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WASHINGTON -- President Biden released a proposed $6 trillion budget Friday for fiscal year 2022, promising to "reinvest in education, research, public health, and other foundations of our country's strength."

The proposal contained a variety of healthcare-related initiatives, including:

• $97.5 billion to improve access to Department of Veterans Affairs (VA) healthcare, including increases in funding for women's health, mental health, suicide prevention, and veterans' homeless programs. The budget also proposes $882 million for medical and prosthetic research to advance VA's understanding of traumatic brain injury, the effects of toxic exposure on long-term health outcomes, and the needs of disabled veterans.
• $8.7 billion in discretionary funding for CDC, including funds to support public health capacity improvements in states and territories, modernize public health data collection nationwide, train new epidemiologists and other public health experts, and rebuild international capacity to detect, prepare for, and respond to emerging global threats.
• $153 million for CDC's Social Determinants of Health program to support states and territories in improving health equity and data collection for racial and ethnic populations. "The administration also looks forward to working with the Congress to advance the president's goal of doubling the federal investment in community health centers, which would help reduce health disparities by expanding access to care," the budget document noted.
• $3.6 billion for the FDA, which, when combined with $2.9 billion in estimated user fees, would give that agency a $6.5 million budget. That amount would include an additional $185 million to address the FDA's critical health infrastructure needs and an additional $97 million for food and medical product safety programs.
• More than $200 million to reduce maternal mortality and morbidity rates nationwide; bolster Maternal Mortality Review Committees; help cities place early childhood development experts in pediatrician offices with a high percentage of Medicaid and Children's Health Insurance Program (CHIP) patients; implement implicit bias training for healthcare providers; and create state pregnancy medical home programs.
• $6.5 billion to launch an Advanced Research Projects Agency for Health (ARPA-H), which would provide large increases in direct federal research spending on healthcare. This funding is part of a $51 billion request for the National Institutes of Health (NIH).
• $10.7 billion in discretionary funding at the Department of Health and Human Services to support research, prevention, treatment, and recovery support services for patients with opioid use disorder, with targeted investments to support populations with unique needs, including Native Americans, older Americans, and rural populations. The budget also includes $621 million specific to the VA's opioid prevention and treatment programs.
• $670 million within HHS to help reduce new HIV cases while increasing access to treatment, expanding the use of pre-exposure prophylaxis, also known as PrEP, and ensuring equitable access to services and supports. Ending the HIV epidemic was also a priority for President Trump.
• $2.1 billion for the Justice Department to address gun violence, including $401 million in state and local grants. In addition, the budget request for HHS doubles funding for firearm violence prevention research at CDC and NIH.
• $340 million for the Title X family planning grant program.

Biden also used the budget document to urge Congress to enact some of his other healthcare initiatives. "The President supports reforms that would bring down drug prices by letting Medicare negotiate payment for certain high-cost drugs and requiring manufacturers to pay rebates when drug prices rise faster than inflation," the document said. "These reforms would lower drug costs and save money for Medicare beneficiaries and people with job-based insurance." The White House also noted that "evidence shows that we can reform Medicare payments to insurers and certain providers to reduce overpayments and strengthen incentives to deliver value-based care, extending the life of the Medicare Trust Fund, lowering premiums for beneficiaries, and reducing federal costs."

The administration also reiterated its support for including a public option for health insurance in the Affordable Care Act marketplaces; giving people age 60 and older the option to enroll in Medicare, with financing separate from the Medicare Trust Fund; and providing premium-free, Medicaid-like coverage through a federal public option in states that have not expanded Medicaid.

Marc Goldwein, senior vice president for policy at the Committee for a Responsible Federal Budget, noted several other healthcare items of interest, including a substantial amount of spending -- about $400 billion -- in long-term care," including more money for long-term care workers, Goldwein said. The low salaries of long-term care workers "have been a persistent problem," said Tara Straw, JD, senior policy analyst at the Center on Budget and Policy Priorities. "People are working for poverty wages, and to really recruit and train people and maintain a workforce with an aging population, we need to invest. And that's part of what this big infusion of cash would do."

Another noteworthy item in the budget proposal is an expansion of the Net Investment Income Tax (NIIT), Goldwein said; that is a tax levied on investment revenue received by high-income earners. The proposed budget takes the tax revenue from the expanded NIIT and applies it to the Medicare Trust Fund. "While I haven't done the math on that yet, that would substantially extend the solvency of the Medicare Trust Fund," he said.

Straw also highlighted the proposal's inclusion of $160 billion over 10 years that would go toward making permanent the Affordable Care Act's premium tax credits; the American Rescue Plan passed by Congress included a 2-year expansion of the credits that "is already having a big, big impact," she said. "We've had more than a million people enroll in the federal marketplace" partly as a result of those subsidies.

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