Congress learned, in numerous hearings in the last two years, that short staffing, lack of housing for professional staff, short funding for equipment, buildings, and even basic utilities have added up over the years to an Indian Health Care system that is close to failure in some areas. Yet the need for local, accessible and culturally knowledgeable care is strong as ever. How will this budget respond?
The federal government has operated the Indian Health Service (IHS) since 1921, in recognition of its trust responsibility to protect the health of Native people. The IHS provides a range of medical services, including inpatient, ambulatory, emergency, dental, public health nursing, and preventive health care through 650 health care facilities in 36 states.
IHS Facilities: Despite recent funding increases approved by Congress, the federal government still spends just $35 per user on IHS facilities that serve Native people, compared to $374 per user for the nation as a whole. According to a committee staff memorandum prepared for a recent hearing of the House Natural Resources Subcommittee on Indian, Insular and Alaska Native Affairs, Indian Health Service hospitals are, on average, 40 years old —triple the average age of most U.S. hospitals. The increased age of IHS facilities adds to the risk of building code noncompliance and compromises the delivery of healthcare. The staff estimated that, at the current replacement rate, a new 2016 facility would not be replaced for 400 years. The cost to bring IHS facilities to needed capacity and condition is enormous, about $14.5 billion.
Indian Health care services are another imbalanced story. As of 2014, IHS was spending about just over $3,000 per patient each year, compared to the national average of just over $8,000. This skewed spending continues in spite of the fact that Native Americans typically have more serious health problems and more barriers to access to health care services than other Americans.
The President’s budget would retreat to 2016 levels of funding for Indian Health Services, and would cut much deeper than that into needed funding for health facilities – a $98 million cut compared to 2016. Overall, the cuts from nearly every line item in the proposed Indian Health budget add up to a $300 million retreat from the FY2017 appropriations decisions made by Congress earlier this year.
This choice disregards the record built by House and Senate committees in the 114th Congress on the shocking and literally deadly deficiencies in staffing and facilities in Indian health centers. The committees in both houses are continuing to legislate on management, staffing, training, equipment, standards and adequacy of facilities, but the President’s budget takes away the resources needed to make progress in these clinics and ensures continued failure to serve Native American patients with the quality of care they deserve.
The President’s budget also retreats to the 2016 funding level for the required payment of contract support costs for tribes that manage health facilities and services, even though tribes live in a real world where there is opportunity to turn back the clock, even a year or two, to a time when costs and needs might have been lower, and progress was clearly slower.
*The bottom line for Indian Health proposals – a $300 million retreat from responsibility and progress.
The Appropriations Subcommittee on Interior and Environment will consider funding for the programs and facilities that are part of the Indian Health Service. See the members of these House and Senate Subcommittees here.