PORTLAND, OR – Just before the Christmas holiday, Congress passed a $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.
The 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,” said Indian Health Service Director Roselyn Tso. “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 IHS 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.
“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,” said U.S. Senator Jeff Merkley, Chairman of the Senate Interior Appropriations Subcommittee. “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.”
“Tribal communities in the Pacific Northwest rely on the Indian Health Service to access quality, affordable health care and medications,” said U.S. Representative Rick Larsen. “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.”
“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,” said Nickolaus Lewis, Chairman of the Northwest Portland Area Indian Health Board. “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.”
“This is a great day for Indian health,” said Ron Allen, Chair, Jamestown S’kallam Tribe. “We now can rely on stable health coverage for our elders, veterans and families.”
“This is historic in that it gives the Indian health system some stability and predictability in funding cycles.” said Nate Tyler, Treasurer, Makah Tribe. “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.”
“It is a long time coming. It will help save lives,” said Andy Joseph, Councilman, Colville Tribal Business Council. “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.”
“It’s taken years of prayer, effort, and unity to get to this rightful place for tribal nations,” said Cheryle A. Kennedy, Chairwoman, Confederated Tribes of Grand Ronde. “Thank you to our brothers and sisters who helped in the battle, now we can rejoice together. It’s a great day.”