Health Care Funding Priorities in President Biden’s FY 2023 Budget
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Health Care Funding Priorities in President Biden’s FY 2023 Budget

Brownstein Client Alert, March 28, 2022

Today, Monday, March 28, President Joe Biden unveiled his Fiscal Year (FY) 2023 budget request, the second of his presidency. The $5.7 trillion proposal calls for $1.7 trillion in discretionary spending and $3.7 trillion in mandatory spending. Historically, the president’s budget request kicks off the congressional budget process, serving as a starting point for lawmakers to determine funding levels and national spending priorities. Congress is under no obligation to adopt all or any of the president’s budget. Instead, the president’s budget request is used to indicate the president’s recommended spending and revenue levels along with policies the administration wants to prioritize. Since both the House and Senate are still narrowly controlled by Democrats, they will be more inclined to entertain the priorities that the Biden administration has put forth.

Last year’s budget focused on the president’s two legislative packages: the American Jobs Plan and American Families Plan. Parts of each of these packages later became the Build Back Better Act, which is still being negotiated. This year’s budget includes a deficit neutral reserve fund to account for future legislation that includes tax and prescription drug reforms, like those in the Build Back Better Act. The budget contains no details regarding the policy specifics but leaves that up to Congress. This gives Congress room to enact policies from Build Back Better but acknowledges that the scale of that legislation will decrease based on feedback from moderate Democrats.

The FY 2023 budget contains several initiatives and priorities that were not included last year. These include:

  • Advanced Research Projects Agency for Health (ARPA-H). The Budget includes $5 billion for ARPA-H, compared to the $6.5 billion requested in FY 2022. The goal of the agency is to “drive transformational innovation in health research and speed application and implementations of health breakthroughs” in areas such as cancer, diabetes and dementia. Additionally, the budget contains an increase in funding ($49 billion request; $4 billion more than the FY 2022 enacted levels) to the National Institutes of Health (NIH).
  • Cancer Moonshot Initiative. The budget prioritizes investments to address cancer. The goal of the administration is to reduce the cancer death rate by at least % over the next 25 years, while also improving the lives of cancer survivors. To this end, the administration proposes investing in ARPA-H, the National Cancer Institute, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).
  • Mental Healthcare. The budget proposes reforming coverage for mental health and investing in the mental health workforce. The budget requires private health insurance to cover mental health benefits and contain an adequate network of behavioral health providers. For federal health care providers, such as Medicare and TRICARE, the budget lowers patients’ costs for mental health services by requiring parity between behavioral health and medical benefits. The budget proposes to increase the number of mental health providers serving Medicaid beneficiaries, while also investing in workforce development and service expansion at primary care clinics and non-traditional sites. Finally, the budget makes investments in youth mental health, suicide prevention programs and the National Suicide Prevention Lifeline. Last year’s budget included money for Community Mental Health Services block grants, funding for those in the criminal justice system, resources to partner mental health providers with law enforcement and funds to expand suicide prevention activities.
  • HIV/AIDS Epidemic. The National HIV/AIDS Strategy for the United States 2022–2025 commits to a 75% reduction in HIV infection by 2025. The administration is committing to this strategy by including $850 million ($670 million was requested in FY 2022) across multiple areas of the Department of Health and Human Services (HHS) to reduce HIV cases, increase access to pre-exposure prophylaxis (PrEP) and equitable access to services and supports to those living with HIV. Specifically, the administration proposes to increase access to PrEP among Medicaid beneficiaries. The budget also proposes a new mandatory program that would guarantee PrEP at no cost for all uninsured and underinsured individuals, Indian Health Services and tribal entities.
  • Future Pandemic and Health Security Threats. The budget makes investments in pandemic preparedness and biodefense across HHS agencies totaling $81.7 billion over five years. Specifically, it provides:
    • $40 billion to the Office of the Assistant Secretary for Preparedness and Response,
    • $28 billion for CDC to enhance public health system infrastructure, threat surveillance and global health security (last year’s budget requested $8.7 billion in funding for CDC),
    • $12.1 billion to NIH for research and development of vaccines, diagnostics and therapeutics against high priority biological threats and safe and secure laboratory capacity and clinical trial infrastructure,
    • $1.6 billion for FDA to expand and modernize regulatory capacity information technology and laboratory infrastructure to support the evaluation of medical countermeasures.
  • Public Health Systems and Capacity. The budget includes $9.9 billion to build health care systems capacity at CDC. This money would be used to improve the immunization program, expand health infrastructure in states and territories, strengthen the public health workforce, modernize public health data collection and conduct studies on long COVID. The administration also proposes investments in community violence intervention and firearm safety research to address gun violence.
  • Expand Access to Vaccines. The budget would establish a Vaccines for Adults program that would provide uninsured adults access to all vaccines recommended by the Advisory Committee on Immunization Practices at no cost. The budget would also expand the Vaccines for Children program to include all children under age 19 enrolled in the Children’s Health Insurance Program and consolidate vaccine coverage under Medicare Part B, making more preventive vaccines available at no cost to Medicare beneficiaries.
  • Maternal Health and Health Equity. The budget includes $470 million ($200 million in the FY 2022 request) to reduce maternal mortality and morbidity rates, expand maternal health initiatives in rural communities, implement implicit bias training for healthcare providers and create pregnancy medical home demonstration projects. The budget also extends and increases funding for the Maternal, Infant and Early Childhood Home Visiting program.
  • Healthcare Services for Low-Income Women. The budget provides $400 million to the Title X Family Planning program.
  • Domestic Violence and Gender Based Violence. The budget includes $519 million, more than double the 2021 enacted level, for Family Violence Prevention and Services program to support domestic violence survivors. Additional funding would be provided for domestic violence hotlines and cash assistance for survivors of domestic violence, as well as funding to support a demonstration project evaluating services for survivors at the intersection of housing instability, substance use coercion and child welfare. The budget would provide over $66 million for victims of human trafficking and survivors of torture.

As mentioned above, the president’s budget request starts the Congressional budget process. The budget presented by the Biden administration provides an aspirational roadmap to what the president would like to be implemented, how much Congress integrates these ideas into their own remains to be seen. The HHS Secretary Xavier Becerra will testify before the House Appropriations Subcommittee on Labor and Health and Human Services on Thursday, providing more insight into the Department’s priorities. HHS also released their budget request today. Brownstein will monitor the hearings and release an analysis on the HHS budget later this week.

This document is intended to provide you with general information regarding health care priorities in President Joe Biden's FY 2023 budget request. The contents of this document are not intended to provide specific legal advice. If you have any questions about the contents of this document or if you need legal advice as to an issue, please contact the attorneys listed or your regular Brownstein Hyatt Farber Schreck, LLP attorney. This communication may be considered advertising in some jurisdictions. The information in this article is accurate as of the publication date. Because the law in this area is changing rapidly, and insights are not automatically updated, continued accuracy cannot be guaranteed.

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