President Biden unveils his proposed 2024 Health & Human Services Dept. Budget

Obviously much of this is unlikely to actually go anywhere given House Republicans plans to almost completely defund the ACA and completely gut Medicaid overall, but as President Biden always says, "Don’t tell me what you value. Show me your budget—and I’ll tell you what you value.”

So, you know...there's that. Via the HHS Dept:

HHS Releases President’s Fiscal Year 2024 Proposed Budget 

Investments address urgent needs to extend Medicare solvency, lower drug costs, bolster public health preparedness, improve the well-being of children and seniors, expand access to health care, increase the health care workforce, and advance research underlying medicine, public health, and social services

The Biden-Harris Administration today released the President’s Budget for Fiscal Year 2024. The budget details a blueprint to grow the economy from the bottom up and middle out, lower costs for families, protect and strengthen Medicare and Social Security, and reduce the deficit by ensuring the wealthy and big corporations pay their fair share—all while ensuring no one making less than $400,000 per year pays more in taxes.

The HHS budget makes critical, targeted investments in the American people that will improve health and well-being and promote greater prosperity and economic growth for decades to come. Specifically, these investments will address urgent needs to lower drug costs, bolster public health preparedness, improve the health and well-being of children and seniors, make child care affordable, expand access to health care, increase the health care workforce, and advance research underlying medicine, public health, and social services. The proposed HHS budget includes $144.3 billion in discretionary funding and $1.7 trillion in mandatory funding for FY 2024. The proposed HHS budget also extends the solvency of Medicare’s Hospital Insurance (HI) Trust Fund by at least 25 years without cutting benefits or provider payments. 

Highlights of the budget include:

Extend Medicare Solvency by at Least 25 Years and Lower Drug Costs

More than 67 million Americans depend on Medicare, and we must work to ensure millions more can depend on the program in the future. The FY 2024 legislative proposed law package extends Medicare Trust Fund solvency by at least 25 years, without cutting benefits. We achieve this by directing all revenues from the net investment income tax, including tax code reforms that ensure high-income earners pay their fair share into the Medicare Hospital Insurance (HI) Trust Fund. Specifically, the budget modestly increases the Medicare tax rate on income above $400,000, closes loopholes in existing Medicare taxes and dedicates the Medicare net investment income tax to the HI Trust Fund, as originally intended.

We also achieve this by building on efforts in the Inflation Reduction Act to lower prescription drug prices and credit savings from certain prescription drug reforms to the HI Trust Fund. The budget strengthens newly-established negotiation power by allowing Medicare to negotiate prices for more drugs and bringing drugs into negotiation sooner after they launch. It also strengthens the requirement that drug companies pay rebates to Medicare when they increase prices faster than inflation by extending this rule to commercial health insurance.

The budget helps make prescription drugs more affordable for seniors by limiting Medicare cost-sharing on high value generic drugs to $2.  The budget also modifies the Medicaid Drug Rebate Program in territories and authorizes HHS to negotiate Medicaid supplemental rebates on behalf of states.  The budget also limits cost-sharing for insulin at $35 a month.

Expand Access to Health Care

Health centers provide services to underserved populations across the country, including low-income patients, rural and ethnic minorities, rural communities, and people experiencing homelessness.  The FY 2024 budget provides $7.1 billion for Health Centers, which includes $5.2 billion in proposed mandatory resources, an increase of $1.3 billion above FY 2023 enacted.  This investment puts the Health Resources and Services Administration (HRSA) on a path to doubling Health Center Program funding over five years.  At this funding level the Health Center Program will provide care for approximately 33.5 million patients.

With enrollment in health coverage at an all-time high, the budget invests $183 billion over ten years to expand access to quality, affordable healthcare by making the enhanced premium tax credits previously extended under the Inflation Reduction Act permanent. The budget provides Medicaid-like coverage to individuals in states that have not adopted Medicaid expansion under the Affordable Care Act while incentivizing states with existing expansions to maintain coverage.

BOOM, there it is: Permanent extension of the enhanced ACA subsidies of the ARP/IRA, and bringing back the "Fedicaid" proposal to cover Medicaid Gap enrollees in states which haven't expanded the program (although it sounds like North Carolina is about to reduce that population significantly anyway).

The budget also prioritizes investments that will expand access to high quality health care in Indian Country. Building on the historic passage of advance appropriations for the Indian Health Service (IHS), the FY 2024 budget proposes $8.1 billion in discretionary funding for the IHS Services and Facilities accounts. Combined with $1.6 billion in proposed mandatory funding for Contract Support Costs, Section 105(l) Leases, and the Special Diabetes Program for Indians, total resources for IHS in FY 2024 are $9.7 billion, an increase of $2.5 billion above FY 2023 enacted. This funding will expand access to healthcare services, address key operational capacity needs, and modernize outdated facilities and information technology systems.  Beginning in FY 2025, the budget would make all funding for IHS mandatory, and would grow funding over time to address inflationary factors, backlogs in services and facilities, and other key operational needs.

Public Health Preparedness

The federal response to the COVID-19 pandemic demonstrated the importance of preparedness for emergent health crises.  As we continue to feel the effects of the COVID-19 pandemic, HHS is working to protect the health and safety of the American people through strategic investments to bolster and ensure nationwide preparedness, including:

$20 billion in mandatory funding across the Administration for Strategic Preparedness and Response (ASPR), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and the Food and Drug Administration (FDA), to transform the nation’s capabilities to prepare for and respond rapidly and effectively to future pandemics and other biological threats.  

$1 billion for the Biomedical Advanced Research and Development Authority (BARDA) to develop innovative medical countermeasures 

$995 million for the Strategic National Stockpile

$400 million in new pandemic preparedness and biodefense funding for ASPR to continuously invest in long-term capabilities to enable a rapid response to emerging biological threats, including securing the domestic medical supply chain and developing next-generation medical countermeasures that address key preparedness gaps.

$10.5 billion in discretionary funding for the CDC to prioritize investments in core capabilities, such as data, workforce, laboratory capacity and infrastructure.  These critical capabilities are necessary to ensure that CDC and our nation are well positioned to prevent and address current and emerging public health threats.

Transforming Behavioral Health Care

In response to the current behavioral health crisis and in support of the President’s national mental health strategy to strengthen system capacity, connect more Americans to care, and create a continuum of support through the investment in the provision of equitable, evidence-based mental health services, HHS will invest in services to provide more Americans with access to the best treatment for mental and substance use disorders where it’s needed. SAMHSA will dedicate $836 million to the 9-8-8 and Behavioral Health Services program.  This investment will support services for LGBTQI+ youth and for Spanish speakers, invest significantly in local crisis centers, and develop a national media campaign. SAMHSA will also dedicate $100 million for mobile crisis response. This investment will expand partnerships with 9‑8‑8 local crisis centers, community providers, 911 centers, and first responders to promote health‑-first‑ responses to mental health, suicidal, and substance use crisis events.

NIH funding will provide an additional $200 million to prioritize innovative mental health research and treatment.  NIH will allocate a portion of these resources to launch the new precision psychiatric initiative. The budget also includes mandatory legislative proposals to modernize and expand Medicare’s mental health benefits and to improve behavioral health for the private insurance market and Medicaid beneficiaries, with an emphasis on improving access, promoting equity, and fostering innovation.

Improve the Well-being of Children and Seniors

Childhood programs are essential to providing advantages that can last a lifetime and HHS recognizes the value of investing in children. The FY 2024 budget includes a mandatory proposal to fund childcare for low- and middle-income families and universal preschool for all four-year-old children, at an estimated cost of $600 billion over 10 years. In addition, it provides $9 billion for the Child Care and Development Block Grant, and $13 billion for Head Start to provide comprehensive early learning and development services to infants, toddlers, and preschool-aged children. The Head Start investment includes $575 million to increase pay for Head Start teachers to help address staff shortages in the program and prevent classroom closures.

In addition, HHS’ budget includes $7.3 billion for the Office of Refugee Resettlement, including, $5.5 billion to care for unaccompanied children while they are in the government’s custody and provide them supportive services to ensure their well-being after they are released to sponsors, as well as $1.7 billion to help rebuild the nation’s refugee resettlement infrastructure and resettle up to 125,000 refugees in 2024. The budget also proposes to invest nearly $10 billion in reforms to transform child welfare, including by reducing the number of children entering foster care by keeping more families safely together, placing more children with kin caregivers and fewer children in group homes, and substantially increasing the support provided to foster youth who age out of care without a permanent caregiver.

As America’s older population increases, it is critical to promote the health, safety, and dignity of elders through long term care. The FY 2024 budget affords $150 billion over 10 years in improving and strengthening Medicaid home and community-based services to ensure more people who are aging and those with disabilities can receive care in their home or community. In addition, the FY 2024 budget includes resources to strengthen nursing home oversight, including $566 million for the discretionary CMS Survey and Certification Program, nearly a 40 percent increase above enacted funding, for nursing homes and other facilities’ health and safety inspection surveys.  The budget also includes multiple enforcement provisions to protect seniors, such as identifying and penalizing nursing homes that commit fraud, endanger patient safety, or prescribe unnecessary drugs.

Advancing Scientific Knowledge to Improve Lives

Investments in the Cancer Moonshot Initiative will advance progress on the goals of reducing the cancer death rate by at least 50 percent over the next 25 years and improving the experience of people who are living with or have survived cancer, their families, and caregivers. The budget includes $1 billion for dedicated Cancer Moonshot activities across CDC, IHS, HRSA, and FDA, as well as a total investment at the National Cancer Institute (NCI) of $7.8 billion to drive progress on ways to prevent, detect, and treat cancer. The FY 2024 budget includes $716 million in NIH discretionary resources for dedicated Cancer Moonshot activities, particularly projects which detect cancer, demonstrate the mechanisms that drive it, or identify candidates for new treatments. The budget also proposes additional mandatory funding for the 21st Century Cures Act Beau Biden Cancer Moonshot initiative at NCI in 2025 and 2026.

To support the goals of the Cancer Moonshot initiative, the FY 2024 budget includes $839 million to support various activities across CDC, including cancer prevention and control programs, tobacco prevention, HPV prevention and analysis of cancer clusters, and laboratory and environmental health activities.  The budget also includes $108 million within IHS to address specialized cancer care needs in tribal communities, $50 million to support FDA efforts to improve evidence generation for underrepresented subgroups in oncology clinical trials, as well as support decentralized trials and sources of evidence through patient-generated data, learnings, and real-world evidence, and $20 million to support HRSA funded health centers efforts on improving access to life-saving cancer screenings and early detection services for underserved communities. 

Advanced Research Projects Agency for Health (ARPA-H) supports the development of high-impact research advances that drive real world impact.  The FY 2024 budget provides $2.5 billion, with an initial focus on cancer and other diseases such as diabetes and dementia, to advance high-potential, high-impact biomedical and health research that cannot be readily accomplished through traditional research or commercial approaches.

The FY 2024 budget investment in advancing scientific knowledge includes $48.6 billion in discretionary and mandatory resources for NIH that will include $121 million to improve scientific understanding of nutrition and health.  NIH will allocate resources to the NIH Common Fund Community Partnerships to Advance Science for Society to ensure nutrition, health and food security research efforts provides an equitable opportunity for marginalized groups to realize the benefits of the research.

Expand the Health Workforce

The health workforce plays a vital role in responding to public health threats, addressing health disparities, and improving the health and resiliency of communities.  As the demand for healthcare workers increases, HHS remains committed to strengthening and expanding the workforce. The FY 2024 budget provides $2.7 billion for HRSA workforce programs, including $947 million in mandatory resources, to expand workforce capacity across the country.  The discretionary budget includes $28 million for a new program to address growing concerns related to healthcare workforce shortages and $25 million for a new program to support the adaptation of workplace wellness in healthcare facilities including hospitals, rural health clinics, community health centers, and medical professional associations. The FY 2024 budget also includes $106 million for CDC to support public health training and fellowship programs to support a pipeline of personnel ready to address public health threats.