President Joe Biden's budget proposal for fiscal 2024 may lack major new healthcare initiatives, but his policy agenda includes numerous items that would affect providers, health insurance companies and patients.
The Biden administration released details Thursday of the president's plans, which touch on Medicare, Medicaid, the Children's Health Insurance Program, the health insurance exchanges, the Indian Health Service, prescription drug prices, mental healthcare, rural health, HIV/AIDS, cancer and other issues.
Biden takes aim at health insurance companies that administer Medicaid benefits for states. Medicaid and CHIP managed care organizations are not required to meet medical loss ratio thresholds in every state, as Medicare, commercial and exchange carriers must. Under the White House budget plan, Medicaid and CHIP insurers would have to spend 85% of the money they receive to cover enrollees on medical costs. The federal government would save $20 billion over 10 years by imposing an MLR minimum and recouping excess funds.
The budget proposal also expands on Biden's previously announced behavioral health agenda by calling for reduced out-of-pocket costs for Medicare enrollees, mental health workforce development and parity for mental health coverage under private health insurance. Among the White House’s plans are an additional $100 million for crisis response programs and more than $400 million to fund Health Resources and Services Administration and Substance Abuse and Mental Health Services Administration programs to boost the supply of behavioral health professionals, including those from racial and ethnic minorities.
Other highlights in Biden's fiscal 2024 budget plan include:
- Health insurance exchanges: The White House would permanently extend enhanced subsidies for health insurance exchange users.
- Medicaid: The budget calls for the creation of a federally funded "Medicaid-like" coverage plan to provide benefits to low-income adults in states that have not expanded Medicaid under the Affordable Care Act. The plan also would support expanding home- and community-based services for Medicaid beneficiaries with $150 million over 10 years designed to improve these services and working conditions for home care personnel.
- Community health centers: Biden proposes boosting funding for federally qualified health centers to enable them to treat about 33.5 million patients a year, or double their current capacity, according to the White House.
- Rural health: $416 million in proposed funding includes $30 million to support rural hospitals at risk of closure, $165 million for opioid epidemic response and $10 million in new funding for rural mental health services.
- Indian Health Service: The White House seeks a short-term funding increase and to classify the IHS budget as mandatory spending as of fiscal 2025.
- HIV/AIDs and hepatitis C: The administration aims to improve access to HIV/AIDS treatment and prevention and to reduce costs for hepatitis C medications.
- Prescription drug prices: Biden proposes expanding on the Inflation Reduction Act by allowing the federal government to set prices on a broader array of medicines, cap cost-sharing for some generic pharmaceuticals under Medicare Part D at $2, beef up Medicaid and Children's Health Insurance Program drug rebates, and require drugmakers to refund private customers when they increase prices at a rate that exceeds inflation.