|President’s FY 2020 Budget
Request to Congress Released
Major Cuts to Domestic Spending
March 11, 2019
Today the President released his fiscal year (FY) 2020 Budget Request to Congress. This document contains funding recommendations to Congress as it begins to draft next year’s appropriations bills.
Additional details on the FY 2020 request will be available in the coming weeks, but you can read the overall budget request here and the HHS Budget in Brief here (Indian Health Service (IHS) starts on page 36). You can also view the recommendations of the Tribal Budget Formulation Workgroup for FY 2020 here.
Overall the budget proposes to cut funding at the U.S. Department of Health and Human Services (HHS) by 12 percent in FY 2020, which includes savings of almost $1.25 trillion from mandatory funding programs such as Medicare and Medicaid. If enacted, major cuts to these programs would significantly impact the Indian health system. However, with Democrats controlling the House of Representatives, it is highly unlikely that many of the cuts suggested in this budget will become law.
Indian Health Service
The Budget for IHS proposes to fund the agency at $5.945 billion in FY 2020. This is about $140 million over the FY 2019 enacted amount. The budget provides increases for Hospitals and Clinics (over $200 million above FY 2019 enacted) and purchased/referred care ($3 million above FY 2019 enacted). There are also increases in the Alcohol and Substance Abuse and Mental Health sections of the budget.
However, the budget also makes several disturbing cuts within the IHS budget. For example, as in FY 2019, the budget request proposes to eliminate funding for the Health Education program. It also would cut Community Health Representatives funding by $39 million from the FY 2019 enacted level. The President recommended zeroing out both of these program in the FY 2019 budget, but Congress restored this funding in the final FY 2019 appropriations bill which was passed last month.
However, the budget does recommend $20 million in funding for the national expansion of the Community Health Aide program. It says “the new National Community Health Aide Program will build a network of health aides to partner with health care providers and provide health care, health promotion and disease prevention services” (HHS Budget in Brief, p. 39).
Electronic Health Records: While there are few details given, the President’s Budget request for IHS recommends $25 million “to begin to transition to a new and modernized Electronic Health Record System.” It notes that the funding will help “lay the groundwork” for improving Health IT at the agency.
Ending HIV Epidemic / Hepatitis C Initiative: Overall, the budget recommends $291 million to improve the treatment and prevention of HIV in the United States. As part of this effort, IHS would receive $25 million for HIV screening and Hepatitis C prevention and treatment. The Budget refers to this as the “Eliminating Hepatitis C and HIV/AIDS in Indian Country Initiative” and notes that this funding would be used to help treat and prevent Hepatitis C and HIV and enhance testing.
Special Diabetes Program for Indians: The budget does not propose to move the Special Diabetes Program for Indians (SDPI) from mandatory funding to discretionary. “Mandatory funding” is funding which Congress must authorize in order for the program’s funding to continue, to “discretionary spending” allows Congress to control the funding as part of the annual appropriations process. The budget proposes level funding for SDPI at $150 million per year for FYs 2020 and 2021. Current funding for SDPI expires on September 30, 2019. Historically, NIHB and Tribes have proposed increasing SDPI funding to $200 million per year and renewing it for a minimum of 5 years.
Facilities and Construction: The Budget Request proposes a total cut of $75 million from facilities programs funding, including a $77 million from the Health Care Facilities Construction program. This is especially concerning, given that facilities in the Indian health system represent some of the oldest health facilities in the country and that can negatively impact the delivery of health services.
For questions about the President’s Budget request for FY 2020, please contact NIHB’s Director of Congressional Relations and firstname.lastname@example.org or (202) 507-4085.
 “Mandatory funding” is funding already available once a law is passed. Medicare, Medicaid, and the Children’s Health Insurance Program represent examples of mandatory funding. “Discretionary” spending is funding that Congress must appropriate each year. Most of the IHS budget (with the exception of the Special Diabetes Program for Indians and third party collections) is discretionary.