Northwest Portland Area Indian Health Board Letter in Support of H.R. 5549 — July 28, 2022

Summary

A letter dated July 28, 2022 from the Northwest Portland Area Indian Health Board (NPAIHB) to the Honorable Teresa Leger Fernandez and the Honorable Jay Obernolte of the Subcommittee for Indigenous Peoples of the United States, Committee on Natural Resources, expresses support for H.R. 5549, the Indian Health Service Advance Appropriations Act. It says NPAIHB was established in 1972 and advocates on behalf of the 43 federally-recognized Indian Tribes in Idaho, Oregon, and Washington. The letter says the list of bi-partisan cosponsors for H.R. 5549 has grown to fifteen. It says advance appropriations for the Indian Health Service are a budget-neutral and flexible solution to the outsized impacts of funding disruptions.

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                                 July 28, 2022

The Honorable Teresa Leger Fernandez              The Honorable Jay Obernolte
Chair                                             Acting Ranking Member
Subcommittee for Indigenous Peoples of            Subcommittee for Indigenous Peoples of
 the United States                                 the United States
Committee on Natural Resources                    Committee on Natural Resources
U.S. House of Representatives                     U.S. House of Representatives
1324 Longworth House Office Building              1329 Longworth House Office Building
Washington, DC 20515                              Washington, DC 20515


RE: Support for H.R. 5549, the Indian Health Service Advance
Appropriations Act

Dear Chair Fernandez and Acting Ranking Member Obernolte:

On behalf of the Northwest Portland Area Indian Health Board, write to express
support for H.R. 5549, the Indian Health Service Advance Appropriations Act.
NPAIHB was established in 1972 and is a tribal organization under the Indian Self-
Determination and Education Assistance Act (ISDEAA), P.L. 93-638, that advocates
on behalf of the 43 federally-recognized Indian Tribes in Idaho, Oregon, and
Washington (Portland Area Tribes) on specific health care issues. The Board’s
mission is to eliminate health disparities and improve the quality of life of American
Indians and Alaska Natives (AI/AN) by supporting Portland Area Tribes in the
delivery of culturally appropriate, high quality health care. “Wellness for the seventh
generation” is the Board’s vision.

Introduced by the late Representative Don Young and originally co-sponsored by
Representatives McCollum, Kilmer, Kind, Mullin, Cole, Johnson, and Strickland,
the list of bi-partisan cosponsors for H.R. 5549 has grown to fifteen. We urge
Congress to pass this bipartisan policy solution to end the undue suffering of our
people and unnecessary drain on taxpayer resources.

Advance appropriations for the Indian Health Service (IHS) are a bi-partisan and bi-
cameral policy initiative that increases tribal and federal government efficiency,
reduces federal taxpayer waste, and, most importantly, saves American
Indian/Alaska Native (AI/AN) lives by providing more effective funding for health
care service in Indian Country. Since advance appropriations are merely advance
agreements to provide funding at a later date, they are a budget-neutral and flexible
solution to the outsized impacts of funding disruptions on Indian Country, allowing
Congress to respond to changing real-world circumstances and challenges. The
result is continuity of services that reduce bureaucratic inefficiencies and
uncertainty for IHS and for Tribal Nations.
Re: Support for H.R. 5549, the Indian Health Service Advance Appropriations Act
July 28, 2022
Page 2 of 3

The Biden-Harris Administration supports advance appropriations and mandatory funding for
IHS–a historic shift in the paradigm of Nation-to-Nation relations that seeks to restore the
promises made between our ancestors and the United States. Advance appropriations and
mandatory funding are not mutually exclusive requests. However, once IHS obligations are
provided through mandatory direct appropriations, there is no need for advance appropriations
through the annual regular appropriations process. Until such time that mandatory appropriations
are provided, advance appropriations are a fiscally responsible solution to the outsized impacts of
disruptions and uncertainty in funding on the Indian health care system.

H.R. 5549 is an improvement on the exception for IHS accounts provided in the FY 2022 Budget
Resolution because it includes all of the accounts for the Indian Health Service and not just
certain accounts. This is an important improvement because of the nature of inherently federal
functions. Advance appropriations are not about more money in a single accounting period, they
are about advance agreements by Congress that provide certainty and continuity of services,
promote efficiencies, and reduce taxpayer waste on costly duplicative tribal and federal
budgetary functions. If only certain funded accounts are provided continuity of services while
necessary and inherently federal IHS functions remain subject to the stops and starts of the
annual appropriations process, then Congress is not utilizing the policy of advance
appropriations to maximize its best fiscal features.

The coronavirus pandemic is not over, and funding certainty and stability are critical to saving
AI/AN lives as we continue to combat the ongoing effects of COVID-19. The total number of
Coronavirus cases per week reported by IHS has been on the rise since April 2022, and experts
believe the actual infection numbers for the United States in the first week of July were about
seven times higher than the number of reported cases. Further, the seasonal cycle is a consistent
feature of respiratory viral infections, lending to the widely-held prediction that the virus will
exhibit some form of seasonality. This means that advance appropriations for IHS will provide
funding certainty and continuity of services for the fall and winter months when surges in
patients’ needs due to respiratory illness and disruptions in federal funding are most probable.
Simply, advance appropriations will provide increased efficiency during times of increased need.

Advance appropriations for IHS are a simple promise: a promise that the United States honors
and upholds its treaty and trust obligations; a promise that Congress will enact solutions that
cease the generational trauma and undue and unnecessary suffering of AI/AN people; and a
promise of certainty and security for AI/AN communities and our most vulnerable populations.
As Congress works to restore the promises made, all options must be on the table. AI/AN lives
cannot wait.

If you have any questions about our request, please feel free to contact Elizabeth J. Coronado,
Senior Policy Advisor at ecoronado@npaihb.org or (559) 289-9964. Thank you for considering
our views on H.R. 5549.


       Sincerely,
Re: Support for H.R. 5549, the Indian Health Service Advance Appropriations Act
July 28, 2022
Page 3 of 3




       Nickolaus D. Lewis
       Chair, Northwest Portland Area Indian Health Board
       Secretary, Lummi Indian Business Council


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