President Biden Releases FY24 Budget Proposal

March 09, 2023

On March 9, the White House released President Biden’s FY24 budget proposal, which outlines the Administration’s funding priorities for the upcoming fiscal year. As a reminder, Congress has the authority to approve, reject, or modify the administration’s budget recommendations.

ASTHO issued a statement in response to the FY24 President’s budget proposal.

It is important to note that additional details about this budget will be released next week. Therefore, the ASTHO government affairs team was unable to conduct a detailed analysis of the budget. In addition to the proposed discretionary funding increases for ASTHO member priorities, the information provided below is meant to be a snapshot of new initiatives and policies proposed by President Biden.

State and territorial health officials should view the HHS budget in brief for additional information about the federal agencies and programs beyond what is highlighted below.

Key Public Health Funding Proposal Highlights

ASTHO’s member priorities saw proposed increases in the President’s FY24 budget:

• $600 million, a $250 million increase from FY23 for public health infrastructure and capacity.
• $340 million, a $165 million increase from FY23 for public health data modernization.
• $106 million for public health workforce training and fellowship programs.

Pandemic Preparedness

The budget request includes $20 billion in mandatory funding (over five years) for HHS public health agencies in support of the Administration’s pandemic prevention and preparedness and biodefense priorities as outlined in the 2021 American Pandemic Preparedness: Transforming Our Capabilities plan and 2022 National Biodefense Strategy and Implementation Plan for Countering Biological Threats, Enhancing Pandemic Preparedness, and Achieving Global Health Security (National Biodefense Strategy and Implementation Plan).

• $10.5 billion for ASPR to:
• Advance research and development of vaccines.
• Provide therapeutics and diagnostics for high priority viral families.
• Scale up domestic manufacturing capacity for medical countermeasures.
• Support the public health workforce.
• $6.1 billion for CDC to:
• Modernize and build laboratory capacity.
• Strengthen public health data systems, as well as enhance domestic and global disease surveillance, biosafety, and biosecurity efforts.
• Support capabilities for monitoring and evaluating vaccine and medical countermeasure safety and effectiveness.
• $2.69 billion for NIH to:
• Conduct research and development of vaccines diagnostics and therapeutics against high priority viral families.
• Enhance biosafety and biosecurity.
• Expand laboratory capacify and clinical trial infrastructure.

National Hepatitis C Elimination Program

The FY24 budget includes a new HHS-wide proposal to eliminate hepatitis C infections in the United States, with a specific focus on high-risk populations. This five-year program will increase access to curative medications and expand implementation of complementary efforts such as screening, testing, and provider capacity. The budget also reproposes the mandatory Pre-Exposure Prophylaxis (PrEP) Delivery Program to End the HIV Epidemic in the United States (“PrEP Delivery Program”). The PrEP Delivery Program will provide PrEP and associated services at no cost to uninsured and underinsured individuals and expand the number of providers serving underserved communities. The budget also increases access for Medicaid and CHIP beneficiaries by requiring states to cover PrEP and associated laboratory services with no cost sharing, and places guardrails on utilization management practices like prior authorization and step therapy. The national hepatitis C elimination program will have a significant impact on the Medicare population. Hepatitis C disproportionately affects baby boomers, many of whom are eligible for Medicare. Untreated, hepatitis C can cause advanced liver disease, liver cancer, and death. An eight-to-12 week course of oral direct-acting antiviral medication cures hepatitis C in more than 95% of people. Under this program, the federal government pays 100% of cost-sharing for Medicare Part D beneficiaries.

CDC Vaccines for Adults

As a complement to the successful Vaccines for Children program, the budget establishes the Vaccines for Adults program within CDC. This new capped mandatory program will provide uninsured adults with access to routine and outbreak vaccines recommended by the Advisory Committee on Immunization Practices.

FDA

$103 million to support the implementation of FDA’s Overdose Prevention Framework. Specifically, the funds will support activities that include:

• Promoting appropriate prescribing of medications with abuse potential, including opioids, stimulants, and benzodiazepines.
• Expanding the availability of, and access to, overdose reversal products.
• Expanding the availability of, and access to, evidence-based treatments for substance use disorders.
• Increasing surveillance, enforcement, and indictment efforts targeting illegal, unapproved, counterfeit, and potentially dangerous products at international mail facilities, express courier hubs, and ports of entry.

HRSA

$130 million in new funding for Long COVID Integrated Diagnostics and Care Units, as well as support for provider training, capacity building, and consultation to provide primary care providers with knowledge about Long COVID diagnostics and treatment.

SAMHSA

$2 billion in mandatory funds for the Mental Health System Transformation Fund to expand access to mental health services through workforce development and service expansion.