National Council of Urban Indian Health
1 Massachusetts Avenue NW
Suite 800-D
Washington, DC 20001
Phone: 202.544.0344
Press Release
NCUIH, NIHB, and NCAI Celebrate Historic Inclusion of Advance Appropriations for the Indian Health Service
FOR IMMEDIATE RELEASE Washington, DC | Friday, December 23, 2022 – Today, Congress enacted a Fiscal Year (FY) 2023 omnibus spending package, including a historic provision providing advance appropriations for the Indian […]
What is Advance Appropriations for the Indian Health Service?
Advance appropriations is funding that becomes available one year or more after the year for which the appropriations act is passed. The Indian healthcare system, including the Indian Health Service (IHS), Tribal facilities, and urban Indian organizations (UIOs), is the only major federal healthcare provider funded through annual appropriations. Advance appropriations will stabilize IHS funding and allow for long-term planning by insulating Indian healthcare providers from government shutdowns and continuing resolutions.
Why is Advance Appropriations needed to save Native lives?
The current policy of funding IHS through regular appropriations has led to constant uncertainty for UIOs. Every year, on average, there are five continuing resolutions to keep the government open, and there were long government shutdowns in 1996, 2013, and 2019.
Lapses in federal funding puts lives at risk. During the 2019 government shutdown, several UIOs had to reduce services or close their doors entirely, forcing them to leave their patients without adequate care. One UIO suffered 7 opioid overdoses, 5 of which were fatal. Advance appropriations is critical to provide certainty to the IHS system and ensure unrelated budget disagreements do not risk lives.
President Biden on Indian Health Service Advance Funding at 2023 White House Tribal Nations Summit
Why is Advance Appropriations Needed for the Indian Health Service?
Native Leaders Call on Congress to Act Now to Provide Stable Funding with Advance Appropriations for the Indian Health Service.
Native leaders and Congress express support for funding certainty through advance appropriations for IHS in House hearing.
Native American Lifelines left without resources during the 2019 government shutdown.
NCUIH’S ADVOCACY
Interactive Timeline
Interactive Historical Timeline of IHS Advance Appropriations
2019 Shutdown Report
This report captures the consequences of not having advance appropriations for IHS during the government shutdown and its impact on Native communities.
Learn More
Advocacy
Advance appropriations has been a priority for Indian Country for years and we have seen broad support on this issue from Native health advocates.
Over the past 10 years, there have been six resolutions in support of advance appropriations from NCUIH, the United South and Eastern Tribes (USET), the Inter-Tribal Council of the Five Civilized Tribes (ITC), the National Indian Health Board (NIHB), the National Congress of American Indians (NCAI), and the American Bar Association.
- On January 17, 2019, NCUIH sent a letter to the Vice Chairman of the Senate Committee on Indian Affairs (SCIA), Tom Udall, in support of IHS advance appropriations legislation.
- On March 9, 2022, NCUIH joined NIHB and over 70 Tribal nations and national Indian organizations in sending a series of joint letters to Congress requesting advance appropriations for IHS in the FY 2022 omnibus.
- On June 16, 2022, NIHB and NCAI requested that the Committee support and include IHS advance appropriations in the current FY 2023 appropriations bill in an action alert.
- In June, NCUIH sent letters to Speaker Pelosi, House Minority Leader McCarthy, Senate Majority Leader Schumer, Senate Minority Leader McConnell, Senate Interior Appropriations Committee, and SCIA to support advance appropriations for IHS.
See full summary for more details.
Congressional and Federal Support
There has also been strong long-standing support from Congress on this issue. On January 12, 2022, the Native American Caucus sent a letter to House Appropriations Committee Chair DeLauro and Ranking Member Granger requesting that advance appropriations for IHS for FY 2023 be included in the final FY 2022 appropriations bill, and again on June 3 requesting that, while the process of shifting IHS to mandatory appropriations is underway, advanced appropriations for IHS be included in the final FY 2023 Appropriations bill. On April 25, 2022, a bipartisan group of 28 Representatives requested up to $949.9 million for urban Indian health in FY 2023 and advance appropriations for IHS until such time that authorizers move IHS to mandatory spending, and 12 Senators sent a letter with the same requests. Last year, for the first time ever, President Biden included an additional $9 billion in advance appropriations to IHS for FY 2023 in his budget request and the Senate Appropriations Committee included an additional $6.58 billion in advance appropriations to IHS for FY 2023 in its FY 2022 Interior, Environment, and Related Agencies bill.
Back in 2014, SCIA held its first hearing on advance appropriation bill Indian Health Service Advance Appropriations Act of 2013 (S. 1570). In a House Natural Resources Subcommittee for Indigenous Peoples (SCIP) hearing held during the last Congress on advance appropriations bills H.R. 1128 and H.R. 1135, former IHS Principal Deputy Director, Rear Admiral Michael Weahkee, reaffirmed Indian Country’s repeated request for advance appropriations stating that “[t]hrough the IHS’s robust annual Tribal Budget Consultation process, Tribal and Urban Indian Organization leaders have repeatedly and strongly recommended advance appropriations for the IHS as an essential means for ensuring continued access to critical health care services. The Department continues to hear directly from tribes advocating support for legislative language that would provide the authority of advance appropriations for the IHS. The issues that Tribes have identified present real challenges in Indian Country and we are eager to work with Congress on a variety of solutions.”
On July 28, 2022 SCIP held a hearing on the Indian Health Service Advance Appropriations Act (H.R. 5549) where IHS Acting Deputy Director Elizabeth Fowler reaffirmed IHS’s support for advance appropriations stating that “We remain firmly committed to improving quality, safety, and access to health care for American Indians and Alaskan Natives. Mandatory funding and advanced appropriations are necessary and critical steps toward that goal… [I] urge the House to act on advanced appropriations through the appropriations process with or without the authorizing legislation that is the subject of this hearing.”
The U.S. Commission on Civil Rights report from 2018, “Broken Promises: Continuing Federal Funding Shortfall for Native Americans” serves as another benchmark of support by including advance appropriations for IHS as a key recommendation to the federal government to ensure greater funding stability for IHS.
Find out if your Member of Congress supports advance appropriations for IHS here.
Legislation
Since 2013, legislation on this effort has been introduced in 11 bills:
- 10/2013 – Indian Health Service Advance Appropriations Act of 2013 (H.R. 3229)
o Sponsors: Reps. Young and Lujan - 10/2013 – Indian Health Service Advance Appropriations Act of 2013 (S. 1570)
o Sponsors: Sens. Murkowski, Begich, Udall, Schatz - 1/2015 – Indian Health Service Advance Appropriations Act of 2015 (H.R. 395)
o Sponsors: Reps. Young and Lujan - 1/2017 – Indian Health Service Advance Appropriations Act of 2017 (H.R. 235)
o Sponsor: Rep. Don Young - 2/2019 – Indian Programs Advanced Appropriations Act (H.R. 1128)
o Sponsors: Reps. McCollum, Young, Cole, Haaland, Grijalva, Ruiz, Mullin, Watson Coleman, Lujan, Titus - 2/2019 – Indian Programs Advanced Appropriations Act (S. 229)
o Sponsors: Sens. Udall, Tester, Cortez Masto, Smith, Heinrich, Warren, Schatz - 2/2019 – Indian Health Service Advance Appropriations Act of 2019 (H.R. 1135)
o Sponsors: Reps. Young, McCollum, Cole, Lujan, Mullin, Ruiz - 2/2019 – Indian Health Service Advance Appropriations Act of 2019 (S. 2541)
o Sponsors: Sens. Murkowski, Udall, Sullivan, Baldwin, Heinrich, Cortez Masto, Rosen, Wyden, Merkley, Smith, Tester, Warren, Schatz - 10/2021 – Indian Health Service Advance Appropriations Act (H.R. 5549)
o Sponsor: Reps. Young, McCollum, Kilmer, Kind, Mullin, Cole, Johnson, Strickland - 10/2021 – Indian Programs Advance Appropriations Act of 2021 (H.R. 5567)
o Sponsor: Reps. McCollum, Young, Cole, Davids, Gallego, Herrera Beutler, Kilmer, Kind, Mullin, Norton, Ruiz - 10/2021 – Indian Programs Advance Appropriations Act of 2021 (S. 2985)
o Sponsors: Sens. Lujan, Klobuchar, Smith, Warren, Cortez Masto, Baldwin, Padilla, Tester, Heinrich, Rosen, Wyden, Peters