HHS Budget Proposal Boasts Hefty Price Tag for Pandemic Preparedness

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

In total, the Biden administration proposed $127.3 billion in discretionary budget authority and $1.7 trillion in mandatory funding for FY 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 FY 2023
• $470 million to reduce maternal mortality in FY 2023
• $20.2 billion in discretionary funding for the Administration for Children & Families early care and education programs
• $397 million for Behavioral Health Workforce Development Programs
• $697 million for 988 (new lifeline to replace the 10-digit National Suicide Prevention Lifeline) and behavioral health services

“Budgets are more than just dollars, they’re about values,” Becerra said. “You’ll find the fingerprints of fairness and inclusion on everything we do at HHS.”

The $81.7 billion mandatory funding request for pandemic preparedness over 5 years stretches across the Office of the Assistant Secretary for Preparedness and Response, CDC, NIH, and FDA. The proposal said the money will support a rapid response to future pandemics or “other high consequence biological threats.”

“That is a drop in the bucket compared to what it’s costing so far to deal with COVID,” Becerra said, reminding reporters that the federal government’s pandemic funds are already running dry.

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

Those funds are needed “immediately” he said.

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

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

Carole Johnson, administrator for the Health Resources and Services Administration, said the government is trying to support uninsured individuals by directing them to covidtests.gov, to community health centers for care and by reminding them to check whether they may be eligible for Medicaid.

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

When asked about access to a possible second COVID-19 booster for adults 50 and over, Dawn O’Connell, Assistant Secretary for Preparedness and Response at HHS, said she anticipated having enough doses to meet that need, should a second booster be authorized this week.

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

CDC’s Push for Interoperability

The proposed budget includes $200 million for 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 “core public health infrastructure and capacity across all levels of government,” and address “surge needs.”

Also included is $353 million for Global Public Health Protection “to ensure a strategic regional presence and improve global public disease detection and emergency response” and $50 million to support the CDC’s new Center for Forecasting and Outbreak Analytics, which will continue to enhance the government’s ability to identify potential new health threats.

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

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

Prioritizing Mental, Behavioral Health

The budget proposal also looks to support mental health parity within the Medicare program. Unlike most private and employer-based plans and Medicaid, Medicare is not subject to the 2008 Mental Health Parity and Addiction Equity Act, which called for health plans to offer mental health and substance use benefits “on par with” medical and surgical benefits.

The proposed budget would close that gap, with the document saying it would make sure “that mental health and substance use disorder benefits under Medicare do not face greater limitations on reimbursement or access to care relative to medical and surgical benefits.”

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

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

Johnson said that the proposed budget also aims to grow the mental health and substance use disorder workforce by leveraging “not only graduate level social workers and counselors… but also those critical community-based connectors like community health workers and peer support, to make sure people with lived experience are part of our solution as well.”

“We want everyone to know that whether it’s a broken bone or common cold or a mental challenge, that you’re going to get the services made available to you, that you need, and so our job is to continue to break down those barriers,” Becerra added.

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

ONDCP also underscored the “historic $85 million” earmarked for CDC’s harm reduction services and $63 million directed towards the Substance Abuse and Mental Health Services Administration’s First Responder Training program.

Rahul Gupta, MD, director of the 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 overdose.”

Maternal Health Support

The Office of Minority Health aims to target areas with high rates of adverse maternal health outcomes or significant disparities across racial and ethnic lines in maternal health outcomes, the budget proposal noted. The U.S. has the highest maternal mortality rate among developed countries, with disproportionately high rates among Black, American Indian, and Alaska Native women.

The FY2023 budget includes $86 million to build on this increased focus on adverse maternal health outcomes. The budget proposal noted that $42 million of this will be directed towards the Office on Women’s Health “to fund activities relating to disease prevention, health promotion, service delivery, research, and healthcare professional education, for issues of particular concern to women throughout their life span.”

Becerra noted that CMS is also offering every state the opportunity to extend postpartum care in Medicaid for a full year, and to date, five states have accepted that offer.

“We need everybody to do that, because it should be the case that a woman, whether she has the money or not, will continue to get care after she’s delivered for more than just 60 days,” he said.

Investing in HIV Prevention, Biomedical Research

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

Executive Director of the AIDS Institute, Michael Ruppal praised this move in a statement, noting that “President Biden committed to end the HIV epidemic in the U.S. … and this budget is a follow-through of that commitment.”

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

The Biden administration also plans to direct $49 billion in discretionary funding to 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.”

Asked whether the ARPA-H program would be housed within or outside of NIH, Becerra hedged on his answer.

“I guarantee… 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, lauded the fact that there was “significant funding for medical research” in the proposed budget, but stressed that for ARPA-H to succeed, it “must be coupled with meaningful growth in the NIH base budget,” which the current budget fails to provide.