Ten hours before the spending bill that funds the Indian
Health Service was set to expire, potentially leaving more than 2.5 million
Native Americans without health care access, Congress came through with a
historic win for Indian Country.
On Thursday, Dec. 22, the Senate passed President Joe
Biden’s $1.7 trillion Omnibus spending bill that will fund the government
through most of 2023. Included in that bill is a significant policy change for
Indian Country: $9.5 billion in advance appropriations available to the Indian
Health Service (IHS) over the next two years. The House passed the bill around
2 p.m. EST on Dec. 23, sending it to be signed by President Biden before a
government shutdown that would begin tonight at midnight.
Advance appropriations signify a major departure from how
the federal government has historically funded IHS, which is the only major
federal healthcare program subject to annual appropriations.
Those annual appropriations make tribes vulnerable to budget
uncertainties and government shutdowns. In December 2018, when the federal
government shut down for a record-breaking 35 days, IHS was unable to provide
funding to tribal healthcare operations and, as a result, many tribal
healthcare employees were furloughed, and tribal citizens were unable to get
proper care.
“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,” IHS Director Roselyn Tso said in a
statement to Native News Online. “This predictability is especially
important during a lapse in appropriations or a continuing resolution.”
Advance appropriations are a budgetary solution that tribal
leaders have advocated for for about a decade. They allow for new funding to
become available one year or more after the year of the appropriations act in
which it is contained.
Leaders at the National Indian Health Board, the National
Council of Urban Indian Health, and The National Congress of American Indians
celebrated the hard-fought win in a joint press release on Friday.
“Including advance appropriations for Indian health in the
omnibus is a historic moment for Indian Country over a decade in the making,”
National Indian Health Board (NIHB) President William Smith (Valdez Native
Tribe), said in a statement. “While Indian health remains chronically
underfunded, this provision will help ensure that the Indian Health Service can
provide stable, uninterrupted care to our people even when there is a
government shutdown. We are confident that we can build on this win and
continue our work toward full and mandatory funding for the Indian Health
Service, fulfilling the promises this country made to our people over two
centuries ago.”
Former NIHB Director of Government Relations Aaron Payment
(Sault Ste. Tribe of Chippewa Indians), called Congressional passage of advance
appropriations for IHS funding “a monumental first step” in fulfillment of
treaty obligations.
“The funding tribes receive is nominal compared to the
valuation of the hundreds of million acres tribes ceded,” Payment told Native
News Online. “Withholding our funding is an abrogation of the treaty and trust
obligation.”
Additionally, Payment added, “the jagged pill is just for
the first year.” In subsequent years, Congress will allocate funding as usual,
because IHS will already have been ahead by one year.
“We believe that after the first year that there won’t be
any issues,” Payment said. “Then we’ll move on to advance appropriations for
the Interior, and BIE, and any tribal funding under EPA. All of our funding
should be advance-appropriated, and it should also be mandated.”
The move also puts IHS on equal footing with other major
federal healthcare programs such as The Veterans Health Administration,
Medicare, and Medicaid. The Department of Veterans Affairs healthcare programs
have been funded with advance appropriations since 2010. Medicare and Medicaid
both receive mandatory funding.
U.S. Senator Jeff Merkley (D-OR), told Native News Online
that government shutdowns in 2018 and 2019 were the force that gave Congress
the momentum to finally move forward with advance appropriations for IHS.
Merkley proposed advance appropriations for Indian Health
Service in his fiscal year 2022 Senate Interior, Environment, and Related
Agencies appropriations bill.
“It became clear when I took over the Interior Subcommittee,
I wanted to say it’s not acceptable for our responsibilities for the US
government to provide health care services to the tribes,” Merkley said. “It’s
not acceptable for that funding to lapse. Quite frankly, we have a model for
addressing this, which is the Department of Veterans Affairs. We had a good
example of the tool to use, we just had to persuade everyone that we needed to
use it.”
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