The National Indian Health Board is a dedicated advocate in Congress on behalf of all Tribal Governments and American Indians/Alaska Natives. Each weekly issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis, and action items. To view all of our legislative resources, please visit www.nihb.org/legislative/washington_report.php.
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In This Week's Washington Report
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House Appropriations Releases Interior Bill Funding the Indian Health Service
On Wednesday, June 29, 2022, the House Appropriation Committee approved the fiscal year (FY) 2023 Interior, Environment, and Related Agencies funding bill. The House Appropriations Subcommittee on Interior, Environment, and Related Agencies approved their Committee Bill Report last week and was considered by the full House Appropriations Committee this Wednesday.
The FY 2023 Interior, Environment, and Related Agencies appropriation bill would fund the Indian Health Service (IHS) at $8.1 billion. This is an increase of $1.5 billion above FY 2022 enacted level which was an underwhelming $6.6 billion and is $1 billion below the President's FY 2023 budget request. The FY 2023 Tribal Request, however, recommends fully funding the Indian Health Service at $49.8 billion according to the Tribal Budget Formulation Workgroup (TBFWG) recommendations.
In his budget request, the President proposed to fund the Indian Health Service at $9.3 billion for FY 2023 in a bold 10-year plan. It would first shift the IHS funding from discretionary to mandatory starting in 2023 and would automatically grow to $36.7 billion by 2032. Because it would be mandatory funding, it would be tied to the medical rate of inflation, salary growth, and population growth, and be safe from sequestration cuts and discretionary budget instability.
While robust Tribal consultation between Tribal nations, Tribal organizations, the Biden Administration, and Congress is needed to lay out a framework to shift from discretionary to mandatory funding, the National Indian Health Board and Tribal health advocates request advance appropriations for FY 2023 - a longstanding, critical Tribal recommendation. The House bill, unsurprisingly, does not include advance appropriations despite robust Tribal advocacy and the Administration's commitment to Tribal healthcare.
Key IHS funding provisions include:
- Indian Health Services - $5,743,044,000
- Hospitals and Health Clinics - $2,766,028,00
- Electronic Health Records/IT - $284,500,000
- Dental Health - $307,902,000
- Mental Health - $129,960,000
- Alcohol and Substance Abuse - $264,032,000
- Purchase / Referred Care - $1,097,255,000
- Indian Health Care Improvement Fund - $232,138,000
- Contract Support Costs - $969,000,000
- Payments for Tribal Leases - $111,000,000
- Indian Health Facilities - $1,306,979,000
- Sanitation Facilities Construction - $175,167,000
- Health Care Facilities Construction - $399,896,000
The Senate Appropriations Committee is expected to begin their markups in July. NIHB will continue to advocate for advance appropriations and full funding for the Indian Health Service. A summary of the bill is here. The text of the draft bill is here.
For questions, please contact NIHB Director of Government Relations Aaron Payment, EdD at [email protected].
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Representative Rashida Tlaib (D-MI-13)
Serving as the House's third poorest district in the nation, Representative Tlaib represents Detroit and its surrounding metropolitan areas. Known as the "squad" that was elected in 2018, Representative Tlaib, along with Representative Alexandria Ocasio-Cortez (D-NY), Representative Ayanna Pressley (D-MA), and Rep. Ilhan Omar (D-MN) are highly progressive members who push for economic reform, high taxes on corporations, social justice reform, and equitable climate change mitigation.
Tribal Healthcare Legislation
Tlaib cosponsored the Comprehensive Addiction Resources Emergency Act (CARE) which provides resources for substance use recovery. Specifically, it would provide emergency assistance to Tribal nations and other jurisdictions affected by substance use disorder, including the use of opioids and stimulants. It would also make financial assistance available to Tribal nations to provide cost-efficient delivery systems for those with substance use disorder and their families.
Additionally, Tlaib cosponsored Truth and Healing Commission on Indian Boarding School Policies Act. This bill would establish a commission to investigate and document the detrimental Indian boarding school policies and historical trauma resulting from those policies and to make recommendations, among others, for federal resources and assistance to aid in healing from that trauma. In the House, the bill received a hearing and was marked up. In the Senate, the bill received a hearing.
Cosponsoring an act that seeks to codify Tribal consultation, Tlaib supports the Requirements, Expectations, and Standard Procedures for Effective Consultation with Tribes Act (RESPECT). The act seeks to establish and support a process through which Tribes and the federal government engage in meaningful consultation, strengthen the government-to-government relationship, and establish minimum standard procedures to ensure these goals are met. Among these procedures is the authority for Tribes to engage in litigation with the federal government when dissatisfied with the consultation process and outcomes.
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NIHB and NCAI Push for
Indian Health Care Funding and Advance Appropriations
The National Indian Health Board and the National Congress of American Indians joined forces to elevate Tribal leader voices to Capitol Hill on securing Advance Appropriations for the Indian Health Service (IHS). This action alert was for the House Appropriations Committee: we asked the committee to support and include IHS advance appropriations in the current appropriations bill. Advance appropriations would help shield IHS and Tribal health systems from the harmful impacts of continuing resolutions and government shutdowns. Support and passage of advance appropriations in the next appropriations cycle would begin the necessary process for establishing budget certainty and help improve the health care delivery system for Tribal nations and their citizens. It is a meaningful step in fulfilling the United States trust responsibility and treaty obligations to Tribal nations for Indian health care.
Although the House did not secure advance appropriations in their appropriation bill (see above), it is still recommended that Tribal leaders call, e-mail, and send letters to Members of Congress on the Senate Committee on Appropriations and Senate Subcommittee on Interior, Environment, and Related Agencies, and representatives from their state or district. NIHB and NCAI have prepared scripts and templates that can be downloaded:
For questions, please contact Aaron Payment, EdD, Director of Government Relations at [email protected].
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Join the National Indian Health Board (NIHB) as we take a look back at the history of NIHB and build our plans for the next 50 years. Together we will explore the topics of health equity, health policy, Tribal advances in health, and many more. The National Tribal Health Conference (NTHC) serves as a forum to discuss policy and political work in the arenas of Tribal health care, public, behavioral, and environmental health. Tribal leaders, Tribal health directors, administrators, policy analysts, advocates, and Native youth and early career professionals are invited to join.
The event will be held in Washington, DC at the Hyatt Regency Capitol Hill from September 25-29, 2022.
Conference events will include Tribal Listening and Consultation Sessions with federal agencies, no-cost institutes, plenary sessions, breakout sessions, an exhibit hall and marketplace, fitness activities, and cultural events. Special events will be held for Native youth and early career professionals as well as new Tribal leaders. The Annual Heroes in Health Awards Gala and 50th Anniversary Celebration will be held on Tuesday, September 27, 2022.
Learn more and register here.
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