- Details
- By Elyse Wild
As a $340 billion House budget resolution moves toward a floor vote this evening, Native advocates warn that proposed cuts to Medicaid would buckle the already strapped Indian Health Service (IHS).
Under the Republican-led budget resolution, the Energy and Commerce Committee, which oversees Medicaid, is tasked with pinpointing at least $880 billion in cuts to programs under its jurisdiction.
While the GOP resolution doesn't explicitly target Medicaid, lawmakers say that achieving the cuts would be impossible without gutting the program that helps pay for healthcare coverage for up to two million — about one-third of — American Indians and Alaska Natives (AI/AN). If passed, the resolution could result in the largest funding cuts to Medicaid in U.S. history.
In a Feb. 6 webinar by the Georgetown University Center for Children and Families and the National Council of Urban Indian Health (NCUIH), panelists highlighted the relationship between Medicaid and the IHS.
"Medicaid plays a critical role in Indian Health Service,” Winn Davis, congressional relations director for the National Indian Health Board (NIHB) said during the webinar.
IHS is funded at about $8 billion nationally, but the actual funding need is in the tens of billions of dollars, as estimated by the National Tribal Budget Formulation Workgroup. Davis stated that while Medicaid accounts for 30-60% of overall funding at many IHS facilities, this only represents around 0.2% total Medicaid funding.
“Medicaid cuts can put rural tribal communities at serious risk,” NIHB’s Davis said. “We're concerned that Medicaid cuts can exacerbate health disparities in tribal communities.”
Those disparities extend nearly across the board, with Native Americans facing some of the highest rates of heart disease, diabetes, cancer, mental illness, substance use disorders and maternal and infant mortality.
Medicaid cuts would affect both reservation-based IHS facilities and Urban Indian Organizations (UIO), which serve Native Americans in cities.
IHS provides around $90 million in annual funding for 41 UIOs in the US that operate 87 facilities across 22 states. This number falls drastically short of the $949 billion annual budget needs of UIOs, according to the National Tribal Budget Formulation Workgroup.
UIOs depend heavily on Medicaid, receiving around $85 million in Medicaid funds in 2019, with nearly 60% of UIO patients enrolled in the program.
NCUIH Vice President Meredith Raimondi said Medicaid is vital for AI/ANs who live in metro areas — with UIOs serving eight of the ten cities with the most Native American Medicaid enrollees, including Los Angeles, New York and Phoenix.
Medicaid is a “critical supplement” for the federal government to meet its obligations to provide healthcare for tribal citizens, Raimondi said.
The proposed budget includes reforms to “protect” vulnerable populations, including children, pregnant women, individuals with disabilities and seniors. NIHB’s Davis warned these measures won’t work in Indian Country, particularly work requirements for able-bodied adults on reservations or remote Alaskan communities.
“Eighty percent of Alaska Native communities exist off the road systems,” he said. “Jobs in these communities may not meet Medicaid work requirements.”
Another proposal would cap federal Medicaid reimbursements to states, shifting responsibility to states that don’t share the federal government’s trust and treaty obligations to provide healthcare to tribal nations. NIHB is urging Congress to exempt Native beneficiaries from these types of reforms.
The potential Medicaid cuts come as IHS already struggles with staffing shortages and other challenges. IHS, which faces a 30% vacancy rate, narrowly avoided losing more than 2,000 employees earlier this month when Health and Human Servies Secretary Robert F. Kennedy, Jr.
More Stories Like This
IHS Scholarship Program Applications are Due by Feb. 28Healthy Teeth and Success in School
Morongo Breaks Ground on $55 Million Healthcare Facility
Masto, Mullin Introduce Bill Aimed at Hiring and Retention at the Indian Health Service
