Chronic severe underfunding prevents IHS from providing quality health care; Udall bill would help it leverage limited funds
During a Wednesday hearing of the U.S. Senate Indian Affairs Committee about substandard care at several Indian Health Services (IHS) facilities, U.S. Senator Tom Udall urged IHS officials to help address the public health crisis at the struggling Na’Nizhoozhi Center, Inc. (NCI) detox center in Gallup, N.M.
NCI offers a desperately needed social detox program, which is at risk of closing due to underfunding. The Center is not an IHS facility, but is the only detox facility serving the population in the rural community adjacent to the Navajo Nation and Pueblo of Zuni, and an estimated 98 percent of the clients are Native American.
Udall acknowledged that the issues facing NCI are complex, but he said IHS must work collaboratively and creatively with other federal agencies, Tribes and local officials in Gallup to find a long-term funding solution for the clinic because Tribal patients rely on it for care. “When critical public health facilities close, people are going to die,” Udall told officials at the hearing.
“The area in and around Gallup, N.M., has long experienced an alarming number of alcohol-related deaths of Native peoples. Last winter, 17 people died from alcohol-related incidents, including exposure to harsh, cold temperatures. Since the facility serves such a large Native population, IHS needs to be part of the team working with local officials and other stakeholders to solve this public health crisis in Northwest New Mexico,” Udall said at the hearing. “I believe there is a public health crisis going on, and there is a very real risk this center could close in a matter of weeks. Senator (Martin) Heinrich and I have been working together with local stakeholders, state officials, Tribes and IHS to prevent this. And the local community is really raising the alarm.”
Udall also raised concerns about numerous problems with staffing and quality of care at IHS facilities nationwide, including in New Mexico.
Witnesses at the hearing represented IHS, the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services. They pledged to work on improving accountability within IHS leadership but also highlighted the need for additional funding to retain and recruit medical staff.
Udall, the lead Democrat on the Appropriations subcommittee that funds IHS, agreed that Congress and the administration must devote adequate resources to support Indian health facilities. He raised the specific example of the Crownpoint Health Care Facility in Crownpoint, N.M. Last summer, the facility was forced to close its emergency room for over a month due to staffing issues.
IHS’ per patient spending lags far behind the national average, and Udall has long pushed for funding to improve Indian health care. In 2014, the IHS spent just $3,107 per capita for patient health services, compared to the national average of $8,097 per person, $7,036 per patient in the Department of Veterans Affairs health care system, and $11,910 per Medicare patient.
Udall and Senator Lisa Murkowski (R-Alaska) have introduced a bipartisan bill that would help IHS better leverage its limited funds and spend a larger proportion of its resources on patient care and staffing issues. IHS currently spends an estimated 30 percent of its Health Professions Account to pay taxes to the federal government, which takes away needed funding from investments in skilled medical professionals. Udall’s bill would make the program exempt from a federal income tax requirement (as the National Health Service Corps currently is).
“Unfortunately staffing issues and facility disrepair are becoming synonymous with the Indian Health Service,” Udall said at the hearing. “We need more resources for the agency to recruit and retain competent and committed staff. I will continue to push for this change and I hope that the administration has a specific plan to tackle this issue.”