Joint Letter to Congress for Indian Health Care — The Honorable Nancy Pelosi, The Honorable Kevin McCarthy

Summary

A joint letter to Congress for Indian health care, addressed to Nancy Pelosi, Speaker of the House, and Kevin McCarthy, Minority Leader, with the subject line Indian Health Care Funding and Advance Appropriations. On behalf of the undersigned Tribal nations, Tribal and national Indian organizations, and friends of Indian health, it requests Advance Appropriations and no less than the House-passed level of $8.114 billion for the Indian Health Service (IHS) in the final Appropriations bill for FY 2022. The letter states that the Indian health system is underfunded by nearly 50% of appropriate levels and that Continuing Resolutions or government shutdowns disrupt health care service delivery. It closes with lists of signatory Tribal nations, organizations and friends of Indian health.

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JOINT LETTER TO CONGRESS FOR INDIAN HEALTH CARE

The Honorable Nancy Pelosi The Honorable Kevin McCarthy
Speaker of the House Minority Leader

House of Representatives House of Representatives

1236 Longworth House Office Building 2468 Rayburn House Office Building
Washington, DC 20515 Washington, DC 20515

Re: Indian Health Care Funding and Advance Appropriations
Dear Speaker Pelosi and Minority Leader McCarthy:

On behalf of the undersigned Tribal nations, Tribal and national Indian organizations, and friends
of Indian health, we write to respectfully request that you support and include Advance
Appropriations and no less than the House-passed level of $8.114 billion for the Indian Health
Service (IHS) in the final Appropriations bill for FY 2022.

We call upon Congress to honor the United States’ trust responsibility and treaty obligations to
Tribal nations by securing these requests to improve the health care status of American Indians
and Alaska Native people.! Tribal nations exchanged millions of acres of land for the agreements
and promises in the treaties between our nations, including the obligation for the provision of
comprehensive health care from the United States.

Accordingly, these federal responsibilities are carried out, in part, by the IHS, within the
Department of Health and Human Services. This agency provides both direct care and resources
for the delivery of health care services to American Indian and Alaska Native people.* The IHS
and the Indian health care delivery system are unique in this regard.

American Indian and Alaska Native people often face the most significant health disparities among
all populations in the United States. The rates of diabetes, suicides, behavioral health challenges,

' Congress declared the fulfillment of the trust responsibility and treaty obligations to achieve the highest health care
levels for American Indians and Alaska Natives and to provide the requisite resources to be the policy of this Nation
in the Indian Health Care Improvement Act. 25 U.S.C. §1602.

? Although the federal trust responsibility and treaty obligation extends throughout the federal government, the IHS
is the primary agency which carries out these responsibilities. The IHS provides health care services either directly
to American Indian and Alaska Native people, or through contracts or compacts with Tribal nations which, in turn,
provide the services. The IHS may also enter contracts with urban Indian organizations to provide health care
services to American Indian and Alaska Native people in certain urban locations.

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COVID-19 infections, hospitalizations, and deaths are higher than most other populations. Yet,
the Indian health system is underfunded by nearly 50% of appropriate levels to address these health
care disparities.

Strategic investments from the COVID-19 relief funding packages such as the American Rescue
Plan Act, have been welcomed. However, the underlying conditions which contributed to the tragic
COVID-19 outcomes remain unaddressed. These conditions include, for example, the lack of
adequate health care facilities, specialty care facilities, available workforce, and consistent and
recurring funding for prevention and treatment services.

This chronic underfunding significantly limits the availability and accessibility of health care
services for our communities. It also leaves the Indian health care delivery system particularly
vulnerable to the instability of the federal funding process when Continuing Resolutions or
government shutdowns occur.

Each day without full funding, with only temporary or no funding from the Continuing Resolutions
or government shutdowns, is a step backward for Indian health care delivery systems. Health care
service delivery, administrative functions, and other operations are significantly impeded, delayed,
or disrupted during periods of Continuing Resolutions or government shutdowns to the detriment
of the American Indian and Alaska Native patients.

Congress can change that. The United States and Tribal nations share a government-to-government
relationship and a mutual resolve to improve the health of our communities. Securing the House-
passed levels of funding and Advance Appropriations will provide the initial step forward to
funding stability for the Indian health care delivery system.

We urge Congress to take this necessary step and stand ready to work with you in improving the
lives of American Indian and Alaska Native people. Thank you for your consideration in this
matter.

Tribal Nations

Assiniboine Sioux Tribes of the Fort Peck Reservation, Chairman Floyd Azure
Cherokee Nation, Principal Chief Chuck Hoskin, Jr.

Citizen Potawatomi Nation

Coeur d’ Alene Tribe

Confederated Tribes of the Chehalis Reservation

Confederated Tribes of the Colville Reservation

Kashia Band of Pomo Indians of the Stewarts Point Rancheria, Chairman Reno Keoni Franklin
Kaw Nation

Keweenaw Bay Indian Community

Fort McDermitt Paiute and Shoshone Tribes of the Fort McDermitt Indian Reservation
Mississippi Band of Choctaw Indians, Chief Cyrus Ben

Muscogee (Creek) Nation, Principal Chief David Hill

Northern Arapaho Tribe of the Wind River Reservation

Northwestern Band of the Shoshone Nation

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Oglala Sioux Tribe

Omaha Tribe of Nebraska

Oneida Nation of Wisconsin

Prairie Band Potawatomi Nation

Puyallup Tribe of Indians

Red Cliff Band of Lake Superior Chippewa
Rosebud Sioux Tribe

Santee Sioux Tribe of Nebraska

Sault Ste. Marie Tribe of Chippewa Indians, Chairperson Dr. Aaron Payment
Sisseton-Wahpeton Oyate

Squaxin Island Tribe, Chairman Kristopher Peters
Swinomish Indian Tribal Community

Tulalip Tribes

Walker River Paiute Tribe

Yankton Sioux Tribe

Organizations

Affiliated Tribes of Northwest Indians

AI/AN Health Partners

Alaska Native Health Board

American Academy of Pediatrics

American Indian Health Service of Chicago
American Indian Health & Services, Inc.

Bristol Bay Area Health Corporation

Butte Native Wellness Center

Council of Athabascan Tribal Governments
Coalition of Large Tribes

First Nations Community Health Source

Friendship House Association of American Indians
Great Plains Tribal Chairmen’s Association, Inc.
Great Plains Tribal Chairmen’s Health Board

Indian Family Health Clinic of Great Falls, Inc.
Indian Health Center of Santa Clara Valley

Kansas City Indian Center

National American Indian Housing Council

National Center for American Indian Enterprise Development
National Congress of American Indians

National Council of Urban Indian Health

National Indian Child Welfare Association

National Indian Gaming Association

National Indian Health Board

Native American Boarding School Healing Coalition
Native American Finance Officers Association
Native American Rehabilitation Association of the Northwest, Inc.
Native Directors, Inc.

Native Women’s Health Care

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Northwest Portland Area Indian Health Board

Oklahoma City Indian Clinic, CEO Robyn Sunday-Allen
Riverside-San Bernardino County Indian Health, Inc.

Rocky Mountain Tribal Leaders Council

Self-Governance Communication & Education Tribal Consortium
Southern Plains Tribal Health Board

Sault Tribe Health Division

United American Indian Involvement, Inc.

United South & Eastern Tribes Sovereignty Protection Fund
Urban Inter-Tribal Center of Texas

Winnebago Comprehensive Healthcare System

Friends of Indian Health

Deborah Parker, Tulalip Tribes

Walter Lamar, Lamar Associates LLC.

Wendy Helgemo, Big Fire Law & Policy Group LLP.

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