Biden Budget Requests Steep Increases for NIH, CDC, SAMHSA

Kerry Dooley Young

May 28, 2021

President Joe Biden requested notable increases for certain federal medical programs in his first fully detailed budget request, while also highlighting efforts to address gun violence and the opioid epidemic and prepare better for pandemics.

Biden's fiscal 2022 request, released Friday afternoon, serves as a formal marker for the White House's views on national health policy, with Congress having the responsibility to draft and set budgets. Lawmakers would need to make cuts elsewhere in the federal budget in the months ahead to accommodate Biden's bids for generous increases for some federal health agencies.

Still, some of Biden's favored programs such as the National Institutes of Health (NIH) enjoy strong bipartisan support in Congress. The president is seeking a notable increase in what amounts to the NIH's annual operating expenses, which would be newly appropriated money known in federal fiscal terms as discretionary budget authority.

The NIH's discretionary budget authority would rise by about 22%, or $9.03 billion, to $50.5 billion in fiscal 2022, which starts in October, from $41.5 billion in the current budget year, fiscal 2021.

The budget authority for the Centers for Disease Control and Prevention (CDC) would rise by $1.5 billion (about 21%) to $8.54 billion, and that for the Substance Abuse and Mental Health Services Administration (SAMHSA) would rise by $3.72 billion (about 63%) to $9.59 billion.

"[The US Department of Health and Human Services (HHS)] is at the center of many challenges facing our country today — the COVID-19 pandemic, mental and other behavioral health challenges, the opioid addiction crisis, racial inequality and more," said Xavier Becerra, HHS Secretary, in a statement.

The HHS summary of the fiscal 2022 budget request briefing document describes the proposed increase for the CDC as the largest budget authority increase for the agency in almost 2 decades.

Gun Violence 'A Public Health Issue'

The White House is seeking to increase efforts within the NIH and the CDC to address firearm violence prevention, according to a budget summary. 

"Almost 40,000 people die as a result of firearm injuries in the United States every year, while homicide is the third leading cause of death for people ages 10-24," the HHS summary says. "This is a public health issue, and one that disproportionately impacts communities of color."

The HHS summary says that the budget request would double CDC and NIH funding for firearm violence prevention research. Within this field, Biden is seeking $100 million for the CDC to start a new Community Violence Intervention initiative, in collaboration with the Department of Justice, to implement evidence-based community violence interventions at the local level.

Other shared areas of focus between the NIH and the CDC include efforts to prepare for the effects of climate change, according to the HHS summary of the budget request. Biden is seeking an increase of $100 million in the NIH for this field and an additional $100 million investment in the CDC's Climate and Health program.

The budget request also says that Biden seeks more than $220 million in discretionary funding for fiscal 2022 to reduce maternal mortality and morbidity. This includes increased funding for the CDC's Maternal Mortality Review Committees and the Health Resources and Services Administration's Rural Maternity and Obstetrics Management Strategies Program, as well as other increases across HHS programs.

The Biden request also would increase the budget for the Biomedical Advanced Research and Development Authority by $227million to $823 million, seeking to better prepare the nation for pandemics and other crises.

Focus on Public Option

Fiscal 2022 starts on October 1. But lawmakers routinely miss this deadline and complete annual spending bills to finalize government agencies' budgets well into new fiscal years. Lawmakers in both parties and chambers will work in the months ahead to hash out the operating budgets for federal agencies, using Biden's detailed request as a guide.

Biden's budget also includes messages of support for goals of his fellow Democrats that would be separate from this routine annual budget process handled through appropriations bills.

The budget document summarizes major planks of Biden's healthcare agenda, including his support for allowing Medicare to negotiate payments for certain high-cost drugs and requiring manufacturers to pay rebates when drug prices rise faster than inflation.

This section of the budget request also said that Biden supports efforts to help Americans get lower-cost coverage choices, such as by creating a public option that would be available through the health insurance exchanges created by the Affordable Care Act and giving people age 60 and older the option to enroll in Medicare with the same premiums and benefits as current enrollees, but with financing separate from the program's trust fund.

"Healthcare is a right, not a privilege. Families need the financial security and peace of mind that comes with quality, affordable health coverage," the HHS budget summary says.

Kerry Dooley Young is a freelance journalist based in Washington, DC. She is the core topic leader on patient safety issues for the Association of Health Care Journalists. Young earlier covered health policy and the federal budget for Congressional Quarterly/CQ Roll Call, and the pharmaceutical industry and the US Food and Drug Administration for Bloomberg. Follow her on Twitter at @kdooleyyoung.

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