The White House on Monday released President Joe Biden's $5.8 trillion fiscal year (FY) 2023 budget proposal, which prioritizes mental health initiatives and future pandemic preparedness.
Prioritizing future pandemic preparedness
The budget proposal emphasizes the importance of future pandemic preparedness, requesting $81.7 billion in funding over the next five years to "prevent, detect, and respond to emerging biological catastrophes." This includes:
- $40 billion for the research, development, and manufacturing of vaccines, treatments, and tests
- $28 billion to CDC for pandemic preparedness, including surveillance, lab capacity, and the public health workforce
- $12.1 billion to NIH for research on vaccines and other mitigation measures
- $1.6 billion to FDA for labs and information technology
In addition, Biden is proposing a 26.8% funding increase for HHS in FY 2023, with a proposed $127.3 billion in discretionary funding allocated to the agency—nearly $27 billion more than the department was allotted for FY 2021.
However, HHS Secretary Xavier Becerra called the administration's preparedness funding request "a drop in the bucket compared to what it's cost so far to deal with Covid."
"What we need to continue to finish the job on Covid, we need immediately," Becerra said. "What we're asking for in this budget for long term preparedness is very separate."
"We hope that we're given the chance to make those long-term investments, preparing for the long game," he added.
Advancing mental health care
Biden in the budget is also requesting $51.7 billion to improve the mental health system, including:
- $7.5 billion for workforce development and service expansion
- $35.4 billion to improve access to mental health care for Medicaid beneficiaries
- $3.5 billion to improves access for Medicare beneficiaries by updating fee-for-service benefits, allowing three behavioral health visits each year with no cost sharing, abolishing the 190-day lifetime limit on psychiatric hospital care, and implementing mental health parity rules
- $275 million over 10 years for the Labor Department to enforce mental health coverage regulations at large-group health plans
In addition, the budget proposes health insurers be required to cover mental health care with sufficient provider networks and ensure parity in coverage between behavioral health and medical benefits, Modern Healthcare reports.
Additional health care related funding requests
Further, the proposed budget aims to improve the public health infrastructure in various additional ways, including:
- The establishment of a new Vaccines for Adults program that would give uninsured adults free access to vaccines purchased in bulk by the federal government, after CDC's vaccine advisory committee recommends them
- $400 million in funding for the Title X Family Planning Program, which gives low-income individuals access to family planning and other health care services
- Multiple investments across the FDA, CDC, National Cancer Institute, and Advanced Research Projects Agency for Health to further President Biden's Cancer Moonshot initiative, which aims to cut the U.S. cancer death rate by 50% over the next 25 years
- $850 million to decrease new HIV cases through increased access to prevention and support services
- $119 billion to medical care for veterans—a 32% increase—to fully fund inpatient, outpatient, mental health, and long-term care services
- $9.1 billion—a 20% increase from 2021—to the Indian Health Service, as well as shifting the funding from discretionary to mandatory funding
According to the New York Times, the budget recommended very few formal policy proposals for the Medicare, Medicaid, and Affordable Care Act health care programs. However, the White House still aims to implement major changes to those programs through its Build Back Better legislation—which has been held up in Congress since December 2021. Instead of itemizing and scoring those priorities, the budget mentions them and establishes a deficit-neutral reserve fund that can accommodate them, which ultimately makes it difficult to determine the package's overall impact on federal spending, the Times reports.
Ultimately, Biden's budget is just a proposal, and any additional funding for pandemic preparedness and other new initiatives must first obtain congressional approval—something that has proven to be a challenge in recent months, despite health experts highlighting the need for additional funding, The Hill reports. (Paavola, Becker's Hospital CFO Report, 3/28; Goldman, Modern Healthcare, 3/28; Sullivan, The Hill, 3/28; Weiland/Sanger-Katz, New York Times, 3/28)