Biden's $6.8T budget: 15 healthcare takeaways

President Joe Biden proposed a $6.8 trillion budget March 9, and it includes several healthcare initiatives, including plans to extend Medicare's solvency by 25 years and making COVID-era ACA subsidies permanent. 

15 healthcare takeaways:    

1. Medicare: The proposed budget would extend the solvency of the Medicare hospital insurance trust fund by 25 years. The fund is projected to run out of money by 2028. The budget would extend the life of the trust fund without cutting benefits through a tax increase on Americans making more than $400,000 a year, raising the tax rate from 3.8 percent to 5 percent a year. 

President Biden proposed expanding Medicare's power to negotiate drug prices with manufacturers. The proposed budget would increase the number of drugs on which the program can negotiate the price and cut the number of years before new drugs can be negotiated. The budget would also cap Medicare copays at $2 for some generic medications. 

2. Medicaid: The proposed budget would require states to adopt 12-month postpartum Medicaid coverage. At least 30 states have voluntarily expanded postpartum Medicaid coverage. 

The proposed budget would establish a "Medicaid-like" insurance option for low-income adults in states that have not expanded Medicaid. 

President Biden also proposed allocating $150 billion over 10 years to fund Medicaid home healthcare services. 

3. Discretionary HHS funding: President Biden is asking Congress to approve $144 billion in discretionary budget funding for HHS in fiscal 2024, representing a $14.8 billion increase from 2023.  

4. Healthcare workforce: The budget asks for $32 million to grow the nursing workforce and $28 million to support innovative approaches to recruit and retain new providers. It expands the National Health Services Corps, which provides loan repayment and scholarships to healthcare professionals who practice in underserved areas. 

Additionally, it aims to bolster the high school-to-career pipeline, proposing a $200 million expansion of dual-enrollment, work-based learning programs. 

The budget also allocates funds to the Global Health Worker Initiative, which aims to train, equip and protect the international healthcare workforce.  

5. Rural hospital assistance: President Biden's proposed budget calls for $30 million to provide assistance to rural hospitals at risk of closure and to support expansion of hospital service lines to meet rural communities' needs. The budget also supports rural healthcare workforce development training programs and telehealth. In addition, it provides dedicated funding for rural health clinics to support behavioral health. 

6. ACA subsidies: The proposed budget would make permanent expanded income-based tax-credit subsidies for ACA Marketplace plans implemented as part of the Inflation Reduction Act.

7. Pandemic preparation: The budget calls for $400 million in new discretionary funding to prepare for pandemics and biological threats, as well as supporting advanced development and procurement of vaccines, therapeutics and diagnostic capabilities against known and unknown high-priority threats.

8.  Vaccination: The budget includes a new program to give uninsured adults access to free routine and outbreak vaccines. Additionally, it expands the Vaccines for Children program to include all children younger than 19 enrolled in the Children's Health Insurance Program. 

9. Cancer moonshot: The budget calls for $2.8 billion for the Cancer Moonshot initiative revived under President Biden last year. Of that total, $1.7 billion would go to HHS to support dedicated activities at the National Cancer Institute, CDC, Health Resources and Services Administration and Indian Health Service. 

10. Community health centers: The proposed budget would grow the Health Center Program's reach and put it on track to double in size. It would also expand the Teaching Health Center Graduate Medical Education program, which trains residents in rural, high-need community health clinics. 

11. VA healthcare: President Biden proposes $121 billion in discretionary VA medical funding, $2.3 billion above the 2023 enacted level. The budget also includes $20.3 billion for the Cost of War Toxic Exposures Fund, which increases healthcare and benefits delivery for veterans exposed to environmental hazards such as burn pits. That proposal is $15.3 billion above the 2023 enacted level. 

12. Maternal health crisis: The budget allocates $471 million to support the White House's blueprint for addressing the maternal health crisis. This initiative aims to decrease maternal mortality and morbidity rates by implementing implicit bias training for healthcare providers, addressing perinatal health disparities — including support of the perinatal healthcare workforce — and other educational initiatives. The budget proposal requires continuous Medicaid coverage for 12 months postpartum. 

13. Title X: The budget proposes providing $512 million in funding for the Title X Family Planning Program, which provides family planning and other healthcare services to low-income individuals. If approved, that would be a 79 percent increase above the enacted 2023 level to increase the number of patients served to 4.5 million. 

14. HIV and Hepatitis C reduction: The budget proposes $850 million to help HHS reduce new HIV cases. It supports programs that would expand access to both curative and preventive medications — including a mandatory program to guarantee PrEP at no cost to uninsured and underinsured individuals — and proposes a national program to expand screening, testing, treatment, prevention and monitoring of Hepatitis C infections.

15. Behavioral healthcare: President Biden proposes significant investments in behavioral healthcare. The budget aims to eliminate the 190-day lifetime limit on inpatient psychiatric facility services; require Medicare to cover three behavioral health visits without cost sharing; permanently extend funding for community mental health centers; and authorize the Labor Department to impose civil monetary penalties for Mental Health Parity and Addiction Equity Act noncompliance, among other adjustments. 


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