The Biden administration released the president’s budget request for Fiscal Year (FY) 2023 on March 28. While the annual exercise provides a blueprint of the White House’s priorities and spending proposals across all federal departments and agencies, final funding decisions will be determined by Congress.
The FY 2023 budget request proposes $127.3 billion in discretionary budget authority for the Department of Health and Human Services (HHS), a $13.3 billion (11.6%) increase over FY 2022, including increases for the Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), and the new Advanced Research Projects Agency for Health (ARPA-H), among other programs, while proposing effectively flat funding for the National Institutes of Health (NIH).
Upon the budget's release, AAMC President and CEO David J. Skorton, MD, and Chief Public Policy Officer Karen Fisher, JD, issued a statement noting, “The AAMC appreciates President Biden’s continued commitment to crucial programs and initiatives that would improve the nation’s health through proposed investments in medical research, public health, and patient care in his FY23 budget request,” but also emphasizing that “in order for ARPA-H to be successful, the investment in ARPA-H must be coupled with meaningful growth in the NIH base budget, which the budget request neglects to include.”
Additionally, the administration proposes a new $82 billion mandatory pandemic preparedness fund, available over 5 years, to supplement appropriations for related activities at the CDC ($28 billion), NIH ($12 billion), Assistant Secretary for Preparedness and Response (ASPR, $40 billion), and the Food and Drug Administration ($1.6 billion).
The request includes additional details on research, public health, and health care agencies, and programs that impact academic medicine. On March 31, HHS Secretary Xavier Becerra testified on the administration’s request for the department before the House Appropriations Committee [refer to related story].
National Institutes of Health (NIH)
The president proposes $45.5 billion for NIH’s base budget, a $275 million (0.6%) increase over the comparable FY 2022 funding level, and $5 billion for the Advanced Research Projects Agency for Health (ARPA-H), a $4 billion (400%) boost over funding Congress provided to HHS to establish the entity in FY 2022.
The Ad Hoc Group for Medical Research, an NIH advocacy coalition of nearly 400 organizations convened by the AAMC, issued a statement expressing concern that the “bold proposal for the nascent Advanced Research Projects Agency for Health (ARPA-H) comes at the expense of NIH’s annual base budget, which ultimately would undermine the success of both entities.”
The request also proposes to rename two NIH institutes as part of an HHS-wide proposal to avoid stigmatizing language around addiction by removing the word “abuse” from agency names.
Centers for Disease Control and Prevention (CDC)
The budget proposes a total program funding level of $10.7 billion for the CDC, an increase of $2.2 billion (27%) over the comparable FY 2022 enacted levels. Within the CDC budget, the proposal would reduce funding levels for the Racial and Ethnic Approach to Community Health (REACH) by $2 million to $64 million and would maintain funding for the Prevention Research Centers at $27 million.
The CDC budget also includes $153 million for the agency’s Social Determinants of Health (SDOH) program. The SDOH program, which received $8 million in FY 2022 funding, was proposed in the AAMC-endorsed Social Determinants Accelerator Act (H.R. 2503), which Congress has yet to pass [refer to Washington Highlights, April 23, 2021].
According to the CDC congressional justification, the budget proposes $250 million for a new community violence intervention initiative at the CDC. The budget also proposes to increase funding for firearm violence prevention research supported by the CDC ($35 million, a $22.5 million or 180% increase over FY 2022 levels) and the NIH ($25 million, doubling funding over FY 2022 levels).
Agency for Healthcare Research and Quality (AHRQ)
The president’s proposal requests $416 million for AHRQ, representing a $66 million (18.9%) increase over FY 2022. In addition to the funding provided through the appropriations process, AHRQ also receives a transfer from the Patient-Centered Outcomes Research Trust Fund, expected to be $111 million in FY 2022, bringing the agency’s proposed total to $527 million.
Health Resources and Services Administration (HRSA)
The president proposes $8.5 billion for HRSA discretionary funding, $53 million (0.6%) less than the comparable FY 2022 level. The budget proposes $1 billion for the HRSA Title VII health professions and Title VIII nursing workforce development and diversity programs, a $211 million (26%) increase over FY 2022 enacted levels. The budget also includes $37 million for Centers of Excellence (a $12 million or 50% increase over FY 2022); $18 million for the Health Careers Opportunity Program (a $3 million or 20% increase over FY 2022); and $2.3 million for Faculty Loan Repayment (a $1 million or 88% increase over FY 2022).
The budget request proposes a new investment of $50 million under Title VII to fund the AAMC-supported Dr. Lorna Breen Health Care Provider Protection Act (P.L. 117-105), which supports evidence-informed strategies to prevent burnout in the health workforce and promote clinician well-being [refer to Washington Highlights, Feb. 25].
The budget proposes $210 million in discretionary funding (an increase of $88 million or 72% over FY 2022 enacted levels) and $292 million (flat funding) in mandatory funding for the National Health Service Corps (NHSC). Additionally, the president’s budget request proposes $350 million (a $25 million or 9% decrease below FY 2022) for Children’s Hospitals Graduate Medical Education (CHGME) and $13 million (a $2 million or 18% increase over FY 2022) for the Rural Residency Planning and Development programs. The budget proposes to maintain mandatory funding for Teaching Health Centers graduate medical education at current levels.
340B Drug Discount Program
The budget proposes $17 million (a $7 million or 68% increase over FY 2022 enacted levels) to provide HRSA with resources to “continue to build on is program integrity efforts” with the implementation of an Administrative Dispute Resolution process and increased audit and oversight activities. Additionally, as in past years, the budget proposal requests rulemaking authority over the program to expand the agency’s current statutory regulatory authority.
Maternal Health and Mortality
The budget requests $276 million, an increase of $202 million over FY 2022, across HRSA programs to reduce maternal morbidity and mortality and improve maternal health. This includes funding for State Maternal Health Innovation Grants, Alliance for Innovation on Maternal Health Safety bundles, and rural maternal health initiatives. It also proposes $10 million to support HRSA’s efforts to expand providers’ capacity to screen for and treat maternal depression and related behavioral health conditions. The budget also includes $164 million for the CDC’s maternal health programs.
The budget reiterates the administration’s support for telehealth coverage in the Medicare program beyond the COVID-19 public health emergency. The budget specifically requests $45 million for HRSA to promote telehealth, a 25% increase over FY 2022 enacted levels.
Hospital Preparedness Program (HPP) and Other Preparedness Investments
The proposal requests $292 million for the HPP program within the Office of the Assistant Secretary for Preparedness and Response (ASPR), a funding level $3.8 million (1.3%) lower than the FY 2022 omnibus.
In addition to the proposed new mandatory Pandemic Preparedness fund, the request proposes to bolster appropriations over final FY 2022 funding levels for the Biomedical Advanced Research and Development Authority (BARDA), the Strategic National Stockpile, and the National Disaster Medical System.
Mental and Behavioral Health
The president’s budget proposes $275 million to the Department of Labor over ten years to enhance enforcement of the 2008 Mental Health Parity and Addiction Equity Act, as well as $125 million in mandatory funding for the HHS over five years to enforce mental health and substance use disorder parity requirements. The budget also would extend parity protections to Medicare beneficiaries and require that all insurers cover at least three behavioral health visits per year with no cost-sharing.
The budget would provide states with $7.5 billion in funding over ten years to pursue grant and demonstration opportunities to build their behavioral health provider capacity for Medicaid beneficiaries. In addition, the budget proposes to disallow some state Medicaid agencies’ policies limiting reimbursement for medical and behavioral health visits furnished on the same day, a major impediment to the implementation of integrated behavioral health models.
The budget proposes to extend Medicare reimbursement to additional behavioral health provider types, including licensed professional counselors, marriage and family therapists, and community health workers.
The budget proposes $553 million for the Certified Community Behavioral Health Clinics Expansion Grant program, and it proposes to allow states currently participating in the model to convert their demonstration to a permanent Medicaid state plan option.
Other Departments and Agencies
Department of Veterans Affairs (VA) Medical and Prosthetic Research
The president’s request includes $916 million in discretionary spending for VA research in FY 2023 as well as $30 million for the VA’s American Rescue Plan allocation, for a total investment of $946 million. This represents a $64 million or 7.3% increase over FY 2022 enacted funding levels.
National Science Foundation (NSF)
The president’s budget proposes $10.5 billion for the NSF in FY 2023, a $1.7 billion (19%) increase over the comparable FY 2022 funding level. Within the NSF request is a proposed $8.4 billion for research and related activities, representing 80% of the overall request.
Department of Education
Within the Department of Education, the administration proposes legislative changes to permanently make student loan forgiveness tax exempt. Additionally, the administration continues to support expanding federal student aid to Deferred Action for Childhood Arrivals (DACA) recipients.
The budget proposes $102.3 million for the Strengthening Historically Black Graduate Institutions program, which provides support to Historically Black Colleges and Universities (HBCU) medical and other health professions schools, for FY 2023. The budget would provide $450 million for the Research Infrastructure Investments program for HBCUs, Tribal Controlled Colleges and Universities, and minority-serving institutions that would support both planning and implementation grants designed to promote transformational investments in research infrastructure, including physical infrastructure and human capital development.