WASHINGTON — Native American health advocates are trying to secure a more equitable deal from the U.S. Congress for funding the Indian Health Service (IHS).

In preparation for the upcoming fiscal year 2023 U.S. Interior Department appropriations bills, the National Council of Urban Indian Health today sent a letter to House Speaker Nancy Pelosi (D-CA) requesting that House leaders support advance appropriations for the IHS.

The letter notes that as opposed to stable, mandatory funding, the Indian health system — including IHS, tribal facilities and urban Indian organizations — is the only major federal health care provider funded through annual appropriations.

IHS’s total direct service user population is 1.6 million, according to the agency. Not all Indians -- not even the vast majority — use IHS, we should note.

“If IHS were to receive mandatory funding, or at the least, advance appropriations, it would ensure continuity of care for Native Americans and complement President Biden’s budget request to honor commitments to Tribal nations and communities,” the NCUIH wrote in an action alert today.

“In fact, there have been Native deaths due to government shutdowns in the past, and the lives of Native people should not be subject to politics. We need this to protect Native people and preserve access to health care.”

Stacy Bohlen, chief executive officer of the National Indian Health Board, said earlier this year that federal legislators have long failed to honor their trust obligations on Indian healthcare.

“Congress can end this practice by passing advanced appropriations that will provide two years of funding,” Bohlen, a citizen of the Sault Tribe of Chippewa Indians, told attendees of a winter National Congress of American Indians meeting.

Bohlen noted that the Biden administration and Senate leadership have expressed support for mandatory IHS funding.

The White House included a request to Congress for $9.1 billion in mandatory IHS funding in March for fiscal year 2023. Congress provided $6.6 billion for IHS its fiscal year 2022 omnibus.

The Tribal Budget Formulation Workgroup (TBFWG), a consortium of tribal health leaders, has said that over $49.8 billion is needed at IHS to properly serve Native Americans for 2022 alone.

While current funding levels come nowhere near that, the mandatory or advance appropriations idea could be an easier sell, advocates hope, although they’ve faced recent obstacles.

“We’re getting pushback from the Hill on some esoteric issues that really should not be a stopping point for us,” Bohlen said in February, adding that some Hill staffers believe Indian Country only wants advance appropriations because the Veterans Health Administration has it.

“That is an affront to sovereignty,” Bohlen said. “Advanced appropriations supports the government’s trust obligation to provide healthcare service to our people.”