IHS proposes $93M sanitation cut as Alaska Native villages face sanitation gaps

Alaska Native villages still rely on honey buckets and haul wagons for basic sanitation. Now the Indian Health Service wants to cut sanitation facilities construction funding by $93 million below fiscal year 2026 levels.

The agency told the Senate Indian Affairs Committee it needs to prioritize direct patient care over infrastructure. Over 2,000 water and sanitation projects remain unfunded across Indian Country.

Chair Lisa Murkowski challenged the logic during the fiscal year 2027 budget hearing. She asked how cutting sanitation funding aligned with preventing illness.

"Keep me from getting sick by making sure that I have sanitary conditions in my village, that I am able to wash my hands, bathe my kids. It is kind of the basic thing," Murkowski said.

Reliance on infrastructure act funds

The Indian Health Service chief of staff told the committee that $1.9 billion has gone to Alaska over the past four years under the Infrastructure and Jobs Act for water sanitation projects currently underway. The agency plans to continue that work using unobligated funds from the act.

He acknowledged significant challenges but said the agency faces a balancing act in a tight budget environment. "This was a prime opportunity to really invest in things that would revolutionize direct patient care," he said.

The budget prioritizes direct health care services. That includes $84 million to staff and operate new and expanded facilities, $265 million for current services to keep pace with inflation and workforce demands, $5 million for increased oversight of Indian Health Service-operated hospitals and health clinics, and $287 million for electronic health record modernization.

What happens when infrastructure money runs out

Murkowski pressed on what happens when Infrastructure and Jobs Act funding expires. She told the hearing she cannot return to communities that made progress under the infrastructure bill and tell them the funding pipeline has closed.

She said the Infrastructure and Jobs Act funds were designed to supplement base funding because sanitation needs were so severe. They were not meant to replace ongoing appropriations.

The administration proposed similar cuts last year. Congress rejected them on a bipartisan basis.

Senator Brian Schatz said Congress plans to fight the cuts again. "It is disappointing, but let us remember that this administration proposed similar cuts last year and Congress rejected them on a bipartisan basis," Schatz said. "So as a member of this committee and the Appropriations Committee, and being pretty good friends with the key appropriator and chair of the relevant committee on the Appropriations Committee, we are going to continue to fight against these cuts and protect federal funding."

At the end of the hearing, the chief of staff clarified that some apparent cuts to programs such as scholarships and health professions reflected timing against fiscal year 2026 appropriations rather than intended policy cuts. He said the agency had proposed increases for several programs. Congress funded them at higher levels than the administration had planned before the budget was finalized.