(IHS Appropriations) The National Indian Health Board is committed to ensuring that funding for the Indian Health Service and other agencies affecting health care and public health in Indian Country fully honors the trust responsibility for health.. The federal promise to provide Indian health services was made long ago. The United States made this promise in a series of treaties with Tribes, exchanging compensation and benefits for Tribal land and peace. The Snyder Act of 1921 (25 USC 13) legislatively affirmed this trust responsibility. To facilitate upholding its responsibility, the federal government created the Indian Health Service (IHS) and tasked the agency with providing health services to American Indians and Alaska Natives (AI/ANs). Since its creation in 1955, IHS has worked to fulfill the federal promise to provide health care to Native people.
Additionally, the federal government provides state and local government with large sums of money to support public health infrastructure. But those funds largely do not reach Indian Country. Much of the federal funding going out from the Department of Health and Human Services is in the form of competitive grants. This process just does not work for Tribal nations which are often small, under staffed and under resourced and located in extremely rural and remote areas. Competitive grant opportunities do not honor the trust responsibility to Tribal nations.
In passing the Affordable Care Act, Congress also reauthorized and made permanent the Indian Health Care Improvement Act (IHCIA). This reaffirmed the duty of the federal government to American Indians and Alaska Natives, declaring that “it is the policy of this Nation, in fulfillment of its special trust responsibilities and legal obligations to Indians — to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.” For American Indians and Alaska Natives (AI/ANs), the federal budget is not just a fiscal document, but also a moral and ethical commitment. The budget request for Indian health care services reflects the extent to which the United States honors its promises of justice, health, and prosperity to Indian people. Despite some funding increases over the last several years, IHS is still far below total need, and our people continue to experience some of the worst health discrepancies in the country.
In 2023, an executive order was issued on Reforming Federal Funding and Support for Tribal Nations To Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination (EO 14112). This historic document clearly acknowledges the “right of Tribal Nations to self-determination, and that Federal support for Tribal self-determination has been the most effective policy for the economic growth of Tribal Nations and the economic well-being of Tribal citizens.” The Executive Branch must continue the work of EO 14112 to identify new sources of funding for Tribal nations and expand self-governance across the government. EO 14112 clearly acknowledges the lack of funding resources in Indian country, and encourages the federal government to creatively embrace new types of funding, or expansion of self-governance programs to ensure Tribal nations are given the financial support that they need and that was promised to them.
After more than a decade of tireless advocacy by Tribes, Tribal organizations, and Champions for Indian Country, on Friday, December 23, 2022, Congress enacted a Fiscal Year (FY) 2023 omnibus spending package, including FY 2024 advance appropriations for the Indian Health Service (IHS). Prior to this change, IHS was the only federal healthcare provider without basic certainty of funding from one year to the next. Currently, IHS advance appropriations is authorized through FY 2026 (P.L. 118-5).
This enactment marks a historic paradigm shift in the nation-to-nation relationship between Tribal nations and the United States. With advance appropriations, American Indians and Alaska Natives will no longer be uniquely at risk of death or serious harm caused by delays in the annual appropriations process. However, the inclusion of advance appropriations each year is not guaranteed and does not apply to all IHS budget accounts NIHB will continue to advocate for permanent Advance appropriations for the whole IHS budget.
The treaty and trust obligations of the United States to provide for Indian health care are duties that should be mandatory direct appropriations; but until such time, advance appropriations are an interim step that will save lives.
A Special Thank you on Advanced Appropriations
This success would not have been possible without all the advocacy from Tribes, Tribal organizations, and Urban Indian organizations. We would like to also provide special thanks to Leader Schumer, Speaker Pelosi, and the Biden-Harris administration for championing this historic change, as well as House and Senate appropriators, the Senate Committee on Indian Affairs, the House Committee on Natural Resources, the House Native American Caucus, and all of Indian Country’s champions throughout Congress. Finally, we would like to thank the Office of Management and Budget Director Shalanda Young, Department of Health and Human Services (HHS) Secretary Becerra, IHS Director Roselyn Tso, and all the OMB and HHS staff who worked tirelessly to realize this moment. Together, we made history.
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President Trump’s recent Executive Orders on federal funding could have serious implications for Tribal health. NIHB is actively advocating for Tribal Nations and providing key updates—click to learn more and access resources.
