Indian Health Service budget promises funding for opioid epidemic

Tuesday, February 13, 2018

Trump administration seeks $150 million to help tribes with opioid crisis

'A crisis in our Native communities'
By Kevin Abourezk
@Kevin_Abourezk

Among the few bright spots for Indian Country within President Donald Trump’s proposed budget is a $413 million increase for the Indian Health Service.

According to the fiscal year 2019 request, the funding will provide a significant boost for direct clinical services, referred care, drug and alcohol rehabilitation and mental health care. And as part of a larger, $10 billion national campaign to combat the opioid epidemic, the president has proposed $150 million in new funding to the IHS to provide multi-year competitive grants based on need for opioid abuse prevention, treatment, and recovery support in Indian Country.

"We have a crisis in our Native communities,” Rep. Don Young (R-Alaska) said at the winter session of the National Congress of American Indians in Washington, D.C., on Tuesday, telling tribal leaders that drug traffickers are “abusing and killing your kids.”

Young wasn't the only one who brought up the issue on the opening day of NCAI's meeting. Rep. Darrell Issa (R-California), who is not running for re-election this year, said tribes face the same problems with addiction as others and mustn’t be forgotten as they fight those problems.

“Let’s be candid. In Indian Country you are not exempt from the problem of the opioid crisis,” Issa said.

National Congress of American Indians President Jefferson Keel kicks off winter session in Washington DC. Busy day hearing from members of Congress and officials from Trump administration pic.twitter.com/BBN6QxHoYU
— indianz.com (@indianz) February 13, 2018

The IHS provides health care to more than 2.2 million Native Americans and Alaska Natives. Many tribes, through compacts and contracts with the agency , administer their own health care programs. Those tribes manage more than 60 percent of IHS’s total budget.

According to an NCAI analysis released on Tuesday, Trump’s budget would reduce or eliminate funds for many tribal program while increasing funding primarily only for Indian health and justice programs. Among the many Indian programs targeted for elimination are the Indian Community Development Block Grant, Low Income Home Energy Assistance Program and Tribal Energy Loan Guarantee Program.

The largest proposed increase for IHS is a $353 million increase in funding for direct health care services, which would allow IHS to expand those services across the country. Direct health care services include outpatient and inpatient care in hospitals and clinics, behavioral health services, and dental health services.

“The budget prioritizes funding for direct health services to support improved health outcomes for American Indians and Alaska Natives,” an HHS budget overview said.

You can read the @HHSgov Budget in Brief here: https://t.co/oHrvk2pdsi pic.twitter.com/PVXQQMSDgT
— Alex Azar (@SecAzar) February 12, 2018

Other increases for IHS proposed in the budget include:

· An additional $159 million to support staffing and operating costs for six new or replacement health facilities to be completed in fiscal years 2018 and 2019. Those newly constructed facilities include: Red Tail Hawk Health Center in Arizona, Fort Yuma Health Center in California, Muskogee (Creek) Nation Health Center in Oklahoma, the Northern California Youth Regional Treatment Center in California, the Yukon-Kuskokwim Primary Care Center in Alaska and the Cherokee Nation Regional Health Center in Oklahoma.

· Funds to fully pay for contract supports costs, which support tribes that administer their own health programs as part of self-determination programs.

· An increase of $32 million for the Purchased/Referred Care program to support medical care for catastrophic injuries, specialized care and other critical care services. The program provides access to health care services where no IHS or tribal facility is available.

· An increase of $30 million for mental health, alcohol and substance abuse programs.

· $58 million to assist facilities, including those in the Great Plains Area, with meeting the Centers for Medicare and Medicaid Services quality health standards.

Rep. Nancy Pelosi (D-California), the Democratic leader in the House: “The trust responsibility is not just a legal arrangement, it’s a moral obligation” #ECWS2018 pic.twitter.com/nfvSe9zkMB
— indianz.com (@indianz) February 13, 2018

Despite those increases, Trump’s proposed budget still includes cuts for other Indian health programs, including a $70 million decrease in funds for preventive health services. The budget would provide just $89 million for those services.

Also lost within those funding cuts would be the Health Education program and the Community Health Representatives program. However, the budget would keep funding for the Public Health Nursing and immunization programs at nearly the same levels.

Other cuts to Indian health care would include:

· $36 million less for Indian health facilities funding.

· $38 million less for construction of new and replacement health care facilities that are on the 1993 Health Facilities Construction Project Priority List.

· $3 million less for purchasing and maintaining medical equipment.

Additionally, the budget impacts the popular yet politically sensitive Special Diabetes Program for Indians. It proposes to classify the $150 million in annual grants as "discretionary" rather than "mandatory," a change that could affect future efforts to fund the program.

Given that the program was about to expire until Congress recently extended the program for two years after strong lobbying efforts from Indian Country, the change has advocates worried.

Keeping the program going "should not even be a question, that should be a fact,” Rep. Nancy Pelosi (D-California), the Democratic leader in the House, said at NCAI on Tuesday.

Rep. Don Young (R-Alaska) on proposed cuts in #TrumpBudget: “He’s my president but it’s not my budget,” Young told the National Congress of American Indians #ECWS2018 pic.twitter.com/9FKJXce6Ip
— indianz.com (@indianz) February 13, 2018

Now that the budget has been submitted, it's up to Congress to write the bills that fund the federal government. Throughout the day during NCAI's meeting, lawmakers from both parties told tribal leaders that they were going to assert that role.

“He’s my president, but it’s not my budget,” Congressman Young said.

Tribal leaders will be focusing more on the opioid epidemic as NCAI's winter session continues on Wednesday. They are looking at legislative, legal and community strategies during an afternoon breakout.

Though the Trump administration has sent a slew of top officials to the meeting, no one from the Department of Health and Human Services or the Indian Health Service is represented on the agenda. That's a marked change from NCAI's prior meetings.

More than a year into the new era, the IHS also lacks a permanent leader. President Trump nominated Robert Weaver, a citizen of the Quapaw Tribe, for the job but he never secured a confirmation hearing in the Senate amid questions about his qualifications.

"We keep hearing positive signs on one hand and negative on the other," NCAI President Jefferson Keel said of the lack of a director for the IHS. "We just don't know. That is inexcusable."

Department of Health and Human Services FY2019 Budget Documents:
Budget in Brief | Indian Health Service