Pingree and DeLauro hold up advance appropriations for Indian health

White House, Senate want to stabilize Indian Health Service funding, while top House appropriators drag feet.

U.S. Reps. Rosa DeLauro (D-CT) (left) and Chellie Pingree (D-ME) have been holdouts on supporting advanced appropriations for the Indian Health Service. They won’t say why. (Getty Images)

WASHINGTON — Tribal health advocates are optimistic that enough U.S. House members will see the light on the need for advance appropriations for the Indian Health Service (IHS) that such funding will become a reality by 2024.

But U.S. Reps. Rosa DeLauro (D-CT) and Chellie Pingree (D-ME) are presenting a major obstacle, multiple advocates tell Indigenous Wire, and tribal leaders, fellow legislators, and Biden administration officials are all trying to figure out why.

The long-fought for funding mechanism would help account for perennial shortfalls in the IHS funding stream that result in some tribal health facilities being unfunded and/or underfunded for a good portion of each year.

During such lapses in appropriations, tribal health facilities supported by IHS dollars can’t make job offers or approve salaries, and they are unable to enter into long-term commitments with health workers and partners or support contracts. Above all, they can’t offer quality, sustained healthcare to ailing Native Americans they are charged with serving.

Jonathan Nez, president of the Navajo Nation, testified July 28 before the U.S. House Subcommittee for Indigenous Peoples that IHS is only federal health delivery system that is not protected from federal government shutdowns and continuing resolutions.

“Every [American Indian and Alaska Native] community has been impacted by government shutdowns that could be avoided through advance appropriations,” Nez testified.

By providing advance funding, the U.S. Congress would fund tribal health facilities before they run out of cash each year.

It seems like a simple, common-sense concept, but since some powerful Congress members don’t understand — and/or don’t want to understand — how the IHS system works, tribal health advocates’ work on this front has fallen short of passing for decades.

This year, there is real momentum, with the Biden White House already on board, including advance appropriations for IHS within its most recent budgetary request to Congress.

The Senate has made recent strides, too. The U.S. Senate Appropriations Committee released its fiscal year 2023 Interior, Environment, and Related Agencies bill in July with an inclusion of $5.577 billion in advance appropriations for IHS for the following fiscal year.

The committee noted in its summary of the bill that “budget uncertainty due to temporary lapses of appropriations and continuing resolutions affect the orderly operations of critical healthcare programs for [American Indian/Alaska Native] communities.”

Tribes and Indian health organizations have long made the case to policymakers that advance appropriations are a matter of fulfilling federal trust and treaty responsibilities to tribes. Beyond that, they have argued unsuccessfully that not only should advance appropriations be a no-brainer, but funding for the IHS and related Indian health program budgets should be mandatory as opposed to their current discretionary status. Tribes would then not have to make the case each year to the federal government that its federal trust and treaty commitments be kept.

Tribal advocates also note that lawmakers have seen the benefit of mandatory funding for veterans, but not for Native Americans.

Fawn Sharp, president of the National Congress of American Indians, testified July 28 before the House Subcommittee for Indigenous Peoples that there is a difference between what is owed to Natives compared to veterans in that Natives have treaties signed by their ancestors that call on the federal government to fully pay for Indian health services.

While the White House and Senate are on board, it’s been an uphill battle in getting the House to agree. When the House passed H.R. 8294 as part of a six-bill appropriations package on July 21, the bill did not include IHS advance appropriations. 

Some House members simply do not see funding Indian health with the same urgency as funding veterans’ health, tribal advocates lament.

Some lawmakers have also told tribal advocates that they have not received enough information from IHS and/or the Department of Heath and Human Services (HHS), to definitively support passage of tribal advance appropriations.

IHS and HHS officials maintain they have shared all information needed for Congress to support advance appropriations. Some believe that House members are making IHS and HHS leaders a scapegoat for simply not wanting to fulfill tribal treaty and trust obligations.

The Office of Management and Budget and Domestic Policy Council, too, have shared supporting information with wary House members, according to multiple sources.

So why won’t the House act on the info? Some health advocates believe that some lawmakers simply don’t want to support advance appropriations because they feel like doing so would take away a bargaining chip during continuing resolution and/or government shutdown negotiations.

“It’s not right for them to hold tribal health obligations hostage,” one health advocate tells Indigenous Wire. “But Congress has done it for so long, they just can’t get out of that way of thinking, even when given strong evidence.”

Tribal officials have lately been pressing Janet Erickson, a top staffer with the House Interior, Environment and Related Agencies Subcommittee under U.S. Rep. Chellie Pingree (D-ME), to study the issue.

“Congresswoman Pingree is important for us to get,” another tribal advocate tells Indigenous Wire. “She is aware of this issue — our Alaska Native advocates and others are talking to her staff. She can get there.”

The position of U.S. Rep. Rosa DeLauro (D-CT), chair of the U.S. House Appropriations Committee, has additionally been one of confusion for tribal leaders who say she seemed close to supporting advance appropriations last year. However, she pulled back her support at the last moment for unexplained reasons.

Some staffers for House members who support advance appropriations tell Indigenous Wire that they are frustrated with legislators including Pingree and DeLauro on this matter.

“With the Democrats in charge and with Republicans who are supportive, this should be an easy sell,” one legislative staffer said. “But no one is above playing politics.”

Pingree and DeLauro’s offices have not responded to requests for comment. We will update when and if they do.