Miracle in the making: Indian Health Service to receive advance appropriations

U.S. Senate passes 2-year funding deal providing extra $5 billion for IHS through '24; U.S. House expected to soon follow suit.

The Coalition of Large Tribes (COLT) and numerous tribal advocates urged the U.S. Congress to include advance appropriations for IHS in the fiscal rear 2023 omnibus appropriations bill. (courtesy COLT)    

WASHINGTON — Tribal health advocates are widely celebrating advance appropriations funding included for the Indian Health Service (IHS) within the nearly $2 trillion federal omnibus spending bill, which passed today by a bipartisan vote of 68 - 29.

The $5-billion inclusion is significant and is expected to pass the U.S. House and be signed into law by President Joe Biden by the end of the week.

Tribes have for decades been unsuccessful in their push for permanent, forward-funding for the IHS in fulfillment of federal trust and treaty responsibilities. Under such a structure, tribal health would not be classified as another entitlement program subject to the alternating whims of U.S. Congresses, including cuts, sequestration and government closures.

“In the past, when the federal government shut down, so did health care funding for Tribes and their members. That is unacceptable,” U.S. Sen. Ben Ray Luján (D-NM) said in a statement this evening. “Health care for American Indians and Alaska Natives is a trust and treaty responsibility, one that we must ensure is there even during temporary lapses in annual appropriations.”

Short of complete, permanent forward-funding, tribal health advocates were successful in convincing a majority of their allies in the upper and lower legislative chambers to support advance appropriations for IHS for two years.

The formula approved by the Senate will allow Indian health programs to be budgeted and planned in a more concrete manner, ideally strengthening and improving Native access to health care.

Under the Senate deal affirmed today, the IHS will receive more than $5 billion in advance appropriations for IHS through 2024. That’s on top of approximately $7 billion budgeted by the federal government for IHS in fiscal year 2023.

The House is expected to pass the same deal, according to Senate sources. And Biden will then sign it into law.

Tribal advocates have made the case for advance appropriations time and again throughout the 117th session of Congress, which very soon comes to a close.

But some Democratic allies, including outgoing House Appropriations Committee Chair U.S. Rep. Rosa DeLauro (D-CT), were difficult to convince, a variety of tribal officials and Native health advocates say.

EARLIER: Pingree and DeLauro hold up advance appropriations for Indian health

Some, including U.S. senators like U.S. Sen. Lisa Murkowski (R-AK), felt that funding for IHS was difficult to budget in an advance fashion due to unique agreements with tribes.

But Murkowski, who is the vice-chair of the Senate Committee on Indian Affairs, was on board with the final plan and had long expressed support for more concrete funding for Indian health.

“With IHS, over half of its budget is contracted or compacted, which is foundational to tribal self-determination but a very different budgeting approach than is used by the VA for health care delivery,” a spokesperson for Murkowski told Indigenous Wire in October. “Therefore, Congress must make sure to take into account these types of different budget mechanics in providing advance appropriations.”

Tribal officials have long said that if the U.S. Department of Veterans Affairs can do it for vets, it can be done for Indians.

Today proved that to be true.

Still, various advocates were unsure if the final deal, seriously under discussion in both chambers since early fall, would ultimately come to fruition.

Tribes have often been let down by federal legislators on this front in the past.

But members of the Senate Committee on Indian Affairs and others were ultimately successful in convincing their allies. So, too, was a Biden White House open to the idea, as were various administration officials who made their support resoundingly clear during last month’s White House Tribal Nations Summit.

“Advance appropriations will protect IHS programs from service disruptions and other negative impacts caused by funding uncertainty and government shutdowns,” U.S. Sen. Brian Schatz (D-HI), chairman of the committee, said in a statement issued tonight.

“It brings IHS into parity with all other federal health care providers and the U.S. closer to upholding its trust responsibility to provide Native communities with quality health care.”

“Future year funding is critically important to providing continuity and certainty for health care delivery,” added U.S. Sen. Jon Tester (D-MT), former chair of the committee.

“Guaranteeing funding for the Indian Health Service through 2024 is a huge win for Tribal Nations,” U.S. Sen. Tina Smith (D-MN) echoed. “It means that the federal government is one step closer to meeting its legal, trust and treaty responsibilities to the millions of American Indians and Alaska Natives who rely on the IHS for their health care.

“Congratulations to the Tribal leaders and Native health advocates who fought for this for decades.”