The National Indian Health Board is a dedicated advocate to Congress on behalf of all Tribal Governments and American Indians/Alaska Natives. Each weekly issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis, and action items. To view all of our legislative resources, please visit www.nihb.org/legislative/washington_report.php.
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In This Week's Washington Report
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Senate Committee on Appropriations Releases FY 2023 Appropriations Bills with Historic Commitment to Advance Appropriations for
Indian Health Service
The National Indian Health Board (NIHB) Chairman William Smith (Valdez Native Tribe) highlighted, “The historic nature of the possibility of enacting advance appropriations for the Indian Health Service to stabilize health care in Indian Country.”
The Interior and Related Agencies bill provides $11.52 billion for Tribal programs. For fiscal year (FY) 2023, the bill provides $7.38 billion for IHS, an increase of $762 million above the FY 2022 enacted level. This provides $2.7 billion for hospitals, clinics, doctors, nurses, and health services; $260 million for dental health; and $127 million for mental health programs such as suicide prevention initiatives for American Indian /Alaska Native (AI/AN) youth, and tele-behavioral health programs.
The bill also provides an advance appropriation of $5.577 billion for IHS for FY 2024. Therefore, the vast majority of IHS funding will be provided by an advance appropriation. The Committee noted in the appropriation bill summary that “Budget uncertainty due to temporary lapses of appropriations and continuing resolutions affect the orderly operations of critical healthcare programs for AI/AN communities.” Advance appropriations will enable IHS to continue to provide health services without interruption or uncertainty, improving the quality of care and providing peace of mind for patients and medical providers.
This funding also increases Indian health facilities investments by 15 percent for a total of $1.08 billion for new hospital construction, new and replacement equipment, and water and solid waste infrastructure improvements for AI/AN communities, which are critically important for public health.
For nearly a decade, NIHB has worked alongside Tribal nations and other Tribal and urban Indian health advocates to secure advance appropriations for IHS. Following the devastating impact in 2013 of the 16-day government shutdown, NIHB moved quickly to pass Resolution 14-03 which supports advance appropriations. Since that time, there have been numerous bi-partisan bills introduced in support of advance appropriations for IHS by champions such as Senator Lisa Murkowski (AK), Congresswoman Betty McCollum (MN), and the late Don Young (AK).
Jonathan Nez, President of the Navajo Nation and an NIHB Board Member, testified last week in support of advance appropriations as the first and vital step toward truly honoring the treaty and trust obligation as an entitlement. “This first step in elevating Indian Health Care to advance appropriations is significant and welcomed,” said NIHB Chairman Smith.
More information on the Senate Interior and Related Agencies Appropriation Bill:
What can Tribes do? Tribes can contact their member of Congress and ask them to support this legislation.
For questions, please contact Aaron Payment, EdD, NIHB Director of Government Relations at apayment@nihb.org.
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Senate Committee Indian Affairs Votes to Advance Director of Indian Health Service Nominee
A citizen of the Navajo Nation, Roselyn Tso is currently the Director of the Navajo Area of IHS, and previously held the position of Director of the Office of Direct Services and Contracting Tribes at IHS. Tso began working for IHS in 1984, and prior to working with the Navajo Area, she spent years working in the Portland Area, which included roles such as the Portland Area Planning and Statistical Officer, Equal Employment Officer, Special Assistant to the Area Director, and as Director of the Office of Tribal and Service Unit Operations. As Director for Tribal and Service Unit Operations, she was responsible for implementing the Indian Self-Determination and Education Act, working directly with Tribes and direct service Tribes.
Currently, IHS is led by Acting Principal Deputy Director Elizabeth Fowler, who has been serving on an interim basis since the resignation of Rear Admiral Michael Weahkee on January 20, 2021. The absence of a confirmed Director impedes the ability of both the Tribes, the Administration as well as Congress to carry out a bold vision for the Indian, Tribal and Urban, or I/T/U, system for which the IHS is responsible.
NIHB passed Resolution 22-02 on February 24, 2022, calling on President Biden to nominate an IHS Director to ensure that IHS has a leader who can set forth a vision to address the health disparities that American Indian/Alaska Native (AI/AN) people face.
On March 7, 2022, the National Indian Health Board (NIHB) sent a letter to the SCIA to highlight the ambitious, necessary priorities the Tribes expect the new Director to embrace. The agency must have a permanent, competent leader who is capable and willing to advocate and act with diplomacy and tenacity, to respect Tribal nations and their voice, and to transform and reform institutional operations through innovative, effective, and sustainable systems-wide changes.
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Senator Tina Smith (D-MN)
Senator Smith introduced the Tribal Health Data Improvement and the Native Behavioral Health Access Improvement Act. Both bills are intended to elevate American Indian/Alaska Native healthcare. The Tribal Health Data bill would improve Tribal access to important public health data and information. It also reauthorizes through fiscal year (FY) 2026 the National Center for Health Statistics in the Centers for Disease Control and Prevention (CDC). The Department of Health and Human Services (HHS) must (1) establish a strategy for providing data access to Indian Tribes and Tribal epidemiology centers; and (2) make available all requested data related to health care and public health surveillance programs and activities to IHS, Tribes, Tribal organizations, and Tribal epidemiology centers.
The Native Behavioral Health bill would provide important base funding for Tribal communities to address behavioral health issues. More specifically, this bill would expand Tribal access to public health care data and public health surveillance programs. It would require HHS to establish a strategy for providing data access to Indian Tribes and Tribal epidemiology centers. In addition, the bill would make available all requested data related to health care and public health surveillance programs and activities to IHS, Tribes, Tribal organizations, and Tribal epidemiology centers.
Additionally, Smith cosponsored the Tribal Medical Supplies Stockpile Access Act. This bill would directly increase access to the Strategic National Stockpile for health programs or facilities operated by IHS, Tribes, or Tribal organizations for the purpose of stronger responses to public health emergencies. Specifically, if HHS distributes pandemic or epidemic products (e.g., drugs or medical devices) to states or other entities, HHS must also deploy such products directly to health programs or facilities operated by IHS or other Tribal entities.
Supporting NIHB's longstanding Tribal request, Smith cosponsored the Indian Programs Advance Appropriations Act. This bill would provide advance appropriations for IHS which would shield the agency from budget uncertainty due to continuing resolutions, government shutdowns, and the appropriations processes.
She also cosponsored the Truth and Healing Commission on Indian Boarding Schools Act. This bill would establish a commission to investigate and document the detrimental Indian boarding school policies and historical trauma resulting from those policies and to make recommendations, among others, for federal resources and assistance to aid in healing from that trauma.
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House Committee on Appropriations Releases Second Health Bill
On June 30, the House Committee on Appropriations held its markup of the fiscal year (FY) 2023 Labor, Health and Human Services, Education and Related Agencies (LHHS) appropriations bill. The Committee has jurisdiction over numerous programs important to American Indian/Alaska Native (AI/AN) health and public health including nearly every health-related program not covered by the Indian Health Service (IHS).
If passed, this bill would provide an overall increase of $28.5 billion, or 13 percent, above FY 2022 funding levels. HHS would receive a total of $124.2 billion, an increase of $15.6 billion above the FY 2022 enacted but $298 million below the President’s budget request.
Click here to view the key funding provisions. |
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House Appropriations Releases Interior Bill Funding the Indian Health Service
On Wednesday, June 29, 2022, the House Appropriation Committee approved the fiscal year (FY) 2023 Interior, Environment, and Related Agencies funding bill. The House Appropriations Subcommittee on Interior, Environment, and Related Agencies approved their Committee Bill Report last week and was considered by the full House Appropriations Committee this Wednesday.
The FY 2023 Interior, Environment, and Related Agencies appropriation bill would fund the Indian Health Service (IHS) at $8.1 billion. This is an increase of $1.5 billion above the FY 2022 enacted level which was an underwhelming $6.6 billion and is $1 billion below the President's FY 2023 budget request. The FY 2023 Tribal Request, however, recommends fully funding IHS at $49.8 billion according to the Tribal Budget Formulation Workgroup (TBFWG) recommendations.
In the budget request, the President proposed to fund IHS at $9.3 billion for FY 2023 in a bold 10-year plan. It would first shift IHS funding from discretionary to mandatory starting in 2023 and would automatically grow to $36.7 billion by 2032. Because it would be mandatory funding, it would be tied to the medical rate of inflation, salary growth, and population growth, and be safe from sequestration cuts and discretionary budget instability.
While robust Tribal consultation between Tribal nations, Tribal organizations, the Biden Administration, and Congress is needed to lay out a framework to shift from discretionary to mandatory funding, the National Indian Health Board (NIHB) and Tribal health advocates request advance appropriations for FY 2023 - a longstanding, critical Tribal recommendation. The House bill, unsurprisingly, does not include advance appropriations despite robust Tribal advocacy and the Administration's commitment to Tribal healthcare.
Key IHS funding provisions include:
- Indian Health Services - $5,743,044,000
- Hospitals and Health Clinics - $2,766,028,000
- Electronic Health Records/IT - $284,500,000
- Dental Health - $307,902,000
- Mental Health - $129,960,000
- Alcohol and Substance Abuse - $264,032,000
- Purchase/Referred Care - $1,097,255,000
- Indian Health Care Improvement Fund - $232,138,000
- Contract Support Costs - $969,000,000
- Payments for Tribal Leases - $111,000,000
- Indian Health Facilities - $1,306,979,000
- Sanitation Facilities Construction - $175,167,000
- Health Care Facilities Construction - $399,896,000
The Senate Appropriations Committee is expected to begin its markups in July. NIHB will continue to advocate for advance appropriations and full funding for IHS. A summary of the bill is here. The text of the draft bill is here.
For questions, please contact Aaron Payment, EdD, NIHB Director of Government Relations at apayment@nihb.org.
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THE POWER OF IDENTITY: A PATH TO TRIBAL HEALTH EQUITY
Join the National Indian Health Board (NIHB) as we take a look back at the history of NIHB and build our plans for the next 50 years. Together we will explore the topics of health equity, health policy, Tribal advances in health, and many more. The National Tribal Health Conference (NTHC) The event will be held in Washington, DC at the Hyatt Regency Capitol Hill from September 25-29, 2022. Learn more and register here.
NIHB invites Tribal leaders, health directors, policy specialists, advocates, and allies to submit Presenter Abstract Proposals for NTHC focusing on the following five content areas:
- Transformational Policy Change to Achieve Health Equity
- Beyond Health Care: A Holistic Approach to Health Equity
- Leveraging Tribal Resources for Health Equity
- Respecting Tribal Sovereignty: A Path to Accelerating Tribal Health Equity
- Honoring our Past, Preparing for our Future
Learn more and submit Presenter Abstract Proposals here.
NIHB is accepting nominations for the 2022 Outstanding Service Awards until August 23. All awards will be presented at the Annual Heroes in Health Awards Gala, taking place as part of NTHC. The Gala will be held at the National Museum of the American Indian in Washington, DC, on Tuesday, September 27, 2022. Learn more and submit Award Nomination here.
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