President’s Budget Outlines Policy and Spending Priorities

Today, the White House released President Biden’s budget request for fiscal year (FY) 2024, which begins on October 1.

Though non-binding on Congress, presidential budgets are important policy documents that articulate the administration’s goals and priorities. They are often used to guide future reforms, introduce or refine ideas, and stake out positions. In Congress, they kick off work to fund the federal government for the coming fiscal year.

Presidential budgets are typically comprehensive and detailed, making spending recommendations for nearly every program, project, and activity Congress funds through the now-underway federal budget process. Administrations may also suggest changes to programs not impacted by annual spending bills, like Medicare, that would require separate Congressional action.

This year’s budget follows this pattern, touching on an array of federal initiatives. As outlined below, it offers Congress specific ideas to improve programs serving older adults and people with disabilities, including Medicare and Medicaid.

Solvency and Sustainability

As previewed earlier this week, President Biden’s budget would extend the solvency of the Medicare Part A Trust Fund by at least 25 years, largely through tax increases and further action to curb prescription drug prices.

In Medicaid, the budget seeks to lower spending by preventing managed care insurers from over-charging the program. Reining in these inappropriate payments aligns with the administration’s other recent efforts to correct excess payments in Medicare Advantage (MA). As Medicare Rights outlined in our template and own comments, the amounts overpaid to MA plans total billions of dollars each year, costs that are borne by and to the detriment of beneficiaries, taxpayers, and Medicare. We welcome the administration’s ongoing efforts to advance payment accuracy and insurer accountability.

Coverage and Affordability

Critically, the budget makes significant investments in long-term care, allocating $150 billion over 10 years to Medicaid home and community-based services (HCBS). This funding would help more people remain in their homes and communities, improve the quality of jobs for home care workers, and better support family caregivers.

The administration also proposes several Medicare benefit changes, such as a $2.00 cap on certain generic prescriptions and coverage for nutrition and obesity counseling. Again this year, the White House is calling on Congress to make behavioral health services more available and affordable, including by eliminating cost-sharing for certain visits, reimbursing additional providers, and strengthening the workforce.

Though the budget does not outline a specific plan to remedy Medicare’s lack of comprehensive vision, dental, and hearing coverage, it does note the administration “looks forward to working with the Congress” on such measures.

Access and Enrollment

As ever, Medicare coverage improvements are only helpful if people can enroll and use their benefits. We applaud the administration for putting forth an FY24 budget that recognizes this disconnect and allocates funding to address it.

Specifically, the budget envisions funding Medicare’s administrating agencies—the Social Security Administration (SSA) and the Centers for Medicare & Medicaid Services (CMS)—to examine enrollment improvement strategies, including for the growing number of people who are not receiving Social Security when they become Medicare eligible and must actively enroll.

The study would also identify opportunities to connect people with their coverage more quickly. It would build on the BENES Act’s updated Medicare effective dates by exploring ways to eliminate remaining waits for coverage, such as the time it can take to receive a Medicare card in the mail before accessing benefits. We strongly support these important policies and encourage the administration to harness all available authorities to advance the FY24 budget’s specific recommendations and underlying goals.

Separate budget provisions would support complementary agency infrastructure and staffing improvements. This new financing would let CMS improve its data sources and verification services, with the aim of streamlining systems and beneficiary access to care. A long overdue SSA budget increase would help the agency improve customer service experiences at field offices, state disability determination services, and call centers. It would also allow SSA to build the capacity it needs to process disability claims more quickly and “reduce the amount of time claimants have to wait for decisions on vital benefits.”

The budget would also make quality health coverage easier to obtain and afford for those who are not yet Medicare eligible. It would permanently extend the enhanced Affordable Care Act tax subsidies and provide Medicaid-like coverage to individuals in non-expansion states, paired with financial incentives for Medicaid expansion states to maintain their programs.

Next Steps

The White House’s budget is likely to contrast sharply with the one House Republicans plan to present later this spring. They are said to be pursuing significant savings, using a former Trump administration official’s proposal as a blueprint. Under that plan, many critical programs bolstered in the president’s budget submission—including Medicaid, housing supports, and food assistance—would see devastating cuts. These differences are likely to impact upcoming conversations over the federal debt limit and the nation’s fiscal trajectory.

Conclusion

Medicare Rights is continuing to review the president’s FY24 budget request and supplementary materials, but we are encouraged by the proposals so far. The updates to lower beneficiary costs, strengthen the programs on which they rely, and improve the coverage they receive would be made more meaningful and effective by the investments in Medicare enrollment and service delivery. We have long called on policymakers to ensure these systems work well, and together. The FY24 budget request would finally begin to achieve that alignment.

Read the President’s FY24 Budget Request to Congress.

Read Medicare Rights comments on the 2024 Advance Notice.