Significant Shifts on the Healthcare Horizon

President Joe Biden released the complete details of his fiscal year 2022 budget proposal, requesting $6 trillion in spending and a $1.8 trillion annual deficit. The administration requested increases across most departments and agencies, including a 6.5 percent boost to nondefense discretionary spending.

Concurrently, the Supreme Court is poised for a whirlwind end of term, with justices expected to clear the court’s docket of more than 20 pending cases before July. The remaining disputes could yield several landmark decisions.

Health and Human Services Secretary Xavier Becerra testified Tuesday, June 8, 2021, on the agency's fiscal year 2022 budget request. Topics he engaged with lawmakers on included the impact of unaccompanied minors at the southern border, the foster care system, pandemic preparedness, health care data collection, and insurance coverage gaps. Significant line items include:

• Funding for health initiatives, including expanding access to mental health care;
• $4.3 billion for the Centers for Medicare and Medicaid Services;
• $400 billion for an expansion of the Medicaid program, including pay and benefits for community-based and home health care workers; and
• $754 million for the Community Services Block Grant.

Highlights from Secretary Becerra’s testimony include:

• Senator Cantwell (D-WA) said we had expanded access to care, which was important during COVID-19, but before COVID-19, we still had affordability issues. She asked the Secretary for his ideas on putting more affordability into the system, including standards in home health. Secretary Becerra said to continue to improve the Affordable Care Act versus trying to dismantle it would be best. He added that the more flexibility we offer, the greater the chance we could drive down costs and get reimbursement rates right and ensure good care at home and in the community and family care.
• Senator Bennet (D-CO) asked about a public option and a timeline for working in earnest together on refining the proposal. He emphasized his concern with the increased rates of mental health and mental health illness that young people are experiencing, leading to death by suicide, substance abuse, or other mental and behavioral health challenges. Bennet asked how we should use this funding to help address these mental health challenges and how mental health can be integrated into in-home and community-based services for children receiving services. Secretary Becerra said he wants to provide greater access and a public option at a lower cost quickly to prevent things from getting worse.
• Senator Casey (D-PA) said that consumers who search for insurance online are at risk of being funneled into a non-ACA compliant junk plan by misleading ads in online search results. Secretary Becerra said he would expand the funding for the outreach and the education work to ensure that people understand health insurance and what they need if they are a family of four, a single individual, 20 years old, 30 years old, or 80 years old.

At the same time, the Supreme Court is poised to hear five landmark decisions, one of which could greatly detour the Administration’s ability to move forward with many of its healthcare proposals. The big case to watch was the Affordable Care Act challenge. However, as of Thursday, June 17 the Supreme Court upheld the Affordable Care Act in a 7-2 ruling.

• The other four include:
  • Same-sex foster parents and religious liberty
  • Voting rights
  • NCAA athlete compensation
  • Student free speech