Last year, the quality of health care offered by the Indian Health Service was called into question. This year, Congress begins to focus on the inadequate facilities that fail to support good quality care.
The House Natural Resources Subcommittee on Indian, Insular and Alaska Native Affairs (Subcommittee) met on March 9 to explore infrastructure issues in Indian country and territories. In spite of its broad title, the hearing focused on health care infrastructure.
The new chair, Rep. Doug LaMalfa (CA-01) and the vice-chair, Rep. Norma Torres (CA-35) opened the meeting with an overview of facts about health care facilities in Indian country being left behind. A video of the hearing is available here.
The staff memorandum for the hearing notes that
The current average age of Indian Health Service hospitals stands at an abysmal 40 years of age, triple the average age of most U.S. hospitals.
Despite funding increases by Congress, the Federal Government still spends just $35 per capita on IHS facilities that serve Native people, compared to $374 per capita for the nation as a whole.
The memo also provides a fairly comprehensive summary of the operations and facilities of the Indian Health Service, the laws that authorize its programs, and funding issues in the last 10 years.
A recent Indian Health Service report to Congress on funding available for facilities needs identified unmet facility needs of over $10 billion dollars, with appropriations for IHS facilities in FY2016 totaling only $105 million. Low as it is, compared to need, that $105 million appropriation is the highest amount IHS has received in the past 20 years, while unmet needs have accumulated.
Subcommittee members and witnesses agreed on the need to upgrade and expand IHS facilities to meet the needs in Indian Country and in urban areas. Even so, the Subcommittee was taken aback by the size of the price tag resulting from the deferred maintenance and investment in the facilities: $14.5 billion. That amount is, indeed, a lot of money – even if spread out over several years. But the federal government does in fact have that amount to spend – depending on priorities. Within the President’s call for a $1 trillion package of infrastructure improvements, $14.5 billion would amount to less than 1.5 percent of the total. A single project that the President plans – a wall along the southern border, would cost between $10 and $20 billion.
Health Care Debate Continues
The House could not compile the necessary votes to dismantle the Affordable Care Act; House leaders are moving to other issues. Meanwhile, concerns about the availability and quality of health care available through the Indian Health Service have not been resolved.
Indian Health Care Improvement Act (IHCIA) Preserved. By the time the debate had reached the floor of the House, it was already clear that the permanent authorization of the Indian Health Care Improvement Act (the law that establishes and continues the Indian Health Service) would be protected, even though it is “incorporated by reference” in the Affordable Care Act. But a number of other provisions in the law – some specific to Indian country, some affecting low-income families and individuals, including Indians – were (and still are) at risk of deep budget cuts and limitations.
The “replacement bill” that was under consideration would have placed a per-person limit on medical assistance through Medicaid, and would have handed the total sum of per-capita payments to states, to allocate as they wish. While some types of payments and reimbursements to the Indian Health Service would have been continued under that plan, direct use of Medicaid funds by Indian families would have been limited by state rules and decisions.
Heavy Weather Ahead. The debate will continue as the President’s budget proposal is considered. Deep cuts in social programs, including health, education, economic development, and income supports are expected. See notes in “Budget Outlines” regarding the budget and appropriations decisions coming up soon in Congress.