Fiscal Year 2010 Budget in Brief

Overview

ADVANCING THE HEALTH, SAFETY, AND WELL-BEING OF OUR PEOPLE

FY 2010 President’s Budget for HHS
(dollars in millions)

Composition of the FY 2010 Budget
$879 Billion in Outlays

The Department of Health and Human Services enhances the health and well-being of Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.

The Department of Health and Human Services (HHS) Budget, consistent with the President’s goals, invests in health care, disease prevention, social services, and scientific research. These investments will improve the lives of children, families, and seniors by creating a healthy foundation for everyone to fully participate in the American community.

The President’s FY 2010 HHS budget totals $879 billion in outlays, an increase of $63 billion over FY 2009. The Budget proposes $78 billion in discretionary budget authority for FY 2010. The Budget also proposes legislation to support activities that received about $2 billion in FY 2009 discretionary appropriations, mostly as emergency funding, with mandatory funding beginning in FY 2010. As a result, on an accounting basis, the HHS discretionary budget request declines by $166 million even though discretionary programs increase by nearly $2 billion outside the programs benefiting from the proposed mandatory legislation.

As described in this section, the FY 2010 President’s Budget invests in key HHS priority areas to fulfill the President’s health care vision by continuing on the path to health reform and building on the American Recovery and Reinvestment Act of 2009 (Recovery Act).

The President’s proposed reserve fund for Health Reform (refer to the following section) invests in developing a long-term path to affordable, quality health care for all Americans.

The Department’s portion of the American Recovery and Reinvestment Act of 2009 (refer to the section following Health Reform) addresses and responds to critical challenges in our health care system through investments that immediately impact the lives of Americans.

FY 2010 PRESIDENT’S BUDGET
The following goals and initiatives are highlights of the President’s vision for a healthier, safer, and more prosperous America. HHS will continue to seek improvements and strive to exceed expectations in the following endeavors:

• Securing and Promoting Public Health;
• Delivering Human Services to Vulnerable Populations;
• Investing in Scientific Research and Development; and
• Improving Quality of and Access to Health Care.

SECURING AND PROMOTING PUBLIC HEALTH

Advancing Food Safety: The Budget includes an additional $511 million for the Food and Drug Administration (FDA), the largest increase ever requested, with $259 million of the increase devoted to food safety efforts. This funding level would increase and improve inspections, domestic surveillance, laboratory capacity, and domestic response to prevent and control food borne illness. FDA will increase the number of food inspectors by approximately 20 percent in FY 2010.

Lowering Drug Costs: The Administration is committed to lowering the costs of drugs for all Americans. The FY 2010 Budget creates a new pathway to approve generic biological products, supports FDA’s efforts to establish a framework to allow the importation of safe prescription medicines from other countries, and provides for an industry funded user fee for generic drug review.

Preventing and Treating HIV/AIDS: The FY 2010 Budget includes $3 billion, an increase of $107 million above FY 2009, in the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) to enhance HIV/AIDS prevention, care, and treatment. The increase includes an additional $53 million for CDC to support domestic HIV/AIDS testing and surveillance, capacity building, and HIV prevention activities among high-risk groups. Within HRSA, an additional $54 million is included for the Ryan White HIV/AIDS program to increase access to health care among uninsured and underinsured individuals living with HIV/AIDS and to help reduce HIV/AIDS related health disparities.

Addressing Autism Spectrum Disorders: The President is committed to providing an additional $1 billion over the next eight years to expand support for children, families, and communities affected by autism spectrum disorders (ASD). The FY 2010 Budget includes $211 million across HHS for ASD research, treatment, screenings, surveillance, public awareness, and supportive services.

Reducing Health Disparities: The FY 2010 Budget includes $354 million for combating health disparities to improve the health of racial and ethnic minorities, and low-income and disadvantaged populations. These funds include $143 million for the Minority AIDS Initiative under the Ryan White Act, $116 million for Health Professions and Nursing Training Diversity Programs, $56 million for the Office of Minority Health, and $40 million for the CDC Reach program.

Protecting Against Pandemic Influenza: Reassortment of avian, swine and human influenza viruses has led to the emergence of a new strain of H1N1 influenza A virus, (2009 – H1N1 flu) that is transmissible among humans, and as of April 28, 2009 is confirmed to have caused infections in humans in Mexico, the United States, Canada, Spain, and the United Kingdom. On April 28, 2009 the President announced a supplemental request of $1.5 billion for the Federal response to this outbreak. These funds, in addition to the FY 2010 Budget request of $584 million and the remaining balances, will allow HHS to develop, produce, and distribute antivirals, vaccines, personal protective equipment, and other medical counter measures, as well as conduct public health surveillance and response efforts in the face of the current outbreak.

Supporting Advanced Development: The FY 2010 Budget includes $305 million for Advanced Research and Development to sustain the support of existing next generation countermeasure development in the high priority areas for anthrax, enhanced biothreats, and acute radiation syndrome. The funding for advanced research and development for FY 2010 will be provided through a transfer of funds from the BioShield Special Reserve Fund.

Improving the Quality of Emergency Care Systems: The FY 2010 Budget includes $10 million for a new Emergency Care System program, which will improve the quality of emergency rooms at regional hospitals, and set national standards. This initiative will develop national standards for emergency care performance measurement, and will support a demonstration program to improve the quality of operations and outcomes and regional emergency medical systems.

DELIVERING HUMAN SERVICES TO VULNERABLE POPULATIONS

Zero to Five Plan: The FY 2010 Budget sustains critical support for the President’s “Zero to Five” plan for young children and their families by building on investments made in the Recovery Act.

Investing in Head Start and Early Head Start: Due chiefly to one-time Recovery Act funding, Head Start will serve 978,000 children in FY 2009, an increase of approximately 70,000 over FY 2008. Approximately 115,000 infants and toddlers, nearly twice as many as in FY 2008, will have access to Early Head Start services in FY 2009 and FY 2010. The FY 2010 Budget requests an additional $122 million to enable Head Start to sustain the FY 2009 increase in children served in FY 2010.

Expanding Home Visitation Programs: The President’s FY 2010 Budget includes a legislative proposal for a new mandatory program which would provide funds to States to establish and expand evidence-based home visitation programs for low-income families. The FY 2010 Budget assumes $124 million in budget authority and $87 million in outlays, with the program growing to $1.8 billion in outlays in FY 2019.

Home visitation is an investment that can have substantial effects on outcomes such as child health and development, readiness for school, child maltreatment, and parenting abilities to support children’s optimal cognitive, language, social-emotional, and physical development. Research including several randomized control trial studies showed one model of home visitation using nurses resulted in Medicaid savings from reductions in preterm births, emergency room use, and subsequent births. The proposal is estimated to save Medicaid $664 million over 10 years, including $189 million in 2019.

Preventing Teen Pregnancy: The Budget provides $178 million in funds for teen pregnancy prevention programs to address rising teen pregnancy rates. Funds will support State, Tribal, Territory, and community-based efforts to reduce teen pregnancy using evidence-based models as well as promising programs that require further evaluation.

Expanding Drug Courts: The Administration is requesting an increase of $35 million to expand the treatment capacity of drug courts. Drug courts use close supervision, drug testing, sanctions, and incentives to ensure that offenders stick with their treatment plans and refrain from further criminal activity.

Within the increased funding for drug courts, $5 million will support families affected by methamphetamine abuse. Depending on their individual needs, children will receive early intervention and prevention services, mental health and child counseling, and other services to improve their safety and well being.

Reducing Long-Term Foster Care: There is a substantial need for innovative approaches to improve outcomes for children languishing in foster care. The Budget request includes $20 million to fund projects that will implement and sustain evidence-based or evidence-informed practice improvements. Additionally, grantees demonstrating an improvement in child and family outcomes will be eligible to receive bonus funding.

Providing Home Energy Assistance for Low-Income Families: The FY 2010 Budget requests $3.2 billion for the Low-Income Home Energy Assistance Program (LIHEAP), the largest LIHEAP funding request for any year except the most recent when the Nation was threatened with an unprecedented increase in energy costs. Energy prices are volatile, making it difficult to match funding to the needs of low income families. For this reason, the Budget includes a legislative proposal to provide additional mandatory LIHEAP funding if energy prices increase significantly.

IMPROVING QUALITY OF AND ACCESS TO HEALTH CARE

Increasing Child Health Care Access: The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), signed by the President on February 4, 2009, extends the Children’s Health Insurance Program (CHIP) through 2013 by providing an additional $44 billion to increase enrollment. CHIP enrollment between FY 2008 and FY 2013 is estimated to increase from 7.9 million to over 12 million children.

Enhancing Medicare and Medicaid Integrity: The FY 2010 Budget invests $311 million in discretionary resources to strengthen program integrity activities within the Medicare and Medicaid programs, with particular emphasis on greater oversight of Medicare Advantage and the Medicare Prescription Drug program. Reducing fraud, waste and abuse in government spending is a top priority for the Administration, and this investment represents the first year of a multi-year strategy.

These funds will augment existing mandatory resources for combating health care fraud and abuse. Moreover, the additional funding will better equip the Federal government to minimize inappropriate payments, pinpoint potential weaknesses in program integrity oversight, target emerging fraud schemes by provider and type of service, and establish safeguards to correct programmatic vulnerabilities.

Strengthening Medicare Sustainability: The Administration is committed to strengthening Medicare’s long term sustainability. The FY 2010 Budget bolsters the Medicare program by aligning incentives toward quality, promoting efficiency and accountability, and encouraging shared responsibility. Containing Medicare cost growth is not only essential to preserving the Medicare Trust Funds, but it also is a fundamental component of systemic health care reform.

Strengthening the Health Professions Workforce: The FY 2010 Budget includes over $1 billion to support a wide range of programs to strengthen and support our Nation’s health care workforce. These investments will expand loan repayment and scholarship programs for physicians, nurses, and dentists who are committed to practicing in medically underserved areas. Additionally, this funding will enhance the capacity of nursing schools, increase access to oral health care through dental workforce development grants, target minority and low income students, and place an increased emphasis on ensuring that America’s senior population gets the care and treatment it needs.

Within this total, the Budget includes $330 million, an increase of $136 million for programs that are part of the President’s initiative to address the shortage of health care providers in underserved areas. Programs included as a part of the President’s initiative are the National Health Service Corps, the Nurse Loan Repayment and Scholarship Program, State Oral Health Workforce Program, and the Nurse Faculty Loan Program.

Improving Access to and Quality of Rural Health: The President shares HHS’s belief in increasing access to health care and improving the quality of health care in rural areas. The FY 2010 Budget includes $73 million for a new “Improve Rural Health Care” initiative. The initiative includes increased funding for Rural Health Care Services Outreach, Network, and Quality Improvement grants ($55 million); services provided by State Offices of Rural Health ($9 million), and Telehealth grants to expand the use of telecommunications technologies ($8 million).

Improving Health Outcomes of American Indian and Alaska Natives: The FY 2010 Budget includes nearly $5 billion for the Indian Health Service (IHS), an increase of $454 million. This represents a significant investment, and will support and expand the provision of health care for American Indians and Alaska Natives. The increase will focus on reducing health disparities, supporting Tribal efforts to administer programs at the local level, and ensuring that where necessary, IHS services can be supplemented with care purchased from outside the Indian health system. The Budget affirms the President’s commitment to improve health outcomes for American Indian and Alaska Native communities, and reflects a balance with funds provided for construction, equipment, and infrastructure in the Recovery Act.

Advancing Comparative Effectiveness Research: The FY 2010 Budget supports HHS wide comparative effectiveness research, including $50 million within the Agency for Healthcare Research and Quality (AHRQ). This research will improve health care quality by providing patients and physicians with state of the science information on which medical treatments work best for a given clinical condition. The National Institutes of Health (NIH) is also a significant contributor to comparative effectiveness research. The Recovery Act provided $1.1 billion for comparative effectiveness research. Agencies will continue utilizing these funds in FY 2010.

Enhancing Health Information Technology: The FY 2010 Budget advances the President’s health IT initiative and accelerates the adoption of health information technology – an essential tool to modernize the health care system – and the utilization of electronic health records (EHR). The Office of the National Coordinator for Health Information Technology (ONC) will continue its current efforts as the Federal health IT leader and coordinator. This role will be vital to the President’s health IT initiative. During FY 2010, HHS will also prepare to provide Recovery Act incentive payments beginning in 2011 to physicians and hospitals using certified EHRs.

INVESTING IN SCIENTIFIC RESEARCH AND DEVELOPMENT

National Institutes of Health: The FY 2010 Budget request of nearly $31 billion for NIH maintains a strong commitment to biomedical research, and builds on the unprecedented $10.4 billion in total provided to NIH in the Recovery Act. Within this total, more than $6 billion will support cancer research across NIH. This funding is central to the President’s sustained plan to double NIH cancer research over eight years. In FY 2010, NIH estimates it will support a total of 38,042 research project grants, including 9,849 new and competing awards.

HHS BUDGET BY OPERATING DIVISION

(mandatory and discretionary dollars in millions)

^1/ FY 2009 Recovery Act appropriations were provided to fund programmatic costs in multiple fiscal years.
^2/ The Recovery Act appropriated $1.1 billion for comparative effectivness research and transferred $400 million of this amount to NIH. Of the remaining $700 million, $400 million is for allocation at the discretion of the Secretary.
^3/ Recovery Act contains $5,150 million in discretionary budget authority and $5,000 million in mandatory budget authority.

COMPOSITION OF THE HHS BUDGET

(dollars in millions)

^1/ American Recovery and Reinvestment Act of 2009 (ARRA)
^2/ In addition to HCFAC amounts in Agency program levels, $25 million is shown in OIG for Medicaid Integrity (FY 2008, 2009, and 20 1
    $25 million in OIG for Medicaid Fraud in FY 2009; and the following amounts transferred to the Department of Justice (DOJ) :
    $175 million in FY 2008, $201 million in FY 2009, $211 million in FY 2010.

^1/ FY 2009 and FY 2010 Recovery Act funding included in this table. See details on Mandatory Recovery Act table.
^2/ FY 2010 does not include Medicaid savings of $1.450 billion and Medicare savings of $520 million to finance health care reform.
^3/ Includes outlays for the Child Enrollment Contingency Fund in FY 2009 and FY 2010.

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