On September 25, 2012, the Senate Interior Appropriations Subcommittee released a draft FY 2013 Interior, Environment and Related Agencies appropriations bill and budget chart which contains appropriations for both the Indian Health Service (IHS) and Indian Affairs. In this Memorandum we report on the Senate Subcommittee’s recommendation for FY 2013 funding for the IHS in relation to the Administration’s and the House Appropriations Committee’s recommendations. There is no Senate report accompanying the draft bill (which does not have an assigned number).
The IHS and other federal agencies are currently operating under a Continuing Resolution (CR) at an annualized amount slightly above their FY 2012 levels. The CR runs through March 27, 2013, or until a regular appropriations bill is enacted, whichever is sooner. It is uncertain whether Congress will be able to enact full FY 2013 appropriations measures, a year-long CR, or a sequestration alternative when it returns after the November elections. Behind the scenes congressional negotiations are taking place even now regarding these matters.
In an Appropriations Committee press release, Senators Reed (D-RI) and Murkowski (R-AK) (Chair and Ranking Member, respectively, of the Interior Subcommittee) stated that they hope the Senate Subcommittee bill “will serve as a roadmap as discussions continue to finalize a responsible, balanced fiscal year 2013 appropriations bill.”
We reported on the House Appropriations Committee markup of its FY 2013 Interior, Environment and Related Agencies bill (HR 6091, H. Rpt. 112-589) in our General Memorandum 12-086 of July 13, 2012. We do not repeat here all the details of the House Committee bill and report.
The bills contain the same legislative language regarding a cap on Contract Support Costs; Contract Support limitation; Individuals with Disabilities Education Act data collection; prohibition on implementation of eligibility regulations; services for non-Indians; assessments of the IHS by the Department of Health and Human Services; and limitation on no-bid contracts. The FY 2012 appropriations act extended through October 1, 2013, the provision which provides that IHS funds for Alaska be made available only to regional Alaska Native health organizations (with some exceptions) and, thus, the FY 2013 bills do not address this matter.
FUNDING OVERVIEW
The House Committee recommended $187 million over the FY 2012 enacted level and $71 million over the Administration’s request for the IHS. The Senate Subcommittee recommended $86 million over the FY 2012 enacted level and $30 million below the Administration’s request.
There are two major differences between the bills. The House Committee recommends $34 million more for Contract Health Services and $70 million more for Contract Support Costs than does the Senate Subcommittee.
The Senate Subcommittee recommends $5 million more for Direct Operations than does the House Committee. The House Committee recommends $2.5 million over the Administration’s and the Senate Subcommittee’s recommendations for Urban Indian Health. There are no differences between the two bills in the Facilities account.
Staffing of New Facilities. The House Committee recommended $4 million over the Administration’s request of $49.2 million for staffing and operation costs of new facilities. It is unclear whether the Senate Subcommittee recommendation includes this increase. The Administration, in its budget justification, would allocate the funds as follows: Norton Sound Regional Hospital ($10.6 million); Chickasaw Nation Health Clinic in Ardmore ($8.9 million); Cherokee Nation Health Center ($2.8 million); Chickasaw Nation Health Clinic in Tishomingo ($5.3 million); Southcentral Foundation Valley Primary Care Center ($13.5 million); and Tanana Chiefs Conference Interior Health Center ($8.1 million).
Lack of Funding for Built-in Costs. The bills do not provide, nor did the Administration request, funding for population growth, civilian pay raises or inflation (other than Contract Health Services). There would be a 1.7 percent pay increase for Commissioned Officers and the President has proposed a 0.5 percent pay increases for federal employees.
FUNDING FOR INDIAN HEALTH SERVICES
FY 2012 Enacted $3,866,181,000
FY 2013 Admin. Request $3,978,974,000
FY 2013 House Committee $4,049,612,000
FY 2013 Senate Subcommittee $3,948,625,000
SPECIAL DIABETES PROGRAM FOR INDIANS
While the entitlement funding for the Special Diabetes Program for Indians (SDPI) is not part of the IHS appropriations process, those funds are administered through the IHS. The SDPI is currently funded through FY 2013 at $150 million annually (PL 111-309).
HOSPITALS AND CLINICS
FY 2012 Enacted $1,810,966,000
FY 2013 Admin. Request $1,849,310,000
FY 2013 House Committee $1,851,448,000
FY 2013 Senate Subcommittee $1,852,948,000
The bills, as requested by the Administration, would provide $57.5 million for the Indian Health Care Improvement Fund, which is the same as the FY 2012 enacted level and $12 million above the FY 2011 level. We do not have information on the Senate Subcommittee’s $1 million increase over the House amount.
DENTAL SERVICES
FY 2012 Enacted $159,440,496
FY 2013 Admin. Request $166,297,000
FY 2013 House Committee $166,597,000
FY 2013 Senate Subcommittee $166,297,000
It appears that the Senate Subcommittee bill does not include the House Committee add-on of $300,000 above the Administration’s request for staffing in support of the Early Childhood Caries initiative.
MENTAL HEALTH
FY 2012 Enacted $75,588,864
FY 2013 Admin. Request $78,131,000
FY 2013 House Committee $78,131,000
FY 2013 Senate Subcommittee $78,131,000
ALCOHOL AND SUBSTANCE ABUSE
FY 2012 Enacted $194,296,627
FY 2013 Admin. Request $195,378,000
FY 2013 House Committee $195,378,000
FY 2013 Senate Subcommittee $195,378,000
CONTRACT HEALTH SERVICES (CHS)
FY 2012 Enacted $843,575,117
FY 2013 Admin. Request $897,562,000
FY 2013 House Committee $897,562,000
FY 2013 Senate Subcommittee $863,575,000
The House Committee bill, consistent with the Administration’s requests, would provide $34 million to cover the cost of inflation (calculated at 3.6 percent) and a $20 million program increase. It appears that the Senate Subcommittee did not include the $34 million for inflation.
Catastrophic Emergency Health Fund (CHEF). Both bills recommend that within the total is $51.5 million for CHEF, the same as the FY 2012 enacted level and $6.5 million below the FY 2011 level.
PUBLIC HEALTH NURSING
FY 2012 Enacted $66,632,218
FY 2013 Admin. Request $69,868,000
FY 2013 House Committee $69,868,000
FY 2013 Senate Subcommittee $69,868,000
HEALTH EDUCATION
FY 2012 Enacted $17,056,666
FY 2013 Admin. Request $17,450,000
FY 2013 House Committee $17,450,000
FY 2013 Senate Subcommittee $17,450,000
COMMUNITY HEALTH REPRESENTATIVES (CHR)
FY 2012 Enacted $61,406,592
FY 2013 Admin. Request $61,531,000
FY 2013 House Committee $61,531,000
FY 2013 Senate Subcommittee $61,531,000
HEPATITIS B AND HAEMOPHILUS
IMMUNIZATION (HIB) PROGRAMS IN ALASKA
FY 2012 Enacted $1,927,000
FY 2013 Admin. Request $1,927,000
FY 2013 House Committee $1,927,000
FY 2013 Senate Subcommittee $1,927,000
URBAN INDIAN HEALTH
FY 2012 Enacted $42,984,115
FY 2013 Admin. Request $42,988,000
FY 2013 House Committee $45,488,000
FY 2013 Senate Subcommittee $42,988,000
INDIAN HEALTH PROFESSIONS
FY 2012 Enacted $40,595,942
FY 2013 Admin. Request $40,598,000
FY 2013 House Committee $41,598,000
FY 2013 Senate Subcommittee $40,598,000
Programs funded under Indian Health Professions and their estimated FY 2013 amounts are: Health Professions Prepatory and Pre-Graduate Scholarships ($3.8 million); Health Professions Scholarships ($10.5 million); Extern Program ($1.18 million); Loan Repayment Program ($21.3 million); Quentin N. Burdick American Indians into Nursing Program ($1.76 million); Indians Into Medicine Program ($1.16 million); and American Indians into Psychology ($757,386).
TRIBAL MANAGEMENT
FY 2012 Enacted $2,577,000
FY 2013 Admin. Request $2,577,000
FY 2013 House Committee $2,577,000
FY 2013 Senate Subcommittee $2,577,000
DIRECT OPERATIONS
FY 2012 Enacted $71,653,171
FY 2013 Admin. Request $72,867,000
FY 2013 House Committee $67,567,000
FY 2013 Senate Subcommittee $72,867,000
The Administration requested a $1,115,000 increase in order to address an array of matters including oversight and accountability and responding to GAO and OIG and Congressional recommendations regarding management and oversight of programs. The House Committee, however, recommended a $4.1 million reduction below the FY 2012 level and $5.3 million below the Administration’s request. The reduction would come from the Headquarters portion of funding.
SELF-GOVERNANCE
FY 2012 Enacted $6,044,314
FY 2013 Admin. Request $6,044,000
FY 2013 House Committee $6,044,000
FY 2013 Senate Subcommittee $6,044,000
CONTRACT SUPPORT COSTS
FY 2012 Enacted $471,437,491
FY 2013 Admin. Request $476,446,000
FY 2013 House Committee $546,446,000
FY 2013 Senate Subcommittee $476,446,000
Increase. The House Committee, but not the Senate Subcommittee, recommended a $70 million increase over the Administration’s request or $75 million over the FY 2012 enacted level, for a total of $546 million. The Committee report states:
With this increase, the Committee is attempting to fund the projected shortfall so the Federal government can meet its contractual obligations. The Committee directs the Service to work with Tribes and tribal organizations to explore options for improving the transparency of current year contact support cost information, and to report back to the Committee within 90 days of enactment of this Act.
(H. Rpt. 112-589, p. 81)
Indian Self-Determination (ISD) Fund. Both bills, consistent with the Administration’s proposal, would again authorize up to $10 million of the total CSC funds for an Indian Self-Determination Fund. The IHS may allocate funds to the ISD Fund to support new or expanded self-determination contracts, grants, self-governance compacts or annual funding agreements.
Cap on Contract Support Costs. Both bills, consistent with past appropriations acts, would continue language regarding a funding cap on contract support costs.
Contract Support Limitation. Both bills would, consistent with the Interior Appropriations Acts for FYs 1999-2012, attempt to limit the ability of the IHS and BIA to fund past-year shortfalls in contract support funding from remaining unobligated balances for those fiscal years.
FUNDING FOR INDIAN HEALTH FACILITIES
FY 2012 Enacted $440,346,317
FY 2013 Admin. Request $443,502,000
FY 2013 House Committee $443,864,000
FY 2013 Senate Subcommittee $443,864,000
MAINTENANCE AND IMPROVEMENT
FY 2012 Enacted $53,720,909
FY 2013 Admin. Request $55,470,000
FY 2013 House Committee $55,470,000
FY 2013 Senate Subcommittee $55,470,000
FACILITIES AND ENVIRONMENTAL HEALTH SUPPORT
FY 2012 Enacted $199,413,427
FY 2013 Admin. Request $204,379,000
FY 2013 House Committee $204,741,000
FY 2013 Senate Subcommittee $204,741,000
MEDICAL EQUIPMENT
FY 2012 Enacted $22,582,000
FY 2013 Admin. Request $22,582,000
FY 2013 House Committee $22,582,000
FY 2013 Senate Subcommittee $22,582,000
CONSTRUCTION
Construction of Sanitation Facilities
FY 2012 Enacted $79,582,464
FY 2013 Admin. Request $79,582,000
FY 2013 House Committee $79,582,000
FY 2013 Senate Subcommittee $79,582,000
Construction of Health Care Facilities
FY 2012 Enacted $85,047,706
FY 2013 Admin. Request $81,489,000
FY 2013 House Committee $81,489,000
FY 2013 Senate Subcommittee $81,489,000
The bills, consistent with the Administration’s request, would complete construction of the San Carlos Health Center ($41.5 million) and continue construction for the Kayenta replacement health center ($40 million).
OTHER
Transam Equipment, Ambulances, Demolition Fund. The bills, consistent with the Administration’s proposal, would continue funding of up to $500,000 to purchase TRANSAM equipment from the Department of Defense and $500,000 to be deposited in a Demolition Fund to be used for the demolition of vacant and obsolete federal buildings. Up to $2.7 million is proposed for the purchase of ambulances.
The House Committee bill and report are available at http://appropriations.house.gov/. The Senate Interior Subcommittee bill and funding chart is available at http://www.appropriations.senate.gov
If we may be of further assistance regarding FY 2013 Indian Health Service appropriations, please contact us at the information below.
