In Historic First, Merkley Announces Advance Appropriations for the Indian Health Service

Washington, D.C. – Today, Oregon’s U.S. Senator Jeff Merkley, Chairman of the Senate Interior Appropriations Subcommittee, announced a big win for Indian Country: the inclusion of his proposal to provide advance funding for the Indian Health Service (IHS) in the final fiscal year 2023 omnibus bill—guaranteeing health care services through the agency never stop during a lapse in government appropriations.

“This is a big deal. Health care for Tribal communities should never shut down because we fail to pass a budget— health challenges and emergencies do not wait on Congress,” said Senator Merkley, whose Interior Appropriations Subcommittee oversees billions of dollars in funding for services to Indian Country. “When I sit down to write our annual appropriations bill, one of my very top priorities is to ensure Congress is upholding its trust and treaty responsibilities and providing fairness to Indian Tribes through the federal budget process. One critical way to do this is to ensure that the IHS is protected from future lapses in appropriations—and protected from budget uncertainty in unpredictable budget years. This will give health care providers peace of mind, help with recruitment and retention, help ensure IHS operates like a modern health care system, and most importantly, help ensure health care for patients never stops.”

This historic win for Tribes comes after Senator Merkley first proposed advance appropriations for IHS in his fiscal year 2022 Senate Interior, Environment, and Related Agencies appropriations bill—the first time an IHS advance appropriation was ever proposed in an appropriations bill.

The IHS receives the majority of its funding through annual appropriations, which has at times complicated the delivery of health care services to over 2.5 million Native Americans who rely on the IHS for health care. Lapses of appropriations and continuing resolutions have hampered the ability of the IHS and the Appropriations Committee to plan budgets to support critical health programs with the continual uncertainty of funding in future years. Advance appropriations is a budgetary solution that provides for new funding to become available in the following fiscal year to help provide certainty for at least two fiscal years and will be a major change in the way the IHS functions. The Department of Veterans Affairs medical care programs have been funded with advance appropriations since fiscal year 2010.

In December 2018, appropriations for the IHS lapsed as part of the longest government shutdown in United States history. During the 35-day shutdown, the IHS was unable to provide funding to Tribally-operated and Urban Indian Health Organizations. Many were unable to draw on reserve funding or had no alternate resources to maintain health care operations. Another lapse in appropriations of the unparalleled duration in fiscal year 2019 made it all the more difficult for the IHS and contracted Tribes and Urban Indian Health Organizations to maintain operations. In response to the shutdown, Senator Merkley joined 14 Senators to introduce the Indian Programs Advance Appropriations Act in 2019, which ultimately did not pass Congress before adjournment.

In addition to government shutdowns, continuing resolutions have posed a number of operational challenges for IHS, Tribes, and Urban Indian Health Organizations. It is administratively burdensome to provide full continuity of health care under unpredictable budget years, which has led to the latest efforts to get this proposal passed and signed into law.