The Biden administration released an overview of the president’s fiscal year (FY) 2022 discretionary funding request on April 9. The preliminary budget overview provides the administration’s proposed top-line funding for departments and agencies, and it includes a proposed $769 billion nondefense discretionary budget, which would represent a 16% increase over FY 2021. A more detailed budget request is expected from the administration later this spring.
Upon the budget’s release, AAMC President and CEO David J. Skorton, MD, issued a press statement stating, “The AAMC is pleased to see the Biden administration’s substantial proposed budget increases for the Department of Health and Human Services (HHS), including medical research and public health agencies in fiscal year 2022, which reflect important steps to reinvest in the nation's health security.”
For HHS, the budget proposes $131.7 billion for FY 2022, which the White House request described as a $25.1 billion (23.5%) increase over FY 2021 enacted funding. The HHS budget request includes proposed funding for several research, public health, and health care departments, agencies, and programs that impact academic medicine.
National Institutes of Health (NIH)
The Biden administration requests $51 billion for the NIH, including $6.5 billion to establish a new Advanced Research Projects Agency for Health (ARPA-H) with an intended focus on cancer, diabetes, and Alzheimer’s disease. ARPA-H is described in the request as representing a “major investment in Federal research and development [that] would drive transformational innovation in health research and speed application and implementation of health breakthroughs.”
The AAMC-convened Ad Hoc Group for Medical Research issued a press statement applauding the proposed investment in the NIH and urging no less than $46.1 billion for the NIH base program level budget in FY 2022. “We also look forward to learning more about the proposed ARPA-H initiative to accelerate the implementation of research findings. Our community of patients, scientists, clinicians, academic and research institutions, and industry appreciates the President’s bold vision to promote transformational innovations against the full range of maladies that patients face,” the coalition stated.
Centers for Disease Control and Prevention (CDC)
The president’s FY 2022 request proposes $8.7 billion for the CDC. According to the budget request, “This would be the largest budget authority increase for CDC in nearly 20 years and is needed to restore capacity to the world’s preeminent public health agency,” citing several priorities to enhance public health response efforts, including improved data collection and public health workforce training.
Within the CDC allocation, the budget would provide $153 million to the Social Determinants of Health (SDOH) program. The SDOH program, which received $3 million in FY 2021 funding, was first proposed in the AAMC-endorsed Social Determinants Accelerator Act [refer to Washington Highlights, March 13, 2020].
The budget proposal requests a “doubling” of discretionary funding for firearm violence prevention research at the CDC and the NIH. In FY 2021, each agency received $12.5 million for this research initiative. The budget also proposes a new Community Violence Intervention initiative for the Departments of Justice (DOJ) and HHS to address community gun violence. The president requests that DOJ and HHS receive a combined $200 million for the initiative “to implement evidence-based community violence interventions locally, which may include hospital-based interventions.”
Health Workforce Diversity
The administration’s budget proposal would “provide additional funding to increase the diversity of the healthcare workforce and expand access to culturally competent care.” While no specific programs or funding amounts were mentioned in the budget request, the Health Resources and Services Administration (HRSA) Title VII diversity workforce programs are designed to recruit future health professionals from diverse backgrounds. For FY 2022, the AAMC-led Health Professions and Nursing Education Coalition has recommended $1.51 billion for the HRSA Title VII and Title VIII programs, which would double their FY 2021 appropriation amounts [refer to Washington Highlights, April 2].
The Biden administration is also proposing substantial increases to “programs that help rural communities by providing access to quality healthcare and health professionals.” The request proposes increased funding for the rural residency program, which is administered by HRSA, and for programs that recruit students “from rural areas going to medical school or other training programs, and returning or staying in rural communities to provide care.” While not specifically mentioned in the budget, programs such as the National Health Service Corps are designed to support rural medical students and incentivize providers to practice in rural and other underserved communities.
Maternal Health and Mortality
The budget proposes $200 million to fund efforts to “reduce the maternal mortality rate and end race-based disparities in maternal mortality.” Included in the proposal is additional funding within the HHS budget for the CDC’s Maternal Mortality Review Committees, expansion of HRSA’s Rural Maternity and Obstetrics Management Strategies program, implicit bias training for health care providers, and the creation of pregnancy medical home programs at the state level.
Opioid Epidemic Investments
Without including a specific amount, the proposal describes a “historic investment” to address the opioid epidemic and would provide funding for states and tribes, medication-assisted treatment, research, and the expansion of the behavioral health provider workforce, with “targeted investments to support populations with unique needs, including Native Americans, older Americans, and rural populations.”
The budget request also includes proposed funding for other federal agencies.
Department of Veterans Affairs (VA) Medical and Prosthetic Research
The president’s budget proposal includes $882 million for the VA research program, which is described as “the largest year-over-year increase in recent history.” The final FY 2021 spending bill appropriated $815 million for VA research and also rescinded $20 million in prior-year unobligated balances.
National Science Foundation (NSF)
President Biden’s FY 2022 request includes $10.2 billion for the NSF, which is described as a $1.7 billion (20%) increase over FY 2021. According to the budget request, this investment would support climate science and sustainability research, fundamental research and development, racial equity in science and engineering, and the strengthening of U.S. leadership in emerging technologies.
Department of Education
The president’s budget proposal includes a more than $600 million increase over FY 2021 appropriated amounts for historically Black colleges and universities, tribally controlled colleges and universities, and minority serving institutions. Of the additional funding, $100 million would be dedicated “for programs that aim to increase participation in science and engineering of individuals from racial and ethnic minority groups.”
The release of the president’s budget request kicks off the congressional appropriations activities, with several federal appointees appearing before House and Senate appropriations committees to testify on the FY 2022 budget request during the week of April 12 [refer to related stories on the Department of Health and Human Services and Department of Veterans Affairs].