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- By Elyse Wild
House lawmakers from both parties pledged Thursday to restore advance appropriations for the Indian Health Service after the Trump administration proposed eliminating the funding mechanism that protects tribal healthcare during government shutdowns.
The Trump administration’s fiscal 2026 budget request includes $8.1 billion for IHS, but removes advance appropriations for fiscal 2027 — the first time since 2023 that the protection has been excluded from a budget proposal.
“We didn’t get here to give it up,” said Rep. Tom Cole of Oklahoma, chairman of the House Appropriations Committee and an enrolled citizen of Chickasaw Nation. “We will be retaining advanced appropriations.”
The bipartisan commitment came during a House Appropriations subcommittee hearing where lawmakers questioned IHS Acting Director Benjamin Smith about the agency’s ability to meet federal trust obligations to 2.8 million American Indians and Alaska Natives it serves through 650 hospitals and clinics.
While the budget appears to provide a substantial funding increase, Rep. Betty McCollum (D-Minn.), said that most of the additional money covers court-mandated contract support costs, leaving actual healthcare services funding essentially flat-funded.
Cole started the hearing by noting that while the IHS budget has increased over the years, it continues to fall short of the healthcare system's needs.
“The funding does not begin to meet the full need, but it's a step in the right direction,” Cole said.
IHS has long struggled with underfunding and a 30% staff vacancy rate. The National Tribal Budget Formulation Workgroup, which includes 12 tribal representatives from IHS service areas, recommended a $63 billion funding level for the agency in fiscal 2026 — nearly eight times the proposed budget.
Broad Health Cuts Raise Concerns
Tribal leaders, health advocates, and some lawmakers have raised concerns about hiring freezes and reduced healthcare budgets, further straining the underfunded IHS. The Department of Health and Human Services has faced the most cuts of any federal agency, with a budget reduction of 26% since Trump took office in January 2025.
Rep. Chellie Pingree (D-Maine) cited cuts to the National Institutes of Health, the Centers for Disease Control and Prevention and the Food and Drug Administration.
“I am deeply troubled by this administration's dismantling of programs and research that tribal nations rely on to ensure the well-being of their communities,” Pingree said.
Infrastructure Needs Ignored
Lawmakers raised concerns about the proposed 87% reduction in sanitation facilities construction funding, despite a $4.7 billion backlog needed to address basic water and sewage systems in Native communities.
“This proposed cut is out of touch with reality,” Pingree, the ranking Democrat on the subcommittee, said.
Tribal Self-Governance Expands
The hearing veered into tribal self-governance in healthcare. Cole pointed to certain tribes, like the Choctaw Nation and the Cherokee Nation, that augment IHS appropriations with tribal economic development dollars to finance their own health systems.
Smith said 60% of the IHS appropriation is now tribally managed and operated through the Indian Self-Determination and Education Assistance Act. “It's tribally driven and it's a tribal choice,” he said.
Rep. Celeste Malloy (R-Utah), who also serves on the Natural Resources Committee, referred to an April field hearing on tribal issues in Oklahoma, where she heard directly from tribal members about tribally run healthcare systems.
“It was obvious talking to tribal members how proud they are of the services that they're providing for their own people,” Malloy said.
Overhead Questions Persist
Rep. Michael Simpson (R-Idaho), chair of the subcommittee, asked Smith about the agency's overhead, stating that he has heard from tribes that they would prefer direct appropriations for healthcare.
“Their feeling is that too much comes off the top, and they would get more if we direct appropriately,” Simpson said.
Food Insecurity Addressed
The hearing also addressed food insecurity, which affects about 1 in 4 Native Americans compared to 1 in 9 Americans overall. Pingree inquired about the IHS's Produce Prescription Pilot Program, which received $2.5 million in the fiscal year 2025 for five tribal communities to increase access to fruits, vegetables, and traditional foods.
“Food is very sacred to tribal communities, and it aligns perfectly with the Indian Health Service mission in the four components of physical, mental, social and spiritual health,” Smith said.
Pingree asked Smith if given more funding in 2026, how many more tribal communities could participate.
“I don't want to guesstimate if additional funds come in; there would be a lot of interest, and we would be ready to expand the program,” Smith said.
Health Disparities Highlighted
Rep. Jake Ellzey (R-Texas) focused his inquiry on the socioeconomic factors that converge in Native people having a life expectancy of 65 — more than 10 years less than that of White Americans.
“Life expectancy depends on hope and opportunity and jobs and good food. Otherwise, you're going to be unhealthy, and then what we end up doing is having to spend more money on IHS to treat the problems that we know already exist,” he said.
Ellzey zeroed in on the high rates of sexual violence faced by Native women and the limited amount of rape kits available at IHS facilities.
Smith acknowledged gaps in system-wide coverage, noting the funding for rape kits comes from domestic violence prevention program grants.
Staffing Challenges Continue
The persistent staffing shortages at IHS were a recurring theme. Smith highlighted the agency's expanded scholarship program as a key solution to attract new healthcare professionals to work in tribal communities.
However, lawmakers pointed to the conflict between IHS staffing needs and the federal hiring freeze implemented by Trump during his first days in office.
“The IHS already faces an enduring staff shortage,” full committee ranking member Rosa DeLauro (D-Conn.) said. “It's shameful that under the guise of eliminating waste, fraud and abuse, the administration is targeting the largest health care provider for Native Americans and Alaskan Natives.”
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