The Indian Health Service: Part 2

 Shameless Ask: As the Shutdown drags on, the pinch we feel gets harder and harder, I love writing and sharing these posts, but they take time for me to research, write, and publish. If you feel you benefit from them, and you have a little extra would you consider making a small donation  to help us keep them going. 

Editorial note: I am using the word “Indian” here only in the context of quotes, agency, or organization names. Otherwise, I use the word Native. If my language is incorrect, outdated, and/or offensive and you would be willing to educate me or point me to where best to educate myself, I will edit my writing accordingly, and update this note to reflect what I have learned in hopes of educating others.

Well, it’s day 26. I really didn’t think I would be writing these for this long. But, here we are. So, today I have promised you the conclusion of our dive into the Partial Shutdown’s effects on the Indian Health Service (IHS), to catch up on the background of who IHS is and what they do you should read Part One. 

What’s Happening Now?

What’s happening over at IHS now that they have been defunded and notified their partners at the tribes that services must continue but the bills won’t get paid? Well, this one took a surprising about of research outside of popular media sources. Let’s take a look.

Native Organizations Issue a Plea To Reopen the Government

On Thursday January 10 six national tribal organizations signed and delivered a letter to the President urging him to re-open the government. Specifically speaking to the woes of IHS this letter says:

“Indian Health Service programs serving Indian Country have no FY 2019 appropriations. Despite the fact that the federal government has a trust obligation to provide health care to American Indian and Alaska Native people, the Indian Health Service remains unfunded while other agencies that provide critical health services have advanced appropriations or are otherwise funded. Tribal governments are cutting other services and scraping together scarce dollars, or securing interest-bearing loans, to keep health clinics operational, but this is not sustainable. Of 13 Urban Indian Health Programs (UIHPs) out of 41 that responded to a survey, two of the facilities will shut down in the next week, while five face closure within 30 days if the shutdownontinues. One reported that they have already reduced hours and UIHPs fear of losing their staff who are forced to look for other employment to pay bills. Our 

citizens are worried about whether they will be able to receive health care. This shutdown only emphasizes the need for IHS funding to be allocated on a mandatory funding basis, so that Native people are not subject to federal governmental dysfunction and impasses. If IHS funding was in law outside of the annual discretionary appropriations process, tribal nations would not have to worry each day if their programs are funded. As an interim step, IHS should be funded through Advance Appropriations, which would ensure that basic health services are funded if Congress and the President cannot come to an agreement on appropriations legislation.”

So,  the National Congress of American Indians, The Native American Contractors Association, The Winnebago Tribe of Nebraska, The National Council on Urban Indian Health, The Winnebago Tribe of Nebraska, Chippewa National Indian Education Association, The National American Indian Housing Association, The National Indian Child Welfare Association, and the Self-Governance Communication & Education Tribal Consortium are making 5 key points here:

  1. IHS is currently unfunded for FY19 (for clarity the Government Fiscal Year (FY) runs from 10/1 to 9/30, we are currently in the 2nd quarter of FY19)
  2. The Federal government has a well-established obligation to provide healthcare to American Indian and Alaska Native people
  3. IHS is the only federal agency providing healthcare that remains unfunded for FY19
  4. Because the IHS cannot pay its bills; Tribes are left scrambling for funds to make up the difference
  5. One-Third of clinics are already closed, more will shutdown if this continues

Why Is This Important? 

Well, first and foremost it is our Governments legal obligation to provide this service. We have a lengthy and shameful history, as a nation, of treating native people beyond poorly.  We have treaties in place that cover this specifically. Aaron Payment, chairman of the Sault Ste. Marie Tribe tells the New York Times “The Federal Government owes us this: We prepaid with millions of acres of land, we don’t have the right to take back the land, so we expect the Federal Government to fulfill it’s treaty and trust responsibility.” He’s not wrong, not even a little bit.

In response to being asked to explain how the shutdown is taking a toll on Native people’s healthcare, Kerry Hawk Lessard, the Executive Director of Native American Lifelines tells NPR

“Sure. So as a contract site with the Indian Health Service, we operate on a cost-reimbursement basis, which means that we spend the money and send a voucher into the IHS, and then we get paid back. Before the shutdown, IHS owed us two months worth of vouchers. So when the shutdown occurred, any payments to us stopped, which means that we had to make some quick decisions about what we were going to do. And unfortunately after a meeting, our board of directors, in concert with our fiscal people, decided that we would have money to operate just to the end of this week. So at the end of this week, we are looking at laying off our employees and suspending medical services and mental health services to our clients in both Baltimore and Boston.” Firstly, two months?!?! At the start of the Shutdown IHS was already two months in arrears on these payments. This interview was conducted on January 8th, so it is safe to assume those clinics have been shuttered, the employees laid off, and their patients left without care.

What kind of care are we talking about? Well Ms. Hawk Lessard goes on in that same interview to say “But we do provide direct dental care, direct behavioral health care. And we pay for folks to get care at other places. Now keep in mind. In the Baltimore area, we are home to – in the state of Maryland, the Indian Health Service Headquarters. And we’re also near Washington, D.C. So we’re serving a lot of tribal citizens who’ve come from their homelands to serve in the federal government. So just a snapshot of what will happen in Baltimore – over the last two weeks, we’ve experienced four opioid overdoses, two of which have been fatalities. So for me, the thought that we won’t be there to support grieving families or to connect people who have survived overdoses or who currently have substance abuse problems with treatment is really scary.” As a nation in the grips of an opiod addiction crisis, this nothing good comes from making this treatment less accessible.

She goes on to say “You know, in addition to the fact that 90 percent of my staff members are Native – and for us, you know, these are our relatives. So to, you know, think of telling your grandma, well, I’m sorry; I can’t pay for your insulin this month because there’s the federal government shutdown, and I don’t know when I can pay for it again, it’s really scary. Our people are already really burdened by high health care problems, behavioral health problems. So to know that there is no safety net for them is really scary. I can’t tell any of my clients or vendors or even the people – you know, my car payment in real life. Well, I’m going to pay you in border wall. That’s not an accepted currency right now.” So, when you talk about this issue, please don’t forget that the people being laid off – are also Native people.

With clinics closing and tribal staff being asked to continue to work without pay, or being laid off entirely, the people who rely on these literally life sustaining health care services are left out in the cold. So, please add native people to your list of the effected. Just another piece of collateral damage in what is turning out to be an incredibly damaging time.  I’m going to end this post with another quote from Ms. Hawk Lessard, because I genuinely believe that in this situation it is simply my job to amplify her (and other native peoples) voice(s). “It’s really difficult for a lot of reasons. But I think primarily because all the services to Indian people are predicated on treaty rights and trust responsibilities. We paid well in advance in our lands and with our bodies. One of my ancestors is a survivor of boarding schools. So the fact that these things aren’t available to us now because the government can’t get along is just mind-boggling to me.”