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Roselyn Tso
Roselyn Tso, center, serves as Director of the Indian Health Service. Photo by Indianz.Com (CC BY-NC-SA 4.0)
Republicans eager to rain on historic funding achievement for Indian Country
Wednesday, January 4, 2023

WASHINGTON, D.C. — For the second day in a row, Republicans have been unable to agree on a leader for their party in the U.S. House of Representatives.

But GOP lawmakers of all stripes have found one target in common — and it’s not Rep. Kevin McCarthy (R-California), the would-be Speaker of the House. Since the start of the 118th Congress this week, they have repeatedly slammed the $1.7 trillion omnibus spending bill that has brought historic levels of funding and long-overdue improvements to Indian Country.

“Twelve days ago, 4,000 pages showed up over here — $1.7 trillion in spending, 7,200 earmarks, 24 hours time to read it,” Rep. Scott Perry (R-Pennsylvania) said of the measure on the floor of the House on Wednesday.

When Perry incongruously compared the appropriations package to “a Christmas tree right before Christmas” he rehashed a complaint that has unified Republicans as they have taken control of the House for the first time in five years. He described the bill, which became law less than a week ago, as something that “nobody outside of this town wanted.”

For tribes and their advocates, the Republicans assessments couldn’t be further from the truth. That’s because H.R.2617, otherwise known as the Consolidated Appropriations Act for 2023, includes a major achievement — the new law funds the Indian Health Service ahead of time for the first time in U.S. government history.

“Including advance appropriations for Indian health in the omnibus is a historic moment for Indian Country over a decade in the making,” said William Smith, the vice president of the Valdez Native Tribe who serves as chairman of the National Indian Health Board.

By funding the IHS ahead of time, the agency that provides health care to more than 2.5 million American Indians and Alaska Natives will be able to avoid potential shutdowns of the federal government. That actually happened when Republicans controlled the Congress and the executive branch, causing widespread chaos for tribes and urban Indians barely a year before the COVID-19 pandemic upended the entire system.

“The Indian Health Service is the primary source of health care programs and funding for most tribal nations and an essential part of the federal trust responsibility to Indian Country,” Chief Kirk Francis of the Penobscot Nation said during the White House Tribal Nations Summit last month. “Yet the IHS continues to be the only major federal health care program that remains subject to government shutdowns and stopgap funding.”

Indianz.Com Audio: Tribal Leader Fireside Chat: Health Equity at 2022 White House Tribal Nations Summit

It wasn’t just tribes that fought for enactment of advance appropriations for the IHS, either. President Joe Biden put the entire weight of his administration behind the proposal, helping ensure that it was included in the spending package that McCarthy derided as a “train wreck” only two days before Christmas.

“Regardless of what Congress does — tinkering with the budget — there is no reason why the health care of anyone else in America should be put at stake simply because Congress decides to have a fight on how much to fund the other parts of government,” Secretary of Health and Human Services Xavier Becerra, a Cabinet member whose portfolio includes the IHS, said during the summit on December 1

And despite the criticism that Republicans have been leveling at the omnibus, advance appropriations for the IHS has enjoyed bipartisan support. Rep. David Joyce (R-Ohio), who is expected to chair the legislative subcommittee that determines most of Indian Country’s funding levels, has said all members of Congress — regardless of party affiliation or geographical location — must adhere to the trust and treaty responsibilities of the U.S.

“Congress still has a long way to go before we are able to fulfill the promises we have made to tribes,” Joyce said at the first-ever National Indigenous Cannabis Policy Summit, which was hosted by the Indigenous Cannabis Industry Association in Washington, D.C., a week after the November 2022 election.

“But in the often hyper-partisan environment of Congress, this work we have accomplished together on behalf of Indian Country has been a welcome change — and truly bipartisan,” Joyce said on November 15.

David Joyce
Rep. David Joyce (R-Ohio) addresses the National Indigenous Cannabis Policy Summit in Washington, D.C., on November 15, 2022. Photo by Indianz.Com (CC BY-NC-SA 4.0)

Still, Joyce has indicated that changes are coming now that Republicans are in control of the House for the 118th Congress. During an appearance on C-SPAN last month, he said the appropriations process must be revamped in order to address complaints within his party about “reckless spending” and the way in which legislation is handled in the chamber.

But as the bitter dispute over McCarthy has shown, the new GOP majority in the House is having trouble at handling even the most basic task of electing a Speaker. Rep. Tom Cole (R-Oklahoma), a citizen of the Chickasaw Nation and one of two Native Republicans in the chamber, has had to make motions to adjourn two days in a row in order for his colleagues to figure out a path forward.

Yet even Cole’s status as an elder statesman has not convinced his newest colleague — one from his home state — to support McCarthy for Speaker. Rep. Josh Brecheen (R-Oklahoma), a citizen of the Choctaw Nation and the only other Native Republican in the House, continues to vote for a different Republican candidate, some two days into the 118th session of Congress.

For now, though, the IHS won’t be impacted by the failure of the GOP to govern. The advance appropriations provision in the omnibus means that the agency’s funding level won’t change should Congress be unable to pass an appropriations bill on time later this year. And IHS funding won’t change even if lawmakers resort to what is known as a continuing resolution, which in the past has meant that the agency can’t address the rising costs of health care while appropriations are still being finalized on Capitol Hill.

“Advance appropriations are necessary to ensure continued access to critical health care services for American Indians and Alaska Natives,” IHS Director Roselyn Tso, a citizen of the Navajo Nation, said in a statement on December 23. “Predictable funding will allow us to disburse funds more quickly and enable IHS, tribal and urban Indian health programs to effectively and efficiently manage budgets, coordinate care and improve health outcomes for American Indians and Alaska Natives.”

“This predictability is especially important during a lapse in appropriations or a continuing resolution,” said Tso, who joined the Biden administration in late September 2022, after the agency had been without a permanent leader for nearly two years.

President Biden signed H.R.2617 into law on December 29. According to Tso’s statement, the measure provides nearly $7 billion for the IHS for fiscal year 2023, which began on October 1, 2022.

The advance appropriations provision in the omnibus also means that the IHS will automatically have funding once fiscal year 2024 begins this October 1. The

“We applaud Congress and the White House for listening to Native communities and doing what is right,” Sonya Tetnowski, the president of the National Council of Urban Indian Health said in a statement after the omnibus was unveiled. “For far too long, the federal government has allowed political disputes over budgets to jeopardize the lives of American Indian and Alaska Native people.”

“The National Congress of American Indians (NCAI) in partnership with our invaluable allies at the National Indian Health Board and the National Council of Urban Indian Health have fought for years to get advanced appropriations for the Indian Health Service and commends Congress for taking this critically important step for Indian Country,” said NCAI President Fawn Sharp. “This historic decision comes not a moment too soon as Indian Country continues to be plagued by an ongoing health crisis that affects all of our communities.”

According to an explanatory statement released by the Senate Committee on Appropriations, the omnibus provides more than $5.1 billion to the IHS. The figure is labeled as “advance appropriations.”

Sen. Brian Schatz (D-Hawaii), who began serving as chair of the Senate Committee on Indian Affairs during the 117th Congress, described the $1. 7 trillion spending measure as a “bipartisan deal.” But he also said Democrats took the lead in seeking advance appropriations for the IHS.

“Advance appropriations will protect IHS programs from service disruptions and other negative impacts caused by funding uncertainty and government shutdowns,” Schatz said on December 22. “It brings IHS into parity with all other federal health care providers and the U.S. closer to upholding its trust responsibility to provide Native communities with quality health care. I thank Native health advocates and members of the committee for all their hard work to make this years-long effort a reality.”

Following Cole’s motion to adjourn on Wednesday afternoon, the House is due to regroup at 8pm Eastern. McCarthy, an otherwise powerful lawmaker whose spouse belongs to a group calling itself the Northern Cherokee Nation, has so far failed to achieve enough votes to become Speaker through six rounds of balloting.

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