Washington Report

An NIHB Publication

The Washington Report is an e-newsletter produced by the National Indian Health Board. Each issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis and action items.

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Budget Formulation

NIHB Testifies before Congress on FY 2015 Budget Priorities

On March 26, 2014, NIHB Board Member Andy Joseph testified before the Senate Committee on Indian Affairs regarding the FY 2015 Budget, and specifically on Tribal health Priorities. On April 8, 2014, NIHB Chairperson Cathy Abramson testified in front of the House Interior, Environment and Related Agencies Appropriations Subcommittee.

During both presentations, NIHB reiterated the FY 2015 Tribal Budget Formulation Workgroup Recommendations for FY 2015. NIHB stressed the importance of increasing funding for The Indian Health Service (IHS) to $5.3 billion in FY 2015 and prioritizing purchased/referred care (previously known has contract health services); hospitals and clinics; mental health; alcohol and substance abuse. The testimony also advocated for full funding of contract support costs without cuts to other IHS programs and a full exemption for IHS from any future automatic sequestration cuts. In addition, NIHB’s statement supported Advance Appropriations for the IHS; Achieving Medicare Like Rates for Purchased/Referred Care; a Legislative “fix” for the Definition of Indian in the Affordable Care Act; and multi-year renewal of the Special Diabetes Program for Indians.

NIHB will continue to work closely with Congress in the coming months to ensure that IHS and other programs affecting Tribal health are prioritized in the FY 2015 appropriations process.

Senate Committee on Indian Affairs Testimony (PDF)

House Interior Appropriations Subcommittee Testimony (PDF)

Chart of IHS Spending from FY 2012 to FY 2015 (PDF)



National Indian Health Board Meets with the House Interior Appropriations Subcommittee and the Senate Committee on Indian Affairs

On December 5, 2013, as part of the National Indian Health Board's 4th Quarter meeting, board members met with Members of Congress and their staff to discuss key health priorities.  They discussed topics including funding for the Indian Health Service (IHS), a sequestration exemption for IHS, Advance Appropriations for IHS, the Special Diabetes Program for Indians and other health concerns. 

The Interior Appropriations Subcommittee meeting was attended by Chairman of the Subcommittee, Ken Calvert (R-CA), and the Co-chairs of the Native American Caucus Representatives Tom Cole (R-OK) and Betty McCollum (D-MN).  There were also several staff members present to represent other members of the subcommittee.  During the meeting, the Subcommittee members expressed strong support for Indian health and said that it is important that the federal government fulfill its trust obligation to Tribes. They highlighted support for a sequestration exemption for IHS, and advance appropriations.  Committee members also expressed support for the renewal of the Special Diabetes Program for Indians.

The Senate was not in session last week, but NIHB members had the opportunity to meet with key staff who were also supportive of health concerns brought by the board.  The staff members expressed the desire to work together with Indian Country to get some of these important initiatives to move forward, including the Definition of Indian in the Affordable Care Act.


Contract support costs:

Contract support costs (CSC) are the funds that Tribes and Tribal organizations receive from the government to manage health and other programs that were previously operated by the federal government. For many years, Congress did not appropriate enough funds to fully pay CSC. In 2012, the Supreme Court Ruled that the government must pay contract support costs for Tribes even if Congress has not appropriated the funds. Due to this decision, Contract Support Costs were fully funded by Congress in FY 2014. However, in order to achieve this, cuts had to be made to other areas of the Indian Health Service Budget. Congress has asked IHS and the Tribes to develop a long-term solution to funding CSC.

On May 12, 2014, The National Indian Health Board passed a resolution that would require that CSC are appropriated as mandatory spending. To view that resolution, click here. NIHB remains committed to ensuring that all Tribes have a voice in this conversation, and that any solution will benefit the whole of Indian Country.


The National Indian Health Board (NIHB) provides unique insights into the needs of Indian health system during the annual federal budget formulation cycle. The NIHB supports the Indian Health Service (IHS) Budget Workgroup, analyzes budget proposals and provides testimony before Congress regarding the IHS budget.

Learn more about the Federal Budget Process here

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Legislative Inquiries:

Caitrin Shuy
Director, Congressional Relations

926 Pennsylvania Ave, SE
Washington, DC 20003
Phone: 202-507-4085
Email: cshuy@nihb.org