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Federal budget · FY2024

Where does federal health spending go?

$912 billionin FY2024 · 13.5% of all federal spending

This category is separate from Medicare, which has its own budget function (570). Function 550 'Health' covers federal health spending outside Medicare — including Medicaid, ACA marketplace subsidies, federal health research, public health, and federal employee + military retiree health benefits.

Total spending was about $912 billion in FY2024. The biggest line by far is Medicaid (~$616B in federal matching dollars), which routes through every state's Medicaid agency and is then paid to providers and managed-care organizations (UnitedHealth Community Plan, Centene, Molina, Elevance) downstream.

Other major pieces: ACA Premium Tax Credits (~$98B) paid directly to private insurers on behalf of marketplace enrollees; Federal Employees Health Benefits Program (FEHBP) plus TRICARE for Life for military retirees (~$76B combined); NIH research grants (~$48B) flowing mostly to universities (Harvard, Johns Hopkins, UCSF, Stanford); the Indian Health Service (~$9B); HRSA-funded community health centers (~$8B); and the CDC (~$11B).

Smaller but recognizable agencies in this function include the FDA (drug, device, food, and tobacco regulation), SAMHSA (substance abuse and mental health services), and AHRQ (healthcare research quality).

Where the money goes inside health

Agency- and program-level breakdown for FY2024.

  • Medicaid (federal share)$616 billion

    Federal share of Medicaid + CHIP. Joint federal-state program covering 80M+ low-income Americans.

  • ACA Premium Tax Credits & cost-sharing reductions$98 billion

    Subsidies for ACA marketplace insurance plans. Counted as outlays on the spending side.

  • Federal employee + military retiree health benefits$76 billion

    Federal Employees Health Benefits Program (FEHBP) for the federal civilian workforce. Plus TRICARE for Life — Medicare-wraparound coverage that pays Medicare-eligible military retirees' out-of-pocket costs that Parts A and B don't cover (it isn't separate insurance, it sits on top of Medicare).

  • National Institutes of Health$48 billion

    Largest federal medical research funder. 27 institutes including NCI, NHLBI, NIA, NIMH.

  • HRSA (community health centers, rural health)$14 billion

    Federally Qualified Health Centers, Ryan White HIV/AIDS, maternal & child health.

  • CDC$11 billion

    Disease surveillance, immunization programs, public health preparedness.

  • Indian Health Service$9 billion

    Health care delivery for ~2.6M American Indians and Alaska Natives.

  • FDA$7 billion

    Drug, device, food, cosmetic, and tobacco regulation; product approvals.

  • SAMHSA, AHRQ, and other HHS health agencies$33 billion

    Substance abuse & mental health services, healthcare research quality, health workforce, vaccines.

Top recipients — who actually got the money

Largest contractors, grantees, and direct payees within health. The remainder covers personnel, facilities, and the long tail of smaller recipients.

  • State Medicaid programs (federal share — 50 states + DC)$616 billion

    Medicaid's federal matching dollars route through every state's Medicaid agency. California, New York, Texas top the list. States then pay providers and managed-care orgs (UnitedHealth Community, Centene/WellCare, Molina, Elevance) downstream.

  • ACA marketplace insurers (Premium Tax Credits)$98 billion

    Federal subsidies paid directly to private insurers on behalf of enrollees. Centene/Ambetter, BCBS plans (Elevance, HCSC), Oscar, Molina, UnitedHealth, Aetna are the largest marketplace players.

  • Federal Employees Health Benefits + TRICARE for Life$76 billion

    FEHBP covers the federal civilian workforce and their families. TRICARE for Life is Medicare-wraparound coverage for Medicare-eligible military retirees — it pays the out-of-pocket costs Medicare Parts A and B leave behind, not separate primary insurance.

  • Universities + nonprofit research (NIH grants)$40 billion

    NIH's $48B grant pool flows to Harvard, Johns Hopkins, UCSF, Stanford, Penn, Duke, MIT, plus institutes like Broad, Salk, and Howard Hughes Medical Institute.

  • Indian Health Service tribal facilities$9 billion

    ~140 tribally-operated health programs plus IHS-run facilities serving ~2.6M American Indians and Alaska Natives.

  • Federally Qualified Health Centers (HRSA)$8 billion

    ~1,400 community health center organizations serving ~30M people in underserved areas. The bedrock of the federal safety-net delivery system.

  • State + local public health (CDC grants)$7 billion

    CDC's largest spending category — block grants and categorical funding to state health departments for immunization, disease surveillance, and lab capacity.

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