Health care was the focus of last week’s Senate Indian Affairs Committee budget hearing as lawmakers pressed agency leaders on Indian Health Service funding cuts.
While the FY 2027 budget requests $9.1 billion in discretionary funding for the IHS, the budget cuts several key programs, including sanitation facilities, special diabetes programs and scholarships for health professionals.
A director has not yet been nominated for the IHS. Lawmakers said it is past time to fill the agency’s top position with a permanent nominee. IHS Chief of Staff and acting director Clayton Fulton testified before the committee, opening by thanking lawmakers for increasing the agency’s budget by 60% in recent years. He pointed to the IHS’s need to evolve as more tribes opt to operate their own health care under 638 contracts.
Committee Vice Chair Sen. Brian Schatz, D-Hawaii, pressed Fulton on the agency’s staffing shortage, pointing out that it has 1,200 fewer employees than two years ago — a 9% reduction on top of a historic 30% vacancy rate. Fulton replied that the agency is aiming to hire 3,300 new employees this fiscal year. Currently, there are 300 IHS job postings, which have drawn more than 10,000 applications.
Schatz expressed concern that the move is a short-term hiring push rather than a sustainable structural change and requested regular written updates from Fulton.
“Can we make a request to you to summarize all of this in writing — and don’t make us wait 120 days for a letter,” Schatz said. “We just need to know what you’re up to, and it doesn’t have to be perfect. We just need to know what is going on over here. Is it going well? Do we have visibility into this? If you’re meeting all your marks, awesome. Tell us. If not, we should know that too.”
When the hearing turned to the agency’s three-decades-old backlog of priority construction projects, Fulton noted that 36 of 42 projects on the list had been completed.
Sen. Ben Ray Luján, D-N.M., pressed Fulton on the Gallup Indian Medical Center, which was passed over for priority construction funding for the second consecutive year despite prior assurances it would not be skipped again.
“The project is not on this list again for projects this year,” Luján said. “This is the second time under this administration that the project’s been jumped over.”
Fulton said he would provide more information on the center’s standing on the priority list.
Lawmakers also addressed proposed sanitation funding cuts, which fall about $93 million short of FY 2026 enacted levels. The administration has said it intends to bridge the gap with money from the Infrastructure and Jobs Act.
Fulton highlighted the $1.9 billion in funding from the act that has been directed to Alaska over the past four years. Sen. Lisa Murkowski, R-Alaska, pushed back, arguing those funds were meant to supplement, not replace, base funding.
“I don’t think that we can go backward,” Murkowski said. “Those [Infrastructure Act funds] were designed to supplement because we were in such a hole that we needed to put billions of dollars towards it.”
Murkowski emphasized that many communities across Indian Country still lack clean water.
“We’re talking about communities that are still relying on honey buckets, haul wagons … this is public safety, public health — when you don’t have clean water and clean wastewater systems,” she said.
