Congressional delegation asks for IHS forward funding

Alaska’s Congressional delegation has asked for to provide more stability for the Indian Health Service budget.

In a Nov. 12 letter to the chairs and ranking members of the budget committee, the delegation suggested that congress forward fund the Indian Health Service, or IHS, as it does the Veterans Administration, or VA.

In Alaska, more than 30 tribal organizations help deliver health care to Alaska Natives and American Indians on behalf of the federal government, which has a trust responsibility to do so. Generally, the organizations are reimbursed for their work by the IHS, but that has been an increasingly difficult process in the current budget climate. Forward funding would give those organizations the ability to plan their budget farther into the future, and streamline the process.

The letter was signed by Rep. Don Young and Sens. Lisa Murkowkski and Mark Begich.

 “The VA and IHS are the only agencies that provide direct, federally-funded healthcare to specific populations and both agencies provide the services pursuant to longstanding federal policies,” the three wrote.

According to the letter, the IHS has received its funding on-time only once in the last three years. The VA had many of the same budget issues as the IHS does currently when it was funded through continuing resolutions, according to the letter, and changing the funding strategy helped address the issues.

In the letter, which was addressed to four members of U.S. House of Representatives and Senate, the delegation asked that the budget conference enable congress to fund IHS one fiscal year in advance, and for language in the budget recommendation that would disallow any possible points of order against future advance appropriations for IHS medical accounts.

Currently, the IHS budget is part of the regular budget process, and has been subject to sequestration. Murkowski has also asked the administration and agency about that process.

In recent years, funding has been particularly in flux because of sequestration, with uncertainty over the level of cuts IHS, and the organizations it funds, would have to sustain.

During a Nov. 14 hearing, Murkowski talked to the director of IHS about the lack of funding for contract support costs, and the administration’s efforts to cap those costs in previous budgets.

“I am still incredulous that we are still living through this,” Murkowski said during the hearing. “I had to work with my colleagues here in the Senate and on the House of Representatives side of Capitol Hill to keep that language out of the current continuing resolution because the administration was insisting on putting it in. You say you’re listening, but you still keep capping funds in the C.R.”

Contract support costs are the operational costs tribes pay as part of administering tribal health programs. Those can include personal management systems, facilities costs, and liability systems. The Supreme Court ruled in 2012 that tribes should be fully compensated for their work to deliver health care, because that is a federal trust responsibility, but the administration has yet to comply with the court ruling.

This fiscal year, sequestration is expected to result in a 2 percent cut for IHS, according to Murkowski’s press release.

According to the press release from Murkowksi’s office, IHS Director Yvette Roubideaux agreed that was likely but said she didn’t have the final numbers during the hearing.

That would be less than the amount IHS has been sequestered in recent years, although in the past, there has been discussion of a two percent figure that didn’t wind up coming to fruition.

In a September 2013 press release, Yukon Kuskokwim Health Corp., which administers health care in much of western Alaska, wrote that it lost about $4.3 million in funding for the fiscal year that ended in September, and was anticipating losing another $3.4 million in the current fiscal year.

“Sequester is going to affect YKHC and our operating budget for the next nine years,” wrote YKHC President and CEO Gene Peltola in the September release. “Our Senior Leadership Team, with guidance from our Board of Directors, is having difficult on-going discussions about where and how we are going to have to tighten our fiscal belts, similar to what the rest of the nation is facing. This will not be an easy task as we move forward, and certainly patient care and quality of service will be impacted tremendously.”

At the end of September, YKHC announced the closure of its Home Care department and laid off employees from other departments as a result of the ongoing budget cuts, according to the organization.

The delegation’s request for forward funding was supported by several national organization, including the National Congress of American Indians, the National Indian Health Board, the National Council of Urban Indian Health and National American Indian Veterans.

Alaska groups have also supported the proposal, including Maniilaq Association.

Molly Dischner can be reached at

11/20/2013 - 11:33am