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Thursday, December 18, 2003

December 17, 2003

The President
The White House
Washington, DC 20500

Dear Mr. President:

Through treaty and statute, the federal government has made a commitment to provide for the health care needs of American Indians and Alaska Natives. Unfortunately, we are failing to honor this commitment. I am writing to urge you to include a substantial increase in funds for the Indian Health Service (IHS) in your Fiscal Year 2005 budget request. Specifically, I urge you to include $5.54 billion for IHS clinical services, which is a $3.553 billion increase over the Administration's request for Fiscal Year 2004.

It is important to note that even this increase will provide only enough funding to cover basic health care services for the current IHS user population. It would not fully fund the Indian Health Service. To provide clinical services to all eligible Native Americans, the IHS would require $9.079 billion in FY 05. While our ultimate goal should be full funding, our immediate and minimum goal must be to serve those who currently depend on the IHS for their care.

The IHS is the only source of health care for many American Indians and Alaska Natives, but it has not received sufficient funds to provide even basic health care services. For many years, appropriations for the IHS have not kept pace with medical inflation or population growth. As a result, Native Americans increasingly receive health care that is far inferior to what other Americans receive. The funding disparity is alarming: while per capita health care spending for the general U.S. population is about $5,000 a year, per capita spending for each IHS beneficiary is less than $2,000 a year. The U.S. Government spends twice as much per capita on health care for federal prisoners as it spends on care for Native Americans.

This severe funding shortfall means Indians are routinely denied care that most of us take for granted and, in many cases, call essential. In many areas, treatment is deferred unless a patient's condition is life-threatening or he or she risks losing a limb. This literal "life or limb" requirement means Indians do not receive care until their condition has deteriorated significantly, when their treatment involves increased risk and significantly higher costs. Others receive no care at all. This is a national disgrace that simply must end.

Additional federal funds are essential to improve the health of Native Americans, who have a lower life expectancy and suffer from higher rates of medical problems, such as diabetes, heart disease, and sudden infant death syndrome. A $3.553 billion increase in the IHS's clinical services budget is needed to provide essential health care services and to end the delays and denials of care that Native Americans experience all too frequently today. Subsequent year increases should adjust for inflation and any changes in the user population.

Thank you for your consideration of this request.

Sincerely,

Tom Daschle United States Senate

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