Last Friday, Congress passed the $1.7 trillion fiscal 2023 spending package, which included $5.1 billion in advance appropriations for the Indian Health Service (IHS) in fiscal year 2024, by a 68 to 29 vote in the Senate and a 225 to 201 vote in the House. Although the IHS is the principal federal agency responsible for providing health services to American Indians and Alaska Natives, a chronic pattern of underfunding has contributed to a well-documented disparity in health status, with their unmet health care needs remaining among the most severe of any group in the United States.
This monumental legislative victory is largely due to the tireless work of tribal leaders across the country to advance health care for their people. In the pursuit of an advance appropriation commitment from Congress, tribal leaders united in a coordinated advocacy effort along with tribal organizations, urban Indian organizations, allies, members of Congress, the White House, and the Administration.
“Today is a historic day for the Indian Health Service. In addition to including almost $7 billion for IHS in fiscal year 2023, the Consolidated Appropriations Act, 2023 will provide the agency with advance appropriations for the first time. This change will provide critically needed protection from budgetary uncertainty to the entire Indian health system and will align IHS with other federal health care providers. It is also a direct result of years of advocacy from tribal and urban Indian organization leaders, who have long highlighted the need for a more stable and predictable funding stream for the IHS.
Advance appropriations are necessary to ensure continued access to critical health care services for American Indians and Alaska Natives. Predictable funding will allow us to disburse funds more quickly and enable IHS, tribal and urban Indian health programs to effectively and efficiently manage budgets, coordinate care and improve health outcomes for American Indians and Alaska Natives. This predictability is especially important during a lapse in appropriations or a continuing resolution.
We want to thank Department of Health and Human Services Secretary Xavier Becerra, Congress and the Biden Administration for their support in upholding the federal government’s commitments and assuring we will not face the negative impacts of budget uncertainty in fiscal year 2024. We would also like to especially thank the numerous tribes, tribal and urban Indian organizations and advocates who worked tirelessly to secure stable health care funding across Indian Country.” — Statement from Indian Health Service Director Roselyn Tso on historic funding for the agency.
“This is a big deal. Health care for Tribal communities should never shut down because we fail to pass a budget— health challenges and emergencies do not wait on Congress. When I sit down to write our annual appropriations bill, one of my very top priorities is to ensure Congress is upholding its trust and treaty responsibilities and providing fairness to Indian Tribes through the federal budget process. One critical way to do this is to ensure that the IHS is protected from future lapses in appropriations—and protected from budget uncertainty in unpredictable budget years. This will give health care providers peace of mind, help with recruitment and retention, help ensure IHS operates like a modern health care system, and most importantly, help ensure health care for patients never stops. I want to applaud the Northwest Portland Area Indian Health Board for their years of advocacy in helping to get this done.” — U.S. Senator Jeff Merkley (D-OR), Chairman of the Senate Interior Appropriations Subcommittee, which oversees billions of dollars in funding for services to Indian Country.
“Tribal communities in the Pacific Northwest rely on the Indian Health Service to access quality, affordable health care and medications. I commend Tribal members for their advocacy and hard work to include critical advance funding in this year’s spending package so that American Indians and Alaska Natives, including Tribal elders and children, have uninterrupted access to vital care and services.” — U.S. Representative Rick Larsen (D-WA-02).
Nickolaus Lewis (“Juts-kadim”) is a member of the Lummi Tribe of Indians of the Lummi Reservation (Lhaq’temish) in the State of Washington and a Council Member of the Lummi Indian Business Council, the elected governing body of the Lummi Nation. He serves as Chairman of the Northwest Portland Area Indian Health Board, Vice-Chairman for the National Indian Health Board, and as Vice President of the Self-Governance Communication and Education Tribal Consortium. Councilman Lewis sits on several federal advisory committees, including the IHS National Tribal Budget Formulation Workgroup and the Veterans Affairs Advisory Committee on Tribal and Indian Affairs. He is one of the many tribal leaders who have logged thousands of miles traveling across the country to protect and enhance the rights of tribal nations by educating lawmakers and Administration officials, collaborating with tribal and national partner organizations, and speaking to the value of providing advance appropriations for IHS at every opportunity.
“It’s about time! Never has funding for the Indian Health Service come close to meeting the actual level of need, which can only lead one to deduce that the federal government has historically placed less value on Indian health than that of other populations. Advance appropriations will resolve some of the challenges presented by annual discretionary funding like the instability caused by continuing resolutions and lapses in appropriations, but will not address the issue of funding adequacy. With that said, today’s passage of advance appropriations for the Indian Health Service is a major step forward in federal-tribal relations. At the core of Indian health policy are the federal government’s trust responsibility and treaty obligations. Every step the United States takes toward fulfilling its promises to tribes and American Indian and Alaska Native people is a positive step. Indian Country will be celebrating this achievement for a long time to come.” — Nickolaus Lewis, Councilman, Lummi Nation.
With federal funding of the Indian health care delivery system, the stakes are high and measured in human lives. Indian Country need only look back to December 2018 when the government shutdown slowed referrals and halted clinical health care services. Tribal leaders and American Indian and Alaska Native community members across the nation, especially elders who have spent decades in the fight, will rejoice today knowing that advance appropriations for IHS is now the official policy of the U.S. government.
“This is a great day for Indian health. We now can rely on stable health coverage for our elders, veterans and families.” — Ron Allen, Chair, Jamestown S’kallam Tribe.
“This is historic in that it gives the Indian health system some stability and predictability in funding cycles. Funding continuity allows us to address health outcomes and ensures that there will be no lapses in funding. It brings the U.S. Government one step closer to their legal obligation to honor the trust responsibility and Treaty obligations to Tribal Nations.” — Nate Tyler, Treasurer, Makah Tribe.
“It is a long time coming. It will help save lives! I really want to thank Congress, our President, and this Administration. A very huge thank you to all the Area Indian Health Boards’ policy staff and the tribal leaders who helped bring to fruition.” — Andy Joseph, Councilman, Colville Tribal Business Council.
“It’s taken years of prayer, effort, and unity to get to this rightful place for Tribal Nations. Thank you to our brothers and sisters who helped in the battle, now we can rejoice together. It’s a great day.” — Cheryle A. Kennedy, Chairwoman, Confederated Tribes of Grand Ronde.
