Policy Formulation and the Budget Process: What You Need to Know

The public budget plays an integral role in planning for future federal fiscal years in terms of managing resources in the country efficiently and effectively to keep both the country and the federal government running. The federal government budget has to encompass spending plans for the federal government, the state, and the local governments in some of the biggest sectors like health and education. The public budget is largely financed by revenues collected through taxes and borrowing through the selling treasury securities in the form of bonds, notes, and Treasury bills. Local, state, and federal governments present their budgets for approval before the funds are sent to their levels. Healthcare constitutes about 61% of the funds granted to local and state governments. However, despite the states and local governments, the federal governments have agencies that also require funding from the federal budget to run their programs every financial year. Therefore, just like the states and local governments, they require to come up with budgets that Congress can sit and approve. In the case of federal agencies, Congressional authorization committees sit and approve their budget, and President signs the authorization bill giving the agencies legal authority to fund and operate their programs. One such agency is the Health Resources and Services Administration (HRSA). The HRSA is mandated with improving healthcare access for people without insurance, geographically isolated, or medically vulnerable (Health Resources and Services Administration, 2021). They include pregnant mothers, people with HIV/AIDS, mothers and their families, people in rural areas, and people unable to access high-quality healthcare. 

Public Budget 

The HRSA understands the kind of funding it requires to make its programs a success and, therefore, in a better position to formulate their budget proposals to be handed to Congress for approval. The budget goes towards addressing improved healthcare at the state and local government levels. State and local health facilities benefit from HRSA through grants offered by the agency. According to the formulated budget by the agency for the fiscal year 2021, it required $11.2 billion to run its programs (Health Resources and Services Administration, 2020). 

The table below represents major parts of the HRSA budget for the year 2021. 

HRSA Program	Cost in $
Health Centers and Free Clinics	5,700,000,000
HIV/AIDS	2,500,000,000
Health Workforce	826,000,000
National Health Service Corps (NHSC)	430,000,000
NURSE Corps	83,100,000
Teaching Health Centers Graduate Medical Education Program	126,500,000
Children’s Hospital Graduate Medical Education (GME) Program	340,000,000
Workforce Training Programs	47,200,000
Maternal and Child Health (MCH)	1,300,000
Rural Health	246,800,000
Healthcare Systems	139,400,000
Program Management	152,000,000
Vaccine Injury Compensation Program	16,200,000
Total	10,608,500,000

Submission Process 

Step 1 

Departments and agencies submit their proposal to the President one and a half years before the budgets are considered active. The proposal goes to the President to help them submit their budget request to the senate. 

Step 2 

Every first Monday of February, the President passes their budget for the next fiscal year to Congress. 

Step 3 

The House of Representatives and the Senate create budget resolutions. Each chamber sits and reviews the President’s budget and comes up with resolutions presented to the conference committee. The conference committee helps revise the different fin resolutions before a final version is created for voting by each chamber in Congress. 

Step 4 

The Senate and House Committees divide discretionary spending of the budget resolution to 12 subcommittees tasked with overseeing the different agencies like the HRSA. The subcommittees then draft appropriation bills to set the finance for each agency. 

Step 5 

The chambers vote on the appropriation bills separately and once again taken to the conference committee for merging and back to chambers for voting and if approved taken to the President. 

Step 6 

The President signs the bill into law by September 30 for the government to have a budget for its new fiscal year. 

Mission 

HRSA’s mission is its main objective which is to improve access to healthcare for the uninsured, isolated and vulnerable. As stated on their site, the agency’s beneficiaries are health facilities at state and local levels, but the end beneficiaries are HIV/AIDs, pregnant women, mothers with children, access to healthcare in rural areas, and people unable to access high-quality health services. Looking at the 2021 budget, it is possible to pick out attributes of the agency’s mission to their program. For instance, a larger apportionment in the budget is given to health facilities, free clinics, and HIV/AIDS. Health centers and free clinics improve access to healthcare, especially to the contingent of the population that cannot afford decent healthcare (Birs et al., 2016). HIV/AIDs patients are considered vulnerable people, and gaining access to affordable healthcare, services, and medication can become a challenge. Aspects like the rural health program improve healthcare access in rural and isolated areas. The budget is awarded through grants and cooperative agreements. The beneficiaries are about 3,000 beneficiaries comprised of community-based organizations (CBOs), colleges and universities, local, state, and tribal government, hospitals, and private entities. 

Policy 

The federal, state and local governments have a social, political, and economic responsibility in running the country. One of those functions is to manage limited resources so that the US is assured of continuity and the running of the federal government. The governments require financing through a budget to manage scarce resources like education, health, and security in the best way possible. However, managing resources is not all about throwing money at any resource because it requires careful planning to understand arrears of weakness and areas of strength. The effective and efficient way to manage resources is through policies that are tasked with identifying where there is a problem, what the problem is, how to address it, come up with a plan and implement it through a budget (Diamond, 2013). The HRSA budget has enabled the agency to implement most of its policy, which touches on better access to healthcare for the uninsured, vulnerable and isolated. If the agency is not capable of getting the majority of its budget approved, then its policy is put in jeopardy of being ineffective. 

Budget Changes 

HRSA budget changes are mainly attributed to population change, the prevalence of health conditions and diseases, and the economic status of the US, especially for low-income earners as regards access to healthcare. The US population growth for the last decade has been 8% as of 2020, meaning that more people need to access healthcare. However, it can be argued that better policies and strategies have made it possible for governments to facilitate the construction of more healthcare facilities to cater to the growing numbers in the population. However, other attributes like the prevalence of diseases and health complications could also make accessing proper healthcare difficult, as evidenced by soaring health bills in recent years. The economy also determines the distribution of resources through the budget. For instance, Trump’s Administration was feared to have created the looming situation for an imminent economic depression in the USA. The COVID-19 pandemic has also exacerbated the economy further, as most of 2020; the country has been struggling economically. A population increase and the prevalence of conditions like HIV/AIDs, COVID-19 pandemic forced HRSA to increase its budget to cater to more people. However, the economic conditions will cause a reduction in the agency, federal, state, and local allocation. Therefore, rather than scrap, some elements of programs in the HRSA, redistribution of allocations can take place to handle increasing figures. 

References 

Birs, A., Liu, X., Nash, B., Sullivan, S., Garris, S., Hardy, M., Lee, M., Simms-Cendan, J., & Pasarica, M. (2016). Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience, Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility Fee. Cureus , 8 (2). https://doi.org/10.7759/cureus.500 

Diamond, J. (2013). Policy Formulation and the Budget Process. The International Handbook of Public Financial Management , 193–218. https://doi.org/10.1057/9781137315304_10 

Health Resources and Services Administration. (2020). Health Resources and Services Administration Justification of Estimates for Appropriations Committees . https://www.hrsa.gov/sites/default/files/hrsa/about/budget/budget-justification-fy2019.pdf 

Health Resources and Services Administration. (2021). Agency Overview . https://www.hrsa.gov/sites/default/files/hrsa/about/hrsa-agency-overview.pdf