This bill establishes a nine-year pilot program that requires hospitals to purchase at least 40% of their personal protective equipment and medical consumables from domestic manufacturers, with the Secretary of Health and Human Services able to adjust this requirement during supply disruptions or emergencies. Hospitals meeting this domestic purchasing goal receive full reimbursement of domestic product costs from a dedicated fund, while those failing to comply face escalating reimbursement cuts of 2-8% depending on how long they remain non-compliant. The legislation defines domestic products as those with final assembly in the United States and at least 60-75% domestic component costs, with higher standards for textile-based items like masks and gowns. To encourage domestic PPE manufacturing capacity, the bill creates tax credits including per-unit payments for each domestically-made PPE item and a 20% investment tax credit for companies building or upgrading U.S.-based manufacturing facilities, with both credits expiring after December 31, 2035. These provisions override existing trade agreements and Buy American Act limitations to enforce domestic sourcing requirements.