Budget Hearing – Indian Health Service

House Subcommittee on Interior, Environment, and Related Agencies

2025-06-05

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Summary

The meeting focused on the administration's fiscal year 2026 budget request for the Indian Health Service (IHS) with Acting Director Benjamin Smith and Director Curtis in attendance.[ 00:18:26 ] Committee members, including Chairman Michael Simpson, Ranking Member Chellie Pingree, and Chairman Tom Cole, underscored a unified, bipartisan commitment to upholding trust and treaty responsibilities by providing essential healthcare services for American Indians and Alaska Natives.[ 00:19:07 ]

Advanced Appropriations

Committee members vehemently advocated for the continuation of advanced appropriations for IHS, despite its omission from the President's FY26 budget request for FY27.[ 00:20:06-00:20:12 ] Chairman Simpson and Ranking Member Pingree praised the initial implementation of advanced appropriations, recognizing its crucial role in providing certainty and stability for healthcare services in Indian Country.[ 00:19:28 ] Chairman Cole emphatically stated that Congress would ensure its retention, equating it to funding for veterans and emphasizing its necessity to prevent service disruptions during potential government shutdowns. Ranking Member DeLauro affirmed that advanced funding would continue for both veterans and IHS to shield them from the "mishegas" of the appropriations process. Acting Director Smith reported that IHS is currently evaluating the impact of advanced appropriations.[ 00:56:47 ]

Budget Adequacy and Funding Sufficiency

Multiple members expressed concern that the proposed $7.9 billion discretionary funding, while appearing to be an increase, might not adequately meet the full needs of IHS or keep pace with demand.[ 00:20:02 ] The budget includes substantial allocations for contract support costs and section 105.1 leases, which are legally mandated but absorb a large portion of the funding increase, leading to flat funding for other critical services.[ 00:20:02 ] Ranking Member Pingree specifically highlighted an 87% proposed reduction to sanitation facilities construction, which she deemed "out of touch" given the multi-billion dollar backlog.[ 00:22:57 ]

The committee emphasized the need for greater investment to address severe health disparities in Indian Country.[ 00:22:47 ]

Staffing and Healthcare Professional Recruitment/Retention

A significant challenge identified was the persistent 30% vacancy rate within IHS, which impacts its ability to operate facilities and deliver care.[ 00:41:03 ]

Acting Director Smith detailed IHS efforts to streamline hiring, amplify scholarship programs, and expand loan repayment options to attract and retain healthcare professionals.[ 00:42:05 ] Chairman Simpson and Chairman Cole suggested that long-term solutions might involve educating Native Americans from reservations who would be more likely to return and serve their communities, rather than relying solely on loan forgiveness programs for external recruits. Concerns were also raised about the impact of broader administration hiring freezes on critical IHS positions, such as those needed for electronic health record implementation.[ 00:35:29 ]

Health Disparities and Public Health Initiatives

The alarming 10.9-year difference in average life expectancy for American Indians and Alaska Natives compared to the U.S. all-races population was a central concern, underscoring the urgent need for action. The committee discussed initiatives such as the Produce Prescription Pilot Program, which supports access to healthy and traditional foods to combat food insecurity and chronic diseases like diabetes, with $2.5 million awarded in FY25. The Special Diabetes Program for Indians (SDPI) was also highlighted for its critical role, particularly with 80% of its funding directed towards youth programs for prevention and education.[ 01:21:42 ]

Members emphasized that addressing fundamental issues like food access and socio-economic factors are key to improving overall health outcomes and reducing the burden on IHS clinics.

Healthcare Delivery Models and Tribal Self-Determination

The discussion touched upon the balance between IHS-managed facilities and tribally-managed healthcare systems, with 60% of the total IHS appropriation now tribally managed and operated under the Indian Self-Determination Education Assistance Act.[ 00:44:57 ]

Chairman Cole inquired about the mix and advantages of each approach, reaffirming that the choice remains with the tribes, which IHS respects as an expression of tribal sovereignty. Committee members noted that many tribes are proud of their self-managed healthcare services.[ 01:17:10 ]

Infrastructure and Technology

The significant backlog in sanitation facilities construction, estimated at over $1 billion even after Infrastructure Investment and Jobs Act funding, was a major point of concern given the proposed budget cut.[ 00:22:57 ]

IHS stated that approximately 1300 projects are needed and affirmed its commitment to allocate future funding to address this backlog if provided by Congress.[ 01:24:12 ] The modernization of the electronic health record (EHR) system was allocated $191 million, matching the FY25 level, with a pilot rollout scheduled for June 2026 at the Lawton Service Unit. IHS is actively collaborating with the Veterans Affairs (VA) to ensure interoperability and learn from their experiences with EHR implementation.[ 00:50:32 ]

Interagency Coordination and Cross-Cutting Issues

Members raised concerns about the broader impact of the administration's policies on healthcare agencies like NIH, CDC, and FDA, and potential cuts to Medicaid, which tribal communities and IHS facilities rely on for third-party reimbursements.[ 00:23:31 ]

Discussions highlighted the interdependence of IHS with other federal departments (e.g., Department of Justice for rape kits, SAMHSA for addiction support) and the challenges when funding or policy decisions in those areas affect IHS's ability to deliver comprehensive care. Acting Director Smith confirmed that Secretary Kennedy has initiated a Secretary's Tribal Advisory Committee and departmental-level consultations to improve coordination and address these issues.[ 01:05:30 ]

Tone of the Meeting

The meeting maintained a largely bipartisan and collaborative tone, reflecting a shared commitment among committee members to support the Indian Health Service and uphold federal trust responsibilities to Native Americans.[ 00:19:07 ] Members expressed strong consensus and passion regarding the critical importance of IHS's mission, particularly in addressing severe health disparities and the significant gap in life expectancy for tribal communities.[ 00:22:47 ]

While commending IHS leadership, the committee also posed direct and challenging questions about specific budget decisions, administrative policies, and operational effectiveness.[ 00:22:55 ] A sense of urgency and determination was evident in members' statements, especially concerning the continuation of advanced appropriations and the need for comprehensive solutions to long-standing challenges.