The Department of Health and Human Services (HHS) on Thursday released the President’s fiscal year 2024 proposed budget. Among his plans: To protect Medicare, lower drug costs, bolster public health preparedness, transform behavioral health, improve the well-being of children and seniors, expand access to health care, increase the health care workforce, and advance research underlying medicine, public health, and social services.
The proposed HHS budget includes $144.3 billion in discretionary funding and $1.7 trillion in mandatory funding for FY 2024. Here are the highlights:
Extends Medicare solvency for the next 25 years
The White House administration aims to extend Medicare Trust Fund solvency by at least 25 years, without cutting benefits, by increasing the Medicare tax rate on income above $400,000, closes loopholes in existing Medicare taxes, and dedicates the Medicare net investment income tax to the HI Trust Fund. It also builds on efforts in the Inflation Reduction Act to lower prescription drug prices and credit savings from certain prescription drug reforms to the HI Trust Fund.
The budget would allow Medicare to negotiate prices for more drugs and bring drugs into negotiation sooner after they launch. It would also include commercial health insurance in the rule that drug companies pay rebates to Medicare when they increase prices faster than inflation.
It also aims to make prescription drugs more affordable for seniors by limiting Medicare cost-sharing on high value generic drugs to $2. The budget also limits cost-sharing for insulin at $35 a month.
Expands health care access
The White House also wants to double Health Center Program funding over five years to provide care to approximately 33.5 million people. The budget provides $7.1 billion for Health Centers, including $5.2 billion in proposed mandatory resources, which is an increase of $1.3 billion above FY 2023.
HHS said that with enrollment in health coverage at an all-time high, the budget invests $183 billion over 10 years to expand access to quality, affordable health care by making the enhanced premium tax credits previously extended under the Inflation Reduction Act permanent.
Furthermore, the budget would provide Medicaid-like coverage to individuals in states that have not adopted Medicaid expansion under the Affordable Care Act while providing incentives to states with existing expansions to maintain coverage.
PrepareS for emergent health crises
To ensure the country is prepared for future public health emergencies, the budget includes:
- $20 billion in mandatory funding across the Administration for Strategic Preparedness and Response (ASPR), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and the Food and Drug Administration (FDA), to ensure the nation can prepare for and respond rapidly and effectively to future pandemics and other biological threats
- $1 billion for the Biomedical Advanced Research and Development Authority (BARDA) to develop innovative medical countermeasures
- $995 million for the Strategic National Stockpile
- $400 million in new pandemic preparedness and biodefense funding for ASPR to continuously invest in long-term capabilities to enable a rapid response to emerging biological threats, including securing the domestic medical supply chain and developing next-generation medical countermeasures that address key preparedness gaps
- $10.5 billion in discretionary funding for the CDC to prioritize investments in core capabilities, such as data, workforce, and laboratory capacity and infrastructure
Transforms behavioral health care
The budget includes funding for HHS to invest in services that would provide more Americans with access to the best treatment for mental and substance use disorders where it’s needed. The Substance Abuse and Mental Health Services Administration (SAMHSA) will dedicate $836 million to the 9-8-8 and Behavioral Health Services program.
The investment would support services for LGBTQI+ youth and for Spanish speakers, invest significantly in local crisis centers, and develop a national media campaign. SAMHSA will also dedicate $100 million for mobile crisis response. HHS said these funds will expand partnerships with 9‑8‑8 local crisis centers, community providers, 911 centers, and first responders to promote health‑first responses to mental health, suicidal, and substance use crisis events. NIH funding will provide an additional $200 million to prioritize innovative mental health research and treatment. A portion of these resources would launch the new precision psychiatric initiative. The budget also includes mandatory legislative proposals to modernize and expand Medicare’s mental health benefits and to improve behavioral health for the private insurance market and Medicaid beneficiaries, with an emphasis on improving access, promoting equity, and fostering innovation.
Improves the well-being of children and seniors
The budget includes a mandatory proposal to fund childcare for low- and middle-income families and universal preschool for all four-year-old children, at an estimated cost of $600 billion over 10 years. It also provides $9 billion for the Child Care and Development Block Grant, and $13 billion for Head Start to provide comprehensive early learning and development services to infants, toddlers, and preschool-aged children. The Head Start investment includes $575 million to increase pay for Head Start teachers to help address staff shortages in the program and prevent classroom closures.
The HHS budget also includes $7.3 billion for the Office of Refugee Resettlement, including, $5.5 billion to care for unaccompanied children while they are in the government’s custody and provide supportive services to ensure their well-being after they are released to sponsors. The budget proposes to invest nearly $10 billion in reforms to transform child welfare, including by reducing the number of children entering foster care by keeping more families safely together, placing more children with kin caregivers and fewer children in group homes, and substantially increasing the support provided to foster youth who age out of care without a permanent caregiver.
To ensure the health of seniors, the budget provides $150 billion over 10 years to improve and strengthen Medicaid home and community-based services to ensure more people who are aging and those with disabilities can receive care in their home or community. The budget also includes resources to strengthen nursing home oversight, including $566 million for the discretionary CMS Survey and Certification Program, nearly a 40 percent increase above enacted funding, for nursing homes and other facilities’ health and safety inspection surveys. It also includes enforcement provisions to protect seniors, such as identifying and penalizing nursing homes that commit fraud, endanger patient safety, or prescribe unnecessary drugs.
Expands the health workforce
The budget provides $2.7 billion for HRSA workforce programs, including $947 million in mandatory resources, to expand workforce capacity across the country. The discretionary budget includes $28 million for a new program to address growing concerns related to health care workforce shortages and $25 million for a new program to support the adaptation of workplace wellness in health care facilities including hospitals, rural health clinics, community health centers, and medical professional associations. The White House would also provide $106 million for CDC to support public health training and fellowship programs to support a pipeline of personnel ready to address public health threats.
Investments in research
The budget includes $1 billion for dedicated Cancer Moonshot activities across CDC, IHS, HRSA, and FDA, as well as a total investment at the National Cancer Institute (NCI) of $7.8 billion to drive progress on ways to prevent, detect, and treat cancer.
There is also $716 million in NIH discretionary resources for dedicated Cancer Moonshot activities, particularly projects which detect cancer, demonstrate the mechanisms that drive it, or identify candidates for new treatments.
The budget also proposes additional mandatory funding for the 21st Century Cures Act Beau Biden Cancer Moonshot initiative at NCI in 2025 and 2026.
In addition, the budget includes:
- $839 million to support various activities across CDC, including cancer prevention and control programs, tobacco prevention, HPV prevention and analysis of cancer clusters, and laboratory and environmental health activities
- $108 million within Indian Health Service to address specialized cancer care needs in tribal communities
- $50 million to support FDA efforts to improve evidence generation for underrepresented subgroups in oncology clinical trials, as well as support decentralized trials and sources of evidence through patient-generated data, learnings, and real-world evidence
- $20 million to support HRSA funded health centers efforts on improving access to life-saving cancer screenings and early detection services for underserved communities
- $2.5 billion, with an initial focus on cancer and other diseases such as diabetes and dementia, to advance high-potential, high-impact biomedical and health research that cannot be readily accomplished through traditional research or commercial approaches
- $48.6 billion in discretionary and mandatory resources for NIH that will include $121 million to improve scientific understanding of nutrition and health. NIH would allocate resources to the NIH Common Fund Community Partnerships to Advance Science for Society to ensure nutrition, health and food security research efforts provides an equitable opportunity for marginalized groups to realize the benefits of the research