WASHINGTON -- The Obama administration released its fiscal year 2014 budget proposal Wednesday, trimming nearly $400 billion over 10 years from Medicare as expected.

"Our budget ... contributes to the president's goal of cutting the deficit in a balanced way," said Health and Human Services (HHS) Secretary Kathleen Sebelius during an afternoon press conference here. "That means safeguarding every dollar, cutting waste and duplication, and seeking out savings wherever we can, including making some difficult choices we wouldn't have made at other times."

The $967 billion proposed for the overall HHS budget, however, is larger than the $848.2 billion actually spent in FY 2012 and the $907.8 billion estimated for FY 2013.

Medicare would eat up 54% -- about $522 billion -- of the amount proposed for next year, while 31% would go to Medicaid, with the remainder spent on other programs, including Temporary Assistance to Needy Families.

The budget proposal includes another $1.5 billion -- in addition to the $1 billion already spent -- to get ready for the implementation of the health insurance exchanges mandated by the Affordable Care Act (ACA). Some ACA opponents have criticized the request for additional funds, but Sebelius put a different spin on it at the press conference.

"We have judiciously used the administrative fees that were attached to original passage of the Affordable Care Act -- the $1 billion -- which the Congressional Budget Office predicted at the time should be more like $10 billion," she said during a question-and-answer session. "The fact that we've found more efficient ways to get the job done is a tribute to our implementation geniuses."

The 10-year $371 billion Medicare cut is achieved by saving money in two ways: increasing the Medicare premiums that wealthier seniors pay, and negotiating lower prices for prescription drugs bought by "dual eligibles" -- Medicare beneficiaries who are also eligible for Medicaid. Currently, dual eligibles pay Medicare rates for their prescriptions, but Medicaid rates are less expensive.

Other highlights of the budget proposal include:

$4.7 billion to fund the FDA, including $43.4 million for food safety programs. The food safety budget is $296 million, but the rest would come from user fees, including proposed fees for food facilities and food importers.

$327 million for the Title X Family Planning Program, which provides access to primary care and reproductive health services for low-income women in historically underserved communities.

$11.3 billion for the CDC and the Agency for Toxic Substances and Disease Registry. This includes nearly $5 billion for the agency's immunization programs, which provide approximately 50% of the pediatric vaccines and 30% of the adolescent vaccines distributed annually in the U.S. It also includes $40 million for an advanced molecular detection program "to find outbreaks quicker, to find a higher proportion of outbreaks, to stop them sooner, and figure out how they're spreading so we can prevent them more effectively," CDC Director Thomas Frieden, MD, MPH, said at the press conference.

$31.3 billion for the National Institutes of Health, of which 83% would go to fund outside research. NIH also hopes to spend $40 million "on research collaborations with academic institutions, the private sector, and other government agencies on the new Brain Research through Application of Innovative Neurotechnologies (BRAIN) Initiative," as noted in the budget document. The budget also includes $3.1 billion for research on HIV and AIDS.

$434 million for the Agency for Healthcare Research and Quality, of which $301 million would be spent on research on issues affecting the cost, quality, and effectiveness of healthcare" and another $26 million on health information technology research.

The American Medical Association applauded the proposal for tackling physician payment issues.

"We are pleased that President Obama's 2014 budget recognizes the need to eliminate the broken Medicare physician payment formula known as the SGR [sustainable growth rate] and moves toward new ways of delivering and paying for care that reward quality and reduce costs," AMA president Jeremy Lazarus, MD, said in a statement. "It is critical for physicians to have a period of stability and the flexibility to choose options that will help them lower costs and improve the quality of care for their patients."

On the other hand, the American Psychiatric Association and the American Academy of Family Physicians criticized the proposal for the way it seeks to expand access to mental health care. The administration is proposing $130 million in funding to improve access to mental health services for students and young adults; much of the funding would be used to train teachers to identify and refer youth for treatment, and to pay for treatment by social workers, counselors, psychologists, and other nonphysicians.

"We are deeply concerned that the administration's efforts to expand the supply of mental health professionals appear to stop at nonphysician practitioners," the two groups said in a statement. "Along with the administration, we recognize the growing need for mental health providers; however, providing a small amount of training to lesser-qualified health professionals at the expense of utilizing veteran medical psychiatrists will only serve to exacerbate the problem we are trying to solve."