Congress Passes Temporary Government Funding Measure
Congress passed a funding package that was signed into law on Friday, September 30 - one day before the start of federal fiscal year (FY) 2023, averting a government shutdown and keeping the government operating through December 16, 2022. Often referred to as a Continuing Resolution or CR, the measure passed the Senate with a strong bipartisan vote (72-25), while the House vote of 230-201 was mostly along party lines and hinted of funding battles ahead after the midterm elections and in the next Congress.
The Indian Health Service (IHS) is level-funded for the duration of the CR, except for an increase provided for costs of staffing and operating facilities that were opened, renovated, or expanded in FY 2022 and 2023. IHS is expected to continue its policy from FY 2020 of providing the full prior-year base Secretarial amount to Tribal health programs with performance periods starting within the CR period. Tribes and Tribal Organizations with ISDEAA agreements should connect with IHS directly on timing and complete any FY 2023 funding agreements so that funds can be made available.
Formula-based program funding will likely not be distributed until Congress enacts a final FY 2023 appropriation and the IHS completes distribution decisions. Programs operated by the IHS, including contracts to Urban Indian Organizations, are expected to receive level-funding prorated for the duration of the CR.
In addition to these funding inequities within the IHS budget, there exist inequities in relation to other federal healthcare programs. Hardships imposed on these programs by CR and government shutdowns are well documented by the Government Accountability Office, as are the benefits of advance appropriations. Advance appropriations help reduce these hardships by committing, at least one year in advance, to appropriating a full annual budget, available at the start of the fiscal year, regardless of any CR or government shutdown.
According to the Congressional Research Service, IHS is the only major federal provider of health care that is solely funded through regular appropriations on an annual basis. In 27 years, IHS has only once (in FY 2006) received full-year appropriations by the start of the fiscal year. Other federal health care providers, such as the Veterans Health Administration, receive the majority of their funding through advance appropriations, and a number of health programs, including Medicare and Medicaid, receive mandatory funding, which is controlled outside of appropriations acts.
In essence, Congress protects healthcare for seniors through mandatory funding and protects veterans through advance appropriations, yet continues to tolerate leaving Tribes vulnerable to stopgap funding and government shutdowns. This inequity is discriminatory and it needs to stop. A simple proposal for FY 2024 is right in front of Congress and it doesn’t cost one extra dime.
What comes next, and what you can do
Although Members of Congress have gone home until after the midterm elections, the House and Senate Appropriations Committees are busy preparing for inevitable negotiations on final FY 2023 appropriations bills. House Majority and bipartisan Senate leadership have signaled a desire to complete negotiations and enact a final omnibus appropriations bill before the current CR expires on December 16. It’s unclear yet whether House Minority leadership will agree to that timeline or prefer to extend the CR into the new year if midterm elections flip party control of the House.
When the negotiations begin, advance appropriations for IHS will be on the table. This past July, Senators Leahy (D-VT) and Merkley (D-OR) released the FY 2023 Interior, Environment, and Related Agencies appropriations bill containing FY 2024 advance appropriations for the IHS. The bill guarantees a full-year appropriation at the start of FY 2024 that is at least equal to the amounts appropriated for FY 2023 with the exception of funding provided for Electronic Health Records, Sanitation Facilities Construction, and Health Care Facilities Construction.
The Leahy-Merkley proposal for IHS advance appropriations isn’t perfect but it is consistent with NIHB Resolution 14-03 and the 2022 NIHB Legislative and Policy Agenda and is an incremental step towards full mandatory funding for IHS.
If enacted, the Leahy-Merkley proposal provides a level-funding floor for the FY 2024 IHS budget but is not the last word on the matter. Just as with advance appropriations for veterans, Congress can add funding to the IHS budget during the regular FY 2024 appropriations process as more accurate estimates of FY 2024 needs are developed.
Strong and sustained pressure from Tribal leaders to their Members of Congress is still needed. Here are two things you can do:
In June, NIHB and the National Congress of American Indians (NCAI) issued a Call to Action, providing templates and talking points for letters and phone calls to Members of Congress. Consider taking these actions if you have not already done so, and, even if you have, consider reminding those Members that this issue remains a top priority.
In August, the NIHB and the NCAI issued a Call to Action seeking Tribal testimony on the impacts of government shutdowns on the delivery of IHS programs. Allies in Congress are asking for your stories to help get their colleagues on board. Members of Congress frequently ask, “Why do Tribes need Advance Appropriations?” and “How do funding disruptions harm Tribal nations and their people?” Sharing stories with NIHB and NCAI through this survey will help NIHB and NCAI to effectively better advocate for advance appropriations in Congress. Consider filling out the survey if you have not already done so. Or, if you would prefer, you can email your stories directly to Ciara Johnson, NIHB Congressional Relations Associate, at email@example.com.