Early last week, the Biden Administration announced its proposed budget for Fiscal Year (FY) 2025. These annual proposed budgets represent the administration’s “spending wish list” and usually differ significantly from the appropriations bills enacted by Congress. President Biden’s $7.3 trillion budget proposal would increase revenues by an estimated $4.9 trillion over the next decade; these added revenues would help trim the deficit by $3 trillion with the remaining $1.9 trillion going to fund various programs. For Health and Human Services (HHS), the Biden Administration is requesting a discretionary budget of $130.7 billion for FY 2025 – a 1.7% increase from the 2023 spending level. While Democrats will consider the President’s proposed budget when negotiating additional funding, the proposal will face significant challenges as House Republicans push for spending cuts.

Here is an overview of major initiatives on AHPA’s radar:

Prescription Drugs Costs and Access:

• Increasing the pace of negotiations for drugs under Medicare. While the budget does not specify how many drugs would be subject to negotiations, in his State of the Union, President Biden said Medicare should be able to negotiate prices on 500 drugs with the goal of saving Americans up to $200 billion over the next decade.
• Extending the $2,000 out-of-pocket drug costs and the $35 per month insulin cost-share caps to the commercial marketplace.
• Limiting the cost-sharing under Medicare Part D for certain generic prescriptions to no more than $2 for beneficiaries.

Access and Quality:

• Making permanent the expanded premium tax credits that were extended under the Inflation Reduction Act.
• Providing Medicaid-like coverage to people from non-Medicaid expansion states and incentivizing states to expand and maintain their coverage expansion.
• Banning “facility fees” for telehealth and certain outpatient services.
• Extending continuous eligibility from 12 months to 36 months for children under Medicaid and the Children’s Health Insurance Program (CHIP).
• Prohibiting enrollment fees and premiums in CHIP.
• Improving and expanding Medicaid home and community-based services by investing $150 billion over the next ten years.
• Increasing ownership transparency and quality oversight for all nursing home facilities and expanding financial penalties for underperforming facilities.
• Increasing funding for the Title X Family Planning Program to $390 million, 36% more than the 2023 enacted level, to serve 3.6 million patients.
• Requiring state Medicaid programs to provide continuous coverage for 12 months postpartum to reduce gaps in coverage for women. This is currently being done voluntarily by 40 states.
• Permitting CMS to publicly disclose all accrediting organization survey reports.

Social Determinants of Health:

• Creating a new program for families making up to $200,000 annually to help subsidize the cost of quality child care. Families would pay no more than $10 per day, with the lowest income families paying nothing.
• Provide $8.5 billion for the Child Care and Development Block Grant, which serves school-age children.
• Investing $258 billion to build or preserve over 2 million housing units and $28.8 billion in various housing assistance programs.
• Expanding the Low-Income Housing Tax Credit and creating the Neighborhood Homes Tax Credit.
• Requiring reporting of patient-level demographic and SDOH data for quality measurement programs.

Mental and Behavioral Health:

• Requiring commercial health plans to cover services for mental health and substance use disorder and to maintain an adequate network of behavioral health providers.

Cybersecurity:

• Providing $1.3 billion in incentives for hospitals to ramp up cybersecurity measures.
• Recommending penalties for not meeting essential cybersecurity practices to be adopted in 2029; failure to meet these standards could result in a penalty of up to 100% of the annual market basket increase. Beginning in 2031, additional penalties could include reductions of 1% from the base payment.