WASHINGTON, D.C. — For the first time in a decade, Indian Country will be able to rely on a stable source of funding to address diabetes in tribal and urban communities. But the achievement didn’t come without chaos, courtesy of the current occupant of the White House.

The massive COVID-19 and federal funding bill that became law on Sunday includes a three-year authorization for the Special Diabetes Program for Indians (SDPI). The extension is the longest on record since 2010.

“The program has improved the quality of life for many and saved many lives,” President Jonathan Nez of the Navajo Nation said on Monday. “The three-year reauthorization also provides long-term stability for the program, which is important for long-term planning and strategizing.”

But the 400-plus tribal and urban Indian programs that benefit from the program won’t be seeing any increases in resources. Lawmakers only set aside $150 million a year for diabetes prevention and treatment grants, an amount that hasn’t changed since 2004.

Despite the short length and the stagnant funding levels, tribes and their advocates are welcoming the latest extension. It comes after Indian Country spent most of the last 10 years pushing Congress to fulfill its trust and treaty responsibilities by reauthorizing the SDPI.

“Especially after a year in which we had six short-term extensions of SDPI — a couple of which were only for a day — seeing three-year stability is definitely a good thing,” Shervin Aazami, the director of Congressional Relations for the National Indian Health Board, said during a tribal leader town hall last Tuesday.

Just hours later, however, Indian Country’s progress was threatened by Donald Trump. Still sore after losing the presidential election more than a month prior, the outgoing Republican president threatened to blow up the $900 billion package because he said it was filled with “wasteful spending” and didn’t provide enough in direct payments to American citizens.

Trump and his temper tantrum left the country in limbo for days, all during a holiday season already darkened by COVID-19, which has impacted American Indians and Alaska Natives at disproportionate rates. His inaction resulted in a temporary lapse of unemployment benefits for millions of Americans, many of whom are still hurting from job and economic losses brought about by the pandemic.

ICYMI: Donald Trump is threatening to blow up the $900 billion #COVID19 relief and federal funding bill, one that keeps Indian Country programs up & running, fulfilling the trust & treaty responsibility. He says the bill is filled with "wasteful spending."https://t.co/oLDgAnNKRb

— indianz.com (@indianz) December 23, 2020

But as the weekend drew to a close, Trump relented and signed H.R.133 into law on Sunday. Even though he is leaving office in less than month, he said he would send a “formal rescission request” to Congress, demanding cuts in federal programs whose funding levels had already been secured by bipartisan agreement.

He also reiterated his call to increase COVID-19 payments to $2,000 per individual, up from $600 provided by H.R.133. Democrats in the U.S. House of Representatives quickly took him up on the offer and passed a new bill with the higher amount on Monday.

“I know what it’s like to struggle to make ends meet and the torture folks feel when deciding which bills to pay and how they’re going to put food on the table,” Rep. Deb Haaland (D-New Mexico), a citizen of the Pueblo of Laguna who relied on food stamps while raising her child as a single mother, said in the evening after the vote on H.R.5091, also known as the Caring For Americans With Supplemental Help, or the CASH Act.

“We’ve been fighting for this for months, and finally, the president came around after he blocked negotiations since summer,” added Haaland, who is set to make history as the first Native person to lead the Department of the Interior for the incoming Joe Biden administration.

Rep. Sharice Davids (D-Kansas), a citizen of the Ho-Chunk Nation, joined nearly every other Democrat in supporting the $2,000 payments. Along with Haaland, she is one of the firs two Native women to serve in Congress.

“Today I’m voting to provide $2,000 payments to hardworking families who desperately need help,” Davids said on social media on Monday. “Though I’m glad the President finally signed the relief bill, it’s still only a first step. These payments now have bipartisan support & it’s time for action in a national crisis.”

But Trump’s threats didn’t have much of an effect on his own party. Nearly every Republican in the House voted against the higher payments — though Rep. Tom Cole (R-Oklahoma), a citizen of the Chickasaw Nation, was a notable exception.

“The wrath of the coronavirus pandemic has caused unprecedented hardships for many Americans, and I applaud President Trump for urging Congress to deliver more targeted relief to individuals and families in the form of stimulus checks,” said Cole, who has been in office since 2002.

Unfortunately, I am stuck in the Dallas airport and won’t be able to make it to DC for votes tonight. But please know I am standing with President Trump and I would not vote to override his veto. pic.twitter.com/jypaTTMHVf

— Markwayne Mullin (@SenMullin) December 28, 2020

Missing from the entire affair was Rep. Markwayne Mullin (R-Oklahoma), a citizen of the Cherokee Nation. In a video on social media, he said he was “stuck” in an airport and wasn’t able to make it to the U.S. Capitol in time for votes on Monday.

Mullin, however, insisted that he was “standing with President Trump” when it came to a different bill — one that funds the U.S. military. He said he would not vote to override Trump’s veto of H.R.6395, the National Defense Authorization Act for Fiscal Year 2021, also known as the NDAA.

“I apologize about that,” Mullin said of his absence from the proceedings in Washington, D.C.

Mullin, who has been in office since 2012, was left stranded by his own party though. Trump’s stance on the military funding bill failed to sway Republicans, most of whom joined Democrats in overriding the president’s veto. It was the first override in Trump’s first — and only term — as president.

Not even Cole, who has become increasingly partisan over the course of the 116th session of Congress, could be convinced into standing with Trump. He described the veto as disastrous for America’s military.

“If Congress does not enact the NDAA for fiscal year 2021, it will cost military families their extra combat and flight pay, effectively giving them an undeserved pay cut for Christmas and shamefully disregarding the selfless sacrifices they daily make to ensure our shared safety and security,” Cole said in explaining why he went against Trump.

Fiscal year 2021 formally started on October 1, so lawmakers were behind schedule when it came to the defense bill, and with the appropriations bills for federal agencies like the Indian Health Service, which administers the Special Diabetes Program for Indians. The program began in 1997 to address disproportionately high rates of diabetes among tribes and their citizens.

Since then, the grants provided by the SDPI have resulted in “remarkable progress” in Indian Country, according to the IHS. The agency’s 2020 report to Congress outlines the ways in which 404 programs in tribal and urban Indian communities have reduced diabetes among American Indians and Alaska Natives.

“For the first time, diabetes prevalence in AI/AN adults has decreased – and has done so consistently for 4 years, dropping from 15.4 percent in 2013 to 14.6 percent in 2017,” the report states. “Neither the general United States population, nor any other U.S. racial/ethnic group has shown a decrease in prevalence.”

“Diabetes-related mortality for AI/AN people decreased 37 percent from 54.2 per 100,000 in 1999 to 34.4 per 100,000 in 2017,” the report adds.

With SDPI grants, tribes and urban Indian providers are able to use the money in ways that best suit the needs of their people. Many programs incorporate cultural traditions that help ensure the success of diabetes management, treatment and prevention efforts.

“There is no doubt that our program has changed the course of diabetes in the Hopi community,” Chairman Timothy Nuvangyaoma of the Hopi Tribe said at a Congressional hearing in late September.

The positive impact of SDPI grants made it all that more crucial to reauthorize the program, especially in the age of COVID-19, when resources are being stretched thin across Indian Country. Short-term extensions only contributed to uncertainty, according to advocates.

“Roughly 1 in 4 programs have reported delaying essential purchases of medical equipment to treat and monitor diabetes due to funding uncertainty, and nearly half of all programs are experiencing or anticipating cutbacks in the availability of diabetes program services – all under the backdrop of a pandemic that continues to overwhelm the Indian health system,” a letter signed by the National Indian Health Board, the National Council of Urban Indian Health and the said in a joint letter to Congress earlier this month.

84% of Democrats want the Senate to pass a $2,000 direct payment

73% of Republicans want the Senate to pass a $2,000 direct payment

74% of Independents want the Senate to pass a $2,000 direct payment

The House approved a $2,000 direct payment

Let the Senate vote, Mitch!

— Bernie Sanders (@SenSanders) December 29, 2020

Though H.R.133 is finally law, the story is not closed on the CASH Act. H.R.5091 still must be approved in the U.S. Senate, whose Republican leaders are reluctant to take up Democratic achievements, before the $2,000 payments can be sent to Americans.

The Senate also must consider the NDAA override. Sen. Bernie Sanders (I-Vermont), a former Democratic candidate for president, said he will hold up the military funding bill unless the chamber commits to a vote on the CASH Act.

“Let me be clear: If Senator McConnell doesn’t agree to an up or down vote to provide the working people of our country a $2,000 direct payment, Congress will not be going home for New Year’s Eve,” Sanders said of Sen. Mitch McConnell (R-Kentucky), the Senate majority leader.

“Let’s do our job,” Sanders said.

Cronkite News: Indian Country pushes for renewal of successful diabetes program (October 1, 2020)
Legislative Hearing to receive testimony on S. 3126, S. 3264, S. 3937, S. 4079 & S. 4556 (September 25, 2020)
Witness list for Senate Committee on Indian Affairs hearing (September 22, 2020)
Senate Committee on Indian Affairs legislative hearing (September 21, 2020)