GREEN Hospitals Act
- Sponsor
- Sen. Markey, Edward J. [D-MA]
- Committees
- Health, Education, Labor, and Pensions Committee (primary)
- Last action
- Aug 6, 2026
Bottom line
The GREEN Hospitals Act proposes a substantial federal investment to modernize healthcare infrastructure, making it more resilient to climate change while prioritizing environmental justice and labor standards.
What it actually does
This bill, the "GREEN Hospitals Act," expands the existing Hill-Burton grant program to include projects that increase medical facility resilience to climate disasters and public health crises, authorizing $100 billion for these efforts. It also establishes a new $5 billion Planning and Evaluation Grant Program to help eligible entities develop sustainability and resiliency plans for medical facilities, with a strong emphasis on environmental justice communities and labor protections.
Proponents argue
Supporters argue this bill is a critical step to safeguard public health by ensuring healthcare facilities can withstand and operate during extreme weather events and public health emergencies exacerbated by climate change. They contend it addresses long-standing infrastructure needs, promotes environmental justice by directing resources to vulnerable communities, and upholds fair labor practices in federally funded projects.
Opponents contend
Critics, if any, might raise concerns about the significant federal spending authorized by the bill, questioning its potential impact on the national debt or inflation. Some may also argue that the prescriptive labor requirements could increase project costs or administrative burdens for healthcare providers, potentially hindering participation, or that the focus on environmental justice communities could divert funds from other areas with critical infrastructure needs.
The bill is relatively short and clearly structured, making it accessible for an informed reader to understand its core provisions within a reasonable timeframe.
Section 2(a)(1)(A)
Expansion of Hill-Burton Grant Purposes for Climate Resilience
This provision amends the Public Health Service Act to expand the purposes for which Hill-Burton grants can be awarded. It adds a new clause allowing grants to "increase capacity to provide essential health care and update medical facilities to become more resilient to climate disasters and public health crises to ensure access and availability of quality health care for communities in need." This broadens the scope of eligible projects beyond traditional construction or modernization.
Supporters argue
Proponents argue this expansion is vital for modernizing healthcare infrastructure to meet contemporary challenges, ensuring that hospitals and clinics can continue to serve their communities even when faced with increasing climate-related disruptions.
Critics contend
No specific opposition is typically raised against expanding the purposes of such grants, though general concerns about federal spending or the scope of federal involvement in local infrastructure might apply.
Tradeoffs
The provision balances the traditional goals of the Hill-Burton Act (access to care) with the emerging need for climate adaptation and resilience in healthcare infrastructure.
Section 2(a)(1)(B)
Priority for Climate Mitigation and Disaster Resilience in Hill-Burton Grants
This section establishes new priority criteria for awarding Hill-Burton grants. The Secretary must give priority to projects that include resilience against natural disasters, climate change mitigation, or other predisaster adaptations. Specific examples include onsite distributed energy, high-efficiency HVAC systems, various green infrastructure elements (wetlands, green rooftops, tree planting), infrastructure upgrades to protect access routes, and long-term maintenance of decarbonization infrastructure.
Section 2(a)(1)(B) (new paragraph (4))
$100 Billion Authorization for Hill-Burton Climate Resilience Grants
This provision authorizes the appropriation of $100,000,000,000 for fiscal year 2027 to carry out the expanded Hill-Burton grant program. These funds are designated to remain available until expended, allowing for long-term investment in green and resilient health care infrastructure projects.
Section 2(b)(1)
Labor Protections for Hill-Burton Medical Facility Projects
This section amends the Public Health Service Act to require that applications for medical facility projects seeking Hill-Burton funds provide reasonable assurance that the facility will have adequate staffing and either a collective bargaining agreement with one or more labor organizations or an explicit policy not to interfere with employees' rights under Section 7 of the National Labor Relations Act.
Section 3(b)
Establishment of the Planning and Evaluation Grant Program
This section establishes a new "Planning and Evaluation Grant Program" under the Secretary of Health and Human Services. The program will provide planning grants to eligible entities (States, Tribal governments, political subdivisions, or nonprofit private entities) to develop "sustainability and resiliency plans" for their medical facilities and surrounding infrastructure. These plans are intended to protect patient health and community access by enhancing facility sustainability and resilience to climate change and public health crises.
Section 3(e)(2)
Priority for Planning Grants Serving Vulnerable Populations and Environmental Justice Communities
This provision directs the Secretary to give priority for planning grants to applications that focus on improving medical facilities that primarily serve Medicare/Medicaid beneficiaries or a high proportion of uninsured patients. Additionally, priority is given to facilities located in or serving patient populations that experience low-air quality, lack green space, bear higher cumulative pollution burdens, or are at disproportionate risk from climate change's adverse effects, aligning with environmental justice principles.
Section 3(d)(1)(F) and (G)
Davis-Bacon Act and Labor Rights Requirements for Planning Grant Applications
This provision mandates that applications for planning grants must include reasonable assurance that all laborers and mechanics employed on a project will be paid prevailing wages in accordance with the Davis-Bacon Act. Additionally, applicants must provide reasonable assurance that the facility either has a collective bargaining agreement or an explicit policy not to interfere with employees' rights under Section 7 of the National Labor Relations Act.
Section 3(k)
50% Funding Mandate for Environmental Justice Communities in Planning Grants
This provision establishes a specific funding mandate, requiring that not less than 50 percent of the grant funds awarded under the Planning and Evaluation Grant Program must be used for sustainability and resiliency plans for proposed projects located in environmental justice communities.
Section 3(l)
$5 Billion Authorization for Planning and Evaluation Grants
This provision authorizes the appropriation of $5,000,000,000 for fiscal year 2027 to fund the new Planning and Evaluation Grant Program. These funds are authorized to remain available until expended, providing a substantial and flexible funding stream for the development of sustainability and resiliency plans for medical facilities.
This provision prohibits eligible entities from using (or contracting with agencies that use) employment or training agreements that require an employee or participant to pay a debt if their employment or training relationship is terminated. This is a condition for receiving a grant or technical assistance under the Planning and Evaluation Grant Program.
Section 3(j)
Why it matters:While standard for legislative drafting to place such conditions within the relevant program section, its placement might obscure its broader policy implications regarding worker mobility and protection from predatory practices.
Case for: Proponents argue this provision is crucial for protecting workers from exploitative 'training repayment agreement provisions' (TRAPs) that can trap employees in undesirable jobs, ensuring fair labor practices and promoting worker mobility in federally funded projects.
Case against: Some employers or industry groups might argue that such prohibitions could disincentivize companies from investing in employee training, as they lose a mechanism to recoup costs if an employee leaves shortly after receiving expensive training.
Estimated impact: Potentially impacts thousands of healthcare workers and training participants by removing a significant financial barrier to changing employment or leaving training programs, affecting employment contracts across the healthcare and construction sectors involved in these projects.
This is a technical amendment that strikes paragraph (3) of Section 1610(b) of the Public Health Service Act. The removed paragraph required applications for Hill-Burton grants to include an assurance that the project was not inconsistent with the State plan.
Section 2(a)(2)
Why it matters:This is standard legislative practice for making minor adjustments to existing statutes. It simplifies the application process by removing a potentially outdated or redundant requirement.
Case for: Proponents would argue that removing this requirement streamlines the application process for Hill-Burton grants, reducing bureaucratic hurdles and potentially accelerating the approval of critical infrastructure projects, especially given the new climate resilience focus.
Case against: No specific opposition is typically raised against such technical amendments. However, some might argue that removing the 'State plan consistency' requirement could lead to projects that are less integrated with broader state-level healthcare planning, potentially creating inefficiencies.
Estimated impact: Minor administrative impact, potentially simplifying the application process for Hill-Burton grants for all applicants.