Biden’s Budget Request Recommends Significant HIV Fund Increases

Last Friday, the Biden administration released its “skinny budget” outline of its FY22 discretionary requests totaling $1.5 trillion with $769 billion for non-defense programs and $753 billion for defense funding. The funding includes a $25 billion increase from FY 21 for HHS totaling $131.7 billion and a $267 million increase for federal efforts to realize goals aimed at ending the HIV epidemic by 2030.

The budget is the first in a decade that will not be bound by statutory spending caps imposed as part of a deficit-reduction effort in 2011. The absence of those caps gives the administration a freer hand in proposing spending increases, but it could also complicate efforts to amass the bipartisan support needed to pass appropriations bills.  The detailed budget is expected sometime this spring. Other highlights include:

• $8.7 billion: CDC to support core public health capacity improvements in States and Territories, modernize public health data collection nationwide, train new epidemiologists and other public health experts, and build international capacity to detect, prepare for, and respond to emerging global threats. The request is the largest increase for the CDC in 20 years.
• $51 billion: NIH including $6.5 billion for a new Advanced Research Projects Agency for Health (ARPA-H).
• $1.6 billion: Community Mental Health Services Block Grant.
• $670 million: To reduce new HIV cases while increasing access to treatment, expanding the use of PrEP, and ensuring equitable access to services.
• $2.2 billion: Indian Health Service.
• $905 million: National Strategic Stockpile to maintain and replenishment critical medical supplies and restructuring efforts.

Appointments and Nominations

On Thursday, the Senate Finance Committee held hearings on the nominations of Andrea Palm for Deputy Secretary of Health and Human Services (HHS) and Chiquita Brooks-LaSure for Administrator of the Centers for Medicare and Medicaid Services (CMS). The nominees would play a key role in addressing the COVID-19 pandemic, undoing Trump-era policies like Medicaid work requirements, and advancing the Biden Administration’s public health agenda. During the hearing, committee members asked both nominees to expand on their commitments to addressing the racial and geographic disparities in the health care system and the compounded impact of the COVID-19 pandemic.

In response, Palm stressed the importance of federally qualified health centers (FQHCs) abilities to reach underserved, rural, and minority population. Other highlights from the hearing include expressed bipartisan agreement that telehealth flexibilities implemented during the pandemic remain permanent.

House Appropriations Subcommittee HHS FY22 Budget Request Hearing

The House Appropriations LHHS Subcommittee held a hearing with testimony from Secretary Xavier Becerra to examine HHS’s $131.7 billion budget request for FY22.

While ranking Member Tom Cole (R-OK), alongside other Republicans, expressed concerns that the President’s budget devotes an improper amount of attention to domestic programs in lieu of defense spending, the ranking member agreed with suggested increases for the nation’s public health infrastructure and biomedical research and called for further increases to NIH, CDC, and BARDA.

Additionally, the subcommittee’s Democrats praised the administration’s increased attention on health equity and social determinants of health and Secretary Becerra said that the department will facilitate enhanced partnerships with local communities alongside a commitment to put significant amounts of money behind related programs focused on communities most affected by maternal mortality and HIV/AIDS.

Overarching agreement on the need to invest in our nation’s public health infrastructure comes as the CDC, this week, released it 2019 STD Surveillance Report highlighting now six consecutive years of significant increases in rates of STD infections. When considered against the Biden Administration’s proposed $8.7 billion CDC allocation, however, its clear that “agreement” is not yet “action.” To wholistically address the HIV/AIDS epidemic, the administration must commit more funding to STD programs on the ground in our communities to combat the disparate rates of infections for black, Latinx, indigenous, and LGBTQ communities.

Earmarks

Next week, Senate Republicans next week will resolve confusion on whether a “permanent ban” on earmarks in their conference rules prevent members from requesting earmarks. The conference is set to vote April 21 on whether to join their House counterparts and Democrats in lifting the earmark ban. Senate Appropriations ranking member Shelby and other top GOP appropriators point to conference rule which says “[no] action” by the conference “shall be binding in any way on members” during Senate votes. “I think there is a rule that bans earmarks, but there’s also a rule that says we’re not bound by the rules, so I don’t know that there’s going to be an effort to actually overturn [the ban] or just clarify it” said Senator Capito.

Vaccine Shots and Blood Clots

On Tuesday, the CDC and FDA called for an immediate pause of the Johnson & Johnson’s vaccine after six U.S. recipients, all women between the ages of 18 and 48, developed rare blood clots. Nearly seven million people in the United States have received Johnson & Johnson shots so far, and roughly nine million more doses have been shipped out to the states, according to data from the Centers for Disease Control and Prevention. Alternatively, more than 100 million people have received the Pfizer and Moderna vaccines in the U.S. and public health officials maintain that there is more than enough to “continue the pace of current vaccinations of 3 million shots per day.”

So far, 5,800 vaccinated people have become infected in the U.S. with some becoming seriously ill and a total of 74 people who died.