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Administration’s Indian Health Service Budget ‘Cuts The Legs Out’ From Native Health Care System

Jul 12, 2017

Commentary: Today, U.S. Senator Tom Udall, ranking member of the Senate Appropriations subcommittee that oversees the budget for the Indian Health Service (IHS) and vice chairman of the Senate Committee on Indian Affairs, told IHS officials that the Trump administration’s IHS budget proposal is “wholly insufficient to effectively serve communities in dire need of health care services.” During a hearing on the IHS’ fiscal year 2018 budget, Udall also questioned IHS officials about how TrumpCare, Senate Republicans' proposal to repeal and replace the Affordable Care Act, would decimate Medicaid and obstruct access to life-saving health care in Indian Country. 

Credit Office of US Senator Tom Udall (D-NM)

While Udall's subcommittee secured a crucial 5 percent funding increase for fiscal year 2017 in the most recent omnibus appropriations bill, the administration's draft budget proposal called for $300.5 million in cuts to IHS, a “complete departure” from the progress made to rebuild the IHS budget, Udall said. IHS is already severely underfunded: according to recent data, IHS spent just $2,849 per patient in 2013, compared with a national average of of $7,535 per patient and Medicare’s $12,042 per patient. “This proposal would not provide the resources needed for the health and well-being of American Indians and Alaska Natives. It is wholly insufficient to effectively serve communities in dire need of health care services,” Udall said. "Passing the president’s budget would mean less money for inpatient services, preventive health programs, drug addiction treatment, mental health programs and specialty care. It would mean fewer resources to recruit and retain a qualified workforce and to address already underfunded facility infrastructure needs.”

"My experiences have taught me that health care in Indian country suffers from generations of underfunding,” Udall continued. “It’s disheartening to see this administration put forward a budget that would force whole Tribal communities to fully return to a cruel system of health care rationing. 'Life or limb' is no way to run a hospital, and no way to promote healthy Native communities and families.”

Udall pressed IHS officials for answers on the disastrous implications of TrumpCare and the massive proposed cuts to Medicaid for IHS’ ability to provide more services and further stretch limited resources. In New Mexico alone, more than 132,000 Tribal members are enrolled in Medicaid. "For decades, Medicaid has been a crucial program for fulfillment of the federal government’s trust responsibilities. Now is not the time to lose ground on the progress we have made,” Udall said. “We know that Tribal communities can thrive when they have adequate access to health care. We know that Tribal health outcomes improve when access to quality, preventative care is expanded…like we’ve seen over the last few years with Medicaid expansion and third-party billing revenue increases.”

Other members, both Republicans and Democrats, echoed Udall’s concerns about the impact of Medicaid cuts on Indian Country. The subcommittee asked IHS officials to expedite the process of responding to the committee with specific information on how proposed Medicaid changes would affect the ability of IHS to deliver health care services. 

Given the dramatic issues that repeal of the Medicaid expansion would pose for IHS and concern about a lack of consultation with Tribes, Udall asked IHS Acting Director Michael Weahkee, "Have you or any of your staff at IHS been contacted by House or Senate Republican leadership or the White House requesting consultation or technical assistance for various drafts of TrumpCare?” Weahkee responded that, to his knowledge, IHS has not been consulted with during the TrumpCare drafting process. 

Udall said that the budget’s proposed $12 million cuts to alcohol and substance abuse programs, coupled with the repeal of federal essential health benefit requirements in TrumpCare, would be “particularly devastating” for Native Americans, who experience drastically higher rates of substance use and mental disorders compared to non-Native groups. Udall said he was "pleased that this committee was able to secure additional funding for alcohol and substance abuse programs in the omnibus. I know that this funding is critical to patch gaps in service, like those we see in the community of Gallup in my home state,” questioning IHS officials about when funding will be made available on the ground in areas of great need. 

In May, Udall secured $13 million in funding for new Indian Health Services (IHS) substance abuse programs in the major bipartisan appropriations bill to fund the government through September 2017. The provision dedicates $2 million in new funding specifically for partner detoxification facilities, such as Na'Nizhoozhi Center Inc. (NCI) in Gallup. 

Below is Udall’s full opening statement as prepared for delivery: 

I want to offer a warm welcome to the new IHS acting director, Rear Admiral Michael Weahkee who hails from New Mexico. I’m told that you have a lifetime of experience with the IHS system - starting from the very beginning - when you were born in an IHS hospital in Shiprock, New Mexico. 

I also want to welcome Rear Admiral Chris Buchanan, IHS deputy director; Mr. Gary Hartz, director, IHS Office of Environmental Health and Engineering; and Ms. Elizabeth Fowler, IHS deputy director for management operations. 

I look forward to hearing from all of you today. 

Before we get to the budget, I want to recognize the leadership of Senator Murkowski - who has done a tremendous job as chair of this subcommittee, and is someone I am proud to work with. Senator Murkowski and all the members of the subcommittee understand the value and the importance of IHS for all Native communities. And we have made real progress to secure funding to improve health care in Indian Country.  

I am proud of the subcommittee’s work that included an increase for IHS in the most recent omnibus. Securing a 5 percent increase for IHS for fiscal year 2017 - one of the largest increases in the entire appropriations bill - was no small feat. But the members of this subcommittee believe that these investments are critical for healthy Native communities and families. I look forward to continuing our work together as a committee - and to continued cooperation on a bipartisan basis. 

The budget proposed by the administration for fiscal year 2018 is a complete departure from the progress we have made to rebuild the IHS budget. This proposal would not provide the resources needed for the health and well-being of American Indians and Alaska Natives. It is wholly insufficient to effectively serve communities in dire need of health care services.

Passing the president’s budget would mean less money for inpatient services, preventive health programs, drug addiction treatment, mental health programs and specialty care. It would mean fewer resources to recruit and retain a qualified workforce and to address already underfunded facility infrastructure needs.  

With a proposed overall cut to the service of $300.5 million, this budget would eviscerate the gains we made in fiscal year 2017 by instituting a 6 percent reduction, and undo the progress we’ve made to restore IHS funding levels to pre-2013 sequestration levels.

My experiences have taught me that health care in Indian Country suffers from generations of underfunding. It’s disheartening to see this administration put forward a budget that would force entire tribal communities to fully return to a cruel system of health care rationing.  “Life or limb” is no way to run a hospital, and no way to promote healthy Native communities and families.

The president’s proposed fiscal year 2018 budget systematically cuts the legs out from that progress. I am concerned. And I know that Tribes are as well. 

I am concerned that this budget cuts $99 million from IHS facilities - despite the service’s estimated $10 billion construction backlog.

I am concerned it cuts funding for hospitals and health clinic services by $64 million. 

I am concerned it cuts $22 million from mental health and substance abuse programs. 

And, I am concerned it cuts $6 million from loan repayment and scholarship programs needed to fill critical vacancies at IHS facilities. 

Finally, I would quickly like to address the issue of the larger 2018 budget and the cuts it assumes to Medicaid. 

For decades, Medicaid has been a crucial program for fulfillment of the federal government’s trust responsibilities. It is clear to me that any potential changes to national policy regarding Medicaid and health insurance programs – like those contained in the Senate Republicans’ Better Care Reconciliation Act – will directly impact tribal communities and Native lives.  

So, for the record, I would like to urge the majority - on all committees — to follow regular order, hold hearings, and seek Tribal consultation on any proposal that would cut access to critical health care programs.

Now is not the time to lose ground on the progress we have made. We know that Tribal communities can thrive when they have adequate access to health care. We know that Tribal health outcomes improve when access to quality, preventative care is expanded, like we’ve seen over the past 20 years with SDPI, and like we’ve seen over the last few years with Medicaid expansion and third-party billing revenue increases. 

I look forward to speaking with all of you today about how we can do more for Indian Country. And I look forward to the work of this subcommittee to secure the resources necessary to make that happen.

https://www.appropriations.senate.gov/hearings/review-of-the-fy2018-budget-request-for-the-indian-health-service