Senators Underscore the Importance of Urban Indian Health Funding and Safeguarding IHS Funding in FY 2025

On May 23, 2024, the Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies held a hearing with the Indian Health Service (IHS) entitled “To examine proposed budget estimates and justification for fiscal year (FY) 2025 for Indian Country.” At the hearing Chairman Jeff Merkley (D-OR) and Ranking Member Lisa Murkowski (R-AK) welcomed testimony from Roslyn Tso, Director of the Indian Health Service, Jillian E. Curtis, CFO of the Indian Health Service, and Bryan Newland, Assistant Secretary for Indian Affairs at the Department of the Interior. The hearing focused on the President’s FY25 budget and legislative proposals and their potential impact on Indian Country.

Congress Underscores Importance of UIO Funding to Provide Health Care

Many committee members expressed the importance of a budget that fulfills the trust responsibility to provide healthcare to American Indian and Alaska Native people. Sen. Van Hollen, Chris (D-MD) focused his questioning to IHS about the needs of urban Indian organizations (UIOs). Senator Van Hollen expressed concerns that it is critical to mention UIOs, given that UIOs “ensure access to comprehensive, culturally relevant healthcare.” He noted that, “The Indian Health Service spends about 1% on the urban Indian health programs.” Going further Sen. Van Hollen posed the question to Director Tso asking, “What are the limitations today to urban Indian health organizations being able to provide care they need to, and what are some specific proposals to the administration budget that might address that issue?” In response, Director Tso explained that ensuring that reimbursement is similar to the rest of the IHS/Tribal/UIO (I/T/U) system is necessary. She suggested that initiatives such as granting UIOs a 100% Federal Medical Assistance Percentage would be instrumental.

Senator Merkley Emphasizes the Need to Safeguard IHS Funding from Sequestration

Chairman Merkley also noted that IHS needs the same funding protections as the Veterans Health Administration (VHA), “It [the President’s budget] also proposes to make IHS funding exempt from sequestration, which the VA has already gained under the Fiscal Responsibility Act. Well, IHS was forgotten, … we should adopt a number of the VA reforms to afford the same dignity to Native Americans and Alaska Natives.” He also expressed his frustration with the proposed cuts to the Electronic Health Records (EHR) line item, given that the IHS’ EHR is over 40 years old.

Senator Tester (D-MT) noted his concerns regarding the President’s IHS budget proposal being $53 billion short of the estimation determined by Tribes and the current 30% vacancy rate at IHS, “How do you fulfill trust responsibilities with those kinds of numbers?… We put you guys [IHS] in a lose-lose position – we need more doctors, we need more nurses, the works.”

NCUIH is thankful for advocates within Senate who recognize that funding is critical to provide safe, quality, and equitable healthcare for all American Indian and Alaska Native people. NCUIH will continue to advocate for full, mandatory funding for IHS and Urban Indian Health.