the American Association of Colleges of Osteopathic Medicine

This analysis was prepared by McDermott+ Consulting, on behalf of AACOM.

President Biden unveiled his $6.9 trillion budget blueprint for FY24. The budget calls for $1.73 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 $1.7 trillion in mandatory funding and $143 billion in discretionary spending, a 11.5% increase from the 2023 enacted level.

Health Resources and Services Administration

The Budget requests $15.9 billion for the Health Resources Services Administration (HRSA), which is $1.5 billion above FY 2023 enacted. This total includes $9.2 billion in discretionary budget authority and $6.6 billion in mandatory funding and other sources. The HRSA proposals focus on workforce, behavioral health services, and equity. The HRSA budget provides a total of $2.7 billion for workforce programs including:

$27.5 million for health care workforce innovation program;
$809 million for Title VII health professions programs, including primary care training and enhancement, behavioral health workforce education and training, public health and preventive medicine, and public health loan repayment program;
$966 million for the National Health Services Corps, an increase of $548 million above FY 2023 enacted;
$157 million in mandatory funding for FY 2024 for the Teaching Health Center Graduate Medical Education Program;
$387 million, which is $190 million above the FY 2023 enacted, to train about 18,000 behavioral health providers to help respond to the mental health and substance abuse crisis affecting the country;
$25 million, in support of the Dr. Lorna Breen Act, for a new program to foster a culture of wellness in healthcare facilities including hospitals, rural health clinics, community health centers, and medical professional associations.

The budget also includes $5 million for the Training for Health Care Providers program to reduce and prevent biases among healthcare providers in maternity care settings as well as $185 million for the Healthy Start program to reduce disparities in infant mortality and improve infant health outcomes.

Substance use And Mental Health Services Administration

The Budget requests $10.8 billion for SAMHSA, an increase of $3.3 billion above FY 2023 enacted. This funding will be used to expand access to behavioral health care and grow investments in crisis response, harm reduction, the behavioral health workforce, services to people experiencing homelessness, and recovery services. This funding includes:

$4.9 billion specifically for SAMHSA’s mental health and crisis response activities including investments in the 9-8-8 and Behavioral Health Crisis Services program;
$1.7 billion for the Community Mental Health Block Grant program;
$553 million for the Certified Community Behavioral Health Clinics grant program;
$5.7 billion specific to substance abuse prevention and treatment activities, an increase of $1.3 billion over FY 2023 enacted;
$37 million for SAMHSA’s Minority Fellowship programs, an increase of $17 million over FY 2023 enacted.

Agency for Healthcare Research and Quality

The Budget requests $448 million for AHRQ, an increase of $74 million over FY 2023 enacted, including:

$170 million for the health services, research, data and dissemination portfolio;
$59 million for investigator-initiated research to support new and continuing general research grants;
$5 million in new funding to expand behavioral health activities and expand research on long COVID and improving maternal health;
$7 million to advance efforts to coordinate ongoing state-level efforts to develop the necessary infrastructure to create and regularly disseminate a national all-payer claims database;
$18 million for AHRQ’s digital healthcare research portfolio to support the establishment of two Centers of Excellence in Telehealthcare Implementation;
$18 million for the U.S. Preventive Services Task Force (USPTF) to allow the Task Force to expand the number of clinical preventive services reviews in FY 2024.

In addition, AHRQ’s budget will include $116 million from the Patient-Centered Outcomes Research Trust Fund for an overall total program level of $564 million.

National Institutes of Health (NIH)

The Budget requests $48.6 billion in discretionary and mandatory resources for the NIH. This allocation is $920 million above the FY 2023 enacted amount. The budget is estimated to support 44,410 research project grants. The budget is largely focused on funding NIH programs and had limited legislative proposal. Major funding proposals in the budget focus on:

$121 million to support nutrition research, including investments that will advance the goals of the White House National Strategy on Hunger, Nutrition, and Health;
$20 billion to support pandemic preparedness activities;
$716 million to support the most promising ongoing research projects in support of the Administration’s Cancer Moonshot initiative;
$1.8 billion for opioids, stimulant and pain research;
$95 million for health disparities research;
$26 million for NIH-sponsored Centers for AIDS Research;
$3 million to support the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s (NICHD) continued research on mitigating the effects of COVID-19 on pregnant, lactating, and post-partum individuals, with a focus on individuals from racial and ethnic minority groups;
$200 million for the National Institute of Mental Health to support better diagnostics, improved treatments, and enhanced precision of care for mental health.

Advanced Research Projects Agency for Health (ARPA-H)

The budget includes proposed funding for Advanced Research Projects Agency for Health (ARPA-H), which supports the development of high-impact research advances that drive real world impact. The FY 2024 budget provides ARPA-H approximately $2.5 billion, a $1 billion increase above FY 2023 enacted.

Center for Medicare and Medicaid Innovation

The CMMI section of the FY 2024 budget provides an overview of CMMI’s strategic vision and priorities organized around five objectives: driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve system transformation. These objectives guide models and priorities, and CMS measures progress toward achieving goals for each objective to assess impact. The FY 2024 budget does not provide any proposals for new models but does provide a brief overview of three recently announced models selected by the HHS Secretary to address prescription drug affordability.

Advance Maternal Health and Health Equity

The FY 2024 budget requires states to provide 12 months of postpartum coverage in Medicaid and the Children’s Health Insurance Program. The FY 2024 budget specifically directs $276 million towards reducing maternal mortality and morbidity.

Expand Access to Vaccines.

As a complement to the successful Vaccines for Children program, the budget establishes the Vaccines for Adults program. This new capped mandatory program will provide uninsured adults with access to routine and outbreak vaccines recommended by the Advisory Committee on Immunization Practices at no cost. The budget would also expand the Vaccines for Children program to include all children under age 19 enrolled in a separate Children’s Health Insurance Program.

Expand Access to Mental Healthcare

The Budget proposes reforms to health coverage and major investments in the mental health workforce. For Medicare, the budget lowers Medicare beneficiary’s costs for mental health services, requires parity in coverage between behavioral health and medical benefits, and expands coverage for behavioral health providers. The budget also proposes to eliminate the 190-day lifetime limit on psychiatric hospital services. To enhance access to mental healthcare services, the budget also proposes to revise criteria for psychiatric hospital terminations from Medicare, so that a psychiatric hospital can continue to be a Medicare provider as long as any compliance deficiency does not jeopardize patient health and wellbeing. The budget also proposes to allow Medicare to identify and designate additional professionals (in addition to the recent coverage addition for marriage and family therapists and mental health counselors) who could enroll in Medicare and be paid when furnishing behavioral health services within their applicable state licensure or scope of practice that would otherwise be covered when furnished by a physician. Additional providers would include clinical social workers, peer support workers, and certified addiction counselors.

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. The budget proposes $670 million over five years in mandatory funding to expand and modernize the FDA's ability to respond rapidly and to any future pandemic or biological threat. In addition, the FY 2024 budget includes $20 billion in mandatory funding across HHS for pandemic preparedness, which is reflected in Public Health and Social Services Emergency Fund.

Centers for Disease Control and Prevention

The FY 2024 President’s Budget includes $19.5 billion in total mandatory and discretionary funding for CDC and the Agency for Toxic Substances and Disease Registry (ATSDR). This total includes $10.5 billion in discretionary funding, $1.2 billion from the Prevention and Public Health Fund, and $8 billion in current and proposed funding for mandatory programs. In addition, the FY 2024 budget includes $20 billion in mandatory funding across HHS for pandemic preparedness, which is reflected in Public Health and Social Services Emergency Fund. Of this total, $6.1 billion is allocated to CDC.

The budget does not include legislative or regulatory proposals for the CDC. Instead, it focuses on funding initiatives and programs, including improving public health data and infrastructure, improving maternal health, ending HIV, funding the Cancer Moonshot, and improving pandemic preparedness.

Food and Drug Administration (FDA)

The budget includes $7.2 billion for the US Food and Drug Administration (FDA), an increase of $521 million over FY 2023 enacted levels. The budget includes $4.6 billion to support medical product safety activities across the agency.

HIV/AIDS Epidemic

The budget again seeks to improve access to HIV/AIDs treatment. Pre-exposure prophylaxis (PrEP) is a daily medication for people at risk for HIV and can significantly reduce the risk of acquiring HIV. This budget proposal requires coverage of PrEP under Medicaid, including associated lab services, with no cost-sharing, and would regulate utilization management practices. This proposal is estimated save $10.2 billion over 10 years.

Department of Education (ED)

ED Funding

The Budget requests $90.0 billion in discretionary funding for the Department of Education, a $10.8 billion or 13.6% increase from the 2023 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 work includes an $820 increase for the 2024-2025 school year through a combination of mandatory and discretionary funding, thereby expanding access and reaching nearly 6.8 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), a $620 million increase compared to the FY 2023 enacted level. This additional funding is needed to provide better support to student loan borrowers. Specifically, the increase allows FSA to continue to operate the student aid programs, implement critical improvements to student loan servicing, continue to modernize its digital infrastructure, and ensure successful administration of the financial aid programs through a simplified and streamlined application process for students and borrowers.

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 $429 million from the 2023 enacted level. This funding includes $350 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 $16.3 billion in discretionary funding for Treasury, a $2.1 billion or 15 percent increase from the 2023 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 $142.8 billion in discretionary funding for VA, a $3.0 billion or 2.1% increase from the 2023 enacted level. The Budget also includes $112.6 billion in Advance Appropriations (AA) discretionary funding for VA medical care programs in 2025.

Prioritize VA Medical Care

The Budget provides a total of $121 billion in discretionary medical care funding in 2024, $2.3 billion above the 2023 enacted level. In addition to fully funding inpatient, outpatient, mental health, and long-term care services, the Budget supports programs that enhance VA healthcare quality and delivery. The Budget reiterates that medical care for veterans should be considered separately from other appropriations categories in order to ensure that the needs of veterans are never traded off against other national priorities.

Improve Veterans’ Mental Healthcare Services

The budget invests $139 million within VA research programs, together with $16.6 billion within the VA Medical Care program, to increase access to quality mental health care and lower the cost of mental health services for veterans, with the goal of helping veterans take charge of their treatment and live full, meaningful lives. This effort includes support for the Commander John Scott Hannon Veterans Mental Health Care Improvement Act (Hannon Act), clinical trials, and epidemiological studies on risk and prevention factors. In addition, the budget provides $559 million to further advance the Administration’s veteran suicide prevention initiatives, including continued expansion of the Veterans Crisis Line’s 988, additional support for VA’s National Suicide Prevention Strategy and a new $10 million program to further bolster suicide prevention efforts under section 303 of the Strong Veterans Act of 2022.

Opioid Prevention, Treatment and Program Costs

The Budget provides $715 million toward opioid use disorder prevention and treatment programs for FY 2024.

VA Prosthetic and Medical Research Funding

The 2024 request for the Medical and Prosthetic Research appropriation is $938 million, an increase of $22 million, or 2.4%, from the 2023 level (discretionary only). This investment will advance the Department’s research mission, including critical studies to understand the impact of traumatic brain injury (TBI) and toxic exposure on long-term health outcomes. The Office of Research and Development (ORD) will also continue to prioritize research focused on the needs of disabled Veterans including precision oncology, prosthetics, mental health, and suicide prevention as well as other disease areas.

Department of Labor (DOL)

DOL Funding

The Budget requests $15.1 billion in discretionary funding for DOL, a $1.5 billion increase from the 2023 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. The budget allocates $200 million to launch the Sectoral Employment through Career Training for Occupational Readiness (SECTOR) program. SECTOR will scale evidence-based sector partnerships to empower employers in growing industries to design and implement high-quality training, ensuring they have their workforce needs met and that underserved workers have access to high-quality jobs.

Registered Apprenticeships (RA)

The Budget invests $335 million, a $50 million increase above the 2023 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.

Department of Defense (DOD)

DOD Funding

The Budget requests $842 billion in discretionary funding for DOD, a $26 billion or 3.2% increase from the 2023 enacted level.

Enhance Biodefense and Pandemic Preparedness.

This budget builds on the research, development, and acquisition advancements enabled by FY 2023 Enhanced Biodefense and Pandemic Preparedness investments to posture the Department to support timely bio-incident prevention, detection, assessment, response, and recovery in accordance with the National Defense Strategy and the National Biodefense Strategy.

Department of Agriculture (USDA)

USDA Funding

The Budget requests $32.6 billion in discretionary funding for USDA, a $4.7 billion increase from the 2023 enacted level. Resources provided through the 2024 Budget supports the creation of an equitable and climate-smart food and agriculture economy that protects and improves the health, nutrition, and quality of life of all Americans, yields healthy land, forests and clean water, helps rural America thrive, and feeds the world.

Connect More Rural Americans to High-Speed, Affordable, and Reliable Internet

Building on the $2 billion for USDA broadband programs provided in the Bipartisan Infrastructure Law for 2023, the Budget provides $400 million for the ReConnect program, which provides grants and loans to deploy broadband to unserved areas, especially tribal areas.

Department of Energy (DOE)

DOE Funding

The Budget requests $52 billion in discretionary funding for DOE, a $6.2 billion or 13.6% increase from the 2023 enacted level. The President’s 2024 Budget for DOE: invests in basic research and scientific infrastructure authorized in the CHIPS and Science Act; creates jobs building clean energy infrastructure; and advances energy justice.

Clean Energy Infrastructure

The Budget invests $2 billion to support clean energy workforce and infrastructure projects across the Nation, including: $425 million to weatherize and retrofit low-income homes; $83 million to electrify tribal homes and transition tribal colleges and universities to renewable energy; and $107 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.