NIHB’s Analysis of 2024 Federal Spending Negotiations

The House and Senate have each released their annual appropriations bills for the Indian Health Service (IHS) and other HHS accounts. The outlook on spending for FY 2024 is a tightening belt, with very low chances of breakout changes, including the addition of more funding for IHS. This fall, the National Indian Health Board (NIHB) will be advocating to oppose IHS rescissions, expand advance appropriations to all IHS accounts, and reclassify CSC and 105(l) mandatory payments as mandatory spending. Outreach to Congressional members back in their district during August recess and maintaining pressure into the fall will be critical to maximizing Tribal program investment.

Overall, the change in party control of the House of Representatives has ushered in less spending on domestic programs, including U.S./Tribal relations, which corelates with lower spending outcomes in both the House and Senate appropriations bills. While each proposal is more in line with projections of past enacted amounts, the House and Senate take fundamentally different paths to achieve FY24 spending. Under detailed scrutiny, most of the annual increase is carried by just a handful of accounts – a systemic and repetitive practice that leaves some IHS programs losing purchasing power year after year, setting back an already chronically underfunded treaty and trust obligation to Tribal nations. 

Read NIHB’s full analysis.