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Biden Budget Proposal Increases Funding for Health Care, but Does Not Go ‘Big’ Enough

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The budget proposal fails to address a public health option or Medicare negotiation for prescription drug prices -- both ACP priorities

June 18, 2021 (ACP) -- The American College of Physicians is enthusiastic about the strong support for health care spending in the Biden administration's proposed budget for the next fiscal year but is urging the White House to take even more bold action to protect the nation's patients.

Under federal law, the White House submits a budget each year to Congress, which then figures out whether to enact any of the president's specific spending proposals. The next federal fiscal year begins on Oct. 1 and will run through Sept. 30, 2022.

ACP is pleased about many aspects of the proposed budget. “The Department of Health and Human Services, where most ACP priorities are, has gotten a proposed increase of over $25 billion,” said Jared Frost, ACP senior associate of legislative affairs. “We're especially happy that Title VII health professions funding, which was largely eliminated by the previous administration, has been left intact and includes $49 million for training in primary care medicine. This is the only federal program that funds training for primary care physicians. We need these programs, as we have a health care practitioner shortage.”

The budget proposes $8.5 billion for the Centers for Disease Control and Prevention, a $1.5 billion increase over the current fiscal year, and $52 billion for the National Institutes of Health, up $9 billion. “The Biden administration not only emphasized NIH funding but has proposed a new agency within NIH,” Frost said. “The Advanced Research Projects Agency-Health is intended to be more nimble and less risk-averse than other institutes within NIH in order to bring new cures and treatments faster to patients.”

The Agency for Healthcare Research and Quality, long a target to have its funding eliminated or folded into the NIH, will get a $42 million increase to $380 million under the new budget proposal. And the budget proposal includes $7.8 billion for the Health Resources and Services Administration, the main agency that offers programs to train the health care workforce, including physicians. That's an increase of $616 million.

“ACP is also glad to see a $65 million increase for the National Health Service Corps, which provides loan repayment and scholarships for clinicians to serve in underserved areas,” Frost said. “ACP is also encouraged by the Biden budget proposal to double the funding to $50 million overall — $25 million to NIH and $25 million to CDC — for Firearm Injury and Mortality Prevention Research, which is right in line with ACP's request for this important research to prevent death and injury from guns.

“While it is an improvement for the policies and programs that ACP supports, President Biden's budget proposal doesn't go ‘big’ in some areas of health care policy, such as proposing a public option for health coverage or letting Medicare negotiate for prescription drugs,” continued Frost. “These are policies that the president has supported. While the budget proposal expresses general support for these policies and the intention to work with Congress to enact them, there are not specific, detailed plans regarding these issues included in the budget proposal.”

ACP hopes the administration will do more to support a public option for health coverage and Medicare negotiation for prescription drugs. “Another area is the health care workforce,” Frost said. “After the pandemic, it has become clear that not only does the country not have enough clinicians, but clinicians are leaving the health care workforce. The federal government needs to step up to the plate and provide the resources needed to make the clinician pipeline more robust. Unfortunately, the Biden budget misses this opportunity.”

For example, he noted, the only federal program that trains internal medicine physicians in primary care did not receive a spending boost in the budget.

It is unclear whether the president's budget priorities have a chance in Congress. Both the House and Senate are closely divided between the two parties, and the filibuster often prevents legislation from passing the Senate without strong bipartisan support, Frost said. However, a process known as budget reconciliation can allow the Senate to pass a budget with only a majority vote.

For now, ACP continues to advocate for its funding priorities in the annual appropriations process. ACP has submitted written testimony outlining the spending priorities that it wants Congress to fund. The budget debate is likely to continue well into the fall. “We'll be monitoring the situation and lobbying Congress to do the right thing throughout the process,” Frost said. “We'll make sure our viewpoint is heard.”

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Back to the June 18, 2021 issue of ACP Advocate