Indian Health Service Advance Appropriations Bill Introduced in the House

On October 1, 2013, Representatives Don Young (R-AK) and Ben Ray Lujan (D-NM) introduced HR 3229, legislation that would authorize advance appropriations for the Indian Health Service (IHS). The goal is for the IHS and tribal health care providers to have adequate advance notice of the amount of federal appropriations to expect and thus not be subjected to the uncertainties of late funding and short-term Continuing Resolutions (CRs). HR 3229 was referred to the Committees on Budget; Energy and Commerce; and Natural Resources.

The current partial government shutdown due to Congressional inability to enact any fiscal year (FY) 2014 appropriations certainly highlights this precarious budget situation. If IHS was receiving funding on an advance appropriations schedule, its FY 2014 appropriations would have been enacted as part of a FY 2013 appropriations act and the IHS and tribal health care providers would not be faced with being in a new fiscal year with no knowledge of what amount of funding to expect. Instead, the IHS (and other agencies) has had to furlough some employees and have others working on a currently unpaid status. Tribal health care providers are similarly affected.

Advance appropriations are enacted a year before the funds become available, thus allowing the federal agency knowledge of its funding level a year in advance. Fortunately the advance appropriations process does not put additional pressure on the appropriations subcommittees’ allocations. For instance, if FY 2015 IHS advance appropriations were included in the FY 2014 Interior, Environment, and Related Agencies Appropriations Act, those advance appropriations would not be counted against the FY 2014 Interior Appropriations Subcommittee allocation but rather would be counted against its FY 2015 allocation. For the first year of advance appropriations Congress would enact two years of IHS funds, and thereafter revert to appropriations one year at a time.

Veterans organizations advocated for years for Congress to provide the Veterans Administration (VA) with advance appropriations, noting that chronically late funding negatively affected their ability to properly plan and manage its resources, including recruitment and retention of medical personnel. In 2009 Congress responded by authorizing advance appropriations for the VA medical accounts. Like the VA, the IHS and tribal organizations provide direct, federally-funded health care services to a specific population; the Young/Lujan bill would bring parity to the IHS with regard to the federal appropriations process.

Enactment of legislation authorizing advance appropriations is the first step in actually realizing such funding. The Budget Resolution, while not having the effect of law, lists particular programs which may have advance appropriations. In order for IHS advance appropriations to not be subject to a point of order, one would want the IHS Services and the IHS Facilities accounts included on that list in the Budget Resolution. Finally, the Interior, Environment, and Related Agencies Appropriations bill needs to provide the advance appropriations.

Our firm has been working with the Maniilaq Association on the issue of IHS advance appropriations, and the effort has expanded to consist of a coalition of national Indian organizations including the National Indian Health Board, National Congress of American Indians, and the United South and Eastern Tribes. We attach the text of HR 3229 as well as a Dear Colleague letter from Representatives Young and Lujan soliciting co-sponsors.

Please let us know if we may provide additional information regarding the IHS advance appropriations bill.