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- By Levi Rickert
Opinion. In May, the Trump administration released its fiscal 2026 budget. Conspicuously absent from the proposal was a critical provision: advance appropriations for Indian Country health care. Advance appropriations are funds approved by Congress in one fiscal year that become available in a subsequent year, ensuring continuity of services even during budget delays or federal government shutdowns.
The absence of this provision marks a serious regression in policy, threatening the financial stability of the Native American health system, including Indian Health Service (IHS), tribal health facilities and Urban Indian Organizations (UIOs).
Without advance appropriations, the Indian healthcare system becomes uniquely vulnerable. During federal government shutdowns, services are delayed, programs are disrupted, and lives are put at risk. The fiscal 2023 omnibus spending package, passed by Congress in December 2022 and signed into law by President Joe Biden, included a historic provision for advance appropriations for IHS. This marked a transformative step toward fulfilling the federal government’s trust and treaty obligations to Tribal Nations and brought a new level of stability to healthcare in Indian Country.
Before this provision, Native healthcare systems were repeatedly destabilized during periods of political gridlock in Washington. The consequences were severe—and deadly. During the 2018–2019 government shutdown, at least five patients at Urban Indian Organizations died and at least seven others experienced drug overdoses. Within weeks, 25% of urban Indian clinics were forced to close their doors, and nearly 40% reported that they could operate for only 30 days without supplemental funding.
Speaking on a panel at the 2022 White House Tribal Nations Summit, Penobscot Nation Chief Kirk Francis moderated a fireside chat with U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra and Indian Health Service Director Roselyn Tso. Before beginning the conversation, Chief Francis shared how his community was personally impacted by unstable federal funding.
“Delayed funding caused one of our citizens to not receive the medical attention she needed—care that would have identified life-threatening cancer at an earlier stage,” Francis said. “Another citizen’s cardiology issue was only discovered due to an emergency event. And delays in securing inpatient treatment for substance use disorder can mean the difference between life and death.”
Today, IHS and its partner programs serve approximately 2.8 million American Indians and Alaska Natives. These services are not discretionary favors—they are legal obligations, grounded in treaties, statutes, and the federal trust responsibility. The purpose of this responsibility is to ensure the highest possible standard of physical, mental, social, and spiritual health for Native people. Yet, Indian health care remains deeply underfunded and disproportionately impacted by budget instability.
Removing advance appropriations from the FY 2026 budget proposal puts all of this progress in jeopardy. It threatens to reintroduce the same uncertainty that has harmed patients, shut down clinics, and cost lives. Indian Country cannot afford to let this reversal become permanent. Advance appropriations are not a luxury—they are a necessity. Maintaining them is essential to protecting the health and well-being of Native people and upholding the trust responsibility of the United States.
It is also a matter of basic equity. Other federal health programs such as the Veterans Health Administration, Medicare and Medicaid receive advance appropriations or continuous funding mechanisms. Yet the Indian Health Service does not—despite its mandate to serve one of the most underserved populations in the country. According to the Government Accountability Office (GAO), per capita IHS spending in 2017 was just $4,078, compared to $13,185 for Medicare, $10,692 for Veterans Health, and $8,600 for federal inmates.
The Trump administration’s decision to eliminate advance appropriations for Indian Country health care reflects a fundamental disregard for the federal government’s trust and treaty responsibilities that underpin its nation-to-nation relationship with Tribal Nations.
The good news is in Congress there is bipartisan support for advance appropriations for Native health.
This past week, Sens. Ben Ray Luján (D-N.M.) and Markwayne Mullin (R-Okla.), members of the Senate Committee on Indian Affairs, along with Reps. Betty McCollum (D-Minn.), Co-Chair Emeritus of the Congressional Native American Caucus, and Tom Cole (R-Okla.), House Appropriations Committee Chairman, reintroduced the bipartisan, bicameral Indian Programs Advance Appropriations Act (IPAAA).
The legislation is a bill to amend the Indian Self-Determination Act and the Indian Health Care Improvement Act that would authorize advance appropriations in order to avoid lapses in funding for the IHS, Bureau of Indian Affairs (BIA) and the Bureau of Indian Education (BIE).
“Indian Country should not have to suffer the consequences of the federal government’s inaction,” Sen. Mullin said. “It is vital that we uphold our trust and treaty responsibilities to Tribal Nations by ensuring their economic security through the appropriations process,” Mullin said.
Clearly, there is still work to be done as Congress wrestles with the potential for another federal government shutdown at the end of the current fiscal year which ends on September 30.
Fortunately, Native health programs are protected from the potential federal government gridlock that may result in a shutdown because Congress approved advance appropriation and the approval was part of the legislation signed by Trump on July 4, 2025.
Congress must act swiftly to pass the Indian Programs Advance Appropriations Act and ensure that Native health care never again becomes a casualty of political dysfunction.
Thayék gde nwéndëmen - We are all related.
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