Budget Proposal Hearing Summaries from Appropriation Subcommittees |
| April 15, 2021: House Subcommittee on Labor, Health & Human Services (HHS), Education, & Related Agencies
· Chairwoman Rosa DeLauro (D-CT) lauded the proposal and noted the success of vaccination efforts (link) · Ranking Member Tom Cole (R-OK) believed this request spends too much on domestic programs at the expense of defense. He added the recovery is underway and many of the items are not warranted on the scale requested. · Secretary Becerra stressed how “health equity” will permeate all decision-making at HHS and noted that $119.5B of the requested $131.7B comes through this Subcommittee · Q&A: full budget request coming in May, ARPA-H (though different Subcommittee), recommendation not to use interim final rule for No Surprises Act, transparency over HHS contracting for the Office of Refugee Resettlement (ORR), fetal tissue research ban (Secretary stated notice coming 4/16/21), plan to increase in number of refugees, re-allocation of vaccines to Michigan, child care, Hyde Amendment, SDoH, and gun violence research. |
Budget Proposal Summary:
On April 9, 2021, the Office of Management & Budget (OMB) provided Congressional Committees with the President’s discretionary funding request for FY2022,[1] which builds on the priorities included in the recently enacted American Rescue Plan (Pub. L 117-2). Overall, the request restores non-defense discretionary funding to 3.3 percent of GDP, which matches the 30-year average. Though this ‘skinny’ budget represents only top-line budget items,[2] a traditional practice for the first year of a new administration, it does provide helpful information about policies and priorities:
| Highlights of Department of Health & Human Services Items in President’s Funding Request for FY2022 |
| · Prepares for the Next Public Health Crisis – includes a CDC increase of $1.6 billion over 2021 enacted levels, which would be the largest annual budget authority increase in nearly 20 years |
| · Promotes Health Equity by Addressing Racial Disparities – provides additional funding to increase the diversity of the health care workforce and expand access to culturally relevant care |
| · Reduces the Maternal Mortality Rate – includes $200 million to address high rate of maternal and race-based disparities in pregnancy outcomes[3] |
| · Promotes Research & Establishes Advanced Research Projects Agency for Health (ARPA-H) – includes an NIH increase of $9 billion and establishes a new agency to address leading causes of disease (e.g., cancer) |
| · Advances the Goal of Ending the Opioid Crisis – includes an increase of $3.9 billion to help end opioid crisis and includes funds for States/Tribes, medication-assisted treatment, research, and expanding the behavioral health |
| · Outside of HHS, the request also includes funding to address climate change and social determinants of health |
“COVID-19 shed light on how health inequities and lack of federal funding left communities vulnerable to crises.” said HHS Secretary Xavier Becerra. “The President’s funding request invests in America, addresses racial disparities in health care, tackles the opioid crisis, and puts us on a better footing to take on the next public health crisis.”[4]
The budget process for the next fiscal year typically includes: President sends budget request to Congress (February); Congressional Budget Office produces long-term fiscal outlook (March);[5] Budget Committees establish a budget resolution (April); Appropriation Committees pass spending bills (June-July); chambers pass spending bills and then reconcile any differences either in a conference committee or by amendment (July-August); and finally, each chamber passes an identical version of the spending bill, which is then sent to the President for signature (September).[6],[7],[8]
Department of Health & 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.
Help End the Opioid Crisis
- $10.7 billion ($3.9 billion increase over FY2021), to support research, prevention, treatment, and recovery support services, with targeted investments to support populations with unique needs, including Native Americans, older Americans, and rural populations.
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.
Promoting Biomedical Research
- $51 billion ($9 billion increase over FY 2021) for the NIH, including $6.5 billion to establish the Advanced Research Projects Agency for Health (ARPA-H).
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. [9] They state that under a true DARPA model,[10] 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.
Older Americans
- Provides additional resources for the Administration for Community Living to help older adults and people with disabilities maximize their independence and well-being:
- $551 million for home and community-based services;
- “Doubles the funding” for the Lifespan Respite Care program;
- Increases resources for older American meal programs; and
- Expands services for individuals with disabilities.
Early Child Care and Learning
- $19.8 billion ($2.8 billion increase over FY2021) for HHS’s early care and education programs:
- $7.4 billion ($1.5 billion increase over FY 2021) for the Child Care and Development Block Grant;
- $11.9 billion ($1.2 billion increase over FY 2021) for Head Start; and
- $450 million for the Preschool Development Grants program.
The discretionary request proposes a $20 billion increase to provide high-poverty schools with the funding they need to deliver a high-quality education to all of their students. This funding will address long-standing funding disparities between under-resourced school districts and their wealthier counterparts, providing critical new support to both students and teachers.
Women’s Health (also see “Addressing Disparities” section below)
- $340 million (18.7 percent increase over FY 2021 level) to the Title X Family Planning program.
Climate Change (also see “Addressing Disparities” section below)
- Establishes a new Office of Climate Change and Health Equity that would focus on decreasing effects of climate change on vulnerable populations.
- $110 million ($100 million increase over FY 2021) for NIH’s Climate Change and Human Health program to support research aimed at understanding the health impacts of climate change.[11]
The discretionary request includes investments to ensure the benefits from tackling the climate crisis accrue to tribal communities, communities of color, low-income households, and disadvantaged communities that have been marginalized or overburdened.
Rural Health
- “Increases funding” for HRSA in order to help rural communities:
- Support rural health care providers;
- Increase funding for rural residency programs;
- Ensure coal miners and their families receive health benefits; and
- Increase the number of individuals from rural areas going to medical school or other training programs and returning or staying in rural communities (primary focus on primary care physicians, nurses, nurse practitioners, nurse anesthetists, & other needed providers).
Gun Violence
- Doubles funding for firearm violence prevention research at CDC and NIH and
- $100 million to CDC for a new Community-Based Violence Intervention initiative (in collaboration with the Department of Justice) to implement evidence-based community violence interventions locally, which may include hospital-based interventions.
The discretionary request supports existing programs to improve background check systems and invests in new programs to incentivize state adoption of gun licensing laws and establish voluntary gun buyback pilot programs.
Addressing Disparities (also see “Women’s Health” and “Climate Change” sections)
- “Additional funding” to increase the diversity of the health care workforce and expand access to culturally competent care.
- $153 million for CDC’s Social Determinants of Health program to support all States and Territories in improving health equity and data collection for racial and ethnic populations.
- “More than $200 million” to improve maternal mortality and end related race-based disparities:
- Reduce maternal mortality and morbidity rates nationwide;
- Strengthen Maternal Mortality Review Committees;
- Expand the Rural Maternity and Obstetrics Management Services program;
- Support the placement of early childhood development experts in pediatrician offices with a high percentage of Medicaid and CHIP patients;
- Implement implicit bias training for health care providers; and
- Create State pregnancy medical home programs.
- $8.5 billion ($2.2 billion increase over FY 2021) to IHS for health inequities experienced by American Indians and Alaska Natives. Includes an advance appropriation for IHS in 2023 to support Administration and tribal priorities.
- $100 million in new competitive grants for States and localities to reduce the over-representation of children and families of color in the child welfare system and address disparate experiences and outcomes and to provide more support to keep families together.
- $200 million for states and community organizations to respond to and prevent child abuse.
- $489 million (“more than double” the enacted FY 2021 level) to support domestic and gender-based violence survivors and provides additional funding for domestic violence hotlines, cash assistance, and medical supports and services.
- $66 million (45 percent over the 2021) for victims of human trafficking and survivors of torture.
As stated in the budget request, “The discretionary request includes proposals that would contribute to a stronger, more inclusive economy over the long term by investing in children and young people, advancing economic security, opportunity, and fairness for all Americans, addressing longstanding racial, sex-based, and economic inequality, and creating good-paying jobs and protecting workers’ ability to join a union to help rebuild a thriving middle class.”
Treatment of Refugees
- $4.3 billion to the Office of Refugee Resettlement (ORR) to help rebuild the Nation’s refugee resettlement infrastructure and support the resettling of up to 125,000 refugees in 2022, which would represent the highest number of refugees admitted in 30 years.
Civil Rights Enforcement
- $47.9 million (increase of 24 percent) for OCR to help ensure protection of civil rights in healthcare.[12]
[1] https://www.whitehouse.gov/wp-content/uploads/2021/04/FY2022-Discretionary-Request.pdf.
[2] The Administration stated that it would submit a full, detailed budget for consideration in May 2021.
[3] On April 12, 2021, HHS approved its first extension of Medicaid postpartum coverage under American Rescue Plan (Pub. L. 117-2)
[4] https://www.hhs.gov/about/news/2021/04/09/statement-hhs-secretary-xavier-becerra-presidents-fy-2022-discretionary.html
[5] https://www.cbo.gov/system/files/2021-03/56977-LTBO-2021.pdf
[6] 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.
[7] If Congress does not finish appropriations by October 1st, it may pass a continuing resolution to extend current funding levels.
[8] CRS. A Brief Overview of the Congressional Budget Process: https://crsreports.congress.gov/product/pdf/R/R46468.
[9] https://www.sciencemag.org/news/2021/04/biden-wants-65-billion-new-health-agency-speed-treatments
[10] CRS. https://crsreports.congress.gov/product/pdf/R/R45088
[11] The budget request also adds, “In addition, the discretionary request includes $110 million for CDC’s Climate and Health program, a $100 million increase over the 2021 enacted level, to identify potential health effects associated with climate change and implement health adaptation plans.” This may be a duplicate entry.
[12] The HHS Office for Civil Rights (OCR) 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 & Rule.