Biden budget plan prioritizes mental health, public health

The Health and Human Services Department would get a 26.8% spending boost in fiscal 2023 under a budget proposal the White House issued Monday.

The budget plan outlines President Joe Biden's health priorities, which include improving public health infrastructure, advancing mental healthcare and making maternal health more equitable.

Biden is asking Congress to authorize $127.3 billion in discretionary funding for HHS, or $26.9 billion more than the department's allotment for fiscal 2021. The White House compared its budget proposals to fiscal 2021 because Congress only passed fiscal 2022 appropriations earlier this month.

White House budget requests tend to function as presidential wish lists and Congress is unlikely to adopt the majority of Biden's proposals. The president's latest budget departs from the slate of proposals he offered last year on making healthcare more affordable and accessible for patients that largely stalled in Congress.

The fiscal 2023 plan continues to highlight Biden's support for legislation to reduce the cost of prescription drugs, health insurance and long-term care and to promote health coverage for uninsured people. The budget contains few details on those priorities, however.

Instead, the White House plan emphasizes preparation for the next public health crisis. Biden requests $81.7 billion for future threat responses and $9.9 billion to build public health capacity.

This request is separate from the COVID-19 funding the Biden administration has urged Congress to pass after lawmakers left pandemic relief money out of the fiscal 2022 spending bill.

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The fiscal 2023 preparedness funding request "is a drop in the bucket compared to what it's cost so far to deal with COVID," HHS Secretary Xavier Becerra said at a news conference Monday. "We hope that we're given the chance to make those long-term investments, preparing for the long game."
Biden proposes $51.7 billion to improve the mental health system, including $7.5 billion for workforce development and service expansion and $35.4 billion to enhance mental health access for Medicaid enrollees.

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The White House seeks $3.5 billion to improve mental health access for Medicare beneficiaries by modernizing fee-for-service benefits, covering three behavioral health visits per year without cost sharing, eliminating the 190-day lifetime limit on psychiatric hospital care and imposing mental health parity rules.

The budget would require health insurers to cover mental healthcare with adequate provider networks and to ensure parity in coverage between behavioral health and medical benefits. Biden wants Congress to appropriate $275 million for the Labor Department to enforce mental health coverage rules among large-group health plans.

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The White House plan also calls for extending Medicare coverage of telehealth following the COVID-19 pandemic. Congress already authorized a 151-day extension to take effect after Biden decides not to renew the federal public health emergency declaration.

Additionally, the budget outlines a new federal program that would provide free vaccines to uninsured adults, which the administration expects would reduce disparities in vaccinations. The administration also proposes shifting all vaccine benefits for Medicare enrollees to Part B, a shift from current policy that covers some under Part D.

The budget proposes an initiative to provide PrEP, or pre-exposure prophylaxis for HIV, to uninsured and underinsured people at no cost. The plan includes $850 million for HHS to reduce new HIV cases, increase access to PrEP, and make support for HIV patients more equitable.

The budget builds on the administration's maternal health initiatives by requesting $470 million to reduce maternal mortality and morbidity rates, expand maternal healthcare in rural communities, implement implicit bias training for healthcare providers and more. Biden also aims to secure $400 million, a nearly 40% increase from 2021, for the Title X Family Planning program, which funds services for low-income people.

Biden requests $5 billion for the Advanced Research Projects Agency for Health, a program to advance healthcare research that Congress created this month with a $1 billion budget. The White House wants $92 million to fund the Cancer Moonshot that Biden initiated as President Barack Obama's vice president, which aims to halve cancer deaths over 25 years.

HHS and the Justice Department also request $899 million for healthcare fraud and abuse control.

This article has been updated with additional details about President Joe Biden's proposed federal budget.