HHS FY 27 Appropriations Bill Open To Earmarks

Earmarks are provisions in appropriations bills that direct federal funds to specific projects or recipients, bypassing the usual Legislative and Executive Branch management of federal funding processes. They are used by members of Congress to direct money to local projects in their districts, many of which verge on comical.

Earmarks have a storied history of excess and bribery; and are associated with reckless deficit spending.  House Republicans shut down earmarks in 2022, but the Senate never prohibited them.  Now the House Appropriations Committee has relented and earmarks will be permitted in the FY 2027 funding bills:

https://rollcall.com/2026/02/25/labor-hhs-education-earmarks-are-back-in-house-with-limits/

Labor-HHS-Education earmarks are back in House, with limits
Guidance opens up bill’s Health Resources and Services Administration account for ‘community project funding’ aimed primarily at hospitals
By Aidan Quigley - February 25, 2026

House GOP appropriators are allowing earmarks back into their chamber’s Labor-HHS-Education bill after barring them for the past three years, according to guidance that House Appropriations Chairman Tom Cole, R-Okla., released Wednesday for the upcoming fiscal 2027 cycle.

Unlike the Senate’s version, however, Cole’s guidance opens up only the bill’s Health Resources and Services Administration account for “community project funding,” which is largely used to provide funding to hospitals.

And the House has put significantly more restrictions on eligibility within that account, largely limiting the earmarks to just rural clinics and hospitals and Federally Qualified Health Centers, according to subcommittee guidance released Wednesday.

House Republicans had barred earmarks from the Labor-HHS-Education measure after they took back control of the House in the 2022 midterm elections. But the Senate has maintained the bill’s earmark eligibility, and the fiscal 2026 Labor-HHS-Education law includes just under $1.4 billion within those accounts, all from the Senate.

The Health Resources and Services Administration is the largest of the seven accounts eligible in the Senate, and that chamber included $844.5 million in HRSA earmarks for the current fiscal year.

For example, Labor-HHS-Education Appropriations Subcommittee Chair Shelley Moore Capito, R-W.Va., delivered three earmarks worth $15 million each, for renovation of the West Virginia University School of Dentistry, Charleston Area Medical Center technological upgrades and construction of a Marshall University Medical Simulation Center.

House Labor-HHS-Education Appropriations Subcommittee Chairman Robert B. Aderholt, R-Ala., led the push to return House earmarks to the bill, arguing that rural hospitals in his state could benefit.

“Right now, I can’t do anything to help out … a rural hospital,” he said. “I’ve got a lot of rural hospitals. We’re in areas that an earmark could be very beneficial to them.”

Differences from Senate

While the new House guidance takes a step in the Senate’s direction, it falls well short of allowing the wide variety of Senate earmarks that typically make their way into the mammoth Labor-HHS-Education bill.

Senate guidance for the current fiscal year allowed earmarks in the Education and Labor Departments, as well as a wider variety of Health and Human Services accounts.

And even the House earmarks permitted for the Health Resources and Services Administration would come with more strings attached than the Senate requires.

While the House guidance is mostly confined to rural hospitals, with some exceptions, the Senate has allowed earmarks for a wide variety of hospitals, health centers, clinics, skilled nursing facilities, mental health centers and more.

Only four categories of clinics and hospitals are eligible for House earmarks: certified rural health clinics, Federally Qualified Health Centers, Critical Access Hospitals, and rural hospitals. Federal Qualified Health Centers provide care to underserved communities, and are run by nonprofits or public agencies in both urban and rural environments.

The other three categories represent rural institutions. Critical Access Hospitals are largely rural, as they usually must be 35 miles from the closest hospital, according to the Centers for Medicare & Medicaid Services. For the rural clinics and hospitals, HRSA’s definition of rural includes counties with no urban area of 50,000 or more people.

Also barred from receiving funding in the House are any entities that perform or promote abortions, conduct research using embryonic stem cells and provide gender-affirming care. The Senate guidance this year contained no such restrictions.

Some House conservatives, who oppose all earmarks, are likely to be unhappy about the limited expansion. But appropriators may have lessened pushback by only opening up the HRSA account, and not matching the Senate’s more wide-ranging eligibility.

Lawmakers will also be able to request 20 projects each, up from 15. Cole said earlier this month that increasing the number of projects would give lawmakers “more options,” though the overall cap on earmarked spending for House lawmakers is remaining at 0.5 percent of total federal funding.

Cole also released guidance for “programmatic” funding requests, or member asks involving overall funding for individual programs in fiscal 2027 spending bills, as well as for language in explanatory reports.

Senate appropriators haven’t released their own guidance yet for the upcoming spending bills.