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limited or no Internet access, which restricts their access to telehealth services (especially video visits). To improve its health care policies that affect rural regions, HHS should:

• Reduce the regulatory burden and unleash private innovation that can discover solutions to unique, local needs.

• Implement or encourage policies that increase the supply of health care providers, such as increased telehealth access and interstate licensure (a historically state matter), including for volunteers wishing to provide temporary, charitable services across state lines.

• Encourage flexibility in modes of health care delivery, including less expensive alternatives to hospitals and telehealth independent of expensive air ambulances.

OFFICE OF THE SECRETARY

The Secretary of Health and Human Services and the Office of the Secretary necessarily set the tone for the entire department. The Secretary is the most accountable individual within HHS and, along with his or her immediate staff, should therefore be responsible for setting the policies that govern the department’s operations instead of allowing the operational divisions to assume the leading role in policymaking, thereby diffusing responsibility.

Practical reforms to enhance the Secretary’s accountability should include the following:

• Restrict HHS’s ability to declare indefinite public health emergencies (PHEs). Currently, HHS is merely required to notify Congress of sucha declaration within 48 hours. Congress should establish a set time frame for any PHE, placing on the Secretary the burden of proof as to why an extension of the PHE is necessary.

• Reinstate the HHS SUNSET (Securing Updated and Necessary Statutory Evaluations Timely) rule.” Congress should codify the nowreversed Trump Administration rule that required all HHS agencies to review regulations retrospectively and publish results; without such a review, regulations expire.

• Investigate, expose, and remediate any instances in which HHS violated people’s rights by: