March 20, 2024

Looking Ahead to FY 2025 Federal Budget

Introduction

On Monday, March 11, President Biden released his budget proposal for FY 2025, an overall $7.3 trillion budget that includes tax credits for families and new money for housing.

Also last week both Joe Biden and Donald Trump secured enough delegates to clinch the Democratic and Republican nominations for president, respectively, cementing a rematch between the two in November and setting the state for a race with all the baggage of 2020 with new stressors over the economy, the future of democracy and abortion rights.

Meanwhile, House Republicans are furious over projects President Biden wants to fund in FY 2025, including $3 billion to “advance gender equity and equality worldwide.” Meanwhile, the national debt is currently just under $34.5 trillion and the federal budget deficit is $531 billion, according to the latest data.

Congress passed half of their 12 spending bills in a massive $460 billion package just before the March 8 deadline, and the remainder must be funded by March 22 to avoid a partial government shutdown.

Biden’s proposal is largely symbolic and isn’t expected to gain much momentum in the Republican-controlled House, but it represents a significant part of the president’s upcoming pitch to voters as disagreements over federal spending fuel historic levels of division on Capitol Hill.

Biden’s Proposal for Health Care of Priority Populations

Medicare
The proposed budget would extend the life of the Medicare hospital insurance trust indefinitely with a tax rate on Americans making more than $400,000 a year. Biden also proposed allowing Medicare to negotiate lower prices for drugs most widely used to treat blood clots, cancers, arthritis and diabetes.

Medicaid
The proposed budget includes $150 billion to strengthen and expand Medicaid home and community-based services and provides “Medicaid-like coverage” to individuals in states that have not adopted Medicaid expansion.

Women’s Health
The budget provides $594 million for the U.S. Agency for International Development-directed voluntary family planning and reproductive health programs and a contribution to the United Nations Population Fund.

Biden’s Proposal for Mental Health and Workforce Development

Mental Health
The proposal includes several initiatives in the area of mental health including:

• Significant investments in the 988 suicide crisis lifeline and would expand the Centers for Disease Control and Prevention’s suicide prevention programs.
• $1 billion for health IT and certain behavioral health providers.
• $216 million to increase funding for counselors, psychologists, social workers and other mental health professionals in K-12 schools.

Workforce
The proposal also includes $1.8 billion toward boosting development programs in STEM fields that have an emphasis on diversity, equity, inclusion and accessibility.

Opioid Overdose Grant
The proposed required $1.6 billion in supplemental funding for the Department of Health and Human Services to expand substance use prevention, treatment, harm reduction and recovery support services to address the opioid overdose crisis. The budget also invests in a new technical assistance center to strengthen health providers’ understanding and treatment of women’s health within its State Opioid Response grant.

Biden’s Proposal for Health Equity, Infectious Disease and Medical Research   

Maternal Health and Health Equity
The proposal includes $276 million to reduce maternal mortality and morbidity rates and address perinatal health disparities. The proposal also expands maternal health support services by incentivizing states to reimburse doulas, community health workers, peer support initiatives and requires all states to provide continuous Medicaid coverage for 12 months postpartum.

Disease Treatment and Prevention
The proposal includes funding for infectious disease treatment and prevention, including HIV, vaccine-preventable disease and hepatitis C. The budget also proposes a new adult vaccines program and an expansion of the childhood vaccines program.

Medical Research
The proposal includes funding for development of innovation in women’s health centers nationwide. The budget would set aside funding for the expansion of paid family and medical leave programs. It would also double the funding for the Office of Research on Women’s Health at the National Institutes of Health.

Conclusion

Congressional leaders are beginning to discuss the roadmap to funding fiscal year 2025, even as negotiations continue on how to fund the remainder of fiscal year 2024, which began on October 1, 2023.

The kick-the-can appropriations strategies must occasionally occur in our current political reality. However, the tactics should also be accompanied by a smart bipartisan plan that will take time to develop. To produce a budget that is mutually acceptable, leaders from both sides have to overcome the objections of their more radical members who aren’t willing to compromise.

While the President’s proposal appears to embrace many of the HIV funding values that advocates champion, it is important that Congress do its due diligence to ensure not only that we embrace socially responsible initiatives but also that we do so in a way that is both ethically and fiscally responsible.

This is a perfect opportunity for members of the Academy to contact their representatives to show their support for a bipartisan approach to funding that meets the objectives of both sides of the aisle. The Public Policy Department stands ready to support all members who are interested in being a part of this delicate process.

Community Sign-Ons

This week the Academy joined the following community sign-on letters:

• The State Department’s Non-Discrimination Rules
• Florida Steering Committee’s Doxy PEP response letter to Senator Rubio