The Biden administration released the president’s budget request for Fiscal Year (FY) 2022 on May 28. The budget request provides additional detail on the administration's funding proposal for departments and agencies following the release of the top-line discretionary budget request in April [refer to Washington Highlights, April 16]. While the annual exercise provides a blueprint of the White House’s priorities and spending proposals, final funding decisions will be determined by Congress.
Upon the budget's release, AAMC President and CEO David J. Skorton, MD, and Chief Public Policy Officer Karen Fisher, JD, issued a press statement stating, “The AAMC praises President Biden’s visionary commitment to improving the health of the nation by proposing meaningful, increased investments in medical research, public health, and patient care in his FY 2022 budget request. We have learned over this past year just how integral the NIH, the CDC, and other federal health and research agencies are to the health and well-being of every individual in our nation.”
The complete FY 2022 budget request proposes $131.8 billion for the Department of Health and Human Services (HHS), a $25.1 billion (23.5%) increase over FY 2021 enacted funding, and includes additional details on research, public health, and health care agencies, and programs that impact academic medicine.
National Institutes of Health (NIH)
The Biden administration proposes a total of $51.9 billion for the NIH, a $9 billion (21%) increase over FY 2021, including a program level of $45.5 billion for NIH’s existing institutes and centers ($2.5 billion or 5.9% more than the comparable FY 2021 funding level). It also includes$6.5 billion, available through September 30, 2024, for a new Advanced Research Projects Agency for Health (ARPA-H) initiative. Modeled after the Defense Advanced Research Projects Agency (DARPA), ARPA-H would function “with industry, academia, nonprofits, and other Federal agencies, using traditional and nontraditional mechanisms like Other Transaction Authority, to scale up projects with the most promise for improving health and saving lives,” the budget stated.
The AAMC-convened Ad Hoc Group for Medical Research issued a press statement noting that the coalition is “thrilled to see President Biden propose a bold, historic funding level for the NIH overall in FY 2022.” The statement adds that, “To advance the transformative mission of [ARPA-H] and other targeted initiatives – and the NIH overall – it will be critical to ensure that funds supplement, rather than supplant, the core investment in NIH.”
The NIH’s budget materials also acknowledge the coronavirus pandemic’s impact to the research enterprise, noting, “Many NIH-supported research projects across the Nation have ground to a halt as universities and other research institutions have suspended operations. … Similarly, the research workforce, particularly early-career scientists, faces significant challenges as the opportunity to generate and collect data has been disrupted.” On May 26, NIH Director Dr. Francis Collins testified that the agency estimates that the pandemic has had a $16 billion impact on the NIH [refer to Washington Highlights, May 28].
Centers for Disease Control and Prevention (CDC)
The president's FY 2022 request proposes $9.5 billion for the CDC, an increase of $1.7 billion (21.4%) over the comparable FY 2021 enacted levels. The CDC congressional justification outlines four main areas of priority for the agency in FY 2022: building public health infrastructure, reducing health disparities, public health approaches to reducing violence, and defeating other diseases and epidemics. Within the CDC allocation, the budget would maintain the FY 2021 funding levels for the Racial and Ethnic Approach to Community Health (REACH) at $64 million and the Prevention Research Centers at $27 million.
Combatting Gun Violence
According to the CDC congressional justification, the budget proposes $100 million for a new community violence intervention initiative at the CDC that will “fund the 25 cities with the highest number of homicides and the 25 cities with the highest number of homicides per capita” and support evidence-based strategies, including those in hospital settings, to prevent community violence. The budget also proposes to double funding to the CDC and the NIH, from $12.5 million each in FY 2021 enacted levels to $25 million for each agency, for firearm violence prevention research.
Agency for Healthcare Research and Quality (AHRQ)
The president’s proposal requests $380 million for AHRQ, representing a $42 million (12.4%) increase over FY 2021. AHRQ also would receive a transfer from the Patient-Centered Outcomes Research Trust Fund, expected to be $109 million in FY 2022, bringing the agency’s proposed total to $489 million.
Health Resources and Services Administration (HRSA)
The president proposes a total of $7.8 billion for HRSA’s discretionary programs, an increase of $616 million (8.5%) over the FY 2021 enacted level. This includes a proposed $854 million for the HRSA Title VII health professions and Title VIII nursing workforce development and diversity programs, a $91.4 million (12.1%) increase over FY 2021 enacted levels.
The budget proposal includes increases for the Centers of Excellence, Health Careers Opportunity Program, Scholarships for Disadvantaged Students, Minority Faculty Loan Repayment, Geriatric, Mental Health Workforce, Public Health and Preventive Medicine, and Nursing Workforce Diversity Program. All other Title VII and Title VIII programs were flat funded.
The budget proposes $185 million (+$60 million or 54% over FY 2021) for the National Health Service Corps in discretionary funding, and $292.3 million (-$17.7 million or -5.7% below FY 2021) in mandatory funding. Additionally, the president’s budget request proposes $350 million (flat funding) for Children’s Hospitals Graduate Medical Education and $12.7 million ($2.2 million or 21% above FY 2021) for the Rural Residency Planning and Development programs. For Teaching Health Centers GME, the budget proposes $119.3 million in mandatory funding, a $7.2 million (5.7%) decrease.
Maternal Health and Mortality
The budget proposes $220 million in discretionary funding to reduce maternal mortality and morbidity “by implementing evidence-based interventions to address critical gaps in maternity care service delivery and improve maternal health outcomes.” This includes funding to CDC’s Maternal Mortality Review Committees, HRSA’s Rural Maternity and Obstetrics Management Strategies program, as well as other increases across HHS programs. Additionally, the HHS budget includes $3 billion over five years to “invest in maternal health and reduce the maternal mortality rate and end race-based disparities in maternal mortality.”
Access to Coverage
The budget proposes $163 billion over 10 years to permanently extend the policy in the American Rescue Plan Act (P.L. 117-2) to expand subsidies in the Affordable Care Act marketplaces to those who earn above 400% of the federal poverty level (FPL). It also would ensure that individuals with incomes below 150% of the FPL do not pay premiums.
The President also urges Congress to improve Medicare benefits, create a public option available through the ACA marketplace, allow people 60 and above to enroll in Medicare, and extend coverage to people in non-Medicaid expansion states by providing premium-free, Medicaid-like coverage through a federal public option. Additionally, the President calls on Congress to take action to lower prescription drug prices by allowing Medicare to negotiate the prices of certain drugs and to require drug manufacturers to pay rebates when drug prices rise faster than inflation.
The budget requests $37 million (+$3 million over FY 2021 enacted levels) to support the HRSA Telehealth Network Grant Program to increase health care quality and access, expand provider trainings, and improve health outcomes in rural areas.
Hospital Preparedness Program (HPP) and Other Preparedness Investments
The proposal requests $291.8 million for the HPP program within the Office of the Assistant Secretary for Preparedness and Response, an $11.2 million (3.8%) increase over the FY 2021 funding level. The request also proposes to bolster funding for the Biomedical Advanced Research and Development Authority, the Strategic National Stockpile, and the National Disaster Medical System.
In addition to the funds proposed in the FY 2022 request, the HHS Budget in Brief describes a $1.5 billion investment as part of the president’s American Jobs Plan proposal to support “public health resilience” by improving “resilience of hospitals and critical infrastructure, fund health emergency preparedness cooperative agreements, and build resilience against climate effects,” [refer to Washington Highlights, April 2].
Department of Veterans Affairs (VA) Medical and Prosthetic Research
The president’s request includes $882 million for the VA Medical and Prosthetic Research program in FY 2022. The final FY 2021 spending bill appropriated $815 million for VA research and also rescinded $20 million in prior year unobligated balances. The president’s FY 2022 request is a $67 million (8.2%) increase over the comparable FY 2021 level. The budget also estimates that $9 million provided to the VA through the American Rescue Plan Act will be obligated in FY 2021 for COVID-19-related research at the VA.
National Science Foundation (NSF)
The president’s budget proposes $10.2 billion for the NSF in FY 2022, a $1.7 billion (19.8%) increase over the comparable FY 2021 funding level. Within the NSF request is a proposed $8.14 billion for Research and Related Activities, a $1.2 billion (17.8%) increase over the comparable FY 2021 level.
Department of Education
Within the Department of Education’s FY 2022 budget request, the Federal Work Study program would receive $1.2 billion, representing no change from FY 2021. The Strengthening Historically Black Graduate Institutions program, which provides support to Historically Black Colleges and Universities (HBCU) medical and other health professions schools among other graduate programs, would receive $102.3 million, an increase of $15 million (17.2%) over FY 2021.
The budget outlines an investment in training health professionals at HBCUs, Hispanic Serving Institutions, Tribal Colleges and Universities and other Minority Serving Institutions by proposing $200 million in new mandatory funding for the “Health Professionals of the Future” program. This new program is proposed in the American Families Plan [refer to Washington Highlights, April 30].
The release of the president’s complete budget request will accelerate congressional appropriations activities, with both House and Senate appropriations committees expected to begin marking up FY 2022 spending bills later in June.