WASHINGTON, D.C. — A key Republican lawmaker is vowing to protect the Indian Health Service (IHS) from government shutdowns after the Trump administration eliminated a major tribal priority from its new budget request.

At a hearing in the nation’s capital last Thursday, Rep. Tom Cole (R-Oklahoma) offered a simple but strong message for Indian Country. Advance funding for the IHS will continue under his leadership of the House Committee on Appropriations.

“I can just tell you now, we will be retaining advanced appropriations,” said Cole, a citizen of the Chickasaw Nation who is the first Native person to chair the legislative committee that writes the federal government’s funding bills.

“If anything, it’s more critical now,” continued Cole, citing the need to protect the IHS from lapses in funding or other attempts to cut its budget.

“You know, we have situation of extreme polarization,” Cole said of the nation’s political climate. “You could stumble into a government shutdown at any point, and that should not affect the care of Native Americans anymore than we will let it affect the care of veterans.”

“So you can just take that to the bank,” added Cole.”

"We will be retaining advanced appropriations": Rep. Tom Cole (R-Oklahoma), Chair of House Committee on Appropriations, vows to protect advance funding for Indian Health Service after Trump administration proposed to eliminate it in fiscal year 2026 budget request. pic.twitter.com/z6dMNfByjx

— indianz.com (@indianz) June 5, 2025

Indian Country fought hard to secure advance appropriations for the IHS, calling it a “life-saving” policy to ensure the United States lives up to it trust and treaty obligations. During the first Trump administration, tribal and urban Indian providers were cut off from federal funds for 35 days in what was the longest government shutdown in history.

“We have already paid,” William “Bill” Smith, the chair of the National Indian Health Board, said in Congressional testimony earlier this year. “We have paid and paid and paid.”

“We have paid with our land,” Smith, a military veteran who also serves as vice president of the Valdez Native Tribe in Alaska, told the Senate Committee on Indian Affairs in February. “We have paid with our lives, and we paid the deals. We have given up our lands — and the United States said that they’ll take care of us.”

But when President Donald Trump released details of his fiscal year 2026 budget late last month, advance appropriations for the IHS was gone. The Department of Health and Human Services offered no explanation for the omission of the tribal priority, which enjoys bipartisan support in Congress.

“Advanced appropriations continue to provide Indian health system with a certainty needed to properly serve communities, provide stability for health care providers, and improve long-term planning for services,” said Rep. Mike Simpson (R-Idaho), who noted that Congress first approved advance funding for the IHS when one of his Democratic colleagues, Rep. Chellie Pingree (D-Maine) was in charge of the Interior appropriations subcommittee.

Cole credited Rep. Betty McCollum (D-Minnesota) for playing a key role in getting advance appropriations over the finish line. He too highlighted how Republicans and Democrats worked with Indian Country to secure the policy starting in fiscal year 2023.

“We did this for years, back and forth, each of us submitting and co-sponsoring the other’s legislation,” Cole said of his collaboration with McCollum. “So this was a long bipartisan struggle.”

“And the one thing I can assure you — we didn’t get here to give it up,” said Cole.

At today’s @HouseAppropsGOP Interior Subcommittee hearing on the FY 2026 IHS budget, @TomColeOK04 reaffirmed the push for stable funding: “One thing I can assure you, we didn't get here to give it up. I can just tell you now, we will be retaining advanced appropriations.” pic.twitter.com/AZmR81Xevx

— National Council of Urban Indian Health (@NCUIH_Official) June 5, 2025

But protecting advance appropriations for the IHS isn’t the only struggle facing Cole, Simpson and other lawmakers. During the hearing last week, they said Trump hasn’t requested nearly enough money to fulfill the government’s obligations to tribes and their communities.

“The statistics on health disparities, as you know, in Indian Country, are far worse than other populations in America,” said Pingree, the highest-ranking Democrat on the Interior appropriations subcommittee. “In order to make progress in addressing these disparities, we must invest more in health care.”

Trump’s fiscal year 2026 budget calls for $7.909 billion in “discretionary” funding to be spent on the IHS. An additional $159 million in “mandatory” funding boosts the agency’s total request to $8.1 billion.

“As the 18th largest health care system in the United States, the Indian Health Service provides a wide range of clinical, public health, community, and facilities infrastructure services to approximately 2.8 million American Indians and Alaska Natives,” said Benjamin Smith, a citizen of the Navajo Nation who is currently serving as the acting director of the IHS.

The figures make the IHS one of the few places in government where Trump isn’t proposing to reduce or even outright eliminate funding. In fact, the agency would be seeing an increase of more than $921 million if Congress were to enact the request as written for HHS.

But Republican and Democratic lawmakers stressed that the increase at the IHS is almost entirely tied to obligations that the federal government was already supposed to be fulfilling. Barely a year ago this month, the U.S. Supreme Court once again told the HHS that it had to provide tribes with all the funding they need to support their communities. The outcome in Becerra v. San Carlos Apache Tribe and Becerra v. Northern Arapaho Tribe marked the third time in the last 20 years that the high court ruled in support of self-determination and self-governance in Indian Country.

“While the Indian Health Service looks to have a healthy increase — at first glance — at $921 million plus, the vast majority of it is to cover contract support costs and 105(l) leases,” observed McCollum, the latter referring to money the IHS must provide to tribes for leasing health care facilities on their lands. “These are important supports for tribal self-government and the courts have mandated that they must be paid in full.”

“How much of this budget is continually being eaten up by judgments that we end up having to pay for?” asked Simpson, who serves as chair of the Interior appropriations subcommittee.

The IHS representatives at the hearing didn’t provide a direct answer but based on figures in the HHS budget-in-brief, more than a quarter of the fiscal year 2026 budget request would be going to legal obligations — rather than the programs that boost health care in tribal and urban Indian communities.

“So when you start calculating what happens and what we’re obligated to do by court responsibilities, the actual services — any add-on services for facilities, for IHS — is flat funded,” said McCollum.

“Increases for care and staffing are primarily for new facilities,” continued McCollum. “And those are offset by cuts to public facilities.”

 It puts this committee in a difficult position of a lose-lose,” said McCollum. “Somebody’s gonna have to lose  and somebody’s gonna lose a little more if we don’t do things in the way that we’re supposed to.”

According to Cole, the president’s budget request represents a “start.” “In some ways, a good start,” he said of the Trump administration’s efforts.

“But I don’t take this as where we will necessarily end up,” added Cole

Native American communities experience some of the highest rates of chronic illness in the country, largely due to the prevalence of processed foods. Advancing the health and well-being of Tribal nations remains a top priority for me and this administration. pic.twitter.com/jychl6gYRC

— Secretary Kennedy (@SecKennedy) May 14, 2025

Prior to the IHS budget hearing, Cole’s committee heard from Secretary Robert F. Kennedy Jr. on May 14. That was two weeks before the White House and HHS released more information about their fiscal year 2026 spending request but the issue of advance appropriations still came up.

“Your skinny budget — and I haven’t seen your full budget yet — do you maintain that forward appropriation for Indian Health Service?” Simpson asked at the time.

“Yes, Congressman,” responded Kennedy, who added that he has spent “20 percent” of his career working on tribal issues.

“I’m committed to protecting it,” Kennedy said of the IHS. He otherwise did not utter the words “advance appropriations” during the hearing.

“I’m committed to working with you to make sure that we can finally make this work for a population that is not only probably, you know, among the most aggrieved in our history, but also a population that suffers more from chronic disease, that has the shortest lifespan, the highest rates of diabetes, the highest rates of alcoholism, of any other population,” said Kennedy.

As for where the IHS eventually ends up, Cole and his committee will be busy this month. The schedule calls for the appropriations bill that funds the agency to be finished during the week of June 23.

Although the IHS is part of HHS, the agency is included in the same bill that funds the the Bureau of Indian Affairs, the Bureau of Indian Education and other Indian Country programs at the Department of the Interior. The BIA is set to lose at least $1 billion in Trump’s budget proposal.

Budget Hearing – Indian Health Service (June 5, 2025)