- Details
- By Chez Oxendine
- Policy and Law
Mandatory funding, ailing healthcare facilities, and contractual obligations emerged as central concerns during a Senate budget hearing yesterday focused on the needs of two Native-serving federal agencies.
During Thursday’s Senate Appropriations Committee hearing, leaders from the Indian Health Service (IHS) and the Bureau of Indian Affairs (BIA) presented the case for the Biden administration’s proposed budget increases to address longstanding challenges faced by Native American communities.
Testimony by IHS Director Roselyn Tso and BIA Assistant Secretary Bryan Newland emphasized the urgent need for increased funding to bridge critical gaps in healthcare and support services for tribal nations.
Biden’s budget request for fiscal 2025 calls for $8.2 billion for IHS, an increase of $1.1 billion, and $4.6 billion for the BIA, an increase of $651 million.
“As I travel across Indian Country, I see the consequences of decades-long underfunding of the Indian health system,” Tso, an enrolled member of Navajo Nation, testified during the hearing. “The FY 2025 President’s Budget moves the federal government closer to meeting its responsibilities to Indian Country than ever before.”
Newland, an enrolled member of the Bay Mills Indian Community,echoed the sentiment, saying that proper support can help maintain improving relationships with tribes.
“Indian Affairs programs are built on strong and productive government-to-government relations with Tribes,” Newland testified. The fiscal 2025 budget request “maintains strong and meaningful relationships with Native communities, strengthens government-to-government relationships with federally recognized Tribes, promotes efficient and effective governance, and supports nation-building and self determination.”
BIA Budget Priorities
Many of the proposed increases to the Indian Affairs budget centered on investments to strengthen tribal communities through initiatives like the Tiwahe Program, a family-centered service model rooted in Lakota culture, alongside bolstered funding for public safety and justice efforts, economic development activities, and management or tribal trust funds.
“Tiwahe means family in the Lakota language and symbolizes the interconnected-ness of all living things and one’s personal responsibility to protect family, community, and the environment,” Newland explained during his testimony. The budget request calls for an increase of $28.6 million to expand the Tiwahe program to include wellness courts and economic development needs, as well as supporting participation by news tribes and continued funding for the existing 10 Tiwahe tribes.
The 2025 budget request also targeted economic development opportunities. The BIA requested $43 million - an increase of $12.5 million over last year - for community and economic development. Newland pointed to language revitalization, job placement and training, and the Native American Business Incubators Program as supported goals.
Newland also discussed a requested $11 million for the Indian Land Consolidation program. The assistant secretary cautioned that the Land Buy-Back Program for Tribal Nations ended in 2022. That program was intended to address fractionation, which slows landback efforts as more owners become involved in purchases. Funding the Indian Land Consolidation Program will maintain the buy-back program’s momentum, Newland said.
“If the land consolidation program is not funded at a sufficient funding level, all the gains from reducing fractionation from buyback funding could be lost by 2038,” Newland said. “[That will] prevent tribes from effectively using large land areas.”
IHS Budget Priorities
In her testimony, Tso emphasized the critical need for stable and predictable funding through advanced appropriations and a transition to mandatory funding by fiscal year 2026. She highlighted the persistent health disparities faced by American Indians and Alaska Natives, including significantly lower life expectancy and higher rates of chronic disease.
The budget requests for IHS centered on improving patient safety, addressing public health challenges for tribal citizens, improving healthcare infrastructure, and ensuring the long-term sustainability of the IHS.
“The Indian Health system is chronically underfunded compared to other healthcare systems in the U.S.,” Tso testified. Despite substantial growth in the IHS discretionary budget over the last decade, 69% from fiscal year 2013 to the current fiscal 2024 enacted level, “the growth has not been sufficient to address the well documented funding gaps in Indian Country. These deficiencies directly contribute to stark health disparities faced by tribal communities.”
American Indian and Alaska Natives (AI/AN) born today have an average life expectancy that is 10.9 years fewer than the U.S. all-races population. AI/AN life expectancy dropped from an estimated 71.8 years in 2019 to 65.2 years in 2021, Tso said in her testimony.
The budget asks for $345 million to cover rising costs of existing operations. There’s also an ask for $153 million for 10 newly constructed or expanded health facilities opening in fiscal 2024 and 2025. That funding will help soothe overextended services in areas where care is sorely needed, Tso told senators.
That’s in addition to $10 million in funding requests each for sexually transmitted diseases like HIV and Hepatitis C, as well as opioid use.
Chief among the improvements to the IHS budget wasn’t a number, however, but a policy change: making the IHS budget mandatory. The FY 2025 budget request included a proposal to shift the IHS to wholly mandatory funding in FY 2026.
The shift from discretionary spending, which is voted on each year, and mandatory spending, which is set by prior law, would provide certainty for IHS providers and staff, Tso said. If approved, the proposed mandatory spending formula would automatically increase IHS funding each year through 2034, where it would cap at $42 billion. In total, the budget window between FY 2026 and FY 2034 would appropriate $289 billion to IHS.
“Mandatory funding for the IHS provides the opportunity for significant funding increases that would be difficult to achieve within the limitations of the discretionary appropriations process,” Tso said. “This increased stability and ability to conduct longer-term planning will improve the quality of healthcare, promote recruitment and retention of health professionals, and enhance management efficiencies for individual health programs and the Indian Health system at large.”
“Tough choices”
Senators discussed how requested funding would be put to use, focusing in particular on education and law enforcement budgets. Senator John Hoeven (R-North Dakota) asked during one exchange why increasing IHS budgets over the years hadn’t led to a proportionate increase in Native life expectancy.
Tso attributed some of the issues to a struggling workforce and underfunding, even among budget increases.
“There are a number of things IHS deals with across the board. The topics that keep me up at night are our workforce, and the fragility of our healthcare system across the country,” Tso said. “Really looking at the equities and proposals we're asking for — making sure we're on parity with other federal organizations is very important.”
Senator Lisa Murkowski (R-Alaska) conceded that the budgets for BIA and IHS in 2024 were “lean,” saying the Indian Affairs subcommittee “had to make a lot of tough choices.”
However, Murkowski said she wasn’t sure how the mandatory spending could be implemented sans further legislation.
“I agree that there is far more need than funding levels can meet,” Murkowski said. “I'm not sure how the constraints of the fiscal responsibility act would provide for that level of increase now, or how we pay for a shift to mandatory funding in the (coming) years.”
Senators returned later in the hearing to the question of mandatory spending for BIA as well. The budget request for BIA asked that 105 leases and other contract support costs be made mandatory.
Senator Kristyn Sinema (I-Ariz.) asked directly about the impact of denying the mandatory funding request for both BIA and IHS. Newland said it would force the BIA to choose between funding other crucial programs and meeting legal obligations.
“That’s not a position that we or any of our departments want to be in,” Newland said. “I don’t believe that’s a position that Congress wants the nation to be in, either.”
