Bad River Health and Wellness Center — Support for H.R. 5549, the Indian Health Service Advance Appropriations Act

Summary

A letter to Chair Teresa Leger Fernandez and Acting Ranking Member Jay Obernolte of the Subcommittee for Indigenous Peoples of the United States, Committee on Natural Resources, with the subject line Support for H.R. 5549, the Indian Health Service Advance Appropriations Act. The writer expresses support for the bill and states that the list of bi-partisan cosponsors has grown to fifteen. The letter argues that advance appropriations are a budget-neutral and flexible solution to funding disruptions and that the bill includes all the accounts for the Indian Health Service. It closes with the name Robert L. Houle, Assistant Clinic Administrator, Bad River Health and Wellness Center, Bad River Band of Lake Superior Chippewa.

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

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


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

Dear Chair Fernandez and Acting Ranking Member Obernolte:

I write to express support for H.R. 5549, the Indian Health Service Advance Appropriations Act.
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. [I/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 Native 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.

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 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 Native
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 Native people; and a promise of certainty
and security for Native communities and our most vulnerable populations. As Congress works to restore
the promises made, all options must be on the table. Native lives cannot wait.

https://www.dol.gov/agencies/eta/dinap/council

Sincerely,

Robert L. Houle
Robert L. Houle
Assistant Clinic Administrator
Privacy & HIPAA Security Officer
& Secretary of NAETC (Native American Education & Training Council

Bad River Health and Wellness Center
Bad River Band of Lake Superior Chippewa
53585 Nokomis Rd.
Ashland, WI 54806
715-682-7133 x4040


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