HEALTH CARE BRIEFING: Biden Seeks Funding for Future Pandemics

Health agencies would get $81.7 billion in mandatory funding over five years to help prepare for future pandemics under President Joe Biden’s proposed fiscal 2023 budget.

The Biden administration’s plan for fighting future pandemics comes even as it’s asking Congress for funds to combat the current one. The White House asked lawmakers for more than $22 billion in March to replenish Covid-19 response programs, and health officials warned they might need more than that soon. Despite White House pleas, lawmakers have been at a stalemate over approving more funds.

• Read Biden’s full budget request here, and see the appendix with line-by-line details here.

The proposed budget would give HHS $127.3 billion in discretionary funding, a nearly 27% increase compared to fiscal 2021. Agencies were operating under fiscal 2021 funding, with some adjustments, until passage of this month’s fiscal 2022 spending law (Public Law 117-103).

Biden’s vision for HHS puts a new emphasis on vaccine programs and expanding immunization efforts: it would create the Vaccines for Adults program, offering uninsured adults free access to vaccines recommended by the Advisory Committee on Immunization Practices. It would also give the Centers for Disease Control and Prevention a $2.8 billion budget increase to improve its immunization program and expand public health efforts. Read more from Alex Ruoff and Allie Reed.

• The Biden administration’s biomedical innovation budget proposal offers largely flat funding for basic research in favor of a big-ticket new agency focused on medical breakthroughs. The National Institutes of Health’s total budget would grow to about $62 billion in fiscal 2023 under the president’s request, about $20 billion more than it’s had over the last few years. However, $12 billion of that money is designated for part of a larger mandatory pandemic preparedness package. Separately, the White House wants to designate $5 billion in discretionary funds toward the Advanced Research Projects Agency for Health, or ARPA-H. Read more from Jeannie Baumann.
• Federal regulators would get the power to levy fines against health plans that violate mental health parity rules and states would get an injection of $125 million to enforcement parity laws under the budget plan. “The president gave us a charge: let’s stop treating mental health as a stepchild in the health-care sector,” Health and Human Services Secretary Xavier Becerra told reporters Monday. Read more from Alex Ruoff.
• The FDA is seeking to add more stringent postmarket study requirements for the pathway used to approve Biogen’s Alzheimer’s drug. As part of the budget plan, the Food and Drug Administration said it wants the authority to mandate that drugmakers, as a condition of winning accelerated approval for a product, show their post-approval studies are adequately designed to verify the drug’s clinical benefit. Read more from Celine Castronuovo.
• The Biden administration is proposing steep jumps in funding for its antitrust regulators as part of its push to increase competition throughout the U.S. economy. The administration wants to increase the Department of Justice Antitrust Division’s funding by $88 million in fiscal 2023 compared to the unit’s actual funding in 2021. The Federal Trade Commission Competition Bureau would see a $139 million rise under the administration’s proposed fiscal 2023 budget compared with its actual funding levels in fiscal 2021. Read more from Evan Weinberger.

More Coverage:

• Suicide Hotline Funding Sought to Meet Mental Health Crisis
• Growth in Health-Care Spending Slows as Covid Outlays Cool
• BGOV OnPoint: President Biden Seeks $5.8 Trillion in Fiscal 2023

Biden’s Fiscal Year 2023 Budget Proposal — BGOV Webinar: In a March 30 webinar, Bloomberg Government’s expert analysts lead a deep dive review of and provide insights on Biden’s budget proposal for fiscal year 2023, and answer your questions on the administration’s top priorities. Topics include topline agency funding levels, new spending initiatives and revenue proposals, and next steps in the budget process. Register here.

Happening on the Hill

U.S. Covid Response Showing Cracks as Congress Delays Funds Cracks in Covid programs across the U.S. are starting to show after the Biden administration failed to get $22.5 billion in emergency Covid funds earlier this month. While some states had already begun winding down Covid testing, vaccination and treatment operations due to slow demand, the lack of funding is becoming evident elsewhere. New Hampshire announced the permanent closure of all state-managed Covid vaccination sites at the end of March. New York’s Covid response is also suffering from the funding shortfall, and it should be fixed “ASAP,” Manhattan Borough President Mark Levine said Wednesday in a tweet. Read more from Fiona Rutherford.

• Related: World Moves From Shortages to Possible Glut of Covid-19 Vaccines

Senate Floor: Senate Majority Leader Chuck Schumer (D-N.Y.) Monday filed cloture to limit debate on the nomination of January Contreras to be assistant secretary for family support at the Department of Health and Human Services.

House to Vote on Insulin Cap as Senators Seek Bipartisan Deal: The House will vote as soon as Thursday on a bill to cap what people with insurance pay for a month’s supply of insulin at $35, a House Democratic aide told Bloomberg Government. Leaders plan to tee up a vote on a modified version of the bill (H.R. 6833) at the Rules Committee on Wednesday, allowing the chamber to pass the legislation this week. Alex Ruoff has more on the bill.

Mental Health Report Released by Finance Panel: The Senate Finance Committee will release a report Tuesday laying out its options for addressing America’s mental health crisis, Alex Ruoff reports. The report lays out how suicide has remained a leading cause of death for young people and overdose rates have reached historic highs, as the country struggles to retain enough health care providers to respond to demand. The panel, which will hold a hearing on mental health parity on Wednesday, says recommendations made to lawmakers to tackle these issues include:

• Expanding loan repayment and training programs for behavioral health providers;
• Funding school-based mental health programs; and
• Extending parity rules to Medicare and Medicaid.

Universal Health Coverage: The House Oversight and Reform Committee meets for a hearing Tuesday on ways to implement universal health coverage.

Medical Debt: The Senate Banking, Housing and Urban Affairs Committee will convene for a hearing Tuesday to discuss concerns around medical debt.

What Else to Know

Opioid Pill Peddling Case Threatens Future of Pain Treatment: Doctors are increasingly reluctant to prescribe opioids for pain treatment amid soaring addiction rates and fear of liability as two physicians face allegations of pill peddling in a case before the Supreme Court, policy experts say. Xiulu Ruan and Shakeel Kahn are facing over two decades of prison time for allegedly operating like drug dealers with opioid prescriptions. Their fate hinges on how far the justices believe the government should go in proving a doctor’s criminal intent—a thorny issue at the divide between substance use disorder and the need to treat pain.

Lawyers and medical experts likewise say the case contributes to a years-long unease around opioid pain treatment in the medical community, where strict policies around record keeping and dosage paint both doctor and patient as potentially untrustworthy. Read more from Ian Lopez.

With assistance from Alex Ruoff

To contact the reporter on this story: Michaela Ross in Washington at mross@bgov.com

To contact the editor responsible for this story: Giuseppe Macri at gmacri@bgov.com