Today, Thursday, March 9, President Biden unveiled his Fiscal Year (FY) 2024 budget request, the third of his presidency. The $6.1 trillion proposal calls for $1.9 trillion in discretionary spending and $4.2 trillion in mandatory spending. The budget proposes new measures to build on the programs in the Inflation Reduction Act (IRA) designed to lower prescription drug costs. It also touts administration efforts to protect reproductive health care, advance domestic manufacturing and make progress toward ending cancer.
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.
A more detailed breakdown of the Department of Health and Human Services’ (HHS) budget request can be found here. The FY 2024 budget contains numerous health initiatives and priorities including:
- Expands Access to Quality, Affordable Health Care.
- Makes permanent the expanded Affordable Care Act (ACA) premium tax credits that were extended in the Inflation Reduction Act.
- Provides Medicaid-like coverage to individuals in states that have not adopted Medicaid expansion under the ACA, paired with financial incentives to ensure states maintain their existing expansions.
- $150 billion over 10 years to improve and expand Medicaid home and community-based services (HCBS).
- Reduces Drug and Other Health Care Costs for All Americans.
- Allows the price of more Part B and D drugs to be negotiated and brings drugs into negotiation sooner after they launch. Estimated to save $160 billion over 10 years.
- Limits Medicare Part D cost-sharing for high-value generic drugs to no more than $2.
- For the commercial market, proposes to curb inflation in prescription drug prices and cap the prices of insulin products at $35 for a monthly prescription.
- Protects and Strengthens Medicare.
- Reforms the tax code to ensure high-income individuals pay their fair share into the Medicare Hospital Insurance (HI) trust fund. Increases the net investment income tax to 5%, from 3.8%, for earnings of more than $400,000.
- Directs the revenue from the Net Investment Income Tax into the HI trust fund.
- Credits the savings from the budget’s proposed drug reforms into the HI trust fund.
- Advances Progress toward Cancer Moonshot Goals.
- $1 billion Cancer Moonshot activities across the Centers for Disease Control and Prevention (CDC), Indian Health Services (HIS), the Health Resources and Services Administration (HRSA) and the Food and Drug Administration (FDA).
- $7.8 billion for the National Cancer Institute (NCI).
- Increases mandatory funding for the 21st Century Cures Act Beau Biden Cancer Moonshot initiative at NCI through 2026.
- Increases funding for the Advanced Research Projects Agency for Health by $1 billion, for a total of $2.5 billion.
- $258 million in tobacco prevention and control efforts at the CDC.
- Transforms Behavioral Health Care.
- For private health insurance, expands coverage of mental health benefits and strengthens the network of behavioral health providers.
- For Medicare, lowers patients’ costs for mental health services, requires parity in coverage between behavioral health and medical benefits, and expands coverage for behavioral health providers.
- Provides investments in the behavioral health workforce, youth mental health treatment, Certified Community Based Behavioral Health Clinics, Community Mental Health Centers and mental health research.
- Invests in the 988 Suicide and Crisis Lifeline.
- Expands CDC’s What Works in Schools program to up to 75 of the largest local education agencies.
- Accelerates mental health research for promising new treatments and enhanced precision and implementation of existing treatments.
- Invests in Community Health Centers and the Nation’s Health Care Workforce.
- Puts the Health Center Program on a path to double its size and expand its reach.
- Expands the National Health Service Corps.
- $32 million to grow the nation’s nurse workforce.
- $28 million in innovative approaches to recruit, support and train new providers.
- Supports Family Planning Services for More Americans.
- $512 million, a 79% increase above the 2023 enacted level, for the Title X Family Planning program.
- Prepares for Future Pandemics and Other Biological Threats and Strengthens Public Health Systems.
- $20 billion in mandatory funding for HHS public health agencies in support of the administration’s pandemic prevention and preparedness and biodefense priorities.
- $400 million in new discretionary resources within the Administration for Strategic Preparedness and Response, Biomedical Advanced Research and Development Authority, and the Strategic National Stockpile to support advanced development and procurement of vaccines, therapeutics and diagnostic capabilities against known and unknown high-priority threats.
- $10.5 billion in discretionary funding to build public health capacity at the CDC and at the state and local levels, including expanding capacity to respond to emerging threats, including surveillance, laboratory and public health workforce capacities.
- Supports efforts to modernize public health data systems and enables the CDC to establish cadres of response-ready staff who can quickly deploy during emergencies.
- $50 million for the Public Health Emergency Fund.
- Mandatory funding to catalyze development of drugs that address the pandemic threat of antimicrobial resistance.
- Advances Maternal Health and Health Equity.
- $471 million to: support ongoing implementation of the White House Blueprint for Addressing the Maternal Health Crisis and reduce maternal mortality and morbidity rates; expand maternal health initiatives in rural communities; implement implicit bias training for health care providers; create pregnancy medical home demonstration projects; and address the highest rates of perinatal health disparities, including by supporting the perinatal health workforce.
- Requires all states to provide continuous Medicaid coverage for 12 months postpartum.
- Strengthens collection and evaluation of sociodemographic data.
- Supports Rural Health.
- Invests in improving the health of rural communities, including by helping rural hospitals stay open, expanding the pipeline of rural health care workers and facilitating access to quality care.
- $30 million to provide assistance to rural hospitals at risk of closure and to support expansion of hospital service lines to meet rural communities’ needs.
- Dedicates funding to rural communities, including rural health clinics, to support behavioral health.
- Invests in the Treatment and Prevention of Infectious Diseases.
- New mandatory proposal for a national program to significantly expand screening, testing, treatment, prevention and monitoring of hepatitis C infections in the United States.
- $850 million in the Ending the HIV Epidemic Initiative across HHS to aggressively reduce new HIV cases, increase access to pre-exposure prophylaxis (also known as PrEP), and ensure equitable access to services and support for those living with HIV.
- Guarantees PrEP at no cost for all uninsured and underinsured individuals; provides essential wraparound services through states, IHS, tribal entities and localities; and establishes a network of community providers to reach underserved areas and populations.
- Proposes a new Vaccines for Adults program to provide uninsured adults with access to routine and outbreak vaccines at no cost and expands the Vaccines for Children program to include all children under age 19 enrolled in CHIP.
- Reduces Hunger and Diet-Related Chronic Diseases and Improves Food Safety.
- Expands Medicare access to cover nutrition and obesity counseling services and to pilot coverage of medically tailored meals in Medicare.
- Strengthens access to nutrition and obesity counseling in Medicaid.
As mentioned above, the president’s budget request starts the congressional budget and appropriations 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. Agency heads will soon be called to testify before Congress on their respective budget proposals. Brownstein will continue to monitor and will provide further information as the process unfolds.
THIS DOCUMENT IS INTENDED TO PROVIDE YOU WITH GENERAL INFORMATION REGARDING THE HEALTH CARE ASPECTS OF BIDEN ADMINISTRATION'S FY 2024 BUDGET. 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.