Murkowski, Udall, Sullivan Introduce Bill to Protect Indian Health Service Funding During Lapses in Appropriations

U.S. Senators Lisa Murkowski (R-AK), Tom Udall (D-NM), and Dan Sullivan (R-AK) introduced the IHS Advance Appropriations Act of 2019, bipartisan legislation which amends the Indian Health Service Improvement Act to authorize advance appropriations for the Indian Health Service by providing two-fiscal-year budget authority, shoring up the gaps in the funding for the Indian Health Service (IHS), the agency responsible for providing federal health services to American Indians and Alaska Natives. The bill also works to ensure that the federal government fulfills its trust obligation to provide health care services in Tribal communities across the nation. Additional bill cosponsors include Senators Baldwin (D-WI), Heinrich (D-NM), Cortez Masto (D-NV), Rosen (D-NV), Wyden (D-OR), Merkley (D-OR), Smith (D-MN), Tester (D-MT), Warren (D-MA), Schatz (D-HI).

Government shutdowns jeopardize the health, safety, and wellbeing of American Indians and Alaska Natives throughout the country by causing gaps in appropriations for the IHS. Additionally, short-term continuing resolutions cause significant uncertainty in administering programs and make planning more difficult.

“We had one of the longest government shutdowns in history earlier this year, creating anxiety and a ripple of negative impacts throughout a variety of sectors. Health care delivery through IHS was unfortunately caught up in the mix. The IHS should be afforded the same budgetary certainty and protections afforded to the VA, the other federally funded provider of direct health care. This bill works to ensure the IHS is treated with parity and gives the fiscal certainty we need,” said Senator Murkowski. “In the unfortunate event that we are unable to avoid another government shutdown, this legislation would assure that political gridlock does not lead to interruptions in vital health care services delivered by IHS or tribal health entities.”

“Budgetary uncertainty in Washington uniquely jeopardizes the health and welfare of Native communities in New Mexico and across the nation.  It undermines the government-to-government relationship between Tribes and the United States, and threatens the ability of Congress to uphold its trust and treaty responsibilities to Indian Country,” said Senator Udall. “The last government shutdown brought many Tribal health programs to the brink, but the Indian Health Services Advance Appropriations Act will ensure that critical health care services won’t be disrupted by political games. I am proud to work with Senator Murkowski to make sure the budget process more closely aligns with our federal trust and treaty obligations going forward.”

“The vital services that the Alaska Native and Native American health care providers bring to their communities should not be interrupted or diminished due to funding disagreements,” said Senator Sullivan. “This legislation, similar to Veterans Affairs advanced appropriations, will allow Alaska Native providers to better plan, efficiently spend, and deliver better health care to their communities.”

“The Alaska Native Health Board strongly supports Senator Murkowski’s legislation to fund the Indian Health Service on an advance appropriations basis similar to what is already provided to the Veterans Health Administration.  Tribal health care providers in Alaska are especially affected by the chronic lateness of Indian Health Service funding for these essential and lifesaving services funded by the federal government resulting from its Federal Indian Trust Responsibility and for critically needed facilities improvements and expansion, the planning of which are further compounded by climate and geography,” said the Honorable Andrew Jimmie, Chairman of the Alaska Native Health Board.

“The United States has eternal treaty and trust obligations to provide quality healthcare to American Indians and Alaska Natives,” said Kevin J. Allis, Chief Executive Officer of the National Congress of American Indians. “Political impasses should never jeopardize funding for programs that serve Indian Country. We appreciate Senators Murkowski, Udall, and Sullivan, and all the other co-sponsors for introducing the Indian Health Service Advance Appropriations Act of 2019, which will help protect health services in Indian Country from future budget fights.”

“The Indian health system faces significant challenges - from chronic underfunding to ongoing obstacles in recruiting and retaining health providers. All of these challenges are made significantly worse by the reoccurring threats of government shutdowns and use of continuing resolutions,” said Victoria Kitcheyan, Chair and Great Plains Area Representative for the National Indian Health Board. “The National Indian Health Board commends Senator Murkowski for her vision and leadership in introducing S.2541 - Indian Health Service Advance Appropriations Act of 2019. Authorizing advance appropriations for Indian Health Service would further the fulfillment of the Trust responsibility and ensure that IHS and Tribes have the assurances of access to funding needed to engage in long-term planning and improve the continuity and stability of care.”

U.S. Representatives Don Young (R-AK) and Betty McCollum (D-MN) previously introduced companion legislation, H.R.1135, in the U.S. House of Representatives.


  • Congress has previously addressed issues regarding the provision of health care services that rely on the appropriations process through enactment of the Veterans Health Care Budget Reform and Transparency Act of 2009, which authorized Advanced Appropriations for Veterans Administration (VA) medical care programs.
  • Similarly, the IHS Advance Appropriations Act of 2019 provides significant budgetary certainty by authorizing the same protections for IHS health care services that the VA medical services receive, even during a lapse in appropriations.

For the full bill text, click here.

Related Issues: Health, Alaska Natives & Rural Alaska