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  6. Biden Administration Releases Proposed FY23 Budget

Biden Administration Releases Proposed FY23 Budget

March 29, 2022

On March 28, the White House released President Biden’s FY23 proposed budget. The budget outlines the Administration’s funding priorities for the upcoming fiscal year. Congress has the authority to approve, reject, or modify the budget’s recommendations.

ASTHO issued a statement in response to the FY23 President’s budget proposal.

In reviewing the budget documents, some of the FY22 funding levels included in the President’s budget request do not match the funding levels included in the final FY22 Labor, Health and Human Services, and Education Appropriations bill because it was recently signed into law. Therefore, it was impossible for ASTHO to conduct a detailed analysis. State and territorial health officials should view the HHS budget in brief for details and additional information about these programs included in the Congressional justifications hyperlinked below:

Public Health Highlights

Please note the information included below provides high-level summaries of some programs tied to ASTHO’s strategic plan and legislative agenda. For more information about specific programs, please review the Congressional justifications hyperlinked above. Also due to the outdated tables in the Congressional budget justifications, the specific programmatic increases did not match some of the division increases and some programs received proposed decreases. ASTHO’s government affairs team will work to better understand this nuance in the next couple of days.

The overall request proposes $127.3 billion for HHS, an increase of $13.3 billion over the FY22 enacted level. The budget proposes $81.7 billion in mandatory funding over five years across ASPR, CDC, NIH, and FDA for pandemic preparedness. This includes $28 billion in mandatory funding for CDC to invest in the public health system infrastructure, support international capabilities for vaccine preparedness and medical countermeasure development, enhance domestic and global disease surveillance, expand laboratory capacity, further develop a robust public health workforce, and strengthen public health data systems.

Pandemic Preparedness: The budget request includes a proposal to include $81.7 billion in mandatory funding for pandemic preparedness. Within this plan there is:

  • $40 billion for ASPR to conduct advanced research and development of vaccines, therapeutics, and diagnostics for high-priority viral families, scale up domestic manufacturing capacity for medical countermeasures, and expand the public health workforce. This includes managing the mission within ASPR, which will involve recruiting staff and centralizing coordination efforts to ensure alignment of activities across HHS.
  • $1.6 billion for FDA to expand and modernize regulatory capacity, information technology, and laboratory infrastructure to respond to any future pandemic or high-consequence biological threat.
  • $28 billion for CDC to invest in the public health system infrastructure, support international capabilities for vaccine preparedness and medical countermeasure development, enhance domestic and global disease surveillance, expand laboratory capacity, further develop a robust public health workforce, and strengthen public health data systems.
  • $12.1 billion for NIH research and development of vaccines, diagnostics, and therapeutics against high-priority viral families, biosafety, and biosecurity, and to expand laboratory capacity and clinical trial infrastructure.

Vaccines for Adults

CDC is submitting a mandatory proposal for legislative authority and funding—$25 billion over 10 years—to establish the Vaccines for Adults (VFA) program to provide uninsured individuals access to Advisory Committee on Immunization Practices (ACIP) recommended routine and outbreak vaccines at no cost. The VFA program would be modeled on the successful Vaccines for Children (VFC) program and be tailored to adults. The VFA program would provide funding for the purchase of ACIP-recommended vaccines for eligible adults, provider fees, and program operations. Ultimately, the program aims to reduce disparities in vaccination coverage, improve outbreak control of vaccine-preventable diseases, and enhance and maintain the infrastructure needed for responding to future pandemics.

Vaccines for Children

CDC is proposing enhancements to the Vaccines for Children (VFC) program to expand eligibility to all children under age 19 enrolled in the Children’s Health Insurance Program (CHIP), thereby transitioning CHIP vaccine purchase costs from the state to the VFC program. The proposal would also update the provider administration fee structure to increase provider capacity and eliminate cost-sharing for VFC-eligible children.

CDC

The request proposes $10.675 billion for CDC, an increase of $2.23 billion above FY22. Highlights include:

    • $600 million, an increase of $400 million, to support flexible public health infrastructure and capacity investments within states, localities, and territories.
    • $200 million, an increase of $100 million, for the Public Health Data Modernization Initiative.
    • $50 million to sustain investments in the Center for Forecasting and Outbreak Analytics.
    • $1.3 billion for Immunization and Respiratory Diseases, an increase of $383 million above FY22. This includes $994 million for the discretionary Section 317 immunization program and $251 million for the influenza program.
    • $748 million, an increase of $101 million, for global health programs.
    • $106 million, a $45 million increase for Public Health Workforce and Career Development.
    • $35 million, an increase of $15 million for the Infectious Disease Rapid Response Reserve Fund.
    • $1.47 billion, an increase of $126 million for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infection and Tuberculosis Prevention. This includes $310 million for the Ending HIV Epidemic Initiative, an increase of $115 million.
    • The request proposes $402 million, an increase of $174 million for Environmental Health programs. This includes:
      • $110 million, an increase of $100 million for the Climate and Health Program.
      • $90 million, an increase of $49 million for the Childhood Lead Poisoning Prevention Program.
    • $345 million for Occupational Safety and Health, a decrease of $7 million.
    • $1.3 billion for injury prevention and control, an increase of $568 million. This includes:
      • $713 million, a $223 million increase, for opioid overdose prevention and surveillance.
      • $250 million for the Community Violence Intervention Initiative.
      • $35 million, an increase of $22.5 million, for firearm injury and mortality prevention research.
      • $15 million, an $8 million increase, for preventing adverse childhood experiences.
    • $35 million, an increase of $22 million, for the Surveillance for Emerging Threats to Mothers and Babies initiative.
    • $1.6 billion, an increase of $274 million, for chronic disease prevention and health promotion programs. This includes:
      • $153 million, an increase of $145 million, for investments in social determinants of health to improve health equity.
      • $164 million, an increase of $81 million, for Maternal Mortality Review Committees, expanding Perinatal Quality Collaboratives, the Pregnancy Risk Assessment Monitoring System, and CDC’s Hear Her campaign.
    • $842 million for Public Health Preparedness and Response, a decrease of $20 million. The ASTHO government affairs team notes in the Congressional justification documents level funding for the public health preparedness program, as compared to FY22 continuing resolution. We believe the decrease is because Congress increased funding for public health preparedness in the final FY22 bill and this increase wasn’t accounted for thus the budget document shows a decrease in funding. The budget does include a proposed consolidation of project of activity (PPA) Public Health Emergency Preparedness Cooperative Agreement, Academic Centers for PH Preparedness, and All Other CDC Preparedness – to a single PPA under the Public Health Preparedness and Response budget activity. The activities funded in this budget account support program objectives for preparedness and response
    • $748 million, an increase of $101 million, for Global Health.
    • $703 million, a $10 million increase for emerging zoonotic infectious diseases.
    • $85 million, an increase of $4.5 million, for the Agency for Toxic Substances and Disease Registry.
    • Proposal to consolidate CDC’s current budget structure into one CDC-Wide Activities and Program Support account from the current structure of 13 separate Treasury accounts to enable the agency to efficiently brings its resources to bear to address a crisis. The ASTHO government affairs team will look further into this to better understand any potential implications.
    • $160 million or level funding for the Preventive Health Services block grant.
    • The request proposes the following realignments:
      • Realignment of $160 million for Lyme Disease to be included as a non-add under the Vector-borne Diseases program, PPA.
        • Realignment of $13 million for laboratory training and laboratory safety activities from the Surveillance, Epidemiology and Informatics PPA in the Public Health and Scientific Services budget activity to a new PPA entitled Advancing Laboratory Science in the same budget activity.
        • Realignment of $200 million for the Public Health Data Modernization Initiative from the Surveillance, Epidemiology and Informatics PPA in the Public Health and Scientific Services budget activity to a separate PPA entitled Public Health Data Modernization

HRSA

The request proposes $13.3 billion, an increase of $41 million, above FY22 enacted for HRSA. Highlights include:

      • $290 million, an increase of $165 million, to end the HIV epidemic.
      • $400 million, an increase of $114 million, to the Title X Family Planning program to improve access to reproductive and preventive health services.
      • $953.7 million, a $206 million increase, for the MCH Block Grant. The $206 million proposed increase to the MCH Block Grant would be divided as a $24 million increase to the state formula fund and a $182 million increase to Special Projects of Regional and National Significance (SPRANS).
      • $374 million, a $43 million increase, for rural health programs. This includes $165 million, a $30 million increase, for the rural communities’ opioid response program.
      • $2.1 billion for HRSA workforce programs—including $430 million in mandatory and other sources of funding—an increase of $324 million. This funding will expand access to high-quality clinicians and other health professionals, particularly in areas across the country where they are needed most. This effort includes significant new and expanded investments in behavioral health and workforce diversity.

SAMHSA

The request includes $10.7 billion for SAMHSA, an increase of $4.2 billion above FY22. Highlights include:

      • $4.6 billion, an increase of $2.5 billion, for SAMHSA mental health activities, including an increase of $795 million for the Community Mental Health Block Grant.
      • $697 million, an increase of $590 million, to the 9-8-8 and Behavioral Health Services program.
      • $312 million, a $94 million increase, for substance use prevention, which includes $126 million for the Strategic Prevention Framework.
      • $5.6 billion, an increase of $1.6 billion, for substance abuse treatment. This includes funding for opioid prevention and treatment, recovery, and tribal-focused treatment efforts.
        • $3 billion, a $1.1 billion increase, for the Substance Abuse Prevention and Treatment Block Grant to support state prevention, treatment, and recovery efforts.
        • $2 billion, an increase of $475 million, for the State Opioid Response grant program, of which $75 million is set aside for the Tribal Opioid Response grant program.
      • $22 million, an increase of $6 million, for SAMHSA’s Minority Fellowship Programs to improve behavioral healthcare outcomes for racial minority populations.
      • $183 million, a decrease of $109 million, for Health Surveillance and Program Support.

ASPR

$3.6 billion total, an increase of $483 million over FY22 enacted for ASPR. Highlights include:

      • $975 million, an increase of $130 million, for the strategic national stockpile to sustain and expand the current inventory of supplies to ensure readiness for potential future pandemics and other threats.
      • $292 million, a $4 million decrease, for the hospital preparedness program. Within the total, $240 million is proposed for HPP formula-based cooperative agreements to states, territories, and freely associated states, Washington, D.C., and three high-risk political subdivisions. This funding will be distributed across all 62 awards.

FDA

$100 million increase in user fees to support FDA’s mission of reducing the use and harms of tobacco. The request includes funding to enhance FDA’s ongoing oversight of e-cigarettes and other ENDS products, which remains a high priority and is critical to the agency’s public health mission, especially, to protect kids from the dangers of nicotine addiction and other harmful health consequences. The budget proposes the additional user fees and requests authority to include manufacturers and importers of all deemed products among the tobacco product classes for which the FDA assesses tobacco user fees.

$24 million to optimize inspections and enhance inspectional capacity. The budget request increases support for the recruitment and training of new FDA investigators to improve the efficiency of the agency’s human and animal food and medical product inspectional operations. With additional personnel, as well as expanding the use of new and existing inspectional tools, the FDA will enhance its inspectional capacity and build on efforts to keep pace with rapidly expanding industry including medical counter measures and advanced manufacturing.

Require firms to notify FDA of anticipated significant interruptions in the supply of infant formula or essential medical foods for patients with certain inborn errors of metabolism. This proposal would ensure the agency routinely receives timely and accurate information about likely or confirmed shortages in the U.S. and help the FDA to take steps to promote the continued availability of these foods. Additionally, FDA is seeking authority to require firms to provide shortage notification for other FDA-designated categories of food during a declared public health emergency.

Department of Interior (DOI)

The Administration supports funding the renewal of our COFA relationships with the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. The Administration will request necessary mandatory funding to be appropriated to the Department of State, with language calling for continued DOI implementation. The United States remains committed to its long-standing partnerships with the governments and the people of the freely associated states as we work together to promote a free and open Indo-Pacific.