President Biden’s FY 2022 Budget and the Year Ahead

By Michaela Hollis, CHF Staff

On May 28, President Joe Biden unveiled his first annual budget, requesting approximately $6 trillion dollars in federal spending for fiscal year (FY) 2022. The long delayed and highly anticipated budget includes the President’s recommendations for funding levels and outlines the administration’s priorities and initiatives for the upcoming fiscal year. President Biden had a unique opportunity in the FY 2022 budget to propose funding increases for agencies and programs that have been constrained by the budget caps required by the Budget Control Act of 2011 such as public health, medical and scientific research, infrastructure, education, public safety, and more. The budget aims to address the chronic underfunding of core public health programs and restore non-defense discretionary funding.

What’s in the Budget?

The President’s budget contains robust health spending proposals, including a more than 23 percent increase to overall funding for the Department of Health and Human Services. Major themes featured in the President’s budget include significant investments to improve the nation’s pandemic preparedness and response to public health threats, including improvements to public health infrastructure and data modernization efforts; funding to address health disparities and inequities across the health care system; and continued investments in biomedical research.

For the first time in nearly two decades, the Administration proposed significant increases for the Centers for Disease Control and Prevention (CDC), increasing total funding from about $14 billion to $15.4 billion. This includes approximately $8.7 billion in discretionary funding to improve the agency’s preparedness for future health crises. This proposed funding will restore the agency’s capacity to carry out its role to prepare for and respond to current and emerging public health threats. Additionally, the budget includes increased funding to improve health equity and social determinants of health in communities with poor health outcomes. Notably, the CDC’s proposed increase is not distributed evenly across centers as many of the existing programs within the CDC’s National Center for Chronic Disease Prevention and Health Promotion received flat funding in the President’s proposal. While this would be a historic increase for the CDC, sustainable and predictable long-term investments are needed to protect the country from existing and future public health threats.

The National Institutes of Health (NIH) continues to receive proposed increases to advance biomedical research. Total funding outlined in the budget would rise to nearly $52 billion, a $9 billion increase from FY 2021. Of this figure, $6.5 billion would be used to establish the Advanced Research Projects Agency for Health (ARPA-H) within NIH. The funding for ARPA-H is to be available for three years and the program would serve as a public-private accelerator for research on conditions studied across NIH, but Alzheimer’s, diabetes, and cancer were specially highlighted in the budget proposal. ARPA-H has the potential to advance innovative medical treatments; however, it is unclear how this program will exist within the NIH; if the NIH’s base budget will be affected; and if and how Congress will authorize the new entity. Advocates will need to engage with the administration and Congress in the shaping of this research program.

The President’s budget also includes key investments for the Food and Drug Administration’s efforts to modernize data infrastructure and other key operations to maintain the agency’s facilities to meet the demands of its work and workforce. Other notable public health priorities in the President’s budget include funding to address maternal mortality, the opioid epidemic and substance abuse disorders, gun violence prevention, and ending the HIV epidemic.

Still, there were major topics left out of the President’s budget, including drug pricing, a public insurance option, and expanding Medicare’s benefits and eligibility. These were topics then-candidate Biden raised on the campaign trail, and many expected them to be addressed in the President’s first budget. Ultimately, Biden punted these issues to Congress, calling on them to advance legislation that would address these key issues.

It’s Going to be a Busy Summer

The President does not have the final say on funding the government—that is left to Congress. The release of the budget proposal kicked off the annual appropriations process and gave Congress the “go-ahead” to begin drafting the 12 appropriations bills with the House beginning its subcommittee markups this month.  Congress has about four months until the end of the fiscal year on September 30, to pass all 12 appropriations bills or else they will need to enact a continuing resolution to keep the government funded until they can reach a spending deal which has become regular practice.

During this time, Congress has a number of other issues they must address, including the debt ceiling which is set to expire on July 31, and President Biden’s robust infrastructure proposal. Senate Democrats are working to prepare an FY 2022 budget resolution that would pave the way for Democrats to advance an infrastructure package through the chamber without GOP support, using the budget reconciliation process. It looks like this is expected to happen through the month of July. However, it is unlikely reconciliation will include FY 2022 appropriations. We will continue to monitor these discussions and how this process potentially gets tangled up with the looming expiration of the debt ceiling’s suspension.