2023 budget would boost CDC funds, preparedness support: Prevention-focused plan off to Congress
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* Kim Krisberg

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Damiel Amores vaccinates Juan Sanchez against the flu in Redwood City, California, in 2020. President Biden’s fiscal year 2023 budget proposal contains many gains for health, including mandatory funding for CDC’s Vaccines for Adults Program.

Photo by Paul Chinn, courtesy The San Francisco Chronicle/Getty Images

If President Joe Biden’s new budget proposal comes to fruition, it would mean a significant boost in public health funding, including long-term investments in infrastructure. Though it still reflects some missed opportunities, according to health advocates.

In March, the Biden administration released its proposed federal budget for fiscal year 2023, calling for more than $81 billion in mandatory pandemic preparedness funds and an increase of $2.23 billion for the Centers for Disease Control and Prevention, which would mark a 21% increase over fiscal year 2022 levels. Overall, the budget proposes more than $127 billion for the U.S. Department of Health and Human Services, or an increase of $13.3 billion.

The U.S. Health Resources and Services Administration would also get an increase in the Biden budget of $41 million. The administration is requesting a $4.2 billion increase for the Substance Abuse and Mental Health Services Administration, which is working to address mental and substance use disorders that worsened during the COVID-19 pandemic, among other issues.

“The administration’s proposed FY 2023 budget rightly focuses on the critical need to improve the nation’s public health infrastructure, workforce and pandemic preparedness capabilities,” APHA Executive Director Georges Benjamin, MD, said in a news release.

Within the CDC budget, the administration proposes increases in discretionary funding for a number of public health priorities, including an increase of $400 million to invest in public health infrastructure within states, localities and territories; an increase of $383 million for immunization and respiratory diseases; an increase of $145 million for CDC’s Social Determinants of Health Program; and a increase of $174 million for environmental health programs, including a $100 million boost for the Climate and Health Program.

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Image by Penfold, courtesy iStockphoto

CDC’s prevention work on gun violence and injury is also slated for significant increases. The Biden budget proposes a $223 million bump for the agency’s opioid overdose prevention and surveillance work, as well as $22.5 million more for research on preventing gun injuries and deaths and $250 million more for community-based violence intervention work.

CDC’s Public Health Preparedness and Response program, however, would be decreased by $20 million. Some experts said the proposed decrease was likely an oversight.

The new budget, which still has to churn through Congress, also asks for an additional pot of $81.7 billion in mandatory — as opposed to discretionary — funding over five years for pandemic preparedness, including $28 billion for CDC to invest in infrastructure, surveillance, lab capacity, data systems and workforce.

CDC is also submitting a proposal for $25 billion over 10 years to establish mandatory funding for the Vaccines For Adults Program, which would provide millions of uninsured Americans with recommended immunizations.

Dara Lieberman, MPP, director of government relations at Trust For America’s Health, said that overall, proposed funding for CDC is not far off from what the CDC Coalition had urged. The coalition, which APHA helps lead, has asked Congress to approve “at least $11 billion” for CDC’s 2023 fiscal year.

Lieberman said that while the mandatory $81.7 billion in pandemic funding faces “significant political obstacles to getting across the finish line,” the proposal does speak to the urgency of investing in and modernizing public health.

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Felicia Bagneris administers COVID-19 tests in January at the First African Methodist Episcopal Church in Los Angeles. President Biden’s recent budget proposal requests nearly $82 million for pandemic preparedness.

Photo Francine Orr, courtesy The Los Angeles Times/Getty Images

“It reflects what’s needed to rebuild our chronically underfunded public health system and the need to invest in cross-cutting capabilities,” Lieberman told *The Nation’s Health*. “We can’t keep nibbling around the edges… and expect a different result the next pandemic.”

Proposed increases for CDC’s social determinants of health work are also welcome news, she said.

“We’ve seen how interconnected health is with the nation’s security,” she said. “We need to address the root causes of disease to make communities more resilient for the next disaster.”

Erin Morton, MA, executive director of the Coalition for Health Funding, also is pleased to see the proposed funding increases for CDC. But she said she was hoping for higher levels of discretionary funds, especially as the proposed mandatory preparedness money is “a long ways from becoming reality.”

Morton noted that public health agencies are facing a “pretty big cliff” in funding as emergency supplemental money ends and there are no discretionary funds available to fill the void.

“From our perspective, it’s better practice to sustainably and significantly increase discretionary budget lines year over year — that’s the best way to build a public health infrastructure,” she told *The Nation’s Health*. “We really need to focus on getting those base levels up.”

The 2023 proposal also misses an opportunity on chronic disease prevention, according to APHA member Donald Lloyd-Jones, MD, ScM, chair of preventive medicine at Northwestern University.

Under Biden’s proposal, CDC’s chronic disease prevention and health promotion program would get about $1.6 billion, or an increase of $335 million over fiscal year 2022 levels. Organizations that fight chronic disease, such as the American Heart Association, where Lloyd-Jones serves as president, are urging Congress to authorize $3.75 billion.

Lloyd-Jones said the pandemic has highlighted the critical need to curb the country’s high chronic disease burden, which put so many Americans at heightened risk of dying from COVID-19 and still accounts for many of the country’s leading causes of morbidity and mortality.

“What faces us now are chronic epidemics,” he told *The Nation’s Health*. “But they’re preventable, so I think we’re missing a really important opportunity.”

On mental health — another indicator that data shows COVID-19 significantly worsened — the Biden budget calls for a $2.5 billion increase for SAMHSA mental health activities. It also proposes $5.6 billion, or an increase of $1.6 billion, for substance abuse treatment; and $697 million, or an increase of $590 million, for behavioral health services and to support the new three-digit suicide prevention hotline, 988, which goes live nationwide in July.

“We’re in the midst of a mental health crisis and this level of investment is really what’s needed to move the needle,” Jennifer Snow, MPA, national director of government relations, policy and advocacy at the National Alliance on Mental Illness, told *The Nation’s Health*.

Snow noted the Biden budget also proposes $125 million to help states enforce mental health and substance use disorder parity laws, which require insurers cover such services on par with other medical care. Even though the country has had mental health parity laws on the books for more than a decade now, the benefits have not been fully realized — “enforcement is really the key,” she said.

Biden’s budget proposal would also expand mental health parity protections to Medicare.

Work to combat health disparities would also get a lift in Biden’s budget proposal. One particularly big change is a request to switch all Indian Health Service funding from discretionary to mandatory, as well as increase the agency’s fiscal year 2023 budget by 37%. The administration is also proposing more than $470 million in fiscal year 2023 funding across HHS agencies to address high U.S. maternal death rates and disparities in outcomes between Black and white women.

The budget proposes $164 million — or an $81 million increase — for maternal health work at CDC, such as maternal mortality review committees and risk assessment monitoring systems. APHA member Joia Crear-Perry, MD, founder and president of the National Birth Equity Collaborative, said she was “very excited” to see the spending proposal focus on supporting maternal health of Black, American Indian and Alaska Native women, who face disproportionate death rates.

At HRSA, increases are also proposed for maternal health innovation grants and rural maternal health initiatives.

“We’re not going to train our way to justice and joy,” Crear-Perry told *The Nation’s Health*. “We really have to have the people impacted lead the work.”

Biden’s 2023 budget is only a proposal and will likely look very different after it makes its way through Congress and lands back on the president’s desk for signing. In the meantime, Morton at the Coalition for Health Funding urged health advocates to speak up.

“Your voice matters, especially now, coming out of the pandemic,” she said. “Hearing from public health officials, from people in the field — those stories matter. Politics is still local, so hearing from people in home states and districts matters.”

To send a message to members of Congress in support of public health in the fiscal year 2023 budget, visit APHA’s action alert page at [www.apha.org/action-alerts](http://www.apha.org/action-alerts).

For more information, visit [www.whitehouse.gov/omb/budget](http://www.whitehouse.gov/omb/budget).

*   Copyright The Nation’s Health, American Public Health Association