⚡️ NIMITZ HEALTH NEWS FLASH ⚡️ 

“Budget Hearing - Indian Health Service”

House Appropriations Subcommittee on Interior, Environment, & Related Agencies

June 5th, 2025 (recording linked here)

WITNESS & TESTIMONY

• Mr. Benjamin Smith: Acting Director, Indian Health Service

HEARING HIGHLIGHTS

MEMBER OPENING STATEMENTS

• Subcommittee Chair Simpson (R-ID) welcomed Acting Director Smith and praised bipartisan support for Indian healthcare, highlighting Chairman Cole’s historic leadership. He emphasized the success of securing advanced appropriations in FY 2023 and its role in providing stability to tribal health systems. While he acknowledged the $7.9 billion in discretionary funding for FY 2026, he raised concern over the absence of advance appropriations for FY 2027. Simpson reiterated his commitment to ensuring certainty and planning for IHS programs.

• Subcommittee Ranking Member Pingree (D-ME) thanked IHS leaders and emphasized IHS’s role in serving 2.8 million Native individuals through over 600 healthcare sites. She opposed the proposed 87% cut to sanitation facility construction, citing a $1 billion project backlog. Pingree criticized the administration’s plan to eliminate advance appropriations and committed to fighting for its continuation. She also expressed concern over broader cuts to NIH, CDC, and Medicaid, which she said jeopardize tribal health.

• Full Committee Chair Cole (R-OK) reaffirmed his commitment to tribal health and praised bipartisan efforts that led to IHS advance appropriations beginning in FY 2023. He emphasized the danger of government shutdowns for a health system serving 2.8 million Native Americans and likened IHS needs to those of veterans. While acknowledging OMB’s effort, he stated the FY 2026 budget was only a starting point. Cole proposed exploring whether IHS might be better placed under a larger funding jurisdiction to allow long-term planning.

• Full Committee Ranking Member DeLauro (D-CT) supported advance funding for IHS and veterans, stating neither should be disrupted by political gridlock. She criticized the Trump administration’s hiring and funding freezes, which worsened care access and staffing at IHS. DeLauro opposed the 87% cut to sanitation construction and the omission of FY 2027 advance appropriations. She called on Congress to uphold its responsibilities to tribal nations and ensure continued access to essential services.

WITNESS OPENING STATEMENT

• Acting Director Smith thanked the committee and outlined the FY 2026 budget request of $8.1 billion, including $7.9 billion in discretionary and $159 million in mandatory funding. He noted IHS serves 2.8 million Native Americans across 37 states and has seen a 45% budget increase over the past decade. The budget prioritizes staffing for new facilities, modernizing electronic health records, and boosting contract support costs after a key Supreme Court ruling. Smith emphasized the urgent need to address a 10.9-year life expectancy gap for Native populations and affirmed IHS’s commitment to improving care access and outcomes.

QUESTION AND ANSWER SUMMARY

• Rep. Cole asked about recruitment and retention given the 30% vacancy rate and inquired about the proportion of tribally operated vs. IHS-run facilities. Acting Director Smith explained efforts like expedited hiring and loan programs to fill gaps and noted that 60% of IHS funding now supports tribally run programs under self-determination authority.

• Rep. Pingree inquired about the produce prescription pilot program, EHR modernization, and interagency coordination. Acting Director Smith responded that $2.5 million was awarded in FY 2025 to support culturally significant nutrition efforts and affirmed IHS’s readiness to expand the program with additional funding. He reported approximately 50 vacancies tied to the EHR initiative but confirmed that the Lawton pilot remains on track for a June 2026 rollout. Smith also noted ongoing collaboration with the VA and $191 million allocated to maintain current systems during the transition from the legacy VISTA platform.

• Rep. Simpson raised concerns about IHS overhead and direct appropriations to tribes. Acting Director Smith noted that around $5 billion of IHS’s budget is tribally administered, and IHS retains the rest to fulfill its legal obligations.

  Rep. Simpson proposed tribal education as a long-term solution to workforce shortages. Acting Director Smith agreed, highlighting initiatives like graduate medical education and refined scholarships.

• Rep. McCollum (D-MN) warned that court-mandated costs like contract support are absorbing IHS budget increases, limiting funding for new services. On another note, she asked whether IHS is engaged in interagency planning around suicide prevention, addiction, and minority health. Acting Director Smith confirmed participation in cross-agency and tribal advisory meetings, including with HHS and CDC.

• Rep. Zinke (R-MT) asked if IHS would honor its prior commitment to staff a youth center in the Blackfeet Nation. Acting Director Smith assured that IHS would fulfill that commitment and acknowledged substance abuse as a costly, urgent issue.

  Rep. Zinke ended by criticizing the Biden administration for ending an opioid task force launched under Trump.
  

• Rep. Ellzey (R-TX) pressed on IHS capacity for rape kit services and linked poor health outcomes to structural issues like food insecurity, violence, and law enforcement failures. Acting Director Smith agreed to follow up with data and emphasized the agency’s efforts through programs like domestic violence prevention.

  Rep. Ellzey ended by proposing a commissary system modeled after military exchanges to address tribal food deserts and promote prevention.
  

• Rep. Maloy (R-UT) commended tribal self-governance and sought updates on improvements to the Purchased/Referred Care (PRC) program, urban Indian health services, and youth diabetes prevention. Acting Director Smith reported that pending PRC claims had dropped to 21% and processing times had improved, crediting enhanced accountability, metric tracking, and local oversight. He highlighted stronger engagement with urban Indian health organizations through a formal confer policy and welcomed direct collaboration on site-specific issues. On diabetes prevention, Smith noted that 80% of SDPI funds are directed toward youth initiatives and offered to provide a more detailed briefing.

• Rep. Pingree highlighted sanitation facility backlogs and questioned the 87% funding cut in the budget. Acting Director Smith said 1,300 projects are still needed and confirmed IHS would follow congressional direction if more funding is provided.

  Rep. Pingree asked about residency training expansion and collaboration with VA and HRSA. Acting Director Smith confirmed IHS is actively working with federal partners under the VA Mission Act to grow training slots.

• Rep. Simpson flagged Indian water rights settlements as a looming fiscal challenge that should be addressed through the judgment fund, not IHS’s discretionary budget. He asked for updates on IHS lease terminations and emphasized facility preservation. Acting Director Smith committed to keeping the committee informed and maintaining operations where possible.

• Rep. McCollum stressed the link between healthcare recruitment and local infrastructure like schools and housing, and asked how IHS tracks interagency dependence. Acting Director Smith mentioned past cross-agency funding reports and committed to investigating whether a targeted cross-cut for health could be revived.