11 Senators Request Increased Resources for Urban Indian Health in FY24

On April 4, 2023, 11 Senators requested up to $973.59 million for urban Indian health in Fiscal Year (FY) 2024 and advance appropriations for the Indian Health Service (IHS).

Sen. Tina Smith (D-MN) and 10 other Senators sent a letter to Chairman Jeff Merkley (D-OR) and Ranking Member Lisa Murkowski (R-AK) of the Senate Interior Appropriations Committee requesting up to $973.59 million for urban Indian health in FY 2024 and maintaining advance appropriations for IHS. The letter emphasizes the critical role that urban Indian organizations (UIOs) play in health care delivery to American Indian and Alaska Native (AI/AN) patients and the importance of providing UIOs with the necessary funding to continue to provide quality, culturally-competent care to their communities. The National Council of Urban Indian Health (NCUIH) worked closely with the Senators on leading this letter to push for stable funding for IHS and the Tribal Formulation Workgroup’s requests of full funding for urban Indian health. On March 24, 2023, a group of 38 Representatives sent a letter to the House Interior Appropriations Committee with the same requests.

The letter also notes that while Congress has historically acknowledged that significant health disparities exist in Indian Country, IHS remains underfunded at an estimated $4,000 per patient, with UIOs receiving $726 per patient.

This letter sends a clear and powerful message to Chairman Merkley and Ranking Member Murkowski and the members of the Senate that funding for urban Indian health must be significantly increased to fulfill the federal government’s trust responsibility to provide quality healthcare to all AI/AN people.

NCUIH is grateful for the support of the following Senators:

  1. Tina Smith
  2. Tammy Baldwin
  3. Maria Cantwell
  4. Diane Feinstein
  5. Ben Luján
  6. Edward Markey
  7. Alex Padilla
  8. Jacklyn Rosen
  9. Jon Tester
  10. Chris Van Hollen
  11. Elizabeth Warren

Full Letter Text

Dear Chairman Merkley and Ranking Member Murkowski,

We write to thank you for your proven commitment to urban Indian health and the 41 Urban Indian Organizations (UIOs) and to request you continue your support by funding urban Indian health at the highest level possible, up to $973.59 million, and retaining advanced appropriations for the Indian Health Service (IHS) in the Fiscal Year (FY) 2024 Interior, Environment, and Related Agencies Appropriations Act.

UIOs operate 77 facilities across the nation in 22 states, serving the approximately 70 percent of American Indian and Alaska Native (AI/AN) people who live in urban areas. UIOs are an important part of the IHS, which oversees a three-prong system for the provision of health care: Indian Health Service, Tribal Programs, and Urban Indian Organizations (I/T/U). UIOs are not eligible for other federal line items that IHS and Tribal facilities are, like hospitals and health clinics money, purchase and referred care dollars, or IHS dental services dollars. Therefore, this funding request is essential to providing quality, culturally-competent health care to AI/AN people living in urban areas.

Our request for $973.59 million for urban Indian health reflects the recommendation made by the Tribal Budget Formulation Workgroup (TBFWG), a group of Tribal leaders representing all twelve IHS service areas. The significantly increased request reflects the full funding needed for urban Indian health.

Chronic underfunding of IHS and urban Indian health has contributed to the health disparities among AI/AN people. Additionally, AI/AN people living in urban areas suffer greater rates of chronic disease, infant mortality, and suicide compared to all other populations. Urban Native populations are less likely to receive preventive care and are less likely to have health insurance. Yet, despite the historical acknowledgement from Congress of the significant health care disparities in Indian Country, IHS is underfunded at around $4,000 per patient, and UIOs receive just $726 per patient.

In order to fulfill the federal government’s trust responsibility to all AI/AN people to provide quality healthcare, funding for urban Indian health must be significantly increased. It is also imperative that such an increase not be paid for by diminishing funding for already hard-pressed IHS and Tribal providers. The solution to address the unmet needs of urban Native and all AI/AN people is an increase in the overall IHS budget.

Thank you for your continued support of urban Indian health and your consideration of this important request.

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