization, conducting oversight of health care systems' emissions, and issuing 'Climate-Friendly' health system designations and accreditations. The Office will also report to Congress biennially on its activities and recommendations.
Title IV, Sec. 402
Climate Risk Disclosure for Medical Supplies
This section amends the Federal Food, Drug, and Cosmetic Act to establish a task force, coordinated by the Secretary of HHS, Commissioner of FDA, and Administrator of EPA, to develop a strategy for mandatory climate risk disclosure policies for drug and device manufacturers. The task force will recommend methodologies for calculating emissions from the entire lifecycle of medical products (manufacture, transport, use, waste) and propose policies for public disclosure and oversight. Within one year of enactment, the Secretary must promulgate regulations to establish these mandatory disclosures and incorporate climate risk into related regulatory policies.
Title IV, Sec. 403
Council on Green Health Care Manufacturing
This section establishes a Federal interagency working group, the 'Council on Green Health Care Manufacturing,' chaired by the Secretary of HHS, with members from various federal agencies. The Council is tasked with assessing global and domestic medical supply chains, including their environmental and climate impacts, labor conditions, efficiency, and human rights abuses. Based on this assessment, the Council will recommend regulations and a grant program to support the development of sustainable, zero-emission, and U.S.-based medical supply chains, while also promoting good labor conditions and worker protections. The Secretary must then promulgate these regulations within one year.
Title V, Sec. 501
Education and Training on Climate Change Health Risks
This section establishes a competitive grant program, authorized at $9 billion for fiscal year 2027, for health professions schools. The grants support developing and integrating education and training programs focused on identifying, treating, and mitigating mental and physical health risks associated with climate change, particularly for individuals disproportionately affected. Curriculum must address racial and ethnic disparities, reproductive health, and patient counseling strategies. Grant applicants must demonstrate engagement with frontline and environmental justice communities and include provisions for building inclusive career pathways.
Title V, Sec. 502
Building a Community Health Workforce for the Climate Crisis
This section amends the Public Health Service Act to authorize $10 billion annually for fiscal years 2027 through 2036 for community health worker programs. It expands the purposes of these grants to include building career paths for community health workers (CHWs) through accessible training and apprenticeship opportunities, and establishing 150,000 permanent, prevailing-wage CHW positions by 2031. Grant funds can be used for CHW education on climate change health risks, outreach, and home visitation services. Priority is given to environmental justice communities, and applicants must have collective bargaining agreements or non-interference policies regarding unions.
Title V, Sec. 503
Emergency Grants to Safeguard Essential Health Care Workers
This section authorizes 'such sums as may be necessary' for emergency grants to public or private nonprofit health care facilities and home health agencies. These grants are to provide hazardous duty compensation (up to $13/hour, max $25,000/year) to eligible essential health care workers whose work or commute is hazardous during an emergency or disaster. Funds can also be used for safety measures like alternative transit and personal protective equipment. Eligible workers include direct care workers, medical technologists, public health workers, orderlies, and environmental service staff whose work cannot be done remotely.
Title VI, Subtitle A, Sec. 601
Grants for Resilient Community Mental Health
This section authorizes $100 million annually for fiscal years 2027 through 2031 for grants to nonprofit or community organizations to establish, operate, or expand 'community mental wellness and resilience programs.' These programs take a public health approach to mental health, focusing on strengthening community psychological and emotional resilience, especially in the face of climate change. Grants require the organization of 'resilience coordinating networks' composed of diverse community entities. Not less than 20% of funds are set aside for rural areas and 20% for environmental justice communities.
Title VI, Subtitle C, Sec. 621
Medicare Coverage of Medically Necessary Home Resiliency Services
This section amends the Social Security Act to expand Medicare coverage, beginning January 1, 2027, to include 'home resiliency services' for individuals determined to be 'medically at risk' in the event of a climate or man-made disaster. These services, paid at 100% of the lesser of actual charge or a fee schedule, include items like heat pumps for individuals vulnerable to extreme temperatures, solar batteries for those reliant on electrical medical equipment (e.g., ventilators), and energy-efficient cold storage for heat-sensitive medical supplies. HHS, in consultation with other agencies, must establish a process to determine who is 'medically at risk,' considering geography-specific climate risks, medical reliance on equipment, and chronic conditions.
Title VII, Sec. 701
National Climate and Health Research and Innovation Initiative
This section establishes the 'National Climate and Health Research and Innovation Initiative,' authorized at $5 billion annually for fiscal years 2027 through 2036. The Initiative, led by HHS, aims to develop tools, research, and understanding to prevent, treat, and mitigate climate change's health harms. Activities include research into physical and mental health impacts (especially disproportionate impacts), environmental racism, occupational hazards, medical education, housing issues, and socioeconomic factors. It also supports R&D for sustainable health care operations, decarbonization, and low-climate-footprint medical supplies. An Interagency Committee and an Advisory Council are established to coordinate and advise the Initiative.
Defines 'environmental justice community' as a community with significant representation of communities of color, low-income communities, or Tribal and Indigenous communities that experiences, or is at risk of experiencing, higher or more adverse human health or environmental effects.
Sec. 2. Definitions, (1) Environmental justice community
Why it matters:Standard legislative practice to define terms upfront, but its broad scope and direct link to funding priorities across multiple titles make it highly consequential.
Case for: Proponents argue this definition ensures that federal resources and programs are explicitly directed towards the communities most impacted by environmental burdens and climate change, addressing historical inequities.
Case against: Critics might argue that such a broad definition could lead to subjective interpretations or that focusing on specific demographic criteria could inadvertently exclude other deserving communities.
Estimated impact: This definition is foundational, influencing the allocation of billions of dollars in grants and the targeting of numerous programs throughout the bill.
Authorizes the Secretary of HHS to prohibit a hospital and any hospital under the same ownership entity from being eligible to enroll or re-enroll in Medicare/Medicaid for up to three years if the hospital violates the requirements for discontinuing services or closure.
Sec. 201(l)(4)(D)
Why it matters:While not intentionally 'buried' in a deceptive sense, the technical nature of amending existing statute and its placement within a detailed procedural section means a casual reader might overlook the severity of this penalty.
Case for: Proponents argue this strong penalty is necessary to ensure hospitals comply with requirements designed to protect essential health care access, providing a credible deterrent against irresponsible closures.
Case against: Critics might contend that such a severe penalty, especially impacting an entire ownership entity, could be disproportionate and potentially destabilize other facilities under the same ownership, ultimately harming patient access.
Estimated impact: This provision significantly increases the regulatory risk for hospital systems considering closures or service reductions, potentially forcing them to prioritize community access over financial expediency.
Prohibits any amounts made available for community health centers under this section from being used for any activity subject to the reporting requirements of section 203(a) of the Labor-Management Reporting and Disclosure Act of 1959 (29 U.S.C. 433(a)). This effectively prevents federal funds from being used by employers for anti-union activities.
Sec. 202(g)
Why it matters:This is a classic example of a policy rider, attached to a popular funding stream to ensure its passage. It's unrelated to the core purpose of funding health centers, but rather a specific labor protection.
Case for: Proponents argue that federal funds should not subsidize efforts to undermine workers' rights to organize and collectively bargain, ensuring that health care expansion aligns with fair labor practices.
Case against: Critics might argue that this provision is an inappropriate use of health care funding, politicizing essential services and potentially creating administrative hurdles for community health centers.
Estimated impact: This provision ensures that a significant portion of federal health care funding (over $130 billion) cannot be used for anti-union activities, potentially strengthening labor's position in the health care sector.
These sections add requirements for medical facilities applying for Green Hill-Burton construction/modernization grants (Sec. 301) and Planning and Evaluation grants (Sec. 302). Applicants must provide 'reasonable assurance' that the facility has a collective bargaining agreement with one or more labor organizations or 'has an explicit policy not to interfere with the rights of employees of the facility under section 7 of the National Labor Relations Act.'
Sec. 301(b)(1)(L)-(M) and Sec. 302(d)(1)(G)
Why it matters:These are policy riders, using federal funding as leverage to promote specific labor practices. They are attached to broader health infrastructure bills to increase their chances of enactment.
Case for: Proponents argue that linking federal funding to fair labor practices ensures that investments in health care infrastructure also support good jobs and workers' rights, contributing to overall community well-being.
Case against: Critics might argue that these requirements are extraneous to the primary purpose of climate-resilient health infrastructure, could deter some facilities from applying, or impose undue burdens on non-unionized facilities.
Estimated impact: These provisions could significantly influence labor relations within the health care facilities receiving billions in federal grants, potentially encouraging unionization or strengthening existing collective bargaining agreements.
As a condition of receiving a Planning and Evaluation grant, an eligible entity must certify that it, and any contracted staffing agency or training provider, does not use any provision in employment or training agreements that would require an employee or participant to pay a debt if their employment or training is terminated.
Sec. 302(j)
Why it matters:This is a specific policy rider targeting 'training repayment agreement provisions' (TRAPs), which are a contentious labor issue. Its placement ensures it travels with the broader funding bill.
Case for: Proponents argue that TRAPs trap workers in jobs and hinder career mobility, and prohibiting them ensures that federal funds support fair employment practices and worker freedom.
Case against: Critics might argue that TRAPs are legitimate mechanisms for employers to recoup training investments, and prohibiting them could disincentivize employer-provided training or increase costs.
Estimated impact: This provision would protect workers in facilities receiving these grants from potentially exploitative training repayment clauses, impacting employment contracts and worker mobility in a segment of the health care sector.
Adds a new eligibility requirement for community health workforce grants: applicants must have a documented collective bargaining agreement with one or more labor organizations representing employees or have an explicit policy not to interfere with employees' rights under section 7 of the National Labor Relations Act.
Sec. 502(d)(6)
Why it matters:This is another policy rider, leveraging federal funding to promote specific labor practices within the expanding community health workforce. It's a strategic inclusion to advance labor rights alongside health initiatives.
Case for: Proponents argue that ensuring fair labor practices and supporting workers' rights is integral to building a stable, high-quality community health workforce, aligning with the bill's broader goals of equity and well-being.
Case against: Critics might argue that this condition is unrelated to the core mission of expanding the community health workforce and could create barriers for organizations that do not have or wish to have collective bargaining agreements.
Estimated impact: This provision could significantly influence labor relations within organizations receiving grants to expand the community health workforce, potentially encouraging unionization or strengthening existing agreements.