On December 6, 2022, the House Native American Caucus sent a letter with 29 signatures from Members of Congress to the House Committee on Appropriations Chair Rosa DeLauro and Ranking Member Kay Granger on including advanced appropriations for IHS in the final Fiscal Year (FY) 2023 Appropriations bill. With the ultimate goal of mandatory funding, the letter urges the Biden Administration, the Indian Health Service (IHS), authorizing committees, and tribal nations to collaborate and work towards authorizing the shift away from discretionary funding.

The letter emphasizes that “all other federal government healthcare providers—Medicare, Medicaid, Children’s Health Insurance Program, TRICARE, and Veterans Health Administration—are all either under mandatory funding or receive advanced appropriations. IHS is the only major federal healthcare program that does not receive either and is up for annual appropriations,” and “[a]dvanced appropriations for FY24 will enable IHS to continue to provide health services without potential interruption, guaranteeing access to the necessary care for 2.6 million Native Americans and Alaska Natives.”

The outlined priorities include advance appropriations for FY24 to address the disruptions and chronic underfunding of IHS. Appropriate funding can help to avoid the current challenges including staffing shortages, limited equipment availability, and extended wait times. In addition, each Continuing Resolution (CR) requires hundreds of tribal and urban Indian organization (UIO) contracts to adjust for funding, affecting financial stability. Advanced appropriations give Indian health programs the ability to manage budgets, coordinate care, and improve health quality outcomes.

This letter sends a powerful and straightforward message to Chair DeLauro and Ranking Member Granger that in order to fulfill the federal government’s trust responsibility to all AI/ANs to provide safe and quality healthcare, funding for Indian health must be secure.

NCUIH is grateful for the support of the following Representatives:

1. Rep. Tom Cole, Co-chair, Congressional Native American Caucus
2. Rep. Sharice Davids, Co-chair, Congressional Native American Caucus
3. Rep. Markwayne Mullin, Vice Chair, Congressional Native American Caucus
4. Rep. Doug LaMalfa, Vice Chair, Congressional Native American Caucus
5. Rep. Raúl M. Grijalva, Vice Chair, Congressional Native American Caucus
6. Rep. Frank Pallone Jr., Vice Chair, Congressional Native American Caucus
7. Rep. Betty McCollum, Vice Chair, Congressional Native American Caucus
8. Rep. Mary Peltola
9. Rep. Earl Blumenauer
10. Rep. Darren Soto
11. Rep. Adam Smith
12. Rep. Tom O’Halleran
13. Rep. Joe Neguse
14. Rep. Daniel T. Kildee
15. Rep. Dusty Johnson
16. Rep. Jared Huffman
17. Rep. Kurt Schrader
18. Rep.  Gwen Moore
19. Rep. Doris Matsui
20. Rep. Peter DeFazio
21. Rep. Raul Ruiz
22. Rep. Zoe Lofgren
23. Del. Eleanor Holmes Norton
24. Rep. Melanie Stansbury
25. Rep. Shontel Brown
26. Rep. Teresa Leger Fernández
27. Rep. Tony Cárdenas
28. Rep. Ruben Gallego
29. Rep. Liz Cheney

Full Letter Text

Dear Chairwoman DeLauro and Ranking Member Granger,

In the Fiscal Year 2023 (FY23) President’s Budget, the President requested that the funding for the Indian Health Service (IHS) be shifted from discretionary to mandatory funding. This will ensure funding is secured for IHS and the millions of Native Americans and Alaska Natives it serves, regardless of a government shutdown and delayed appropriations. All other federal government healthcare providers—Medicare, Medicaid, Children’s Health Insurance Program, TRICARE, and Veterans Health Administration—are all either under mandatory funding or receive advanced appropriations. IHS is the only major federal healthcare program that does not receive either and is up for annual appropriations.

As members of the Congressional Native American Caucus, we encourage the Biden Administration, IHS, authorizing committees, and tribal nations to collaborate and work towards authorizing this shift to mandatory funding. While this process is underway, advanced appropriations for IHS should be included in the final FY23 Appropriations bill. The advanced appropriations for FY24 will enable IHS to continue to provide health services without potential interruption, guaranteeing access to the necessary care for 2.6 million Native Americans and Alaska Natives.

IHS has been chronically underfunded since its creation in 1955. According to a Government Accountability Office (GAO) Report, in 2017 per capita spending for IHS was $4,078 compared to $13,185 for Medicare. Due to these insufficient funds, IHS regularly experiences staffing shortages, limited equipment availability, extended wait times, and several other problems. Every time Congress passes a Continuing Resolution (CR), IHS must modify hundreds of tribal contracts to adjust for the available funding. This also takes an extensive toll on a tribe’s financial stability as higher interest on loans can occur when there is uncertainty of federal funding, leading to a downgrade in credit rating.

Advanced appropriations would allow Indian health programs to manage budgets, coordinate care, and improve health quality outcomes for Native Americans and Alaska Natives effectively and efficiently. This population suffers disproportionately from a variety of health afflictions including diabetes, heart disease, tuberculosis, and cancer. This change in the appropriations schedule will help the federal government meet its trust obligation to tribal governments and bring parity to federal health care systems. Health care services in particular require consistent and reliable funding to be effective.

Background on Mandatory Funding and Advance Appropriations for the Indian Health Service

The Indian health system, including IHS, Tribal facilities, and UIOs, is the only major federal provider of health care that is funded through annual appropriations. If IHS were to receive mandatory funding or, at the least, advance appropriations, it would not be subject to the harmful effects of government shutdowns and CRs as its funding for the next year would already be in place. This is needed as lapses in federal funding put lives at risk. Without funding certainty during government shutdowns can cause UIOs to reduce services, close their doors, or force them to leave their patients without adequate care.  During the last government shutdown, UIOs reported at least 5 patient deaths and significant disruptions in patient services. Securing stable funding for IHS has been a major priority for Indian Country and NCUIH has taken part in extensive advocacy to ensure the continuation and delivery of health services to all Native people regardless of where they live.

There has also been strong long-standing support from Congress on this issue and legislation on this effort has been introduced in 11 bills since 2013. Currently, 107 current Members of Congress have expressed support for advance appropriations for the Indian Health Service since the first bill was introduced by the late Representative Don Young (R-AK-At Large; H.R. 3229) and Senator Lisa Murkowski (R-AK; S. 1570). Congress has sent letters in the past advocating on this issue:

• January 12, 2022 – Native American Caucus sent letters to the 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 on January 12, 2022.
• April 25, 2022 – Bipartisan group of 28 Representatives requestedup 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.
• June 3, 2022 – Native American Caucus sent another letterencouraging the Committee to work towards shifting IHS from discretionary to mandatory funding and requesting that, while this shift is underway, the Committee include advanced appropriations for IHS in the final FY 2023 Appropriations bill.

Resources on Advance Appropriations for IHS:

• NCUIH Timeline of Advocacy and History of Advance Appropriations for the Indian Health Service
• NCUIH Advance Appropriations for the Indian Health Service Infographic
• NCUIH Resolution Advance Appropriations
• NIHB Resolution on Advance Appropriations
• NCAI Resolution on Advance Appropriations
• USET Resolution on Advance Appropriations

Next Steps

Congress has until December 16, 2022, to pass a longer-term spending package for FY 2023. In the meantime, NCUIH will continue to advocate for advance appropriations in the final FY 2023 omnibus.

FOR IMMEDIATE RELEASE

NCUIH Contact: Meredith Raimondi, Vice President of Public Policy, mraimondi@ncuih.org, 202-417-7781

WASHINGTON, D.C. (November 16, 2022) – The National Council of Urban Indian Health (NCUIH) received a letter from the Indian Health Service (IHS) in response to a request to allow urban Indian organizations (UIOs) to receive an exception apportionment, which would protect them from a government shutdown by providing the full-year base funding amounts.

Today, NCUIH Chief Executive Officer, Francys Crevier (Algonquin), released the following statement in response to the IHS letter:

 “During the last government shutdown in 2019, five patients died. These are five relatives— mothers, fathers, grandparents— who are no longer part of our community and unable to pass on our cultural traditions that they hold, all because of federal budget disputes. It is atrocious and tragic that the government expects Indian health providers to continue providing services to the most vulnerable population in the country without an enacted budget. Congress regularly fails to reach a budget agreement in time year after year, and Native people are the ones that suffer. Budget delays hinder healthcare delivery and it’s unacceptable. To truly honor its commitment to Native people, the government must act to end budget delays that cost lives. Indian Country has tirelessly advocated for secure funding through advance appropriations for IHS, which is the only major federal healthcare provider funded through annual appropriations. The federal government continues to prove that the safety of Native lives is not a concern, as the government fails to fund IHS in a timely manner and does not provide exception apportionment to the programs that carry out healthcare services to the over 70% Native population living in urban areas.”

Background

IHS has only once, in 2006, received full-year appropriations by the start of the fiscal year. In the absence of an exception apportionment during these budget disputes that may cause the government to shut down, UIOs are subject to the shut down too. Federal shutdowns require UIOs to lay off staff, reduce hours and services, and even close their doors, ultimately leaving their patients without adequate health care.

IHS received an exception apportionment to provide the full-year Secretarial Amount to Tribal Health Programs with Indian Self-Determination and Education Assistance Act contracts and compacts, but this exception does not apply to IHS-operated health programs or UIOs. IHS states, “IHS-operated health programs continue to provide services in the absence of appropriations, even if the health programs are unable to pay health care professionals and related staff, pay invoices for referred care, and purchase supplies and medicines.”

Take Action

NCUIH has been working with our partners to #AdvanceIndianHealth and has more information on how to get involved here: https://ncuih.org/advance/. We will continue to push for including advance appropriations for IHS in the final Fiscal Year 2023 spending bill to provide funding certainty to the Indian healthcare system.

• Advance Appropriations One-Pager
• IHS Advance Appropriations Infographic

Full Text of IHS Letter

Dear Ms. Crevier:

I am responding to your September 23, 2022, letter, regarding an exception apportionment for Urban Indian Organizations (UIOs). The Indian Health Service (IHS) is committed to hearing concerns about the effect of the Fiscal Year (FY) 2023 Continuing Resolution on UIOs.

Urban Indian Organizations are a critical component of the Indian health care system. The Indian Health Service’s top priority is to avoid disruptions in operations and to lift the unnecessary administrative burden that comes with Continuing Resolutions (CRs), sequestration, and government shutdowns for the entire Indian health system, including UIOs.

In your letter, you highlight actions that the current and prior Administrations implemented to limit budgetary uncertainty and ensure continuity of operations for IHS and Tribal Health Programs during government shutdowns. You also request that the IHS seek an exception apportionment under the “safety of human life” justification to provide UIOs with funding above the pro-rata amount appropriated under a CR.

An exception apportionment describes a type of account-specific apportionment that can be issued for operations under a CR in lieu of the Office of Management and Budget (OMB) issued automatic apportionment, which provides the pro-rata funding level available under a CR. Exception apportionments must be requested and approved by OMB each year. The IHS has received an exception apportionment for a portion of its funding since FY 2020.

The exception apportionment allows the IHS to provide the full year Secretarial Amount to Tribal Health Programs with Indian Self-Determination and Education Assistance Act (ISDEAA) contracts and compacts with performance periods that start under the period of a given CR, as opposed to the pro-rata funding amount that is otherwise available under a CR. The exception apportionment does not apply to IHS-operated health programs or UIOs. It is important to note that the IHS exception apportionment does not fall under the “safety of human life” exception for apportionments.

The OMB Circular No. A-11: Preparation, Submission, and Execution of the Budget, the basis for a Safety of Human Life and Protection of Federal Property (“life and safety”) establishes that exception apportionments may be granted in extraordinary circumstances where the safety of human life or protection of Federal property is a concern during a government-wide lapse of appropriations.

Instead, the IHS exception apportionment authority is rooted in the unique nature of ISDEAA funding agreements, and the timing of such funding agreements. This is why the exception apportionment only applies to Tribal Health Programs whose ISDEAA agreements have a performance period that begins during the period of the CR. Urban Indian Organizations receive their funding through Federal Acquisition Regulation (FAR) contracts, consistent with Title V of the Indian Health Care Improvement Act, and therefore are not eligible for funding above the pro-rata amount available during a CR under this exception apportionment authority.

Your letter references “excepted programs” under the Antideficiency Act (ADA) during the 2018 – 2019 government shutdown. Indian Health Service operated health care programs are “excepted” during a government shutdown, which means that IHS-operated health programs must continue to provide direct health care services in the absence of an appropriation. The exception under a government shutdown does not provide additional funding during the period of a government shutdown. This exception only applies to Federal functions, and does not apply to Tribal Health Programs. Under this exception, IHS-operated health programs continue to provide services in the absence of appropriations, even if the health programs are unable to pay health care professionals and related staff, pay invoices for referred care, and purchase supplies and medicines.

The criteria for safety of human life excepted programs under a government shutdown is not always the same as the criteria for receiving a safety of human life exception apportionment. Programs that are excepted for safety of human life reasons under a government shutdown generally do not receive exception apportionments. For example, although IHS-operated health programs are excepted during a government shutdown and must continue providing direct health care services in the absence of appropriations, IHS-operated health programs do not receive an exception apportionment. The safety of human life exception for apportionment purposes is used in very narrow circumstances.

The exception apportionment authority provides a partial solution to the unpredictability of Federal appropriations for the IHS, and is likely the extent of what the Agency can achieve within existing authorities. While an exception apportionment does resolve some of the unpredictability in the IHS budget for some Tribal Health Programs, it is not a full solution to the challenges the IHS faces as a result of continuing resolutions. The exception apportionment also does nothing to prevent the negative consequences of government shutdowns for IHS-operated health programs and UIOs; it only prevents those consequences for Tribal Health Programs in some circumstances. The consequences of a government shutdown directly impact the ability of IHS-operated health programs, Tribal Health Programs, and UIOs to provide high quality health care to the American Indian and Alaska Native communities we serve.

The Biden Administration has taken the historic steps of requesting advance appropriations in FY 2022 and a fully mandatory budget in FY 2023 for the IHS to fundamentally change the way the Agency receives its appropriations and resolve the negative impacts of budget uncertainty. We sincerely appreciate your support as we work toward achieving these goals.

Thank you for your continued support on our shared mission to raise the health status of urban Indians to the highest possible level. If you have additional concerns, please directly contact Ms. Jillian Curtis, Chief Financial Officer, Office of Finance and Accounting, IHS, by telephone at (301) 443-0167, or by e-mail at jillian.curtis@ihs.gov.

Sincerely,
Roselyn Tso
Director

On August 22, 2022, the National Council of Urban Indian Health (NCUIH) Board of Directors approved a resolution in support of advance appropriations for the Indian Health Service (IHS). Attaining advance appropriations has been a long-standing priority for NCUIH and Indian Country to ensure stable and predictable funding for IHS and American Indian/Alaska Native (AI/AN) healthcare.

Full Text of Resolution:

WHEREAS the National Council of Urban Indian Health (NCUIH) is the national representative of forty-one (41) urban Indian organizations (UIOs) receiving grants under Title V of the Indian Health Care Improvement Act (IHCIA) and the American Indians and Alaska Natives (AI/ANs) they serve;

WHEREAS NCUIH was established in 1998 to support the development of quality, accessible, and culturally sensitive health care programs for AI/ANs living in urban communities;

WHEREAS the United States has a unique and special relationship with AI/ANs as established through the U.S. Constitution, Treaties with Indian Tribes, U.S. Supreme Court decisions and Federal legislation;

WHEREAS this special relationship includes a trust responsibility to AI/AN citizens as established through Treaties with Indian Tribes, U.S. Supreme Court decisions, and Federal legislation;

WHEREAS the trust relationship requires the United States to provide federal health services to maintain and improve the health of AI/ANs, no matter where they live;

WHEREAS it is the declared policy of the United States, as provided in the ICHIA, “to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy;”

WHEREAS the Indian Health Service (IHS) is chronically underfunded by the federal government, and UIOs historically receive only one percent of appropriated funds for IHS;

WHEREAS the Indian health system, including IHS, Tribal, and UIO (I/T/U) facilities, is the only major federal provider of health care that is funded through annual appropriations;

WHEREAS according to the Congressional Research Service, since FY1997, IHS has only once, in FY2006, received full-year appropriations by the start of the fiscal year;

WHEREAS if IHS were to receive advance appropriations, it would not be subject to government shutdowns, automatic sequestration cuts, and continuing resolutions (CRs) as its funding for the next year would already be in place;

WHEREAS during the thirty-five (35) day government shutdown at the start of FY 2019, the Indian healthcare system was the only federal healthcare entity that was required to continue operations without appropriated funds;

WHEREAS during the FY 2019 shutdown, several UIOs did not have adequate funding to maintain normal operations, and were required to reduce services, lose staff, or close their doors entirely, putting the health and wellbeing of their patients at risk;

WHEREAS in a UIO shutdown survey, five (5) out of thirteen (13) UIOs indicated that they could only maintain normal operations for 30 days without federal funding;

WHEREAS advanced appropriations would uphold the trust responsibility by protecting the Indian healthcare system from future government shutdowns and not counting against spending caps; and

WHEREAS advanced appropriations are imperative to provide certainty to the Indian health system and ensure unrelated budget disagreements do not put AI/AN lives at stake.

NOW THEREFORE BE IT RESOLVED, that NCUIH requests that Congress amend the Indian Health Care Improvement Act to authorize Advanced Appropriation for IHS, including Tribal facilities and UIOs; and

BE IT FURTHER RESOLVED, that this resolution shall be the policy of NCUIH until it is withdrawn or modified by subsequent resolution.

CERTIFICATION

The foregoing resolution was adopted by NCUIH on August 22nd, 2022 with a quorum present.

Background on Advance Appropriations for IHS

Advance appropriations are appropriations that become available one year or more after the year for which the appropriations act is passed. The Indian healthcare system, which includes IHS facilities, Tribal facilities, and urban Indian organizations (UIOs), is the only major federal healthcare provider funded through annual appropriations. Funding through annual appropriations leads to funding uncertainty because the availability and amount of the appropriation is subject to the annual budget negotiation process. If IHS were to receive advance appropriations, it would not be subject to government shutdowns, automatic sequestration cuts, and continuing resolutions (CRs) as its funding for the next year would already be in place.

Lapses in federal funding risk American Indian and Alaska Native lives. Every year, on average, Congress passes five continuing resolutions to keep the government open while Congress reaches a budget agreement, and there were long government shutdowns in 1996, 2013, and 2019. During the Fiscal Year (FY) 2019 shutdown, several UIOs did not have adequate funding to maintain normal operations and were required to reduce services, lose staff, or close their doors entirely, putting the health and well-being of their patients at risk. In a UIO shutdown survey, five out of thirteen UIOs indicated that they could only maintain normal operations for 30 days without federal funding. One UIO suffered seven opioid overdoses, five of which were fatal. Presently, it is unlikely that Congress will reach a budget agreement before the September 30 deadline. If Congress does not reach a budget agreement, Congress will need to pass a continuing resolution to avoid a government shutdown.

NCUIH Resources on Advance Appropriations for IHS:

• Timeline of Advocacy and History of Advance Appropriations for the Indian Health Service
• Advance Appropriations for the Indian Health Service
• NCUIH Resolution Advance Appropriations

NCUIH and Indian Country Advocacy

NCUIH, along with three other national Native organizations the National Indian Health Board (NIHB), National Congress of American Indians (NCAI), United South and Easter Tribes (USET), have been advocating on behalf of advance appropriations for almost a decade. NIHB, NCAI, and USET have all passed resolutions in support of advance appropriations. However, these resolutions don’t explicitly mention UIOs or urban Indians. NCUIH’s resolution provides context for why advance appropriations are essential for UIOs and urban Indian populations and explicitly includes UIOs in the request for advance appropriations.

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 seventy 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 published a legislative action alert requesting that SCIA support and include IHS advance appropriations in the current FY 2023 appropriations bill. Most recently, 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.

Federal and Congressional 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. On June 3 the Native American Caucus sent another letter encouraging the Committee to work towards shifting IHS from discretionary to mandatory funding and requesting that, while this shift is underway, the Committee include advanced appropriations for IHS  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, 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 2019 House Natural Resources Subcommittee for Indigenous Peoples (SCIP) hearing 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.” More recently on July 28, 2022  IHS Acting Deputy Director Elizabeth Fowler reaffirmed IHS’s support for advance appropriations during a SCIP hearing on the Indian Health Service Advance Appropriations Act (H.R. 5549) stating that  “[IHS] remain[s] 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.

History of Advance Appropriations Bills

Legislation on this effort has been introduced in 11 bills since 2013:​

•  10/2013 – Indian Health Service Advance Appropriations Act of 2013 (R. 3229/S. 1570) ​
• Sponsor: Rep. Don Young/Sen. Lisa Murkowski ​
•  1/2015 – Indian Health Service Advance Appropriations Act of 2015 (R. 395)    ​
• Sponsor: Rep. Don Young ​
• 1/2017 – Indian Health Service Advance Appropriations Act of 2017 (R. 235) ​
•  Sponsor: Rep. Don Young ​
•  2/2019 – Indian Programs Advance Appropriations Act (R. 1128/S. 229) ​
• Sponsor: Rep. Betty McCollum/Sen. Tom Udall ​
• 2/2019 – Indian Health Service Advance Appropriations Act of 2019 (R. 1135/S. 2541) ​
• Sponsor: Rep. Don Young/Sen. Lisa Murkowski​
•  10/2021 – Indian Health Service Advance Appropriations Act (R. 5549) ​
•  Sponsor: Rep. Don Young ​
• 10/2021 – Indian Programs Advance Appropriations Act of 2021 (R. 5567/S. 2985) ​
• Sponsor: Rep. Betty McCollum/Sen. Ben Ray Lujan​
  • 7/28/2022- Subcommittee for Indigenous Peoples (SCIP) held a hearing on the Indian Health Service Advance Appropriations Act (R.5549)​
• Sponsor: Rep. Don Young

Next Steps

NCUIH will continue to advocate for Advance Appropriations for the 2022-23 Fiscal Year.