To a US Senator: support mandatory funding for the Indian Health Service

Personalize. If you live in a state with significant tribal population, your senators have particular constituency interest. If you’re a tribal member, IHS healthcare worker, or work in adjacent federal Indian programs, your perspective has additional weight.

Dear Senator [Last Name],

I’m writing as a constituent in [city/town] to ask you to support mandatory funding for the Indian Health Service.

The Indian Health Service is the federal agency responsible for healthcare for federally recognized American Indian and Alaska Native tribal members — a federal trust obligation rooted in treaties and federal law dating to the 19th century. Per-capita IHS funding has historically been less than half of comparable federal health programs (Medicare, the Veterans Health Administration, Medicaid). The result has been measurable: Native Americans face among the worst chronic-disease outcomes in the developed world, with diabetes, cardiovascular disease, and substance-use disorders at rates the IHS system is structurally underfunded to address.

The structural cause of the underfunding is the discretionary-appropriations framework. Each year, IHS competes with every other discretionary federal priority. Continuing resolutions, budget caps, and political environments that constrain non-defense discretionary spending have produced chronic shortfalls relative to assessed need.

Mandatory funding — making IHS appropriations like Medicare appropriations rather than like discretionary line items — would address the structural pattern in several ways:

1. Stable annual increases driven by population growth and healthcare-cost inflation rather than annual political negotiation.

2. Insulation from continuing resolutions and partial shutdowns. Mandatory programs continue to function when Congress operates under CRs; discretionary programs face direct disruption.

3. Multi-year planning capability that allows IHS to plan capital investments, workforce development, and program initiatives with confidence.

4. Treatment as obligation, not benefit. Mandatory funding reframes IHS as the federal government meeting a trust obligation rather than providing a discretionary benefit.

The 2023 advance-appropriations reform was a partial step, providing IHS with appropriations one year ahead of the fiscal year in which they apply. Full mandatory funding is the structural fix that has been advocated by the National Indian Health Board, tribal health organizations, and bipartisan congressional leadership for years.

[Personalize: name a specific concern. Examples: “I’m a tribal member who has experienced IHS care”; “I work in [healthcare/policy] and have seen the funding pattern’s effects firsthand”; “Our state’s tribal nations have advocated for mandatory funding”; “I’m a constituent who follows federal Indian policy and supports the structural reform”.]

I’d appreciate knowing your position on mandatory IHS funding and on broader federal Indian health policy in the current session. Senators on the Indian Affairs Committee and on Health and Appropriations subcommittees with jurisdiction over IHS carry particular weight.

Thank you for your service.

Sincerely,

[Your name] [Your address]