We are here yet again.  Another fiscal year concludes without Congress passing a single spending bill for the upcoming fiscal year.  This means temporary funding will continue until mid-December.  At worst, these stopgap measures are inconvenient for most agencies, but when it comes to Indian Health Service funding, these delays are measured in lives when the Indian health system providers are left scrambling to figure out how to provide consistent health care to 2.1 million American Indians and Alaska natives. 

The National Indian Health Board would like to use this opportunity to reiterate the need for advance appropriations for the Indian Health Service whereby Congress appropriates funds one year in advance. While other government health programs have certainty because their funding is mandatory and/or it is provided on an advanced appropriations basis, the Indian Health Service funding is discretionary and is not provided on an advance basis.  This travesty is amplified by the fact that that the Corporation for Public Broadcasting also receives advanced funding; we don't begrudge CPB this treatment, but the health of the First People of this nation should not be funded after Big Bird.   We think he would agree.


In 1955, Congress created the Indian Health Service to uphold the federal trust responsibility, which is the responsibility the United States assumed over the course of its history in a series of treaties with Tribes, exchanging compensation and benefits for Tribal land and peace.  Yet, today, American Indians and Alaska Natives experience some of the worst health disparities in the country culminating in a life expectancy 4.2 years less than the all-races population.  Our people also die at higher rates than other Americans from alcoholism, diabetes, cancer, maternal deaths and suicide. 

Tragically, these statistics are not surprising, yet they are avoidable; IHS is currently funded at only 59 percent of need.   In 2013, the IHS per capita expenditures for patient health services were just $2,849, compared to $7,717 per person for health care spending nationally.

Compounding the woefully short funding levels, Administrative challenges make health care delivery even more difficult.  IHS and Tribally-run facilities (which receive funding through the IHS under the Indian Self-Determination, Education and Assistance Act, PL 93-638) are not operating on the same playing field as other federal and private health providers because their budgets are at the mercy of the regular appropriations process.  This makes it harder for Tribes to plan activities, hire staff, enter into long-term contracts and engage in a streamlined day-to-day operation that other health providers enjoy.  CRs also place a severe administrative burden on this already underfunded agency.  Unlike other agencies, who can hold off on a grant notice or program activity, IHS is required to pass money down to the Tribes when funding becomes available, which reallocates valuable staff time to administrative duties and away from the direct delivery of health care to this very underserved population.

The Veterans’ Health Administration (VHA), which also provides direct care to patients as a result of contractual obligations made by the federal government, has received advance appropriations since FY 2010.  Yet, the Indian Health systems is left making long-term decisions with only short-term money guaranteed.  Often programs must determine whether and how they can enter into contracts with outside vendors and suppliers, plan programmatic activities, or maintain current personnel.

Last year, at my own Tribe, the Sault Ste. Marie Chippewa Indians, two key employees resigned because of the insecurity of the Federal government appropriations. We lost our nurse practitioner and have yet been able to recruit and find a qualified replacement in our rural location.  In addition, we also lost a seasoned, Community Health Nurse.  Earlier this summer, President / CEO of the Maniilaq Association, an Alaska Native health provider in Northwest Alaska, testified before a House Natural Resources Subcommittee that his clinic must buy heating fuel for their facilities in September of each year, but it because of budget uncertainty they can only purchase a small amount at a time.  If IHS operated on the same playing field with other health providers, Maniilaq would be able to save money by purchasing fuel in bulk.

Advance appropriations will be one important step forward toward improving the health of American Indians and Alaska Natives.   Congress should pass the Indian Health Service Advance Appropriations Act now.

Abramson is the immediate past chairperson of the National Indian Health Board and has been an Elected Councilwoman for the Sault Ste. Marie Tribes Board of Directors for 18 years.She also serves on the Department of Health and Human Services’ Secretary’s Tribal Advisory Committee and the Tribal Leaders Diabetes Advisory Committee.