Advance Appropriations for the Indian Health Service
Summary
Advocacy fact sheet titled Advance Appropriations for the Indian Health Service, with a timeline and a list of bills starting in 2013. It defines advance appropriations as funding that becomes available one year or more after the year the appropriations act is passed, and says lapses in federal funding put lives at risk, citing the 2019 government shutdown when several Urban Indian Organizations reduced services or closed. The timeline lists tribal and organizational resolutions in support, a September 25, 2019 House Natural Resources Subcommittee hearing, and an October 11, 2021 Senate Appropriations Committee action that included an additional $6.58 billion in advance appropriations for FY 2023. The text is partly garbled where letters overlap; the author is not identified.
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“Advance Appropriations for the Indian Health Service.”
Original at docs.house.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/hhrg-117-ii24-wstate-rosettem-20220728-sd022-b822b9037c42-04a57c60ce/
, SHA-256 b822b9037c42c7b46c865ba40db205637397f6ab5239404047057563e8809d30.Full text
ADVANCE APPROPRIATIONS FOR
THE INDIAN HEALTH SERVICE
What is Advance Appropriations?
Advance appropriations is funding that becomes available one year or more after the year for which the appropriations act
is passed. Advance appropriations will stabilize Indian Health Service (IHS) funding and allow for long-term planning by
insulating Indian health care providers from government shutdowns and continuing resolutions.
Why is it needed?
Lapses in federal funding puts lives at risk. During the 2019 government shutdown, several Urban Indian
Organizations (UIOs) had to reduce services or close their doors entirely, forcing them to leave their patients
without adequate care. One UIO suffered 12 opioid overdoses, 10 of which were fatal. Advance appropriations is
critical to provide certainty to the IHS system and ensure unrelated budget disagreements do not risk lives.
Advocacy
July
July30,
30,2020
2020
} In 2013, theThe United
The Honorable South
HonorableRichardRichardShelby and Eastern The
Shelby Tribes,
TheHonorable
HonorableInc. passed
Patrick
Patrick Leahy a resolution in support of advance appropriations for IHS.
Leahy
Chair,
Chair,Appropriations
AppropriationsCommittee Committee Ranking
RankingMember,
Member,Appropriations
AppropriationsCommittee
Committee
} In 2014, theU.S. Inter-Tribal Council of the U.S.
U.S.Senate
Senate
FiveSenateCivilized Tribes passed
U.S.Senate
Resolution No. 14-05 requesting advance
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} In 2014, theThe National
Honorable Nita
The Honorable Nita Lowey
Indian
Lowey Health Board The (NIHB) passed
The Honorable KayGranger
Honorable Kay Granger
Resolution 14-03 to support advance appropriations for IHS.
} In 2019, theChair, Appropriations
National
Chair,
U.S.
U.S.House
Appropriations Congress
HouseofofRepresentatives
Committee
Representatives
Committee of American Ranking
RankingMember,
U.S.House
U.S.
Member,Appropriations
Indians (NCAI)
Appropriations
HouseofofRepresentatives
Representatives
Committee
Committee Resolution 19-001 to support advance appropriations
passed
H-307
H-307U.S.
for the Bureau Washington,
ofCapitol
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Building H-307
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U.S.Capitol
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Building
Washington,DC DC2051520515 Washington,
Washington,DC DC20515
20515
} In 2019, the American Bar Association passed a resolution urging Congress to enact advance appropriations legislation
Re:
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Dear Chair Shelby, Chair Lowey,
Lowey,Ranking Member Leahy,
Leahy,and andRanking Member
MemberGranger:
} On January
Dear Chair17, 2019,
Shelby, Chair NCUIH sent
Ranking a
Member letter to the
Ranking Vice Chairman of the Senate Committee on Indian Affairs, Tom Udall, in
Granger:
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support On of IHS advance
behalf
American
the undersigned appropriations
national organizations legislation
collectively serving all 574 sovereign federally-recognized
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urge you to ensure
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“I/T/U”)
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joint letters fortoCOVID-19
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PAGE1 1ofof2 2
PAGE
Congressional & Federal Support
} In 2014, the Senate Committee on Indian Affairs held a hearing on advance appropriation bill Indian Health Service
Advance Appropriations Act of 2013 (S. 1570).
} In 2018, the U.S. Commission on Civil Rights released its report, Broken Promises: Continuing Federal Funding Shortfall
for Native Americans, which included “Increased, non-discretionary, and advance appropriations for IHS to bring it to
parity with other federal health programs, such as the Veterans Health Administration, including for facilities and urban
Indian health” as a key recommendation.
} On September 25, 2019, the House Natural Resources Subcommittee for Indigenous Peoples of the United States held
a hearing on advance appropriations bills, Indian Programs Advanced Appropriations Act (H.R. 1128) and Indian Health
Service Advance Appropriations Act of 2019 (H.R. 1135).
o Former IHS Principal Deputy Director, Rear Admiral Michael Weahkee, reaffirmed Indian Country’s repeated
request for advance appropriations, “Through the IHS’s robust annual Tribal Budget Consultation process, Tribal
and Urban Indian Organization leaders have repeatedly and strongly recommended advance appropriations for
the IHS as an essential means for ensuring continued access to critical health care services. The Department
continues to hear directly from tribes advocating support for legislative language that would provide the
authority of advance appropriations for the IHS. The issues that tribes have identified present real challenges in
Indian Country and we are eager to work with Congress on a variety of solutions.”
} On October 11, 2021, for the first time ever, the Senate Appropriations Committee included an additional $6.58 billion in
advance appropriations to IHS for FY 2023 in its FY 2022 Interior, Environment, and Related Agencies bill.
} On January 12, 2022, the Native American Caucus sent a letter to House Appropriations Committee Chair DeLauro and
Ranking Member Granger requesting that advance appropriations for IHS for FY 2023 be included in the final FY 2022
appropriations bill.
} On April 26, 2022, a bipartisan group of 28 Representatives requested up to $949.9 million for urban Indian health in FY
2023 and advance appropriations for IHS until such time that authorizers move IHS to mandatory spending.
} On May 27, 2022, 12 Senators requested up to $949.9 million for urban Indian health in FY 2023 and advanced
appropriations for IHS until such time that authorizers move IHS to mandatory spending.
} On June 3, 2022, the Native American Caucus sent a letter to House Appropriations Committee Chair DeLauro and
Ranking Member Granger requesting that while the process of shifting IHS to mandatory appropriations is underway,
Legislation
Legislation on this effort has been introduced in 11 bills over the years starting in 2013:
} 10/2013 - Indian Health Service Advance Appropriations Act of 2013 (H.R. 3229/S. 1570)
o Sponsor: Rep. Don Young/Sen. Lisa Murkowski
} 1/2015 - Indian Health Service Advance Appropriations Act of 2015 (H.R. 395)
o Sponsor: Rep. Don Young
} 1/2017 - Indian Health Service Advance Appropriations Act of 2017 (H.R. 235)
o Sponsor: Rep. Don Young
} 2/2019 - Indian Programs Advanced Appropriations Act (H.R. 1128/S. 229)
o Sponsor: Rep. Betty McCollum/Sen. Tom Udall
} 2/2019 - Indian Health Service Advance Appropriations Act of 2019 (H.R. 1135/S. 2541)
o Sponsor: Rep. Don Young/Sen. Lisa Murkowski
} 10/2021 - Indian Health Service Advance Appropriations Act (H.R. 5549)
o Sponsor: Rep. Don Young
} 10/2021 - Indian Programs Advance Appropriations Act of 2021 (H.R. 5567/S. 2985)
o Sponsor: Rep. Betty McCollum/Sen. Ben Ray Lujan
TIMELINE:
ADVANCE APPROPRIATIONS FOR THE INDIAN HEALTH SERVICE
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