Larry Voegele (left), CEO of the Fred LeRoy Health and Wellness Center in Omaha, Nebraska, and Larry Wright Jr., chairman of the Ponca Tribe, stand together inside the clinic. Photo by Kevin Abourezk

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Indian diabetes program included in bill to keep government running

Wednesday, February 7, 2018

Congress moves to avert shutdown and extend key Indian diabetes program

National Indian Health Board: 'Success is in sight'
By Kevin Abourezk
@Kevin_Abourezk

Note: This post has been updated with the correct spelling of the Ponca Tribe's dietician and diabetes program director. Her name is Sara Pfeifer.

The Special Diabetes Program for Indians is poised to see another day thanks to new developments on Capitol Hill.

The critical program will be funded at $150 million a year for 2018 and 2019 as part of a continuing resolution released on Monday evmening. The measure was followed up by an announcement on Wednesday of an bipartisan agreement to avert another government shutdown.

The continuing resolution must still clear Congress before the SDPI is officially extended. But the National Indian Health Board, with bated breath, applauded inclusion of the diabetes funding.

“NIHB has made long term renewal of SDPI our top legislative priority, and success is in sight,” the health board said in a post on its website.

According to the NIHB, the program has led to a 54 percent decrease in end stage renal disease for American Indians and Alaska Natives, as well as a reduction in Native people’s overall blood-sugar levels. The improvements have helped save lives and reduce the impact of those struggling with diabetes on federal resources, the health board said.

Congress Reaches Bipartisan Government Funding Agreement https://t.co/Q9lwYlgzvM
— Sen. McConnell Press (@McConnellPress) February 7, 2018

The Ponca Tribe is among those that have seen success in Indian Country. The tribe's diabetes program serves about 150 patients at any given time, said Sara Pfeifer, a dietician and acting director of the program.

The program offers cooking and exercise classes, as well as medical nutrition therapy and case management services. It employs a full-time dietician and a registered nurse/case manager, funded with an SDPI grant.

The program also works to ensure the tribe’s other health providers help diabetes patients better manage their disease.

“I do think it’s a very important program,” Pfeifer said. “It is definitely needed.”

Larry Voegele, the Ponca Tribe’s health CEO, said the tribe began exploring other revenue sources to fund the program once it learned Congress had failed to include funding for it in earlier continuing resolutions.

If Congress fails to include funding for the program in the current continuing resolution, the SDPI will run out of money on March 31. Voegele said the Poncas could continue funding the program until mid-July even without additional federal funds.

Beyond July, however, the program’s future would be uncertain, though the tribe has begun searching for new ways to fund it, he said.

Voegele said the tribe is currently looking at better utilizing third-party income, primarily private insurance, generated by the diabetes program to better fund it. The tribe also is considering offering telemedicine and remote home-monitoring equipment to generate new revenue, he said.

And even if Congress approves funding for the SDPI, the tribe would continue to seek other revenue sources for it, Voegele said.

“The threat of loss of the program has been good for us in that it has caused us to start thinking about the services that we provide in a way that we can make them more sustainable in the future,” he said.

“The funding itself though, it will provide us with a base to build from, a certain degree of certainty, at least for the time being, that our staff can be employed and provide the services that are needed by our patients," Voegele added.

The Special Diabetes Program for Indians would be extended for two years through a continuing resolution under consideration in Congress.

The two-year extension of the Special Diabetes Program for Indians is found on page 346 of the 515-page continuing resolution. The measure has been attached to H.R.1892, the Honoring Hometown Heroes Act, which passed the House on Tuesday.

H.R.1892, or some version of it, must pass the Senate, and be signed into law by President Donald Trump, by midnight on Friday in order to avoid a shutdown of the federal government.

Lawmakers would then have until March 23 to pass appropriations bills for the Bureau of Indian Affairs. the Indian Health Service and most other federal agencies. They have been operating at current levels of funding, meaning they haven't seen any promised increases.

"After we pass it, the Appropriations Committees will have six weeks to negotiate detailed appropriations and deliver full funding for the remainder of fiscal year 2018," Sen. Mitch McConnell (R-Kentucky), the Republican majority leader in the Senate, said on Wednesday of the bipartisan funding agreement.

Notably, McConnell said the deal will "unwind the sequestration cuts" that have hindered funding increases for the military and domestic programs. Even that development drew praise from President Trump, who had welcomed the prospect of a shutdown just a day earlier.

The Budget Agreement today is so important for our great Military. It ends the dangerous sequester and gives Secretary Mattis what he needs to keep America Great. Republicans and Democrats must support our troops and support this Bill!
— Donald J. Trump (@realDonaldTrump) February 7, 2018

"The Budget Agreement today is so important for our great Military. It ends the dangerous sequester," Trump wrote in a post on Twitter on Wednesday evening.

In remarks at the White House on Tuesday, Trump had urged Congress to link a funding agreement to tougher immigration laws.

"If we don’t change it, let’s have a shutdown. We’ll do a shutdown," Trump said.

Sequestration also has had a major impact on Indian Country, which was affected immediately due to the way the cuts were implemented.

But Sen. Chuck Schumer (D-New York), the Democratic leader in the Senate, said the bipartisan agreement will send the "arbitrary and pointless sequester caps to the ash heap of history."