	Introduction

The Indian Health Service (IHS), part of the Public Health Service (PHS) of the Department of Health and Human Services (HHS), funds health services to about 1.8 million Indians, members of the nation's 562 federally recognized American Indian and Alaska Native (AI/AN) tribes in IHS service delivery areas. Organization of the IHS Health Delivery System

Currently, the IHS health care delivery system, a largely rural system, is organized into regional area offices and, within each region, local service units. Eligible Population

In general, persons eligible for IHS services are members of federally recognized tribes. bloodlines, or both. Health Status

IHS comparisons of mortality measures indicate that the IHS service population has historically had a greater incidence of illness and higher mortality rates than the general U.S. population. In terms of life expectancy, IHS has found that "American Indians and Alaska Natives born today have a life expectancy that is 2.4 years less than the U.S. all races population (74.5 years to 76.9 years, respectively; 1999-2001 rates)." Appropriations and Funding

IHS funding is separated into four budget categories: health services, facilities, collections (reimbursements from Medicare and Medicaid, as well as private insurance), and SDPI. FEHBP-level coverage for the 1.44 million IHS user population, according to the FDI study, would call for IHS appropriations of about $3.97 billion in FY2004 for personal medical services. Current Legislative Issues

There are a number of Indian health issues that have been or likely will be debated in the 110 th Congress. In the 110 th Congress, the Senate's IHCIA reauthorization bill, S. 1200 , was introduced on April 24, 2007, and reported, with amendments, by the Senate Indian Affairs Committee on October 16, 2007 ( S.Rept. 110-197 ). The Natural Resources Committee ordered H.R. 1328 reported, with amendments, on April 25, 2007; the printed report was published April 4, 2008 ( H.Rept. 110-564 , part 1). S. 1200 was passed, amended, in the Senate on February 28, 2008, and referred in the House to the same committees as H.R. 1328 was discharged from the Energy and Commerce Committee and the Ways and Means Committee on June 6, 2008, and the Natural Resources-reported bill was placed on the House calendar. Neither S. 1200 nor H.R. No IHCIA reauthorization bill has been introduced in the 111 th Congress as of the date of this report, although Medicaid-related provisions concerning cost-sharing, property exclusions, and consultation have been included in current draft economic-stimulus legislation. S. 1200 , as passed by the Senate, and H.R. They would expand the roles of tribes, tribal organizations (TOs), and urban Indian organizations (UIOs) in management and decision-making; organize behavioral health services (alcohol and substance abuse, social services, and mental health programs) into a "comprehensive continuum" of prevention and treatment programs; create a construction priority system for IHS-funded health facilities; authorize long-term and hospice care; exempt Indians from Medicaid and SCHIP premiums and copayments; allow urban Indian health programs (UIHPs) to get reimbursements from Medicare and other third parties; and establish a commission on how to improve Indian health care delivery. 1328 by the House Health Subcommittee of the Energy and Commerce Committee, in the version it forwarded to the full committee in November 2007. Amendments to the Social Security Act

Separate from the reauthorization of the IHCIA, S. 1200 and H.R. 1328 . 1328 . U.S. Congress.
The Indian Health Service (IHS), an agency in the Department of Health and Human Services (HHS), provides health care for eligible American Indians/Alaskan Natives through a system of programs and facilities located on or near Indian reservations and in certain urban areas. The IHS health delivery program is organized into 12 regional area offices and 161 local service units, and serves federal reservations, Indian communities, and urban Indians. In general, persons eligible for IHS services must be in IHS service areas and belong to federally recognized tribes.
The IHS-served population generally has a higher incidence of illness and premature mortality than the U.S. population as a whole. Several IHS publications compare the health conditions and causes of death of the IHS service population with those for the entire U.S. population. According to the latest of these, the average life expectancy at birth for the IHS service area population in 1999-2001 was 74.5 years, or 2.4 years less than the 76.9 years for the total U.S. population.
IHS appropriations are separated into two budget categories: health services and health facilities. For FY2008, the total appropriation for IHS was $3.35 billion, of which $2.97 billion (89%) was for health services and $374.6 million (11%) was for health facilities. Other sources of IHS funding include a special diabetes program and reimbursements from Medicare, Medicaid, and private insurance. Total IHS "program-level" funding, including all sources, was $4.28 billion in FY2008. Indian health advocates argue that IHS funding falls short of the need.
Although a number of legislative issues concerning IHS face the 111th Congress, the primary focus has been on the reauthorization of the Indian Health Care Improvement Act (IHCIA). Two bills (S. 1200 and H.R. 1328) were introduced in the 110th Congress to reauthorize the IHCIA. Both reauthorization bills would have expanded health services, eased processes for reimbursements from Medicaid and other federal programs, coordinated behavioral health programs, and authorized other actions. S. 1200 was reported, amended, by the Senate Indian Affairs Committee on October 17, 2007 (S.Rept. 110-197). S. 1200 was passed, amended, by the Senate February 28, 2008, and sent to the House. H.R. 1328 was reported, amended, by the House Natural Resources Committee on April 4, 2008 (H.Rept. 110-564, part 1). Separately H.R. 1328 was forwarded, amended, by the House Energy and Commerce Committee's Health Subcommittee to the full Committee on November 7, 2007. H.R. 1328 was discharged by the Energy and Commerce and Ways and Means Committees on June 6, 2008, and the Natural Resources version reported in April was placed on the calendar. Concerns continue about many issues in the IHCIA bills, including provisions on Medicaid and other issues listed in a January 2008 Statement of Administration Policy on S. 1200, which threatened a veto of that bill. Neither S. 1200 nor H.R. 1328 were passed by Congress. No IHCIA bill has been introduced in the 111th Congress as of the date of this report, but certain Medicaid-related provisions have been included in draft economic-stimulus legislation. This report will be updated.