The White House released its fiscal 2025 budget blueprint Monday, and its healthcare provisions are very much as President Joe Biden previewed them during his State of the Union address last week.
The Health and Human Services Department budget request offers more detail about Biden's plans, including how his administration wants to respond to cyberattacks such as the one that has crippled UnitedHealth Group unit Change Healthcare for nearly three weeks. Biden also seeks policies to extend the solvency of Medicare, grant HHS greater authority over pharmaceutical prices and enact a small boost for departmental funding.
Related: State of the Union address lays out Biden’s healthcare priorities
The White House requests $130.7 billion in discretionary funding for HHS — a 1.7% increase from fiscal 2023 — on top of the $1.7 trillion the department will spend on mandatory programs such as Medicare and Medicaid that are not subject to annual congressional appropriations. Congress has yet to pass legislation to fund HHS for fiscal 2024, which began Oct. 1, and the department has been operating under the previous fiscal year's spending levels.
"This president's budget introduced today doubles down on the investments that made the comeback of our jobs, our economy and our health possible," HHS Xavier Becerra said during a news conference Monday. "It lays out a vision for a nation that invests in its most vulnerable, fosters innovation and protects Americans' access to the care they need."
Biden continues to advocate for making permanent the enhanced premium tax credits that drove record enrollment on the health insurance exchanges during the recent sign-up period. Congress and Biden increased those subsidies in 2021 and extended them a year later through the end of 2025, so lawmakers would need to renew them.
The White House also restated Biden's plan to create a Medicaid-like coverage program for people who live in the 10 states that have not expanded eligibility under the Affordable Care Act of 2010. In addition, the budget calls for lengthening continuous Medicaid and Children's Health Insurance Program eligibility for children from 12 months to 36 months and allowing states to implement continuous eligibility from birth to age 6.
As Biden said in his remarks to Congress, the budget calls for boosting spending on home- and community-based services by $150 billion over 10 years.
Expanding Medicare drug price negotiations to more medications is a key element of Biden's policy agenda, and a source of budgetary savings. Combined with his proposal to raise Medicare taxes on high-income households, HHS contends the budget would bolster the Medicare trust fund.
While the Change Healthcare cyberattack roiling the healthcare sector wasn't mentioned in the State of the Union speech, the White House addressed the issue in its budget plan. The HHS proposal includes $1.3 billion in Medicare payment incentives to support hospital cybersecurity programs, $141 billion for HHS cybersecurity initiatives and $12 million for the Administration for Strategic Preparedness and Response.
During the news conference, HHS Deputy Secretary Andrea Palm noted that assistance to hospitals would shift to penalties starting in 2029 for facilities that do not meet minimum security standards.
"There are a series of essential goals that are really meant to lift all boats, to make sure that we are really targeting the common vectors and vulnerabilities in cyberattacks, and then there are the enhanced practices which really allow us to get to a greater level of complexity in responding to this," Palm said.
Becerra said that timeline would help hospitals get up to speed.
"We're ready to provide support to be a good partner to help you make the investments you need to adapt to this new cybersecurity world. But at some point, we will transition from supporting to saying, 'You had your chance. Now, you're you're making it difficult for everyone by not being protected,'" Becerra said.
Presidential budget proposals are rarely enacted and sometimes, such as this year, Congress is barely able to enact its own spending plans. Election year budgets tend to be even more aspirational. Still, Biden's plan represents a starting point for fiscal 2025 negotiations, at least in the Democrat-led Senate.
Senate Majority Leader Chuck Schumer (D-N.Y.) hailed Biden's proposals. "That budget will help improve the solvency of vital programs like Medicare and Social Security, which tens of millions of Americans rely on every single day," he said on the Senate floor Monday. "President Biden’s budget will help ensure we continue to make good on the investments from our agenda and build an economy that works for everyone."
Top Republicans blasted the White House's entire slate of proposals.
“The price tag of President Biden’s proposed budget is yet another glaring reminder of this administration’s insatiable appetite for reckless spending and the Democrats’ disregard for fiscal responsibility. Biden’s budget doesn’t just miss the mark — it is a roadmap to accelerate America’s decline," House Speaker Mike Johnson (R-La.) and other House GOP leaders said in a news release Monday.
