June 03, 2021

Biden Administration Releases Proposed Budget for Federal Fiscal Year 2022

The Biden Administration released its federal fiscal year (FY) 2022 budget May 28. The budget proposal includes many provisions to support the administration’s healthcare reform vision, building on expansion and improvement of the Affordable Care Act (ACA). The American College of Radiology® (ACR®) has made an initial review of the budget, focusing on Medicare and Medicaid; the National Institutes of Health (NIH); and the Food and Drug Administration (FDA). Following are highlights from the ACR review.

Medicare and Medicaid

A key aspect of the administration’s healthcare reform vision involves expansion of Medicare eligibility and offering a public option to those not eligible for the program. The administration aims to “reform Medicare payments to insurers and certain providers to reduce overpayments and strengthen incentives to deliver value-based care, extending the life of the Medicare Trust Fund, lowering premiums for beneficiaries, and reducing Federal costs.”

President Biden supports creation of a public option available through the ACA marketplaces and lowering the Medicare eligibility age to 60. People ages 60 and older would have the option to enroll in the Medicare program with the same premiums and benefits as current beneficiaries but funded outside of the Medicare Trust Fund.

In states that have not expanded Medicaid, the president proposes extending coverage to millions of people by providing premium-free, Medicaid-like coverage through a federal public option, paired with financial incentives to ensure states maintain their existing expansions.

The Biden Administration would like to improve and strengthen Medicare, Medicaid and the ACA marketplace plan coverage by reducing marketplace plan deductibles, increasing access to dental, hearing and vision coverage in Medicare, and making it easier for eligible people to get and stay covered in Medicaid. The president also supports eliminating Medicaid funding caps for Puerto Rico and other Territories while aligning their matching rate with states.

The president’s budget also includes support for reforms that would lower the cost of drug prices by letting Medicare negotiate payment for certain high-cost drugs and requiring manufacturers to pay rebates when drug prices rise faster than inflation. The administration asserts that these reforms would lower drug costs and could result in more than $500 billion in Federal savings over 10 years that then could help pay for coverage expansions and improvements.


President Biden’s budget would increase funding for NIH at $51.95 billion, a 21% increase over FY 2021. The budget proposes funding for the following institutes:
• National Cancer Institute: $6.7 billion, an increase from $6.6 billion.
• National Institute of Biomedical Imaging and Bioengineering: $422 million, an increase from $411 million.
• National Center for Advancing Translational Sciences: $879 million, an increase from $855 million.

Biden’s budget proposal includes $6.5 billion to create an Advanced Research Projects Agency for Health (ARPA-H), an initiative “that will speed transformational innovation in health research.”


The budget would allocate $6.5 billion for the FDA, an increase of $477 million above FY 2021 to:
• Address pressing challenges with medical product oversight, including drug development, supply chain resiliency, and product shortages and barriers to innovation.
• Modernize the FDA’s data infrastructure across programs to enhance technology and improve existing services and capabilities.

The president's budget request is a proposal of the administration's intended revenue and spending plans for the following fiscal year but is not the final budget passed by Congress.