|Today, December 20, 2018, the U.S. Commission on Civil Rights released “Broken Promises: Continuing Federal Funding Shortfall for Native Americans“. The Commission evaluated whether the federal government is meeting its trust responsibilities to the Tribes by examining federal budgets and agency spending of on programs or initiatives designed to meet the needs of American Indian/Alaska Native (AI/AN) and Native Hawaiian communities, including programs under the Departments of Health & Human Services, Interior, Housing & Urban Development, Justice, and Education.
This report revisits a 2003 report done by the Commission that found, “funding for services critical to Native Americans–including health care, law enforcement, and education–is disproportionately lower than funding for services to other populations.”
While the new report highlights funding needs across every sector of government, Chapter 2 details funding shortfalls specific to Tribal health. It notes chronic shortfalls across several health areas. Highlights include:
· Indian Health Service (IHS) medical spending per capita in 2016 was $2,834 compared to Medicare’s $12,744 per capita. In other words, IHS could spend just 22% per patient of what Medicare spent.
· The President’s Fiscal Year (FY) 2019 budget request reversed a recent history of modest funding increases for IHS.
· Funding for Urban Indian health cannot keep up with inflation or population increase, and now covers only 22% of need.
· The IHS’s National Behavioral Health Strategic Plan, produced in 2011, cannot be fully implemented without supplemental funding for behavioral health needs in Tribal communities.
· Despite the success the Special Diabetes Program for Indians has created in improving diabetes related health outcomes, the program’s flat funding since 2004 has been increasingly swallowed up by medical inflation, leading to an effective 23% decrease in funding.
· 13% of AI/ANs lack access to clean drinking water and adequate sewage. The cost of rectifying this is approximately $2.8 billion.
· Medicaid Expansion has created a “much-needed boost” to IHS by increasing the level of compensated care in the states that have implemented expansion.
· The Indian Health Care Improvement Act (IHCIA), passed into law in 2010, has “great potential for reducing the vast health disparities that exist today between Native Americans and other demographics.” Unfortunately, many of the provisions in the law remain unfunded eight years later.
The Commission’s report also notes on page 92 that federal law “should exempt Native Americans from [Medicaid] work requirements due to their sovereign status and trust relationship with the federal government.” This is a pressing issue that National Indian Board has been working to rectify as states continue to submit waivers that include work requirements as a precondition to Medicaid eligibility.
You can read the full report here.