On May 28, 2021, the White House released the President’s fiscal year (FY) 2022 budget.[1] This full version of the budget follows the Administration’s “top-line” budget released in early April. For the Department of Health and Human Services (HHS), the administration is requesting $131.8 billion in discretionary.[2] In a statement about the budget request HHS Secretary Xavier Becerra said, “HHS is at the center of many challenges facing our country today—the COVID-19 pandemic, mental and other behavioral health challenges, the opioid addiction crisis, racial inequality and more. The President’s FY 2022 budget invests in building a healthier America by giving us the resources we need to protect and invest in the wellbeing of families nationwide today and the years to come.” [3]

The ultimate budget for HHS and its subagencies will be determined by Congress and not the White House. However, the budget request does provide insight into the Administration’s priorities.

The budget process for the next fiscal year typically includes: President sends budget request to Congress; Congressional Budget Office produces long-term fiscal outlook;[4] Budget Committees establish a budget resolution; Appropriation Committees pass spending bills; chambers pass spending bills and then reconcile any differences; and finally, each chamber passes an identical version of the spending bill, which is sent to the President for signature.[5]^,[6],[7]

Budget Request Highlights

• The budget outlines the administration’s health priorities: preparing for the next public health crisis, promoting health equity, reducing the maternal mortality rate, promoting research through the establishment of a new agency, and addressing the opioid crisis.
• Though the budget does not include any specific drug pricing proposals, it does state the President’s support for allowing Medicare to negotiate for high-cost drugs and requiring manufacturer rebates when drug prices increase faster than inflation.
• The budget also signals the President’s support for creating a public option that would be available on the health care exchanges, giving those age 60 and above the option to enroll in Medicare, and expanding Medicare benefits to include vision, hearing, and dental.
• The Biden Administration proposes to create a new agency within the National Institutes for Health (NIH), called the Advanced Research Projects Agency for Health (ARPA-H).

Department of Health and Human Services (HHS)

Budget Request: $131.7 billion ($25 billion increase / 23.5 percent increase)

Improve Readiness for Future Public Health Crises

• $8.7 billion ($1.6 billion increase over FY 2021) for the CDC to support core public health capacity improvements in states/territories, train personnel to deploy and assist with public health efforts of states/localities, modernize public health data collection, and enhance international deployment.
• $905 million ($200 million increase over FY 2021) for the Assistant Secretary for Preparedness and Response (ASPR) Strategic National Stockpile and enhance the FDA’s organizational capacity.
• $823 million (an increase by $227 million over FY 2021) for the Biomedical Advanced Research and Development Authority (BARDA) to support novel medical countermeasure platforms to further public health responses.

Help End the Opioid Crisis

• $10.7 billion ($3.9 billion increase over FY2021), to support research, prevention, treatment, and recovery support services.
• This funding will include targeted investments to support populations with unique needs, including Native Americans, older Americans, and rural populations.
• Funding will also be used to increase access to medication for opioid use disorder and expanding the behavioral health provider workforce.

Promoting Biomedical Research

• $51 billion ($9 billion increase over FY 2021) for the NIH.
• This includes $6.5 billion to establish the Advanced Research Projects Agency for Health (ARPA-H), which will initially focus on cancer and diseases such as diabetes and Alzheimer’s.

The discretionary request calls for $6.5 billion to launch ARPA-H with an initial focus on cancer and other diseases such as diabetes and Alzheimer’s. It believes this major investment will drive transformational innovation in health research and speed the implementation of breakthroughs.

It is important to note that some proponents of ARPA-H are disappointed that the budget request includes ARPA-H inside of the NIH. ^[8] They state that under a true DARPA model,^[9] projects are vetted by program managers and not peer reviewers like at NIH. They also note that awards are milestone-dependent unlike the multiyear grants issued by the NIH. Even though it is not ideal, the situation of ARPA-H within NIH might just signify expediency as it does not require new legislation.

Ending the HIV/AIDS Epidemic

• $670 million ($267 million increase over FY 2021) for CDC, Health Resources and Services Administration (HRSA), Indian Health Service (IHS), and the National Institutes of Health (NIH) to reduce new HIV cases while increasing access to treatment, expanding use of pre-exposure prophylaxis (PrEP), and ensuring equitable access to services and supports.

Prioritize Mental Health

• $1.6 billion (twice the amount from FY 2021) for the Community Mental Health Services Block Grant, supports those in the criminal justice system, provides funding for partnerships between mental health providers and law enforcement, and expands suicide prevention activities.

Other

• $17 million to improve operations and oversight of the 340B program, which is an increase of $7 million over FY 2021 levels.
  • The budget also provides explicit general regulatory authority over the 340B program to help improve program integrity.
• Over $200 million in discretionary funding to address maternal mortality and morbidity, including funding to:
  • CDC’s Maternal Mortality Review Committees to implement data collection and data-driven action.
  • Expand HRSA’s Rural Maternity and Obstetrics Management Services program.
• $340 million (an 18.7 percent increase) for the Title X Family Planning program.
• An additional $150 million for the CDC’s Social Determinants of Health program to expand funding to states and territories for interventions to improve health equity.
• $48 million (increase of 24 percent) for the Office of Civil Rights (OCR) to help ensure protection of civil rights in healthcare.^[10]
• Permanent expansion of the premium tax credits adopted in the American Rescue Plan.
• $400 billion in spending over a decade for home and community-based care, including raising wages and benefits for home care workers, home and community-based services, and extending the Money Follows the Person program.

[1] https://www.whitehouse.gov/wp-content/uploads/2021/05/budget_fy22.pdf

[2] https://www.hhs.gov/sites/default/files/fy-2022-budget-in-brief.pdf

[3] https://www.hhs.gov/about/news/2021/05/28/statement-by-hhs-secretary-xavier-becerra-on-the-president-fy2022-budget.html

[4] https://www.cbo.gov/system/files/2021-03/56977-LTBO-2021.pdf

[5] Budget resolutions are not subject to filibuster or Presidential veto. Spending bills are subject to both but may be passed with simple majority in Senate using a fast-track process known as reconciliation to implement policies embodied in budget resolutions

[6] If Congress does not finish appropriations by October 1st, it may pass a continuing resolution to extend current funding levels

[7] CRS. A Brief Overview of the Congressional Budget Process: https://crsreports.congress.gov/product/pdf/R/R46468

[8] https://www.sciencemag.org/news/2021/04/biden-wants-65-billion-new-health-agency-speed-treatments

[9] CRS. https://crsreports.congress.gov/product/pdf/R/R45088

[10] The HHS Office for Civil Rights enforces federal civil rights laws, conscience and religious freedom laws, the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security, and Breach Notification Rules, and the Patient Safety Act and Rule.