115A — American Bar Association House of Delegates Resolution (Adopted August 12-13, 2019)

Summary

This is American Bar Association Resolution 115A, adopted by the House of Delegates on August 12-13, 2019, with its accompanying report. The resolution urges Congress to ensure that health care delivered by the Indian Health Service (IHS) is exempt from government shutdowns and federal budget sequestrations on par with exemptions provided to the Veterans Health Administration. It also urges Congress to enact advance appropriations legislation to stabilize IHS funding. The report's introduction says the resolution urges enactment of the Indian Programs Advanced Appropriations Act (H.R. 1128 and S. 229) and the Indian Health Service Advance Appropriations Act of 2019 (H.R. 1135), or similar legislation.

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115A

AMERICAN BAR ASSOCIATION
HOUSE OF DELEGATES
ADOPTED AUGUST 12-13, 2019

RESOLUTION

RESOLVED, That the American Bar Association urges Congress to ensure that the health
care delivered by the Indian Health Service (“IHS") is exempt from government shutdowns
and federal budget sequestrations on par with the exemptions provided to the Veterans
Health Administration;

FURTHER RESOLVED, That the American Bar Association urges Congress to enact
advance appropriations legislation that would stabilize funding for IHS and provide
funding that becomes available one year or more after the year of the appropriations act
in which it is provided; and

FURTHER RESOLVED, That the American Bar Association encourages and supports
legislation that:

(1) addresses threats to the health and well-being of American Indian and Alaska
Native people who tend to live in the most geographically remote and medically
underserved parts of the United States;

(2) avoids short-term continuing resolutions to fund the IHS budget;

(3) ameliorates the harmful effects of federal budget sequestrations on IHS;

(4) contributes to the fulfillment of the United States’ historic and unique federal
trust responsibility owed to Indian tribes; and

(5) provides sufficient, consistent, and predictable funding to support the basic
health care needs of American Indian and Alaska Native people.
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REPORT

|. Introduction

This Resolution urges Congress to enact the Indian Programs Advanced Appropriations
Act (H.R. 1128 and S. 229) and the Indian Health Service Advance Appropriations Act of
2019 (H.R. 1135), or similar legislation, and in addition, legislation that would exempt the
Indian Health Service from federal budget sequestrations. The Indian Programs
Advanced Appropriations Act and the Indian Health Service Advance Appropriations Act
of 2019 would both authorize advance appropriations for the Indian Health Service (IHS).
Legislation exempting IHS from federal budget sequestrations would safeguard IHS from
funding reductions caused by automatic cuts to federal government spending.

IHS is a division within the U.S. Department of Health and Human Services that receives
an annual appropriation from Congress to provide direct medical and health services to
over 2 million American Indian and Alaska Native people in the United States. IHS
provides services directly through a network of hospitals, clinics, and health stations
operated by IHS, and also funds services provided at tribally operated health facilities.
IHS’s mission is to raise the physical, mental, social, and spiritual health of American
Indian and Alaska Native people to the highest level. IHS has the goal of assuring that
comprehensive and culturally acceptable health services are available and accessible to
American Indian and Alaska Native people.

The IHS organizational structure includes a headquarters office in Rockville, MD, and 12
area offices that work with a unique group of Indian tribes on a day-to-day basis through
a network of hospitals, clinics, and health stations. As reported in 2017, facilities directly
managed by IHS consisted of 26 hospitals, 59 health centers, and 32 health stations. IHS
employs over 15,000 individuals, which include approximately 2,400 nurses, 730
physicians, 750 pharmacists, 270 dentists, 130 physician assistants, and 130
environmental health and sanitarians. The Urban Indian Health Program comprises of 41
different programs across the country. During 2017, the IHS system had more than
39,367 hospital admissions and nearly 13.8 million outpatient medical care visits.

As a result of treaties entered into between the United States federal government and
Indian tribes, a unique government-to-government relationship exists between Indian
tribes and the federal government. Consistent with this government-to-government
relationship and statutory authority, IHS is committed to ensuring that comprehensive and
culturally appropriate health services are available and accessible to American Indian and
Alaska Native people. Over 60 percent of the IHS appropriation is administered by Indian
tribes, primarily through self-determination contracts and self-governance compacts. IHS
retains the remaining funds and delivers health services directly to Indian tribes that
choose to have IHS administer health programs. IHS also works closely with Indian tribes
as they assume a greater role in improving health care in their own communities.

Advance appropriations refer to federal funding that becomes available one year or more
after the year of the appropriation is provided. To obtain an advance appropriation for a
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federal program, legislation authorizing an advance appropriation for the program must
first be enacted by Congress. Importantly, advance appropriations allow federal programs
to avert funding gaps and avoid short-term continuing resolutions that are enacted to
prevent a funding gap from occurring until regular appropriations are completed or the
fiscal year ends.

Sequestration refers to the process of automatic and largely across-the-board spending
reductions under which budgetary resources are permanently canceled to enforce certain
budget policy goals. When sequestration occurs, all nonexempt federal programs must
be reduced by a uniform percentage. Congress may pass legislation to exempt certain
federal programs from sequestrations and special rules to govern the sequestration of
federal programs. Special rules adopted by Congress may provide that sequestrations
can only reduce funding appropriated by a certain percentage.

For several years, Indian tribes and tribal organizations have urged Congress to enact
legislation providing IHS with advance appropriations to facilitate improved planning and
provide for more efficient spending. Legislation authorizing advance appropriations for
IHS would prevent federal funding gaps and avoid uncertainties associated with receiving
funds through the enactment of short-term continuing resolutions. In addition, the
enactment of legislation exempting IHS from federal budget sequestrations and
legislation authorizing advance appropriations would provide equivalent status to IHS that
currently is afforded to the Veterans Health Administration.

ll. Provide Equivalent Status to IHS as is Afforded to the Veterans Health
Administration

The Veterans Health Administration provides direct medical care to eligible and enrolled
veterans in the United States. In 2009, Congress enacted the Veterans Health Care and
Budget Reform and Transparency Act of 2009 (Pub. L. No. 111-81) authorizing advance
appropriations for three accounts that comprise the Veterans Health Administration: (1)
Medical Services, (2) Medical Support and Compliance, and (3) Medical Facilities. The
Veterans Health Care and Budget Reform and Transparency Act of 2009 also requires
the Department of Veterans Affairs to submit a request for advance appropriations for the
Veterans Health Administration with its budget request each year. Congress first provided
advance appropriations for the three Veterans Health Administration accounts in FY 2010
and has continued to provide advance appropriations to the Veterans Health
Administration accounts in each subsequent fiscal year. Additionally, Congress has
enacted legislation that exempts programs administered by the Veterans Health
Administration from sequestrations, including the Medical Care account.

The fact that Congress has enacted and implemented advance appropriations for medical
accounts within the Veterans Health Administration provides a compelling reason for
Congress to enact legislation that would authorize advance appropriations for medical
accounts within IHS. Specifically, both the Veterans Health Administration and IHS
provide direct medical care to specific segments of the United States population as a
result of federal policy. Further, just as veterans organizations were alarmed of the impact
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of delayed funding upon the provision of health care services to veterans and the ability
of the Veterans Health Administration to properly plan and manage its resources, Indian
tribes and tribal organizations continue to have these same concerns about the IHS
system. Ultimately, the fact that Congress has authorized advance appropriations to the
Veterans Health Administration and exempted the Veterans Health Administration from
federal budget sequestrations should justify the enactment of legislation to provide
equivalent treatment to IHS.

lll. Benefits of Advance Appropriations for IHS and the Exemption of IHS from
Federal Budget Sequestrations

The enactment of the Indian Programs Advanced Appropriations Act and the Indian
Health Service Advance Appropriations Act of 2019, and separate legislation to exempt
IHS from federal sequestrations is needed for a variety of reasons, including:

(1) Fulfillment of the federal government’s trust responsibility owed to Indian tribes.
Through treaties between Indian tribes and the federal government, a trust responsibility
was established in which the federal government promised the right of Indian tribes to
govern themselves, and to enable Indian tribes to deliver essential services and provide
adequate resources to do so effectively. Although the trust responsibility requires the
federal government to provide for the health and welfare of Indian tribes, IHS remains
highly underfunded, and American Indian and Alaska Native people continue to
experience lower life expectancy and disproportionate disease rates compared with other
Americans. Fulfillment of the federal government’s historic and unique federal trust
responsibility owed to Indian tribes mandates that sufficient, consistent, and predictable
funding is available to support the basic health care needs of American Indian and Alaska
Native people.

(2) Avoiding the threat and effects of government shutdowns such as the recent
35-day government shutdown. The recent 35-day government shutdown, which took
place December 22, 2018 to January 25, 2019, destabilized tribal health care delivery
and access to health care providers within Indian Country. During this shutdown, Indian
tribes and urban Indian centers across the United States were forced to ration health care
services. Numerous facilities faced closure.? In addition, the recent government shutdown
caused doctors and medical staff to work without pay. Tribes are among the worst
impacted by shutdowns because it affects the day-to-day operation of their health clinics
and hospitals.

1 Jessica Farb, Indian Health Service: Spending Levels and Characteristics of IHS and Three Other
Federal Health Care Programs, U.S. Government Accountability Office (Dec. 10, 2018),
https://www.gao.gov/assets/700/695871.pdf (comparing funding levels between IHS, the Veterans Health
Administration, Medicare, and Medicaid. The GAO report noted that in 2016, IHS health care
expenditures per person were only $2,834, compared to $9,990 per person for federal health care
spending nationwide.)

2 Susannah Luthi, Indian Health Service Urban Programs Threatened by Government Shutdown, Modern
Healthcare (Jan. 07, 2019),
https://www.modernhealthcare.com/article/20190107/NEWS/190109933/indian-health-service-urban-
programs-threatened-by-government-shutdown.

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For the Sault Ste. Marie Tribe, the government shutdown cost about $100,000, every day,
of federal money that did not arrive to keep health clinics staffed, food pantry shelves full,
and employees paid.3 In San Jose, California four IHS facilities serving 25,000 Native
American patients per year experienced a lack in funding due to the shutdown.4 San
Diego County neighbors 18 federally recognized tribes, and Indian Health Centers in the
area provide services for thousands of tribal members.5 In Navajo Nation, a 68-year-old
woman who underwent eye surgery could not get a referral from furloughed Indian Health
Service (IHS) staff to deal with high pressure in her eye. In Minnesota, the Red Lake
Nation suspended construction of a dialysis center. A health care contractor announced
the immediate suspension of dental services, and curtailment of financial assistance
programs and ride share services, including addiction counseling.®

(3) Avoiding the constant need to enact short-term continuing resolutions to fund
the IHS budget. During virtually the entire last 20 years, short-term continuing resolutions
have been enacted to fund the IHS budget while Congress works to pass an annual
appropriations act. The constant enactment of short-term continuing resolutions to fund
IHS results in periods of budget uncertainty and prohibits IHS providers from initiating
new activities and projects intended to improve health care delivery services for American
Indian and Alaska Native people. The enactment of legislation authorizing advance
appropriations to the IHS budget would significantly mitigate the funding uncertainty and
disruption to the delivery of health care services caused by the enactment of short-term
continuing resolutions to fund the IHS budget.

(4) Addressing the harmful effects of federal budget sequestrations. In FY 2013,
the federal budget sequestration resulted in a loss of over $219 million to the IHS budget,
which translated into a reduction of primary health care and disease prevention services
for American Indian and Alaska Native people. Federal budget sequestration and the
impacts of the cancellation of budgetary resources continue to be a concern for Indian
tribes and tribal organizations. Legislation exempting IHS from federal budget
sequestrations is needed to allow IHS providers to do the best job possible in planning,
decision-making, and administering health care programs.

(5) Improve the ability of IHS providers to budget, recruit, retain, provide services,
maintain facilities, and perform necessary construction efforts. In general, IHS hospitals
and tribal health care facilities are located in the most geographically remote and

3 Mitch Smith and Julie Turkewitz, Shutdown Leaves Food, Medicine, and Pay in Doubt in Indian Country,
NY TIMES, Jan. 1, 2019, https://www.nytimes.com/2019/01/01/us/native-american-government-
shutdown.html.

4 David Louie, Federal Shutdown Creates Heath Center Crisis for Native Americans in California, ABC 7
News, Jan. 15, 2019, https://abc7news.com/politics/federal-shutdown-creates-health-center-crisis-for-
native-americans/5084968/.

5 Ebone Monet and Anica Colbert, Native American Clinics May Limit Services Due to Government
Shutdown, KPBS, Jan. 11, 2019, https://www.kpbs.org/news/2019/jan/11/native-american-clinics-may-
limit-services-due-gov/.

6 Derrick Z. Jackson, How the Government Shutdown Shredded Indian Health Services, Union of
Concerned Scientists (Feb. 8, 2019), httos://blog.ucsusa.org/derrick-jackson/how-the-government-
shutdown-shredded-indian-health-services.

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medically underserved parts of the United States. These IHS and tribal health care
providers face significant challenges recruiting and retaining qualified health
professionals, which is exacerbated by inconsistent and uncertain federal funding for the
IHS budget. The threat of inconsistent and uncertain funding for the IHS budget means
that health care providers cannot budget with certainty, recruit and retain health
professionals, and deliver health care services that American Indian and Alaska Native
people need. Advance appropriations and the exemption of IHS from federal budget
sequestrations would allow IHS and tribal health care providers to improve budgeting and
better attract and retain medical professionals to work in remote and medically
underserved areas within the United States.

IV. Supportive ABA Policy

The ABA has an extensive history of supporting comprehensive access to healthcare for
American Indians and Alaska Natives, specifically through equitable and efficient funding
streams.

In 2004, in 2004 MM 103C, the ABA called for addressing the various areas where health
care for American Indians and Alaska Natives is deficient, including through the
reauthorization of the Indian Health Care Improvement Act. The resolution specifically
supports federal policy that encourages the administration of health care to Indian and
Alaska Natives, and

“urges Congress to exercise oversight to assure that the Indian Health Service
continues to carry out its responsibilities based upon the federal policies of tribal
self-determination and self-governance.”

This resolution is a natural extension of this broader policy to support Native access to
healthcare.

In January 2019, the ABA acknowledged and condemned the devastating impact of the
December 22, 2018 to January 25, 2019 federal government shutdown, 2019 MM 10B,
particularly in the federal judiciary and the rule of law.

This resolution is also part of extensive ABA policy in support of access to health care
generally. 1994 MM 105 reaffirms support from 1990 and 1972 resolutions, calling for
access to quality health care for all Americans, regardless of income. 2009 AM 10A
extended those calls, while broadening the call to not necessarily be restricted by the
existence of a single-payor system. Notably, 2013 AM 101 calls for parity in coverage for
mental health and substance use disorder treatment services with other health benefits
coverage. 1997 AM 113 supports the provision of comprehensive health care for children
18 years of age and younger, and prenatal care for pregnant women.

The ABA has specifically recognized the importance of reliable and consistent healthcare
funding to ensure continuity and quality of care. In 2017, resolution 2017 MM 116 called
for broadening the scope of Medicare coverage from “medical necessity” to include

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reasonable and necessary prognostic tests, so as to cover items and services for the
prevention of disease, not just diagnose and treatment. 2016 MM 300 sought to relieve
administrative billing barriers against advanced practice providers as a means to increase
productive and focus on patient-centric responsibilities. 2014 MM 110 similarly calls for
recognizing outpatient observation care services in a hospital as billable under Medicare
Part A. 2007 AM 122 calls for continuity in Medicaid funding for persons newly released
from custody. 2005 AM 113B specifically highlights the shared legal obligation that the
federal, state, and territorial governments have to provide a comprehensive set of benefits
to all individuals who meet Medicaid eligibility criteria.

The ABA has additionally long taken a stance supporting Native peoples, including
upholding the federal responsibility to Natives. In 1980, the ABA adopted 1980 MM 110,
urging strict adherence to Indian treaty obligations. The report to the resolution notes:

The trust responsibility imposes on the United States an important standard of
conduct. In Seminole Nation v. United States, 316 U.S. 286 (1942), the Supreme
Court stated that the United States “has charged itself with moral obligations of the
highest responsibility and trust. Its conduct, as disclosed in the acts of those who
represent it in dealing with the Indians should therefore be judged by the most
exacting fiduciary standards.” /d. at 297. ... Under the trust responsibility to Indian
tribes, specifically recognized by Congress and the courts and secured by the
treaties, statutes, and 150 years of judicial precedent, Indian tribes should be able
to look to the future confident that the federal government will approach its
obligation to Indian tribes in a manner consistent with its duty of protection.

80M110, 2-3.

2015 AM 113, which adopts the recommendations contained in the 2014 U.S. Attorney
General’s Advisory Committee on American Indian and Alaska Native Children Exposed
to Violence report. In Recommendation 4.5, calling for periodic training in culturally
adapted trauma-informed interventions and cultural competency for the Indian Health
Service (IHS), the report notes that IHS is woefully under-resourced, noting that “IHS
continues to operate at 52 percent of need and mental health and substance abuse
services are funded at an appalling 7 percent of need.”’

The ABA has previously sought parity in funding access for tribes. In 2001, the ABA
adopted 2001 AM 105C calling on Congress to amend Title IV-E of the Social Security
Act to provide direct tribal access to federal Title IV-E foster care and adoption funding
for children under tribal court jurisdiction. This was reiterated 2013 AM 111A, which called
for the “increased use of federal Title IV-E cooperative agreements and memoranda of

7 ATTORNEY GENERAL’S ADVISORY COMMITTEE ON AMERICAN INDIAN AND ALASKA NATIVE CHILDREN EXPOSED
TO VIOLENCE, U.S. DEP’T OF JUSTICE, REPORT OF THE ADVISORY COMMITTEE ON AMERICAN INDIAN AND
ALASKA NATIVE CHILDREN EXPOSED TO VIOLENCE: ENDING VIOLENCE SO CHILDREN CAN THRIVE 122
(November 2014),

www. justice.gov/sites/default/files/defendingchildhood/pages/attachments/2015/03/23/ending violence _s
o_children_can_thrive.pdf, citing, Gone, J. P.,“Mental Health Services for Native Americans in the 21st
Century United States,” Professional Psychology: Research and Practice 35(1) (2004): 10-18.

6
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understanding between states and Tribes to enable Tribes to operate their own child
protection programs.” 2008 AM 117A urged long-term funding for tribal justice systems,
noting “the effective operation of tribal courts is essential to promote the sovereignty and
self-governance of the Indian tribes.’ In adopting the Indian Law and Order Commission
Report of 2010 in 2015 MM 111A, the ABA recognized immense deficiencies in federal
funding for tribes.

V. Conclusion

The American Bar Association strongly supports and encourages the enactment of
legislation that would bring stability and certainty to the IHS budget by changing its funding
to advance appropriations and providing an exemption from federal budget
sequestrations. This is what Congress has authorized for the medical accounts of the
Veterans Health Administration, and comparable treatment should be authorized for IHS
to promote to the highest level, the health, safety, and welfare of American Indian and
Alaska Native people in the United States.

Respectfully submitted,

Wilson Adam Schooley

Chair, Section of Civil Rights &
Social Justice

August 2019
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GENERAL INFORMATION FORM

Submitting Entity: Section of Civil Rights and Social Justice

Submitted By: Wilson A. Schooley, Chair, Section of Civil Rights and Social Justice

1.

Summary of Resolution(s). This resolution urges Congress to ensure that the health

care delivered by the Indian Health Service (HIS) is exempt from government
shutdowns and federal budget sequestrations on par with the exemptions provided
to the Veterans Health Administration, and to enact advance appropriations
legislation that would stabilize funding for IHS and provide for advance
appropriations.

Approval by Submitting Entity. The Council of the Section of Civil Rights and Social
Justice approved sponsorship of the Resolution during its Spring Meeting on April
12, 2019.

The National Native American Bar Association approved cosponsorship of this
policy on May 6, 2019.

The Commission on Homelessness and Poverty approved cosponsorship of this
policy on May 3, 2019.

Has this or a similar resolution been submitted to the House or Board previously?
No.

What existing Association policies are relevant to this Resolution and how would
they be affected by its adoption? Over several decades, the ABA has adopted
policies supporting comprehensive access to healthcare for American Indians and
Alaska Natives. the ABA called for addressing the various areas where health care
for American Indians and Alaska Natives is deficient, including through the
reauthorization of the Indian Health Care Improvement Act. (ABA Report and
Recommendation 2004M103C, available at
https://www.americanbar.org/content/dam/aba/directories/policy/2004_ my 103c.authchec
kdam.pdf) This resolution is a natural extension of this broader policy to support
Native access to healthcare. The ABA also acknowledged and condemned the
devastating impact of the December 2018 federal government shutdown upon the
federal judiciary and the rule of law. (ABA Report and Recommendation 2019M10B,
available at https:/Awww.americanbar.org/content/dam/aba/directories/policy/midyear-
2019/10b-midyear-2019.pdf.) This resolution is also part of the ABA’s long tradition of
advocating for access to health care. (See ABA Report and Recommendation
1994M105, available at
https://www.americanbar.org/content/dam/aba/directories/policy/1994 my 105.authcheck
dam.pdf, ABA Report and Recommendation 2009A10A, available at
https://www.americanbar.org/content/dam/aba/directories/policy/2009 am _10a.pdf, ABA
Report and Recommendation 1997A113, available at
https://www.americanbar.org/content/dam/aba/directories/policy/1997 am _113.authcheck

5.

6.

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dam.pdf, ABA Report and Recommendation 2013A101, available at
https://www.americanbar.org/content/dam/aba/administrative/crsj/committee/aug-13-
mental-health-disorder-coverage.authcheckdam.pdf.) Furthermore, the ABA _ has
recognized the importance of reliable and consistent healthcare funding to ensure
continuity and quality of care. (ABA Report and Recommendation 2017M116, available at
https:/Awww.americanbar.org/content/dam/aba/directories/policy/2017_hod_midyear_116.docx,
ABA Report and Recommendation 2016M300, available at
https://www.americanbar.org/content/dam/aba/administrative/crsj/committee/feb-16-
medicaid-benefits.pdf, ABA Report and Recommendation 2014M110, available at
https://www.americanbar.org/content/dam/aba/administrative/crsj/committee/feb-14-
medicare-coverage.pdf, ABA Report and Recommendation 2007A122, available at
https://www.americanbar.org/content/dam/aba/directories/policy/2007_am_ 122.authcheck
dam.pdf) Specifically, the ABA highlighted the shared legal obligation that the federal,
state, and territorial governments have to provide a comprehensive set of benefits
to all individuals who meet Medicaid eligibility criteria. (ABA Report and
Recommendation 2005A113B, available at
https://www.americanbar.org/content/dam/aba/directories/policy/2005 am 113b.a
uthcheckdam.pdf.) The ABA has additionally long taken a stance supporting Native
peoples, including upholding the federal responsibility to Natives by urging strict
adherence to Indian treaty obligations (ABA Report and Recommendation 1980M110,
available at
https://www.americanbar.org/content/dam/aba/administrative/crsj/committee/feb-80-
indian-treaty-obligations.authcheckdam.pdf.), calling on Congress to provide direct
tribal access to federal Title IV-E foster care and adoption funding for children under
tribal court jurisdiction (ABA Report and Resolution 2001A105C, available at
https://www.americanbar.org/content/dam/aba/directories/policy/2001_am_105c.authchec
kdam.pdf.), enabling Tribes to operate their own child protection programs (ABA
Report and Resolution 2013A111A, available at
https://www.americanbar.org/content/dam/aba/administrative/crsj/committee/aug-13-
indian-child-welfare-act-111A.authcheckdam.pdf.), urging long-term funding for tribal
justice systems (ABA Report and _ Resolution 2008A117A, available at
https://www.americanbar.org/content/dam/aba/directories/policy/2008 am 117a.authchec
kdam.pdf.), recognizing immense deficiencies in federal funding for tribes (ABA Report
and Resolution 2015M111A, available at
https://www.americanbar.org/content/dam/aba/administrative/crsj/committee/feb-15-make-
native-america-safer.authcheckdam.pdf.), and urging periodic training in culturally
adapted trauma-informed interventions and cultural competency for the HIS. (ABA
Report and Resolution 2015M113, available at
https://www.americanbar.org/content/dam/aba/administrative/crsj/committee/aug-15-
violence-against-children.authcheckdam.pdf. )

If this is a late report, what urgency exists which requires action at this meeting of the
House? N/A

Status of Legislation. Three bills have been introduced in the House and Senate on
this issue— the Indian Programs Advanced Appropriations Act (H.R. 1128 and S.
229) and the Indian Health Service Advance Appropriations Act of 2019 (H.R. 1135).
S. 229 was introduced on Jan. 25", 2019 and read twice and referred to the

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10.

11.

Committee on the Budget the same day. H.R. 1128 was introduced Feb. 8'", 2019
and referred to the Subcommittee on Indigenous Peoples of the United States the
same day. H.R. 1135 was introduced on Feb 8, 2019 and referred to the
Subcommittee on Indigenous Peoples of the United States on March 13, 2019.

Brief explanation regarding plans for implementation of the policy, if adopted by the
House of Delegates. The ABA will urge Congress to enact the Indian Programs
Advanced Appropriations Act (H.R. 1128 and S. 229) and the Indian Health Service
Advance Appropriations Act of 2019 (H.R. 1135), or similar legislation that
accomplishes the goals of the policy, and in addition, legislation that would exempt
the Indian Health Service from federal budget sequestrations.

Cost to the Association. (Both direct and indirect costs) Adoption of this proposed
resolution would result in only minor indirect costs associated with staff time devoted
to the policy subject matter as part of the staff members’ overall substantive
responsibilities.

Disclosure of Interest. There are no known conflicts of interest.

Referrals. By copy of this form, the Report with Recommendation will be referred to
the following entities:

Health Law Section

Commission on Law and Aging

Section of Administrative Law and Regulatory Practice
Commission on Legal Problems of the Elderly

Senior Lawyers Division

Young Lawyers Division

Law Student Division

Standing Committee on Legal Aid and Indigent Defendants
Judicial Division

Tribal Court Council

Center for Human Rights

Coalition on Racial and Ethnic Justice

Commission on Disability Rights

Commission on Hispanic Legal Rights and Responsibilities
Commission on Sexual Orientation and Gender Identity
Commission on Domestic and Sexual Violence
Commission on Racial and Ethnic Diversity in the Profession
Commission on Women in the Profession

Section of State and Local Government Law

Government and Public Sector Division

Contact Name and Address Information. (Prior to the meeting. Please include name,
address, telephone number and e-mail address)

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Mary L. Smith, ABA Secretary
17533 Maple Drive

Lansing, IL 60438-2079

Tel.: (708) 895-7909

E-mail: marysmith828@hotmail.com

Lauren Veronica van Schilfgaarde, Vice Chair
Tribal Law and Policy Institute

8235 Santa Monica Boulevard, Suite 211
West Hollywood, CA 90046

Tel.: (323) 650-5467

E-mail: lauren@tlpi.org

Gerald Brian Gardner, Co-Chair

Tribal Law & Policy Institute

8235 Santa Monica Boulevard., Suite 211
West Hollywood, CA 90046

Tel.: (323) 650-5467

Fax: 323-650-8149

E-mail: jerry@tlpi.org

Paula Shapiro, Acting Director

Section of Civil Rights and Social Justice
1050 Connecticut Avenue NW
Washington, DC 20036

Tel: (202) 662-1029

E-mail: Paula.Shapiro@americanbar.org

12. Contact Name and Address Information. (Who will present the report to the House?
Please include name, address, telephone number, cell phone number and e-mail
address.)

Estelle H. Rogers, CRSJ Section Delegate
111 Marigold Lane

Forestville, CA 95436-9321

Tel.: (202) 337-3332

Email: 1estellerogers@gmail.com

Mark I. Schickman, CRSJ Section Delegate
Freeland Cooper & Foreman LLP

150 Spear Street, Suite 1800

San Francisco, CA

Tel.: (415) 541-0200

Email: schickman@freelandlaw.com

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EXECUTIVE SUMMARY

1. Summary of the Resolution
This resolution urges Congress to ensure that the health care delivered by the
Indian Health Service (HIS) is exempt from government shutdowns and federal
budget sequestrations on par with the exemptions provided to the Veterans Health
Administration, and to enact advance appropriations legislation that would stabilize
funding for IHS and provide for advance appropriations.

2. Summary of the Issue that the Resolution Addresses
IHS is a division within the U.S. DHHS that receives an annual appropriation from
Congress to provide direct medical and health services to over 2 million American
Indian and Alaska Native people in the United States. IHS provides services
directly through a network of hospitals, clinics, and health stations operated by
IHS, and funds services provided at tribally operated health facilities.

This resolution seeks advance appropriations to allow federal programs to avert
funding gaps and avoid short-term continuing resolutions that are enacted to
prevent a funding gap from occurring until regular appropriations are completed or
the fiscal year ends. When sequestration occurs, all nonexempt federal programs
must be reduced by a uniform percentage. Congress may pass legislation to
exempt certain federal programs from sequestrations and special rules to govern
the sequestration of federal programs.

For several years, Indian tribes and tribal organizations have urged Congress to
enact legislation providing IHS with advance appropriations to facilitate improved
planning and provide for more efficient spending. Legislation authorizing advance
appropriations for IHS would prevent federal funding gaps and avoid uncertainties
associated with receiving funds through the enactment of short-term continuing
resolutions. In addition, the enactment of legislation exempting IHS from federal
budget sequestrations and legislation authorizing advance appropriations would
provide equivalent status to IHS that currently is afforded to the Veterans Health
Administration.

3. Please Explain How the Proposed Policy Position Will Address the Issue
This policy supports and encourages the enactment of legislation that would bring
stability and certainty to the IHS budget by changing its funding to advance
appropriations and providing an exemption from federal budget sequestrations. By
adopting this Resolution, the ABA can promote the health, safety, and welfare of
American Indian and Alaska Native people in the United States to the highest level.

4, Summary of Minority Views or Opposition Internal and/or External to the ABA
Which Have Been Identified
No minority views or opposition have been identified.

12

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