Biden's proposed budget includes funds to address disparities and mental health parity

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President Joe Biden's proposed 2023 budget submitted to Congress gives the Department of Health and Human Services $127.3 billion in discretionary budget authority and $1.7 trillion in mandatory funding.  

The budget addresses health disparities, such as the higher maternal mortality rate in the United States among Black and Native American/Alaska Native women, regardless of their income or education levels, according to HHS. This includes more than $470 million in funding across the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, the Health Resources and Services Administration, the National Institutes of Health and the Indian Health Service to reduce maternal mortality and morbidity.  

The administration proposes all Indian Health Service funding as mandatory beginning in FY 2023 to allow for growth beyond what can be accomplished through discretionary spending. The budget includes $9.3 billion in 2023 – a $2.5 billion, or 37%, increase from the 2022 level – to close gaps in direct healthcare services and infrastructure. Funding would grow to $36.7 billion by FY 2032, an increase of 296%.

The budget supports full parity between physical health and behavioral healthcare, including mental health and substance-use-disorder care. 

The budget provides $697 million in 988 and Behavioral Health Services, which will expand access to crisis-care services for people with suicidal ideations or who are experiencing a behavioral-health crisis. The National Suicide Prevention Lifeline will transition from a 10-digit number to 9-8-8 in July 2022.

The budget also includes new mandatory investments totaling $51.7 billion over 10 years to improve behavioral health. 

This includes $7.5 billion for a new Mental Health Transformation Fund for mental-health workforce development and service expansion. It gives $35.4 billion to improve mental health access in Medicaid. It also includes $4.1 billion to permanently extend funding for Community Mental Health Centers.

It gives $1.2 billion to improve access to behavioral-health services in the private insurance market, including a proposal to require coverage of three behavioral health visits with no enrollee cost-sharing.

Another $3.5 billion would improve Medicare mental health coverage by covering three behavioral health visits per year without cost-sharing, revising the criteria for psychiatric hospital terminations from Medicare, eliminating the 190-day lifetime limit on psychiatric hospital services, and applying the Mental Health Parity and Addiction Equity Act to Medicare.

This budget addresses the overdose epidemic by investing $11 billion, including $10.4 billion in discretionary funding, in programs addressing opioids and overdose-related activities across HHS.  

The budget also proposes to remove the word "abuse" from the agency names within HHS – including the Substance Use and Mental Health Services Administration, the National Institute on Alcohol Effects and Alcohol-Associated Disorders, and the National Institute on Drugs and Addiction. Individuals do not choose to "abuse" drugs and alcohol; they suffer from a disease known as addiction, HHS said. 

The budget provides $20.2 billion in discretionary funding for the Administration for Children and Families' early care and education programs, including $12.2 billion for Head Start.

The budget includes an additional $92 million for CDC and FDA in response to President Biden's Cancer Moonshot to reduce the death rate from cancer by at least 50% percent over the next 25 years.

WHITE HOUSE BUDGET ON PANDEMIC PREPAREDNESS 

Biden's budget includes $88.2 billion of mandatory funding over five years across the Department of Health and Human Services, the Office of the Assistant Secretary for Preparedness and Response, the Centers for Disease Control and Prevention, the National Institutes of Health, the Food and Drug Administration, the Department of State, and the U.S. Agency for International Development to prepare for future biological threats in support of objectives within U.S. national and global biodefense and pandemic preparedness strategies and plans.

This includes:

• $40 billion to invest in the development and manufacture of countermeasures, such as for vaccines, therapeutics, diagnostics and personal protective equipment. These funds will also support the development of novel technologies.
• $28 billion for the CDC to enhance the public-health infrastructure, domestic and global threat surveillance, public health workforce development, lab capacity, and global health security.
• $12.1 billion to the National Institutes of Health for research and development of vaccines, diagnostics and therapeutics and other measures.
• $1.6 billion for the Food and Drug Administration to expand and modernize regulatory capacity, information technology and laboratory infrastructure to support the evaluation of medical countermeasures.
• $1.8 billion out of the $88.2 billion HHS request to enable the CDC and NIH to strengthen biosafety and biosecurity practices.
• $6.5 billion would go to the Department of State and USAID to make investments in pandemic and biological-threat preparedness globally. This includes $4.5 billion in seed funding to establish capacity through a financial intermediary fund at the World Band.

ON THE RECORD

"Budgets are about more than dollars. They're about values. And the president's budget is a reflection of our values as a nation," said Health and Human Services Secretary Xavier Becerra. 

Chiquita Brooks-LaSure, Administrator for the Centers for Medicare & Medicaid Services, said: "The COVID-19 pandemic has had devastating effects on the health and wellbeing of people across the country – effects that will be felt for years to come. That's why the president's budget proposal would invest in the nation's physical and mental health needs, as well as pandemic preparedness and resiliency."

 
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Twitter: @SusanJMorse
Email the writer: SMorse@himss.org