On Wednesday, January 14, Congressman Don Young (R-AK) introduced H.R. 395 which would provide for Advance Appropriations for the Indian Health Service (IHS). Tribes and Urban Indian health organizations have been supporting this change in the way IHS is funded in order to achieve better stability in how our health care is funded.
The Indian Health Service Advance Appropriations Act of 2015 would allow the IHS to receive advance appropriations, which are appropriations available one or more years beyond the year for which the appropriations act is passed. This bill would amend the Indian Health Care Improvement Act to authorize advance appropriations for IHS by providing 2-fiscal-year budget authority, meaning that IHS, Tribal and Urban (I/T/U) facilities would know their funding levels one year in advance, although the funds would not be drawn down until the year in which it was spent.
Since FY 1998, appropriated funds for medical services and facilities through IHS have not been provided before the commencement of the new fiscal year, causing Indian health providers great challenges in planning and managing care for American Indians. Although the IHS budget has increased by a historic 29% since 2008, this equates to an average of 7.25% per year, barely enough to cover medical and non-medical inflation and the cost of contract health care for our growing population. Both serious budgetary increases and changes to resources supporting this health care system are necessary if we are going to effectively address the growing gap in health disparities, which has resulted in early death, and preventable, expensive chronic care costs for AI/ANs of all ages. The lateness in enacting a final budget ranges from five days (FY 2002) to 197 days (FY 2011), making quality budget planning almost impossible.
Health care services in particular require consistent funding to be effective. In FY 2010, the Veterans Administration (VA) medical care programs achieved advance appropriations. The fact that Congress has implemented advance appropriations for the VA medical programs demonstrates the importance of advance appropriations for direct health service agencies. Just as the veterans groups were alarmed at the impact of delayed funding upon the provision of health care to veterans and the ability of VA to properly plan and manage its resources, I/T/U facilities have those concerns about the IHS health system. If IHS funding was on an advance appropriations cycle, I/T/U facilities would know the funding a year earlier and their health care services would not be stymied by continuing resolutions. This would lead to greater outcomes for patients in I/T/U programs. For example, hospital administrators would have the ability to continue treating patients without wondering if they had to de-fund facilities or programs. Additionally, IHS administrators would not waste valuable resources in an agency funded at only 56 percent of need by re-allocating the budget each time Congress passed a continuing resolution. Indian health providers would know in advance how many physicians and nurses they could hire without wondering if funding for positions would be available from month to month.