Biden Administration Releases “Skinny Budget” for FY 2022
Proposal Highlights President’s Topline Priorities for Next Year
By Kristen O’Brien, JD
Vice President, McDermott+ Consulting
Last Friday, April 9, the Biden administration released a proposal of their $1.5 trillion Fiscal Year (FY) 2022 budget. In recent administrations, rather than put out an in-depth budget proposal, presidents have chosen to put forward so-called “skinny budgets” that highlight topline funding levels and priorities but are not actual dollar amounts that are provided to agencies or programs. This year’s skinny budget from the administration is different from those in years past, as it only addresses the FY 2022 discretionary budget instead of the typical 10-year window for spending. The document does not include details on policies and spending levels for mandatory programs such as Social Security, Medicare and Medicaid, or include specific mention of post-acute care. Rather, this is more of an aspirational document and starting point for congressional consideration.
Of interest to AMRPA, substantial funding is dedicated to healthcare, showing the priority focus for the Biden Administration. The budget provides $131.7 billion for HHS, a $25 billion or 23.5% increase from the 2021 enacted level. While there is minimal description of use of these funds, the budget does note that funding will support program integrity activities, which could be significant as more details are provided. In addition, this budget does not provide clear offsets for the significant increase in spending on healthcare—these proposals are more likely to be included in the larger budget released in May.
In addition, the budget reflects a strong focus on research, including the creation of a new agency the Advanced Research Projects Agency for Health (ARPA-H) In his budget letter to the Senate Appropriations Committee, the president describes his vision for ARPA-H: “With an initial focus on cancer and other diseases such as diabetes and Alzheimer’s, this major investment in federal research and development would drive transformational innovation in health research and speed application and implementation of health breakthroughs.”
Below you will find some more details included in the budget documents released by the White House. The remainder of the budgeting process will be conducted through the Congressional Appropriations Committees, which will now begin their probing of agency heads on more specific budget justifications before full details on spending are released. Some Appropriations Subcommittees are beginning these hearings as soon as next week. The Biden Administration’s full budget is expected in mid-May.
Key Health Care Highlights from Skinny Budget:
- Mental Health: $1.6 billion for the Community Mental Health Services Block Grant (doubling FY 2021 funding) and resources to partner mental health providers with law enforcement and expanding suicide prevention activities
- Rural Outreach: $32 million to aid people in high poverty and rural communities access federal research and an increase for the rural e-Connectivity Program (Reconnect) for rural broadband.
- Disparities in Health Care: commitment to advanced equity and reduce health disparities across all health care programs and additional funding for access to culturally competent care. Allocates $153 million for the CDC’s Social Determinant’s of Health program to support states and territory efforts to improve health equity and data collection for racial and ethnic populations.
- $9 billion increase in funding for research institutions
- $6.5 billion to launch the Advanced Research Projects Agency for Health or ARPA-H, a new research office targeting treatment and cures for disease – similar to the DoD’s Defense Advanced Research Projects Agency (DARPA)
- Increased funding for and commitment to foundational research and development across the federal government, including the National Science Foundation (NSF) and the National Institute for Science and Technology (NIST)
- Opioids: $3.9 billion to battle the nation’s opioid epidemic
Topline Agency Budget Numbers:
When available, the topline numbers for agencies within HHS are included below.
Centers for Disease Control and Prevention (CDC) – $8.7 billion is included for the CDC, which is the largest budget authority increase in nearly two decades. According to the budget document, CDC would use this additional funding to “support core public health capacity improvements in states and territories, modernize public health data collection nationwide, train new epidemiologists and other public health experts, and build international capacity to detect, prepare for, and respond to emerging global threats.” The request also includes $153 million for CDC’s Social Determinants of Health (SDOH) program to “support states and territories in improving health equity and data collection for racial and ethnic populations.” This is an increase of $150 million over the FY 2021 enacted level.
National Institutes of Health (NIH) – $51 billion is included for the NIH, which is a $9 billion increase over the 2021 enacted level. The budget also establishes the Advanced Research Projects Agency for Health (ARPA-H) and includes $6.5 billion to launch the new Agency. ARPA is expected to “provide significant increases in direct federal research and development spending in health.” The initiative will have an initial focus on cancer and other diseases such as diabetes and Alzheimer’s, drive transformational innovation in health research and speed application and implementation of health breakthroughs.
Office of the Assistant Secretary for Preparedness and Response (ASPR) – No topline number was given, but the budget document notes that the request includes $905 million for ASPR’s Strategic National Stockpile (SNS) to “maintain replenishment of critical medical supplies and restructuring efforts initiated during the COVID-19 pandemic.”
Food and Drug Administration (FDA) – No topline nor major details are included in the request. The FDA was mentioned in the $905 million lump sum allocation alongside ASPR. The request refers to increasing FDA’s “organizational capacity,” which suggests additional staffing and technical resources. Note: The FDA only receives about 55% of its funding through the federal budget, while the remainder comes from industry user fees.
Substance Abuse and Mental Health Services Administration (SAMSHA) – No topline number is given, but the request includes $1.6 billion for the Community Mental Health Services Block Grant, which is double that of FY 2021 enacted.
Health Resources and Services Administration (HRSA) – No topline number is given, but the document notes that the request “increases funding to help rural healthcare providers stay open and care for their rural communities, increase funding for rural residency programs, and ensure coal miners and their families receive health benefits.”
Office for Civil Rights (OCR) – This office is allocated $47.9 million, which is a 24% increase from FY 2021 enacted.
Indian Health Service (IHS) – $8.5 billion is included for IHS, which is an increase of $2.2 billion over FY 2021 enacted.
Cross-Cutting Initiatives Included in Budget
Advancing the Goal of Ending the Opioid Crisis – The request provides $10.7 billion across agencies to help end the opioid crisis. This is an increase of $3.9 billion over the 2021 enacted level.
Home and Community-Based Services – The request notes that it is proposing an additional $551 million for home and community-based services. The request also doubles the funding for the Lifespan Respite Care program, increases resources for meal programs for older Americans, and expands services for individuals with disabilities.
Commitment to end HIV/AIDS Epidemic – The request includes $670 million to “help aggressively reduce new HIV cases while increasing access to treatment, expanding the use of pre-exposure prophylaxis (also known as PrEP), and ensuring equitable access to services and supports.” The funding will be dispersed to the CDC, HRSA, IHS and NIH.
Maternal mortality – The request includes more than $200 million to reduce maternal mortality and morbidity rates nationwide. This includes activities to enhance the Maternal Mortality Review Committees; expand the Rural Maternity and Obstetrics Management Strategies program; assist cities in placing early childhood development experts in pediatrician offices with a high percentage of Medicaid and Children’s Health Insurance Program patients; implement implicit bias training for healthcare providers, and; create State pregnancy medical home programs.
Promoting Health Equity by Addressing Racial Disparities – In addition to the increases for the CDC’s SDOH program, the request provides additional funding (no number given) to “increase the diversity of the healthcare workforce and expand access to culturally competent care.”
Addressing the Public Health Epidemic of Gun Violence in America – The request doubles funding for firearm violence prevention research at CDC and NIH and includes $100 million for CDC to start a new Community-Based Violence Intervention initiative. This initiative’s stated goal is “to implement evidence-based community violence interventions locally” and will be undertaken jointly by the CDC and Department of Justice (DOJ).
Expanding Access to Family Planning Healthcare Services – The request provides $340 million, an increase of 18.7 percent, to the Title X Family Planning program.
Supporting Research to Understand Disparate Health Impacts of Climate Change – The request establishes a new Office of Climate Change and Health Equity that “would focus on decreasing effects of climate change on vulnerable populations.”