the American Association of Colleges of Osteopathic Medicine

This analysis was prepared by McDermottPlus Consulting and Venable, LLP, on behalf of AACOM.

Less than two weeks after signing the fiscal year (FY) 2022 omnibus spending bill, President Biden unveiled his $5.8 trillion budget blueprint for FY23. The budget calls for $1.5 trillion in discretionary spending—programs that aren’t linked with mandatory spending like Social Security—and contains many provisions important to the osteopathic medical education (OME) community. View all budget documents and accompanying fact sheets here.

Department of Health and Human Services (HHS)

HHS Funding

The Budget requests $127.3 billion in discretionary funding for HHS, a $26.9 billion or 26.8%increase from the 2021 enacted level, excluding amounts requested for the Indian Health Service (IHS), which the Budget proposes to shift from discretionary to mandatory funding. This request includes appropriations for 21st Century Cures Act and program integrity activities.

Health Resources and Services Administration

The Budget requests $13.3 billion for the Health Resources Services Administration (HRSA), which is $41 million above FY 2022 enacted. This total includes $8.5 billion in discretionary budget authority and $4.8 billion in mandatory funding and other sources. The HRSA proposals focus on workforce, 340B, and equity. The HRSA budget provides a total of $2.1 billion for workforce programs including:

$397 million for Behavioral Health Workforce Development Programs which is $235 million above the FY 2022 enacted level;
$50 million for Preventing Burnout in the Health Workforce;
$502 million for the National Health Service Corps, including $25 million specifically dedicated to mental and behavioral health providers including peer support specialists in crisis centers and an additional $60 million for loan repayment for clinicians to provide opioid and substance use disorder treatment;
$119 million in mandatory funding for the teaching health center program;
$133 million, an increase of $15 million above FY 2022 enacted, to expand the diversity of the health professions workforce, including Centers of Excellence, Health Careers Opportunity Program, Faculty Loan Repayment, and Scholarships for Disadvantaged Students.

Substance use And Mental Health Services Administration

The Budget requests $10.7 billion for SAMHSA, an increase of $4.2 billion above FY 2022 enacted. This funding will be used to strengthen and support services to address the nation’s behavioral health crisis, to invest in supporting children’s mental health services, and to increase access to community mental health services. This funding includes:

$225 million for Children’s Mental Health Services;
$960 million to expand access to community-based mental health services;
$22 million, an increase of million over FY 2022 enacted, for SAMHSA’s Minority Fellowship Programs.

Agency for Healthcare Research and Quality

The Budget requests $527 million for AHRQ, an increase of $71 million over FY 2022 enacted, including:

$133 million for AHRQ’s health services research, data, and dissemination portfolio, to support targeted research related to COVID-19, the opioid epidemic, primary care, and health equity;
$79 million for patient safety research efforts to reduce risks and harms, to support patient safety organizations, and to address healthcare-associated infection;
$18 million for the AHRQ digital healthcare research portfolio, including the establishment of two Centers of Excellence in Telehealth Implementation.

National Institutes of Health (NIH)

The Budget requests $63 billion in discretionary and mandatory resources for the National Institutes of Health (NIH). This allocation is $16 billion above the FY 2022 enacted amount. Most notably, the Budget sets aside $5 billion for ARPA-H (see below) and $12.1 billion for research and development of vaccines, diagnostics, and therapeutics specifically targeting viruses. Other items include:

$97 million for the Office of Nutrition Research to promote health and reduce diet-related burden of disease;
$2.6 billion for opioid, stimulant and pain research;
$350 million for health disparities research;
$260 million for the development of a universal influenza vaccine;
$26 million for NIH-sponsored Centers for AIDS Research;
$33 million relating to maternal health;
$2 million to establish a center for Sexual Orientation and Gender Identity (SOGI) research;
$300 million for infrastructure projects, i.e. NIH buildings and facilities.

Advanced Research Projects Agency for Health (ARPA-H)

The Budget proposes a major investment of $5 billion for ARPA-H, significantly increasing direct Federal R&D spending in health to improve the health of all Americans. With an initial focus on cancer and other diseases such as diabetes and dementia, this major investment would drive transformational innovation in health technologies and speed the application and implementation of health breakthroughs. Funding for ARPA-H, along with additional funding for the National Institutes of Health, total a $49 billion request to continue to support research that enhances health, lengthens life, reduces illness and disability, and spurs new biotechnology productions and innovation.

Center for Medicare and Medicaid Innovation

Similar to last year’s budget proposal, the CMMI section of the FY 2023 Budget provides an overview of current CMMI models, such as the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model and Primary Care First. It also highlights the evolution of CMMI noting past models, and how CMMI is building on each model iteration. The FY 2023 budget does not provide any proposals for new models. Notably it does not mention the Radiation Oncology Model that is scheduled to begin in 2023. The future of the model remains uncertain.

Advance Maternal Health and Health Equity

The Budget includes $470 million to: reduce maternal mortality and morbidity rates; expand maternal health initiatives in rural communities; implement implicit bias training for healthcare providers; create pregnancy medical home demonstration projects; and address the highest rates of perinatal health disparities, including by supporting the perinatal health workforce.

Expand Access to Vaccines.

The Budget establishes a new Vaccines for Adults (VFA) program, which would provide uninsured adults with access to all vaccines recommended by the Advisory Committee on Immunization Practices at no cost. As a complement to the successful Vaccines for Children (VFC) program, the VFA program would reduce disparities in vaccine coverage and promote infrastructure for broad access to routine and outbreak vaccines. The Budget would also expand the VFC program to include all children under age 19 enrolled in the Children’s Health Insurance Program and consolidate vaccine coverage under Medicare Part B, making more preventive vaccines available at no cost to Medicare beneficiaries.

Expand Access to Mental Healthcare

The Budget proposes reforms to health coverage and major investments in the mental health workforce. For people with private health insurance, the Budget requires all health plans to cover mental health benefits and ensures that plans have an adequate network of behavioral health providers. For Medicare, TRICARE, the Department of Veterans Affairs healthcare system, health insurance issuers, group health plans, and the Federal Health Employee Benefit Program, the Budget lowers patients’ costs for mental health services. The Budget also requires parity in coverage between behavioral health and medical benefits and expands coverage for behavioral health providers under Medicare. The Budget invests in increasing the number of mental health providers serving Medicaid beneficiaries, as well as in mental health workforce development and service expansion, including at primary care clinics and non-traditional sites. The Budget also provides sustained and increased funding for community-based centers and clinics, including a State option to receive enhanced Medicaid reimbursement on a permanent basis. In addition, the Budget makes investments in youth mental health and suicide prevention programs and in training, educational loan repayment, and scholarships that help address the shortage of behavioral health providers, especially in underserved communities. The Budget also strengthens access to crisis services by building out the National Suicide Prevention Lifeline, which will transition from a ten-digit number to 988 in July 2022.

Future Pandemics and Advances to Health Security for Other Biological Threats

The Budget makes investments in pandemic preparedness and biodefense across HHS public health agencies—$81.7 billion available over five years—to enable an agile, coordinated, and comprehensive public health response to future threats, and to protect American lives, families and the economy. The Budget provides $40 billion to the Office of the Assistant Secretary for Preparedness and Response to invest in advanced development and manufacturing of vaccines, therapeutics, and diagnostics for high priority threats.

Centers for Disease Control and Prevention

The Budget provides $28 billion for CDC to enhance public health system infrastructure, domestic and global threat surveillance, public health workforce development, public health laboratory capacity, and global health security. It includes $9.9 billion in discretionary funding to build capacity at the CDC and at the State and local levels, an increase of $2.8 billion over the 2021 enacted level. These resources would improve the core immunization program, expand public health infrastructure in States and Territories, strengthen the public health workforce, support efforts to modernize public health data collection, increase capacity for forecasting and analyzing future outbreaks, including at Center for Forecasting and Outbreak Analytics, and conduct studies on long COVID conditions to inform diagnosis and treatment options.

Food and Drug Administration (FDA)

The Budget includes $1.6 billion for FDA to expand and modernize regulatory capacity information technology and laboratory infrastructure to support the evaluation of medical countermeasures. Further, the Budget encourages the development of innovative antimicrobial drugs through advance market commitments for critical-need antimicrobial drugs.

HIV/AIDS Epidemic

The Budget includes $850 million across HHS to reduce new HIV cases, increase access to pre-exposure prophylaxis (also known as PrEP), and ensure equitable access to services and supports for those living with HIV. This includes increasing access to PrEP among Medicaid beneficiaries, which is expected to improve health and lower Medicaid costs for HIV treatment. The Budget also proposes a new mandatory program to guarantee PrEP at no cost for all uninsured and underinsured individuals, provide essential wrap-around services through States, IHS, tribal entities, and localities, and establish a network of community providers to reach underserved areas and populations.

Department of Education (ED)

ED Funding

The Budget requests $88.3 billion in discretionary funding for the Department of Education, a $15.3 billion or 20.9% increase from the 2021 enacted level.

Pell Grant Increases

To help low- and middle-income students overcome financial barriers to postsecondary education, the Budget proposes to double the maximum Pell Grant by 2029. This begins with a $2,175 increase for the 2023-2024 school year compared to the 2021-2022 school year, thereby expanding access and reaching nearly 6.7 million students.

Investments in Services for Student Borrowers

The Budget provides $2.7 billion to the Department of Education’s Office of Federal Student Aid (FSA), an $800 million, or 43%, increase compared to the 2021 enacted level. This additional funding is needed to provide better support to student loan borrowers. Specifically, the increase allows FSA to implement customer service improvements to student loan servicing and to ensure the successful transition from the current short-term loan servicing contracts into a more stable long-term contract and servicing environment.

Equity in Higher Education

The Budget would increase institutional capacity at Historically Black Colleges and Universities (HBCUs), Tribally Controlled Colleges and Universities (TCCUs), Minority Serving Institutions (MSIs), and low-resourced institutions, including community colleges, by providing an increase of $752 million from the 2021 enacted level. This funding includes $450 million for four-year HBCUs, TCCUs, and MSIs to expand research and development infrastructure at these institutions.

Department of the Treasury (Treasury)

Treasury Funding

The Budget requests $16.2 billion in discretionary funding for Treasury, a $2.7 billion or 20-percent increase from the 2021 enacted level.

Income Exclusion for Student Debt Relief

The Budget proposes to make permanent the American Rescue Plan (ARP) exclusion of certain discharged student loan amounts from gross income. Typically, loan amounts that are forgiven or otherwise discharged are considered gross income to the borrower and subject to individual income tax in the year of discharge. The ARP provides an exception to the treatment of discharged student loan amounts as gross income for certain qualifying student debt that is discharged after December 31, 2020, and before January 1, 2026. Thus, such forgiveness is not subject to taxation. The tax exclusion would be extended to forgiven amounts for both private and public student loans and includes loan amounts borrowed for the education of one’s children (that is, Parent PLUS loans).

Department of Veterans Affairs (VA)

VA Funding

The Budget requests $135 billion in discretionary funding for VA, a $31 billion or 29% increase from the 2021 enacted level. The Budget also includes $128 billion in advance appropriations for VA medical care programs in 2024.

Prioritize VA Medical Care

The Budget provides $119 billion, a 32% increase above the 2021 enacted level, for VA. In addition to fully funding inpatient, outpatient, mental health, and long-term care services, the Budget supports programs that improve VA healthcare quality and delivery, including investments in training programs for clinicians, health professionals, and medical students. The Budget also further supports VA’s preparedness for regional and national public health emergencies.

Improve Veterans’ Mental Healthcare Services

The Budget provides $13.9 billion for VA mental healthcare, which offers a system of comprehensive treatments and services to meet the needs of each veteran and the family members involved in the veteran’s care. The Budget focuses on increasing access to quality mental healthcare and lowering the cost of mental health services for veterans, with the goal of helping veterans take charge of their treatment and live full and meaningful lives.

Invest in Overdose Prevention and Treatment Programs

The Budget provides $663 million toward opioid use disorder prevention and treatment programs, including programs authorized in the Jason Simcakoski Memorial and Promise Act.

Department of Labor (DOL)

DOL Funding

The Budget requests $14.6 billion in discretionary funding for DOL, a $2.2 billion or 18% increase from the 2021 enacted level.

Workforce Development

The Budget invests in effective, evidence-based training models to equip workers with the skills they need to obtain high-quality jobs. Community colleges play a critical role in providing accessible, low-cost, and high-quality training, and the Budget invests $100 million to build their capacity to work with the public workforce development system and employers to design and deliver high-quality workforce programs. The Budget also provides $100 million for a new Sectoral Employment through Career Training for Occupational Readiness program, which would support training programs focused on growing industries, enabling underserved and underrepresented workers to access good jobs and creating the skilled workforce the economy needs to thrive.

Registered Apprenticeships (RA)

The Budget invests $303 million, a $118 million increase above the 2021 enacted level, to expand RA opportunities in high-growth fields, such as technology, advanced manufacturing, healthcare, and transportation, while increasing access for historically underrepresented groups, including people of color and women, and diversifying the industry sectors involved. To improve access to RAs for women, the Budget doubles DOL’s investment in its Women in Apprenticeship and Nontraditional Occupations grants, which provide pre-apprenticeship opportunities to boost women’s participation in RA.

Department of Defense (DOD)

DOD Funding

The Budget requests $773 billion in discretionary funding for DOD, a $69 billion or 9.8% increase from the 2021 enacted level. This two-year growth enables DOD to make the investments necessary to execute the Administration’s Interim National Security Strategic Guidance and forthcoming National Security Strategy and National Defense Strategy.

Enhance Biodefense and Pandemic Preparedness.

The Budget provides robust funding for programs that support the Administration’s biodefense and pandemic preparedness priorities as outlined in U.S. biodefense and pandemic preparedness strategies and plans, including the Office of the Assistant Secretary for Health Affairs, Chemical and Biological Defense Program, and Biological Threat Reduction Program. The Budget supports enhanced investments in medical countermeasures, including vaccines, diagnostics, and therapeutics research and manufacturing; clinical research and testing; early warning and real-time monitoring; biosafety and biosecurity; and threat reduction activities with global partners.

Department of Agriculture (USDA)

USDA Funding

The Budget requests $28.5 billion in discretionary funding for USDA, a $4.2 billion or 17.1% increase from the 2021 enacted level, excluding Food for Peace Title II Grants, which is included in the State and International Programs total. Resources provided through the 2023 Budget complement investments in conservation, forest management, and broadband deployment provided in the Infrastructure Investment and Jobs Act (Bipartisan Infrastructure Law).

Connect All Americans to High-Speed, Affordable, and Reliable Internet

Building on the $2 billion for USDA broadband programs provided in the Bipartisan Infrastructure Law, the Budget provides $600 million for the ReConnect program, which provides grants and loans to deploy broadband to unserved areas, especially tribal areas. The Budget also provides $25 million to help rural telecommunications cooperatives refinance their Rural Utilities Service debt and upgrade their broadband facilities.

Department of Energy (DOE)

DOE Funding

The Budget requests $48.2 billion in discretionary funding for DOE, a $6.3 billion or 15.1% increase from the 2021 enacted level. Resources provided through the 2023 Budget complement major investments in clean energy demonstrations, advanced manufacturing, grid infrastructure, and low-income home weatherization funded in the Infrastructure Investment and Jobs Act (Bipartisan Infrastructure Law).

Clean Energy Infrastructure

The Budget invests $2.1 billion to support clean energy workforce and infrastructure projects across the Nation, including: $502 million to weatherize and retrofit low-income homes; $150 million to electrify tribal homes and transition tribal colleges and universities to renewable energy; and $90 million for a new Grid Deployment Office to build a grid that is more reliable and resilient and that integrates accelerating levels of renewable energy. In addition, the Budget includes $58 million to launch the Net-Zero Labs Initiative, competitively selecting clean energy deployment projects across the national laboratories. These investments would create good-paying jobs while driving progress toward the Administration’s climate goals, including the President’s goal of carbon pollution-free electricity by 2035.

Please contact AACOM Government Relations at aacomgr@aacom.org with questions or for further information.

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