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Bush seeks $4 billion for Indian Health Service

The Indian Health Service emerged nearly unscathed with the release of President Bush's fiscal year 2007 budget on Monday.

Since the start of the Bush administration, the IHS has seen steady increases. The trend continued with a request of $4.0 billion, an increase of $124 million, for the agency that will provide health care and services to an estimated 1.9 million American Indians and Alaska Natives next year.

Due to the patient increase -- the IHS user base has grown by 11.3 percent since 2001 --- and the rising cost of health care, nearly early every single program within the IHS saw some sort of boost. For example, clinical services grew by $147 million to $3.0 billion, preventive health got an $8 million lift to $127 million, contract support costs grew by $6 million to $270 million and facilities support will see a $11 million increase.

At the same time, two long-standing areas of concern saw big cuts. First, the administration is proposing to eliminate entirely the $33 million for urban Indian health, citing coverage available through other programs.

"Unlike Indian people living in isolated rural areas, urban Indians can receive health care through a wide variety of federal, state, and local providers," the budget document states.

Second, the request calls for a $20 million cut to construction of new health care facilities. The account would be funded at $18 million, down from $38 million in 2006, and down from $89 million in 2005.

The elimination of urban Indian programs would affect major Indian population centers such as Albuquerque, New Mexico, where Sens. Pete Domenici (R) and Jeff Bingaman (D) have been fighting to save a clinic. In South Dakota, this would mean a loss of services in Sioux Falls, Pierre and Aberdeen, according to Sen. Tim Johnson (D).

"Essential programs, such as health care and education, are being slashed -� hurting the people that need it most," Johnson said yesterday. "Budgets are about priorities, and it is obvious to me that the president's budget priorities are backwards."

According to IHS, its priorities are to address the increased cost of health care, serve an additional 30,000 tribal members, expand into the area of Indian Country where care is needed the most and work with tribes through health promotion and disease prevention initiatives and through the increased use of information technology.

To meet the increased health care needs, the budget supports four new outpatient facilities in Clinton, Oklahoma; Red Mesa, Arizona; Sisseton, South Dakota; and St. Paul, Alaska. "A FY 2006 PART review found that IHS was effective in placing new health care facilities in areas where they were most needed," the budget states, referring to the Program, Assessment Rating Tool used by the White House to judge performance.

The $18 million sought for health facility construction will be used to complete new outpatient facility in Komatke, Arizona. According to IHS, the facility will alleviate "overcrowding" in the Phoenix Indian Medical Center.

IHS is also working on three health initiatives --� behavioral health, health promotion/disease prevention, and chronic disease management -- in partnership with tribes. The goal is to help Indian communities raise their health status and stem the increase of chronic conditions such as diabetes, heart disease and cancer that are becoming increasingly prevalent among Native Americans.

Finally, IHS is part of an initiative at the Department of Health and Human Services to increase the use of information technology. IHS started its Resource and Patient Management System back in 1984 and the system has won awards and received favorable reviews.

Another IHS system -- called Electronic Health Record -- has been launched in 24 IHS and tribal facilities to provide complete access to medical records, patient scheduling and clinical case management. By the end of 2008, the IHS hopes to have the system up and running at all locations.

FY2007 Budget in Brief:

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