HHS budget proposal puts high price tag on pandemic preparedness

Investments in pandemic preparedness, behavioral health and maternal health were among the “critical priorities” targeted by the Biden administration. proposed budget for fiscal year 2023 for the Department of Health and Human Services, HHS Secretary Xavier Becerra said Monday.

In total, the Biden administration has proposed $127.3 billion in discretionary budget authorization and $1.7 trillion in mandatory funding for fiscal year 2023. Highlights of the proposed budget include:

  • $81.7 billion over 5 years for pandemic preparedness
  • $20.8 billion in discretionary funding for behavioral health programs in fiscal year 2023
  • $470 million to reduce maternal mortality in fiscal year 2023
  • $20.2 billion in discretionary funding for the Administration’s early care and education programs for children and families
  • $397 million for behavioral health workforce development programs
  • $697 million for 988 (new lifeline to replace national 10-digit lifeline for suicide prevention) and behavioral health services

“Budgets aren’t just dollars, they’re values,” Becerra said. “You will find the fingerprints of equity and inclusion in everything we do at HHS.”

$81.7 billion mandatory funding request for pandemic preparedness over 5 years extends to entire Office of the Assistant Secretary for Preparedness and Response, CDC, NIH and FDA . The proposal said the money would support a rapid response to future pandemics or “other biological threats with serious consequences”.

“It’s a drop in the bucket compared to what it’s cost so far to deal with COVID,” Becerra said, reminding reporters that federal pandemic funds are running out. already exhausted.

He clarified that the budget request for long-term pandemic preparedness is “separate and separate” from the Biden administration’s current COVID funding request of $22.5 billion to Congress.

These funds are needed “immediately”, he said.

“Our resources are stretched. We need the support of Congress to finish this fight,” Becerra said, noting that the Provider Relief Fund has stopped accepting claims for testing and treatment for the uninsured. , and will no longer accept requests related to vaccination “on or about April 5.”

“We’re going to stretch where we can, but there’s no doubt that if we don’t get the resources we need, we’re just going to fall behind,” Becerra said.

Carole Johnson, administrator of the Health Resources and Services Administration, said the government was trying to support uninsured people by directing them to covidtests.govto community health centers for care and reminding them to check if they may be eligible for Medicaid.

“We are doing everything we can to try to give people access to these resources, but there is no doubt that the uninsured program is what provides a critical bridge for people and why the consequence of not having funding is important,” she said.

Asked about access to a possible second COVID-19 booster for adults 50 and older, Dawn O’Connell, assistant secretary for preparedness and response at HHS, said she plans to have enough doses. to meet this need, if a second booster was authorized this week.

“What worries us is … if a different variant comes up and we need a variant-specific booster in a few months, it would be a bit more expensive, and we don’t have those doses on hand. “, O’Connell added.

CDC push for interoperability

The proposed budget includes $200 million for the CDC’s data modernization initiative, which aims to make public health data systems more equitable and accessible and $600 million for long-term public health planning, to build “basic public health infrastructure and capacity at all levels of government,” and meet “peaking needs.”

Also included are $353 million for Global Public Health Protection “to provide a strategic regional presence and enhance global public disease detection and emergency response” and $50 million to support the new Epidemic Prediction and Analysis Centerwhich will continue to improve the government’s ability to identify potential new health threats.

“I think one of the lessons we’ve learned over the last 2 years is that we didn’t have interoperable data, the data was slow to come to us, [and] that they weren’t electronic,” CDC Director Rochelle Walensky, MD, said during the briefing.

And while more than 11,000 health systems now have electronic case reports, “that’s less than half of what we need to be,” Walensky said.

Prioritize mental and behavioral health

The budget proposal also aims to support mental health parity within the Medicare program. Unlike most private and employer plans and Medicaid, Medicare is not subject to Mental Health Parity and Substance Abuse Equity Act of 2008which called for health plans to offer mental health and addictions benefits “on par with” medical and surgical benefits.

The proposed budget would close that gap, with the document saying it would ensure “mental health and addiction benefits under Medicare do not face greater limitations on reimbursement or access to care than benefits.” medical and surgical.

The Biden administration has also called for the removal of “limits on the scope of services” provided by licensed professional counselors and marriage and family therapists, which would create a new category of Medicare benefits to allow for direct billing and payment. , so that these professionals can be reimbursed by Medicare.

Removing these statutory limits would help increase access to mental health services for Medicare beneficiaries, especially in rural and underserved areas, the budget document notes.

Johnson said the proposed budget also aims to increase the mental health and addictions workforce by leveraging “not just university-level social workers and counselors…but also those essential community connectors like health care workers.” community health and peer support, to make sure people with lived experience are also part of our solution. »

“We want everyone to know that whether it’s a broken bone, a cold or a mental challenge, you’ll get the services available to you, that you need, and our work So it’s all about continuing to break down those barriers,” Becerra added.

The budget also includes a $21.1 billion request for HHS “to support prevention, treatment, and interdiction efforts” related to substance use, as noted by a Press release of the Office of National Drug Control Policy (ONDCP).

The ONDCP also highlighted the “historic $85 million” earmarked for CDC harm reduction services and $63 million earmarked for the Substance Abuse and Mental Health Services Administration’s first responder training program.

Rahul Gupta, MD, director of ONDCP, said in a statement that these funds “will expand access to evidence-based treatment, reduce the flow of illicit drugs like fentanyl from entering our communities, and prevent overdoses”.

Maternal health support

The Office of Minority Health aims to target areas with high rates of adverse maternal health outcomes or significant racial and ethnic disparities in maternal health outcomes, the budget proposal notes. The United States has the highest maternal mortality rate among developed nations, with disproportionately high rates among black, Native American, and Alaska Native women.

The FY2023 budget includes $86 million to leverage this increased focus on adverse maternal health outcomes. The proposed budget indicated that $42 million of this amount will be directed to the Bureau of Women’s Health “to fund activities related to disease prevention, health promotion, service delivery, research and the training of health professionals, for issues of particular concern to women throughout their lives.

Becerra noted that CMS also offers each state the option to extend postpartum care in Medicaid for a full year, and to date, five states have accepted this offer.

“We need everyone to do this because it should be true that a woman, whether she has the money or not, continues to receive care after giving birth for more than 60 days,” he said. he declares.

Invest in HIV prevention, biomedical research

The budget contains a $237 million proposal to target racial and ethnic gaps in access to pre-exposure prophylaxis (PrEP) to prevent HIV.

AIDS Institute Executive Director Michael Ruppal welcomed the move in a statement, noting that “President Biden is committed to ending the HIV epidemic in the United States…and this budget is a follow-up to this commitment”.

These funds would not only help reduce new HIV cases, but would also target the “imbalance” in care where only 14% of Hispanics and 8% of black Americans receive a referral for a PrEP prescription, the AIDS Institute noted. .

The Biden administration also plans to allocate $49 billion in discretionary funding to the NIH, including $5 billion for its new Advanced Research Projects Agency for Health (ARPA-H). The budget document noted that the new agency “will build high-risk, high-reward capabilities and platforms to drive biomedical breakthroughs.”

When asked if the ARPA-H program would be housed inside or outside the NIH, Becerra hesitated on his answer.

“I guarantee you…wherever it is, we intend to fly [the agency] and the result will be that Americans will benefit,” he said.

David Skorton, MD, and Karen Fisher, JD, of the Association of American Medical Colleges, welcomed the fact that there was “significant funding for medical research” in the proposed budget, but stressed that for the For ARPA-H to succeed, it “must be accompanied by significant growth in the NIH base budget,” which the current budget does not provide for.

  • Shannon Firth has reported on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. To follow

Richard L. Militello