President Joe Biden’s recently submitted discretionary budget has set the stage for his administration’s healthcare priorities and provides a blueprint for Congressional action. While the budget includes predictable healthcare provisions, it also details some unexpected ones, such as a focus on climate change and its impact on health.
The budget, submitted by the Office of Management and Budget to Congress on April 9, is seeking $1.5 trillion in discretionary funding. The budget provisions are not policies set in stone, but rather requests for funding and represent the administration’s “wish list,” said Ben Isgur, leader of PriceWaterhouseCoopers’ Health Research Institute, in a phone interview.
The discretionary budget provides Congress with the guidance it needs to begin the appropriations process. Administration officials are aiming to release the full budget in late spring.
The first major, and most unsurprising, budget request for healthcare is funding to strengthen the public health infrastructure. The government’s request includes $8.7 billion for the Centers for Disease Control and Prevention, which represents the largest funding jump requested in nearly two decades, the White House said.
“The CDC has been the gold standard in public health initiatives, and this funding will help them move forward as well restore some of their luster,” said Stephanie Kennan, senior vice president with McGuireWoods Consulting’s federal public affairs team, in an email. “The pandemic has shown how important it is to have an agency like the CDC operating at its best.”
The budget also includes a request for $905 million for the Strategic National Stockpile. Last year when the Covid-19 pandemic, the healthcare industry was “caught flat-footed,” PwC’s Isgur said.
Amid soaring Covid-19 cases, there were critical shortages in necessary medical supplies like personal protective equipment and ventilators. Ensuring that the healthcare system has the resources it needs to combat future crises is an area of focus, and dollars, for the Biden administration, Isgur said.
Another key focus is health equity and tackling social determinants of health, he said. The discretionary budget includes substantial funding for agencies that can advance health equity, such as $153 million for the CDC’s Social Determinants of Health programs and $47.9 million for the Department of Health and Human Services’ Office for Civil Rights.
In addition, Biden’s budget takes aim at the rising tide of U.S. maternal mortality and the growing racial disparities in labor and delivery outcomes.
Biden has requested that more than $200 million be put toward reducing maternal death and morbidity rates nationwide, by bolstering maternal mortality review committees and expanding the Rural Maternity and Obstetrics Management Strategies program.
It’s not just public health and physical care that has the White House’s attention, but also the swiftly growing mental health crisis.
“Because of what’s happened with the economy and high unemployment last year, because of racial inequity, there’s just a lot of pressure on people and families,” Isgur said. “Maybe we have turned a corner in U.S. society, in the U.S. health system and also in the business community, [where we believe] brain health and mental health is as important as the health of our hearts or our lungs or our circulatory system, and it all deserves focus and resources and treatment.”
The budget calls for $1.6 billion for the Community Mental Health Services Block Grant as well as $1 billion to increase the number of counselors, nurses and mental health professionals in schools.
Further, the Biden administration’s funding requests shine a light on some atypical healthcare priorities.
The budget requests $551 million in funding to expand home care, community-based services and other programs for the elderly and/or disabled.
“The emphasis on home and community-based services surprised me,” McGuireWoods’ Kennan said. “Although Biden had talked about long-term care, we as a nation have not made long-term care a priority for a while.”
Even more surprising is the push the administration is making to understand the link between climate change and health. The budget calls for the creation of an Office of Climate Change and Health Equity, in addition to $110 million for the National Institute of Health’s Climate Change and Human Health program and another $110 million for the CDC’s Climate and Health program.
“It’s an acknowledgment that climate change contributes to health issues,” PwC’s Isgur said.
In some ways, the link between the two is very straightforward — when climate changes rapidly we see an increase in natural disasters, for example. But the interplay between climate and health can be more subtle. The climate crisis, along with unsustainable farming practices and other factors, are driving the increasing emergence of zoonotic diseases like Covid-19, according to a 2020 United Nations report.
The budget does not include any funding requests for a public health insurance option or for expanding coverage under current options, which may surprise some people, Isgur said.
But that doesn’t mean these areas will not be a priority for the current administration. For one thing, the American Rescue Plan Act has several provisions supporting coverage expansion. And it is possible that Biden might create a standalone policy for a public option, Isgur added.
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