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Tribes Share Initial Support: NIHB and NCAI Seek Tribal Testimony on Advance Appropriations
“Government shutdowns represent the inability of government to work as a team. Politics should not be the rule of the day but cooperation and collaboration to run the country, including Sovereign Nations through treaties.”
Ensuring stable and predictable funding for the Indian Health Service, advance appropriations are a longstanding Tribal request and recommendation that the National Indian Health Board (NIHB) and the National Congress of American Indians (NCAI) have diligently advocated for years. Most recently, NIHB and NCAI have joined efforts to collect primary data through a survey from Tribes on the impacts of the Indian Health Service (IHS) from government shutdowns and continuing resolutions
An advance appropriation is funding that becomes available one year or more after the year of the appropriations act in which it is contained. For example, if advance appropriations were secured in the FY23 spending bills there will be an appropriation for FY24 regardless of a government shutdown or continuing resolution occurrence. This means when the budget is being proposed for FY24, the IHS would already have an appropriation for that fiscal year because of the advance appropriation funded from the FY23 spending bills and therefore a more stable, predictable funding stream for IHS.
Endorsing support for advance appropriations for the IHS, the Biden Administration is aware of the adverse impacts of discretionary funding and has included advance appropriation in the FY2023 President’s Budget. Passing their appropriation bills this July, the House did not include advance appropriations despite overwhelming Tribal advocacy. On the other hand, making an historic investment to the health of Indian country, the Senate did include advance appropriations in their appropriation bills providing $5.577 billion for FY 2024. However, securement of advance appropriations is not yet final.
Tribes need advance appropriations for IHS funding now. Allies in Congress are asking for your stories to help get their colleagues on board. Members of Congress frequently ask, “Why do Tribes need Advance Appropriations?” and “How do funding disruptions harm Tribal nations and their people?”
From initial survey responses, Tribal leaders and Tribal health directors have noted federal governmental shutdowns result in loss of patient contact hours, loss of third-party billing opportunity and revenue, and loss of hours of operations of health services.
“There were cuts to Tribal Council and Director Salaries of 8.5 %. Caused huge employee moral issue with people who are termed essential. Promoted racism within the organization. Cut hours and laid off some government staff.”
Overwhelmingly, multiple Tribes have experienced interruptions in providing mental health services, substance abuse treatment, and adverse impacts on recruiting and retaining professional medical staff. Fortunately, or unfortunately, some Tribes did not experience furloughing or layoffs because they were able to use revenue to cover the wages. Others made the tough decision to furlough or layoff medical staff.
"Being critically underfunded affects the services we can provide especially in very remote areas, also not having advanced appropriations makes it hard to plan, and also having to supplement from our third-party funds takes away from the additional services we are able to provide to due people due to no access due because of our location."
Testifying in support of advance appropriations, a Tribe noted that "people who actually visit villages, will better understand [their] living conditions, and see how remote [they] are. Transportation is mainly by aircraft; others, if the weather is allowable, travel by boats and during the winter by snowmobiles".
If you would like to share your stories highlighting direct adverse impacts of unstable IHS funding, please submit through this survey. Answers can remain anonymous in which there is an option on the survey to keep your Tribe’s name anonymous. In addition, you will be routed to a separate link to enter to win a Pendleton.
For questions, please contact NIHB Director of Government Relations Aaron Payment, EdD, at apayment@nihb.org.
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