What GAO Found In June 2025, GAO identified six open recommendations under the purview of the Nuclear Regulatory Commission's Chief Information Officer (CIO), from previously issued work. Each of these recommendations relates to a GAO High-Risk area: (1) Ensuring the Cybersecurity of the Nation or (2) Improving IT Acquisitions and Management. For example, GAO recommended that the agency fully implement all event logging requirements as directed by the Office of Management and Budget. GAO also recommended that the CIO develop guidance regarding standardizing cloud service level agreements, and that the Nuclear Regulatory Commission complete annual reviews of its IT portfolio consistent with federal requirements. The CIO's continued attention to these recommendations will help ensure the secure and effective use of IT at the agency. Why GAO Did This Study CIO open recommendations are outstanding GAO recommendations that warrant the attention of agency CIOs because their implementation could significantly improve government IT operations by securing IT systems, identifying cost savings, improving major government programs, eliminating mismanagement of IT programs and processes, or ensuring that IT programs comply with laws, among others. For more information, contact Nick Marinos at marinosn@gao.gov.

This letter provides GAO's comments on the American Institute of Certified Public Accountants (AICPA) Auditing Standards Board's (ASB) proposed Statement on Auditing Standards (SAS), External Confirmations. GAO promulgates generally accepted government auditing standards, which provide professional standards for auditors of government entities in the United States.

What GAO Found NASA major projects aim to explore the solar system, advance aeronautic technologies, and return U.S. astronauts to the lunar surface through the Artemis missions. These major projects are increasingly focused on Artemis—building a sustained human presence on the moon and ultimately traveling to Mars. The cost and schedule performance of NASA's 18 major projects in development (those that are building and testing their designs) generally remained unchanged over the last year. The four projects that experienced annual cost growth collectively reported over $500 million in overruns. NASA's human spaceflight crew capsule, known as the Orion Multi-Purpose Crew Vehicle program, accounts for over $360 million of this total annual cost growth. Most major NASA projects since GAO's first assessment in 2009 have avoided significant cost overruns. GAO found that of the 53 major projects that have completed development or are currently in the final phase of development, 30 remained under the statutory threshold for reporting cost overruns. Specifically, these 30 project's development costs did not exceed their baselined cost estimates by 15 percent or more. When a project's overrun rises to this threshold, NASA is required to take certain steps. For example, it must notify congressional committees of the overrun and update the project's cost or schedule plans. At the same time, Artemis and Artemis-related cost overruns are an increasing proportion of the portfolio's overall overruns. Three Artemis projects account for nearly $7 billion of the total overruns—or almost half of the overruns collectively experienced by the 53 projects. Accumulated Cost Overruns for 53 NASA Major Projects That Completed or Are in Final Phase of Development Since GAO's First Annual Assessment in 2009 The growing Artemis portfolio could drive cost performance in the future, since NASA recently initiated nine new Artemis projects with estimated total costs over $20 billion. These projects are interdependent, meaning that challenges and delays in one can create challenges and delays for all of them. Further, delays to mission dates can also increase costs. As the Artemis projects progress in development, the agency has taken steps to help manage and mitigate risks, such as creating more oversight of programs through the Moon to Mars office. Why GAO Did This Study The National Aeronautics and Space Administration (NASA) plans to invest about $74 billion in estimated life cycle costs for its portfolio of major projects (those with costs over $250 million). House explanatory statements have included provisions for GAO to prepare status reports on these projects. GAO assessed the (1) cost and schedule performance of NASA's major projects in development, and (2) historical cost performance of NASA's major projects included in GAO annual reviews since 2009. This report also includes summaries of NASA's 38 major projects. GAO collected and analyzed data on the 38 current NASA major projects, visited NASA facilities, and interviewed officials. GAO analyzed cost and schedule performance for 18 projects in development with cost and schedule baselines. GAO also collected and analyzed cost data for 53 historical projects that have completed or are in the final stage of development.

What GAO Found The Department of Veterans Affairs (VA) and Department of Defense (DOD) have shared mutually beneficial medical and other services through 185 sharing agreements, as of April 2025. For example, veterans may receive care at DOD facilities for services including surgery, orthopedics, and mental health. These agreements can result in greater access to care for veterans and cost savings for the federal government, in part because of the discounted rate that VA and DOD pay each other for health care delivered under such sharing agreements. Department of Veterans Affairs Medical Clinic Located on a Military Base VA and DOD collect information on the characteristics of all sharing agreements as well as referrals of veterans to DOD facilities made through sharing agreements; however, the departments do not evaluate the effectiveness of sharing agreements. Officials told GAO that they use the number of sharing agreements and the continuation of agreements as measures of the agreements' value. However, VA and DOD could maximize the benefits of these agreements by developing a performance management process, including establishing performance goals for the agreements, evaluating progress towards the goals, and making changes as appropriate. VA and DOD have taken some steps to identify new or expanded sharing opportunities, including tracking space-sharing projects through a committee. However, the departments largely rely on local officials to identify potential areas for new and expanded sharing, which may result in missed opportunities for sharing. Developing a systematic, department-level process to identify and implement opportunities for new and expanded sharing agreements could help ensure the departments maximize sharing, which could in turn help improve patients' access to care as well as reducing costs. Why GAO Did This Study VA and DOD operate two of the nation's largest health care systems. Together, these systems serve over 18 million beneficiaries. VA's health care system includes approximately 170 medical centers and 1,200 clinics, while DOD's health care system includes more than 700 medical facilities worldwide. VA and DOD have entered into agreements to share health care services to improve access to and cost effectiveness of care. GAO was asked to review the departments' use of sharing agreements. This report describes the number and types of sharing agreements; examines the extent to which VA and DOD assess them; and examines how VA and DOD identify opportunities for new or expanded sharing agreements, among other topics. GAO reviewed VA and DOD documents and data, including active sharing agreements as of April 2025; conducted site visits to 12 VA and DOD facilities with active agreements, selected to represent diversity in geography and the type of sharing taking place; and interviewed VA and DOD officials.

What GAO Found The U.S. territories' levels of public debt vary, along with the factors that affect each of their capacities for economic growth and debt repayment. To assess their ability to repay debt, GAO used the most recently available audited financial statements. Audited financial statements for some territories are almost 2 years late, and independent auditors have identified issues that raise data reliability concerns for the available statements. These financial reporting limitations can lead to poor financial decisions and lost access to capital markets. Geographic Locations of U.S. Territories Commonwealth of Puerto Rico: As of June 30, 2022, total public debt outstanding was $52.8 billion, 47 percent of gross domestic product (GDP). Negotiations and litigation to restructure the electric utility debt are ongoing, and the utility has been struggling to make its pension payments in the meantime. Guam: As of September 30, 2023, total public debt outstanding was $2.5 billion. 2023 GDP data are not available, but the fiscal year 2022 total public debt was $2.6 billion, about 38 percent of GDP. Its tourism industry has not returned to pre-COVID-19 levels, but U.S. military investment is bolstering the economy. U.S. Virgin Islands (USVI): As of September 30, 2021, total public debt outstanding was more than $2.2 billion, or 50 percent of GDP. USVI's electric utility has critical financial and operational problems, which create challenges for residents and can inhibit economic development. Commonwealth of the Northern Mariana Islands (CNMI): As of September 30, 2021, total public debt outstanding was $121.1 million, about 13 percent of GDP. Its tourism-reliant economy has limited prospects for recovery, and the challenges to meet its financial obligations have deepened. American Samoa: As of September 30, 2023, total public debt outstanding was $145.4 million. While 2023 GDP data are not available, the fiscal year 2022 total public debt was $152.4 million, about 18 percent of GDP. Its continued economic reliance on a single tuna cannery presents risks. Why GAO Did This Study The five permanently inhabited U.S. territories—the Commonwealth of Puerto Rico, Guam, USVI, CNMI, and American Samoa—have borrowed through financial markets to bridge the gap between tax receipts and the financial resources required to fund government programs. The territories all face challenges to achieving continued economic growth and financial accountability, both of which are key to debt management. GAO has previously reported on some of the common challenges, including (1) the location of the islands, which leads to a high cost of energy and imported goods; (2) increasing vulnerability to frequent and severe episodes of extreme weather; (3) undiversified economies based on few industries with limited job opportunities; and (4) outmigration and population loss. In 2016, Congress passed and the President signed the Puerto Rico Oversight, Management, and Economic Stability Act. It contains a provision for GAO to review the territories' public debt every 2 years. This is the fifth report in this series. In this report, for each of the five territories, GAO presents public debt figures and describes risk factors that may affect their ability to repay public debt, among other updates. GAO analyzed audited financial statements for fiscal years 2020 through 2023, as available. GAO also reviewed demographic and economic data and interviewed officials from the territories' governments. For more information, contact Yvonne D. Jones at JonesY@gao.gov or Latesha Love-Grayer at LoveGrayerL@gao.gov.

What GAO Found Over the last 30 years, the Department of Defense (DOD) has used different acquisition strategies to procure launches for military satellites from commercial providers. DOD's most recent acquisition strategy—Phase 3—responds to DOD's evolving and growing demand for launch services and infrastructure. Phase 3 is a dual lane approach intended to lower government launch costs, ensure mission success and access to space, and facilitate competition. Lane 1: Expands DOD's supply of newer commercial providers that can meet a subset of launch requirements. Lane 2: Assures DOD's access to space with three commercial providers, which must meet all launch requirements for a specified number of DOD's most critical payloads. DOD is also taking steps to upgrade its launch infrastructure, which is strained by the increased rate of launches. In addition to military launches, companies use federal ranges to meet their own commercial launch needs—and commercial launches have more than quadrupled since 2021. Commercial Launches at Federal Launch Sites Have Quadrupled Since 2021 Increases in commercial launches have resulted in DOD providing more support to commercial entities, but DOD has struggled to accurately bill companies for direct costs. Until recently, DOD could not collect and be reimbursed for indirect costs for commercial space launch services, which include the actual costs of maintaining, operating, upgrading, and modernizing DOD space-related facilities. Recent legislation allows DOD to be reimbursed for indirect costs within certain limitations, but DOD does not have clear cost collection and reimbursement guidance for support services at launch ranges, potentially missing opportunities to recoup millions of dollars. DOD has limited payload processing capacity and lacks sufficient commercial scheduling information to manage payload processing, which is when the payload is integrated with the launch vehicle before it is transported to the launch pad. The lack of insight into commercial processing schedules hinders DOD's efforts to coordinate processing for its own payloads. As a result, it lacks a critical tool to ensure effective coordination and efficient use of its existing and future processing capacity. Why GAO Did This Study Commercial and military activities in space have grown considerably in the last decade, with continued growth expected. This growth will increase the demand on the federal launch infrastructure that supports these activities. DOD has already invested billions of dollars into launch systems and infrastructure. To support the growing demand, DOD expects to spend over $18 billion on launch services and infrastructure over the next 5 years. A Senate report includes a provision for GAO to assess DOD's Phase 3 strategy. GAO's report addresses (1) DOD's Phase 3 strategy to meet its national security space launch demand and (2) the extent to which DOD is addressing launch-related challenges as it executes Phase 3. To conduct this work, GAO reviewed documentation, analyzed launch data, and visited all three federally owned launch ranges. GAO also interviewed DOD officials, other federal agency officials, and contractor representatives involved in launch activities.

What Participants Discussed During the forum, participants identified approaches in five key areas that could help reduce health care spending or increase the value for that spending (see figure). Key Areas Identified by Participants at GAO’s Forum on Health Care Spending in the U.S. Supporting a high-functioning primary care system by providing more resources for team-based care through a payment model that combines fee-for-service payment with a fixed amount paid to providers regardless of the services provided. This could improve continuity of care and care coordination and help decrease unnecessary services and inappropriate tests. Expanding the health care workforce by increasing the graduate medical education opportunities to help address shortages and the uneven distribution of physicians across the country. Increasing compensation and other benefits could also attract and retain home health workers and nursing assistants. Expanding the workforce could increase access to care and reduce the need for costly services, such as institutional care (hospitalization or nursing home care). Reforming health care pricing and promoting high-value care by adopting pricing strategies used by other countries particularly in cases where prices for medical services and pharmaceuticals exceed their clinical value. Reforming Medicare physician payments by revising the Medicare physician fee schedule particularly in cases where it may incentivize physicians to provide specialty care services (e.g., diagnostic imaging) over primary care services (e.g., clinical diagnosis), or to provide more services than are necessary. Mitigating anticompetitive incentives and practices by implementing entirely site-neutral payments in Medicare, wherein Medicare pays the same rate for a medical service regardless of the site where it is performed. This could reduce the incentives for hospitals and physician practices to consolidate. Participants agreed that legislative action, federal investment, or both would be needed to implement most of the approaches discussed. Why GAO Convened This Forum For many years, GAO has raised the alarm about the federal government being on an unsustainable long-term fiscal path. One of the key drivers of federal debt is spending on federal health programs, such as Medicare and Medicaid. Spending on federal health programs is projected to increase at a faster rate than the gross domestic product (GDP) over the next 30 years. As the population ages and health care costs increase, GAO projects that federal spending on health care programs will be 8.5 percent of the GDP in 30 years. Efforts to contain these costs have been met with mixed success. On October 22, 2024, GAO convened a diverse panel of 30 health care experts to focus on the challenges of health care spending. The purpose of the panel was to help advance the dialogue and identify issues associated with one of the most perplexing problems facing the government. It comprised federal government officials, academics, researchers, clinicians, and industry experts who represented a range of expertise and experiences. Participants discussed approaches to reduce health care spending and enhance value received for that spending, among other things. The viewpoints summarized in the report do not necessarily represent the views of all participants, their affiliated organizations, or GAO. GAO provided participants the opportunity to review a draft of this summary. Their comments were incorporated as appropriate. For more information, contact Jessica Farb at FarbJ@gao.gov.

What GAO Found Under coastwise laws, U.S. vessel owners and operators engaged in domestic trade generally must use U.S.-built vessels. The construction of vessels in U.S. shipyards helps to support the U.S. maritime industry, which plays a vital role in national defense. Because U.S.-built vessels generally cost more than foreign-built ones, the Maritime Administration has four financial assistance programs to encourage or improve U.S. shipbuilding. The Federal Ship Financing Program generally offers loan guarantees for vessel construction at U.S. shipyards. In the last 5 years, the program executed two loan guarantees for two vessel owners totaling nearly $400 million. The two tax deferral programs, the Construction Reserve Fund Program and the Capital Construction Fund Program, allow vessel owners or operators to defer paying tax on certain eligible deposits that are placed into an account and can be used to fund projects at U.S. shipyards. In 2024, seven vessel owners or operators had a Construction Reserve Fund program account, and 137 vessel owners or operators had a Capital Construction Fund Program account. Finally, the Small Shipyard Grant program provides grants to small shipyards for equipment or training. In fiscal year 2024, this program had $8.75 million in available funds and had 78 grant applications from shipbuilding or repair companies requesting just under $50 million. These four financial assistance programs have provided some support for vessel owners or operators and shipyards, but the programs' administration does not follow leading practices for assessing program performance. For example, the Maritime Administration cannot determine to what extent the programs are effective in growing the U.S. maritime fleet because it has not established measurable goals for, or assessed the performance of, these programs. Doing so would allow the Maritime Administration to identify any changes that could better increase the nation's shipbuilding capacity to promote national security and economic prosperity. An April 2025 Executive Order established United States policy to revitalize and rebuild domestic shipbuilding and requires certain actions to grow the U.S. maritime fleet. In addition, the 31 industry stakeholders GAO interviewed identified challenges facing vessel owners or operators and shipyards competing within the U.S. domestic maritime industry. They also had ideas to address those challenges (see table). Selected Industry Stakeholders' Ideas to Address Challenges Facing Domestic Vessel Owners or Operators and Shipyards Challenge Ideas Domestic vessel owners or operators face competition with other modes of transportation, such as trucks. Encourage the use of domestic vessels to carry cargo along rivers or between coastal ports. Shipyards face workforce challenges from “boom-and-bust” cycles created by fluctuating demand for new vessel construction. Smooth the workflow through economies of scale, such as through large, consistent federal vessel procurements. Shipyards face challenges with aging infrastructure. Expand the Small Shipyard Grant program, and encourage foreign investment. Source: GAO analysis of 31 stakeholders' statements. | GAO-25-107304 Why GAO Did This Study Concerns over the state of U.S. commercial shipbuilding have grown in recent years. Such concerns are particularly related to the nation's capacity to meet government shipbuilding and repair needs that are critical to national defense. The James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 includes a provision for GAO to review efforts to support the U.S. commercial maritime industry. This report addresses, among other topics, (1) the use of the Maritime Administration's programs to encourage or improve U.S. shipbuilding and the extent to which they follow leading practices and (2) ideas identified by selected stakeholders to address challenges facing the maritime industry. GAO reviewed Maritime Administration documents and compared its four financial assistance programs with leading practices for performance management. GAO also surveyed domestic vessel owners and operators and shipbuilding or repair companies. GAO also visited selected shipyards and interviewed government officials and 31 industry stakeholders selected to provide a range of perspectives on the Maritime Administration's programs and the maritime industry's ability to contribute to national defense.