This post has been archived and contains information that may be out of date.
On May 28, President Biden submitted his federal fiscal year (FFY) 2022 budget request to Congress. The President’s budget indicates the administration’s priorities — including those related to health care — as it and Congress navigate myriad policy issues in advance of FFY 2022.
The budget requests $131.8 billion in discretionary funding and $1.5 trillion in mandatory spending for the Department of Health and Human Services (HHS). This is an increase of approximately 25% over FFY 2021. Below is a summary of select budget items that will affect hospitals and health systems.
- Centers for Medicare & Medicaid Services (CMS): The budget projects $1.4 trillion in mandatory and discretionary outlays for CMS ($96 billion above FFY 2021 enacted). Unlike prior years, this budget does not request specific payment policy changes in the either the Medicare or Medicaid programs.
- American Rescue Plan (ARP) Coverage Expansion: The budget would make permanent the ARP’s expansion of premium tax credits by eliminating required contributions for individuals and families between 100% and 150% of the federal poverty level (FPL) and capping income contributions toward a benchmark plan at 8.5%. The proposal also removes the 400% of the FPL cap on premium tax credit eligibility. If passed, a permanent coverage expansion would cost $163 billion over 10 years.
- Program Integrity: The budget provides $65.8 million in new program integrity funding to address health care fraud. It prioritizes this funding to Medicare medical review and oversight of the Affordable Care Act (ACA) marketplaces.
- Health Resources and Services Administration (HRSA): The budget includes $12.6 billion for HRSA ($497 million above FFY 2021 enacted). Key priorities include:
- Funding for Health Centers: Provides $5.6 billion for health centers, including $3.9 billion in mandatory resources.
- Improving Maternal Health: Provides $138 million to improve maternal health and specifically reduce maternal mortality and morbidity. It also includes funding for the Maternal and Child Health Block Grant ($592 million), State Maternal Health Innovation Grants ($53 million), and Pregnancy Medical Home Demonstration projects ($25 million), and it supports maternity and obstetrics care in rural communities ($10 million).
- Transforming Rural Health: Provides $400 million for rural health programs. This includes $37 million to increase access to services via telehealth and $165 million for the Rural Communities Opioid Response Program.
- Investing in Workforce: Provides a total of $1.8 billion for HRSA workforce programs. This includes $119 million for the Teaching Health Center Graduate Medical Education, $350 million for the Children’s Hospital Graduate Medical Education programs, and $268 million for the Nursing Workforce Development programs.
- 340B Drug Pricing Program: Provides $17 million to improve operations and oversight of the 340B program. The budget requests rulemaking authority to promulgate clear, enforceable standards of participation and ensure covered entities and manufacturers maintain compliance with program requirements.
- Substance Abuse and Mental Health Services Administration (SAMHSA): Provides $9.6 billion for SAMHSA programs ($3.7 billion above FFY 2021 enacted). Key priorities include:
- Substance Abuse Prevention and Treatment Block Grant: Provides $3.5 billion ($1.7 billion above FFY 2021 enacted) to implement treatment and prevention programs. The budget estimates the funding will serve 2.1 million people in FFY 2022.
- Community Mental Health Block Grant: Provides $1.6 billion in funding
- Public Health and Social Services Emergency Fund: Provides $3.5 billion ($676 million above FFY 2021 enacted), to prepare for future public health emergencies. Key priorities include:
- Hospital Preparedness Program: Provides $292 million to support hospitals in all 50 states, eight U.S. territories and freely associated states, and four localities.
- Strategic National Stockpile: Provides $905 million ($200 million above FFY 2021 enacted) to ensure inventory of medical supplies and support restructuring efforts based on the COVID-19 public health emergency. These efforts include modernizing the stockpile’s distribution model and increasing visibility into the domestic supply chain to improve response capabilities.
In addition to telegraphing specific policy priorities for each agency within HHS, the budget request expresses support for, but does not provide specific details, on the administration’s policy priorities related to:
- Improving Health Care Infrastructure: The President’s American Jobs Plan would provide $1.5 billion to increase the resilience of hospitals and critical infrastructure, fund health emergency preparedness cooperative agreements, and build resilience against climate effects.
- Reducing Prescription Drug Costs: The President supports allowing Medicare to negotiate payment for certain high-cost drugs and requiring rebates from manufacturers when drug prices increase faster than inflation. Savings from reduced drug expenditures could be used to help pay for the coverage expansions discussed below.
- Creating Public Health Insurance Options: To expand health insurance coverage, the President supports creating a public option, available through ACA marketplaces, allowing people age 60 and older to enroll in the Medicare program, and creating free, Medicaid-like coverage through a federal public-option available to qualifying individuals in states that have not expanded Medicaid.
Full details of the President’s budget request for HHS are available here.
