The White House on Friday released President Biden's preliminary fiscal year (FY) 2022 budget proposal, which includes a proposal to launch a new agency focused on developing cures for Alzheimer's disease, cancer, diabetes, and other diseases.

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The White House is expected to release a full proposed budget in late spring.

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Biden's budget proposal has no legal effect, because Congress ultimately is tasked with drafting and approving federal spending measures that then must be signed by the president to become law. Even so, the budget proposal does shed light on the administration's federal funding priorities. Below is a breakdown of the administration's health care priorities for FY 2022.

FY 2022 budget proposal details

The budget proposal calls for increasing HHS' budget by 23.5% relative to FY 2021, bringing the department's budget up to a total of $131.7 billion in FY 2022. That $131.7 billion figure would include:

• $51 billion for NIH to support research intended to enhance health and reduces illness and disability;
• $8.7 billion for CDC to modernize public health data collection, train new public health experts, and improve core public health capacity at the federal and state levels;
• $1.6 billion for the Substance Abuse and Mental Health Services Administration to support the Community Mental Health Services Block Grant
• $905 million for FDA and the Office of the Assistant Secretary for Preparedness and Response to invest in FDA's capacity and purchase supplies to maintain the Strategic National Stockpiling and improvements initiated during the coronavirus epidemic; and
• $47.9 million for HHS' Office for Civil Rights.

As part of a $51 billion request for the NIH, the budget proposal calls for forming a $6.5 billion medical research agency within NIH focused on rapidly developing cures for Alzheimer's disease, cancer, diabetes, and other diseases.

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The new agency, which would be called the Advanced Research Projects Authority for Health (ARPA-H), would be modeled after two existing research agencies: the Department of Defense's Defense Advanced Research Projects Agency and the Department of Energy's Advanced Research Projects Agency. If created, the new agency would become one of the NIH's largest bodies—with a budget higher than that of NIH's National Cancer Institute, which is currently NIH's largest agency, STAT News reports.

According to STAT News, it remains unclear how the new agency would function. White House aides provided few details on the new agency during a briefing, and budget documents provide no additional information beyond the agency's proposed funding and research goals. 

As part of the funds for NIH, CDC, and other agencies within HHS, the budget also calls for:

• $10.7 billion to combat America's opioid epidemic by investing in research, prevention, treatment, and recovery services—particularly for Native Americans, older Americans, and rural populations;
• $340 million to expand access to family planning health care services;
• $551 million for home and community-based services;
• $670 million to help end the HIV/AIDS epidemic by increasing access to preventive care and treatment, including pre-exposure prophylaxis;
• $200 million to reduce maternal mortality by investing in rural programs and implicit bias training and childhood development experts in high-Medicaid/CHIP communities; and
• $100 million to address gun violence.

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In addition, the budget calls for promoting health equity and supporting research to understand climate change's impact on health, although the budget doesn't specify funding amounts for those efforts.

Reaction

Republican lawmakers criticized the budget proposal. In a statement Friday, Senate Majority Leader Mitch McConnell (R-Ky.) and other Republican leaders said Biden's budget proposal "prioritized spending trillions on liberal wish list priorities" and neglected funding for the military.

However, Biden said he is hopeful Republicans will ultimately support his budget proposal. "I've already spoken to some of my Republican colleagues about dealing with the infrastructure legislation we have up there, as well as other budget items," Biden said at the White House on Friday. "So we're going to work on seeing if we can get some bipartisan support across the board here."

According to STAT News, at least some of the requests outlined in Biden's preliminary budget proposal are likely to move forward. For example, Senate health committee Chair Patty Murray (D-Wash.) and Sen. Richard Burr (R-N.C.), who is Murray's Republican counterpart, are expected to work on legislation related to pandemic preparedness this year (Facher, STAT News, 4/9; Cohrs, STAT News, 4/9; Hellmann, Modern Healthcare, 4/9; Lucia, Route Fifty, 4/9; King, FierceHealthcare, 4/9).