President Biden’s Budget Strengthens Public Health and Expands Access to Health Care for All Americans
President Biden’s 2023 budget invests in all Americans’ health and well-being. His budget makes key investments to defeat the COVID-19 pandemic and guard against potential future threats to public health, expand access to care, address health disparities, and strengthen behavioral health. The budget also includes a deficit-neutral reserve fund to account for pending legislation that advances critical budget proposals the Administration put forth last year to invest in American families, including proposals to lower costs for prescription drugs and health care premiums. Furthermore, the health care investments in the budget support the President’s Unity Agenda, unveiled at his State of the Union Address, to improve mental health, beat the opioid epidemic, and end cancer as we know it.
Improves U.S. Capacity to Combat Threats to Public Health and Expedite Innovative Health Research
The budget invests significant resources in the nation’s ongoing response to the COVID-19 pandemic, boosts preparedness activities to guard against future pandemics and biological threats, and funds transformational innovation in health technologies. As the Omicron BA.2 subvariant surges, the COVID-19 pandemic is undoubtedly still at the forefront of most Americans’ minds, especially those who are disproportionately affected, including immunocompromised individuals, people with disabilities, and communities of color. The budget makes crucial investments to tackle the pandemic, prepare against future threats to public health, and advance innovative health research.
$110 billion to combat future pandemics and bolster public health preparedness — This investment includes $82 billion to develop medical countermeasures, expand surge capacity, and strengthen public health systems to support President Biden’s plan to transform our capabilities so we can prepare for and respond rapidly and effectively to future pandemics and other high consequence biological threats. The investment also includes $24 billion to establish the Vaccines for Adults program, so uninsured adults can get vaccinated as recommended by the Advisory Committee on Immunization Practices. The budget also invests $280 million to expand the existing Vaccines for Children program to include all children under age 19 enrolled in the Children’s Health Insurance Program. Further investments include $3.6 billion to consolidate vaccine coverage under Medicare Part B, which will make vaccines more accessible, remove financial barriers, and streamline the process for beneficiaries and providers.
Nearly $10 billion for the Centers for Disease Control and Prevention (CDC) to build advanced public health systems and increase capacity — This discretionary funding level, an increase of $2 billion (28 percent) over the 2022 enacted level, will improve core immunization programs, expand public health infrastructure in States and Territories, strengthen the public health workforce, support efforts to modernize public health data collection, increase capacity for forecasting and analyzing future outbreaks (including at Center for Forecasting and Outbreak Analytics), and conduct studies on long COVID conditions to inform diagnosis and treatment options. Furthermore, to advance health equity, the budget invests in CDC programs related to viral hepatitis, youth mental health, and sickle cell disease. To help address the gun violence public health epidemic, the budget invests in community violence intervention and firearm safety research.
$5 billion for the Advanced Research Projects Agency for Health (ARPA-H) — This major investment will build on the $1 billion enacted in 2022 for this newly established agency and significantly increase direct federal research and development spending in health to improve the health of all Americans. ARPA-H will complement the work of the National Institutes of Health by supporting transformative high‑risk, high‑reward research to drive biomedical and health breakthroughs. With an initial focus on cancer and other diseases such as diabetes and dementia, this landmark investment will drive transformational innovation in health technologies and speed the application and implementation of health breakthroughs. This investment also supports President Biden’s plan to supercharge his Cancer Moonshot initiative, which aims to cut cancer death rates by at least 50 percent over the next 25 years and improve the experience and quality of life of people and their families living with and surviving cancer.
$975 million for the Strategic National Stockpile — This funding, an increase of $130 million above the 2022 enacted level, will help sustain and expand the current inventory of supplies to ensure readiness for potential future pandemics and other public health threats.
$828 million for the Biomedical Advanced Research and Development Authority — This funding level, an $83 million increase above the 2022 enacted level, will support the advanced research, development, regulatory approval, and procurement of life-saving medical countermeasures, and support the Broad-Spectrum Antimicrobials Program.
$850 million in discretionary funding and $9.8 billion in mandatory funding over ten years to help end the HIV/AIDS epidemic — The discretionary funding across HHS will continue to support the Ending the HIV Epidemic initiative and reflects a $377 million increase above the 2022 enacted level. This initiative was further solidified in the National HIV/AIDS Strategy (2022-2025), which aims to reduce the number of new HIV infections in the United States by 75 percent by 2025 and by at least 90 percent by 2030. This discretionary funding will allow HHS to work closely with communities to diagnose, treat, and stop the spread of HIV/AIDS. In addition, the mandatory investments will create a national program to guarantee pre-exposure prophylaxis (also known as PrEP) at no cost for all uninsured and underinsured individuals; provide essential wraparound services through states, IHS and tribal entities, and localities; and establish a network of community providers to reach underserved areas and vulnerable populations to support the National HIV/AIDS Strategy.
Expands Access to Health Care while Improving Coverage and Care
To help advance the President’s Unity Agenda to improve mental health and address the opioid epidemic, the budget expands and improves mental health and substance use disorder coverage and infrastructure. The budget also prioritizes investments to close gender and racial health gaps by expanding critical services and supports to parents and their children in underserved communities, improving maternal health, expanding access to health care for low‑income women, and supporting high-quality health care services in Indian Country.
$101 billion to transform mental health and substance use disorder coverage and infrastructure — This investment includes $31 billion to expand access to behavioral health care in the private insurance market; $20 billion to require coverage of three behavioral health visits and three primary care visits without cost-sharing; $24 billion to expand and convert Medicaid demonstration programs to improve community behavioral health services into a permanent program; $7.5 billion to invest in the behavioral health workforce and delivery of services; $7.5 billion to establish Medicaid provider capacity grants for mental health and substance use disorder treatment; and $3.7 billion to permanently extend funding for Community Mental Health Centers. These initiatives support the President’s call for full parity between physical and mental health and substance use benefits.
$21 billion to strengthen behavioral health — This discretionary funding level, which is $4.9 billion above the 2022 enacted level, will allow HHS to tackle long overdue efforts to address mental health and substance use. The funding includes a historic investment in 9-8-8, the new nationwide mental health crisis and suicide prevention number starting in July 2022; a historic investment in Behavioral Health Services, which will expand access to crisis care services for people with suicidal ideations or those experiencing a behavioral health crisis; increased Mental Health Block Grant funds to invest in early intervention and prevention of mental disorders in at-risk youth and adults; and increased funding for Project AWARE and the Mental Health Awareness Training program to improve youth mental health by supporting comprehensive, coordinated, and integrated state and tribal efforts to adopt trauma-informed approaches and increase access to mental health services, among other investments. These investments ensure our nation’s youth, especially young people of color, Indigenous youth, and LGBTQ+ youth, who lack access to affordable mental health care coverage will receive the care they need.
$11 billion to address opioids and overdose-related issues — This investment funds foundational programs across HHS to support the Department’s Overdose Prevention Strategy, which prioritizes four key target areas: primary prevention, harm reduction, evidence-based treatment, and recovery support. These programs will support the development of opioid overdose reversal treatments and treatments for opioid use disorder; intercept and prevent shipments of counterfeit pharmaceuticals and health fraud-related shipments; develop, evaluate, and advance digital health medical devices to address opioid use disorder; fund the Rural Communities Opioid Response Program to support substance use prevention, treatment, and recovery services for opioids and other substance use in the highest-risk rural communities; and fund CDC’s opioid overdose prevention and surveillance, among other activities.
$3 billion to extend and expand the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program — The budget extends and expands the home visiting programs that provide critical services directly to parents and their children in underserved communities. This crucial investment will provide economic assistance, child care, and health support to 165,000 additional families at risk for poor maternal and child health outcomes each year. These programs are proven to reduce disparities in infant mortality.
$470 million to improve maternal health and reduce health disparities — This investment will reduce maternal mortality and morbidity, which is especially high among Black and Native American/Alaska Native women, regardless of their income. This crucial investment will promote maternal health and ensure equitable access to affordable, quality health care for our nation’s pregnant women and mothers. This investment includes increased funding to CDC’s Maternal Mortality Review Committees and other Safe Motherhood programs; HRSA’s State Maternal Health Innovation Grants program and new Healthy Start program initiatives; and other maternal health programs across HHS.
$400 million for the Title X Family Planning program to expand access to health care services for low-income women — This investment is the highest funding level in the history of the program, which has been underfunded for a decade. The proposed funding level will improve overall access to vital reproductive and preventive health services while advancing gender and health equity. The Title X Family Planning program is the nation’s only program dedicated to providing family planning services for people with low incomes. It supports a diverse network of providers that offer a range of crucial family planning services and sexual health care. The program supports many important health care providers in our communities, including federally qualified health centers, hospitals, school-based health centers, freestanding family planning providers, Planned Parenthood affiliates, and more.
$142 billion to guarantee meaningful investments and stable funding for the Indian Health Service (IHS) — The budget provides $9.3 billion in mandatory funding for IHS for 2023, which is a $2.5 billion (37 percent) increase above the 2022 enacted level. Over ten years, the budget invests $142 billion in mandatory funding to substantially expand access to high-quality health care services in Indian Country. The funding increase in 2023 will expand direct health care services, improve facilities and IT infrastructure, and strengthen management and operations, as well as provide targeted increases to address key health issues that disproportionately impact American Indians and Alaska Natives such as HIV, Hepatitis C, opioid use, and maternal mortality. Over the long term, these investments will provide the funding necessary to keep pace with population growth, inflation, and rising health care costs; reduce existing facilities’ backlogs; fully fund programs to meet the level of need and address gaps identified by the 2018 Federal-Tribal Indian Health Care Improvement Fund workgroup; and finalize the modernization of the IHS electronic health record system.
Lowers Health Care Costs for Families
The President’s budget includes a deficit-neutral reserve fund to support pending legislation related to the Administration’s prior proposals to invest in the health and well-being of American families, including proposals to lower costs for prescription drugs and health care premiums. In addition to its support for policies to lower health care costs for families, the budget includes proposals to provide certain medication and health care visits at no cost to individuals.
Provide access to pre-exposure prophylaxis (also known as PrEP) at no cost to help end the HIV/AIDS epidemic — As part of the new national program that invests $9.8 billion in mandatory funding over ten years to support the National HIV/AIDS Strategy mentioned above, PrEP, which can reduce the risk of getting HIV by at least 74 percent, will be provided at no cost for all uninsured and underinsured individuals. The budget also expands access to PrEP under Medicaid by covering the drug and associated services without cost-sharing, while removing utilization management practices that may limit access.
$20 billion to require coverage of three behavioral health visits and three primary care visits without cost-sharing — As mentioned under the $101 billion initiative to transform mental health and substance use disorder coverage and infrastructure above, this investment will improve health outcomes by requiring all plans and issuers to cover three behavioral health visits and three primary care visits each year without charging a copayment, coinsurance or deductible-related fee. Even small out-of-pocket costs deter consumers from seeking medical care, including behavioral health services, and about half of U.S. adults say they or a family member put off care because of the cost. This proposal lowers out-of-pocket costs and expands access to vital primary care and behavioral health services for all Americans, including members of historically underserved racial and ethnic groups who are especially likely to forego necessary care.
Conclusion
The President’s budget makes crucial investments to build a healthier America by expanding access to care and strengthening health infrastructure, while addressing health disparities and advancing gender and racial health equity. The budget’s investments will ensure we can address the critical health challenges we face today – including the COVID-19 pandemic – and improve our readiness and capacity to quickly and effectively respond to future health challenges. The budget also advances the President’s Unity Agenda for the Nation to strengthen public health and drive transformational innovation in health technologies.