National Council of Urban Indian Health (NCUIH)

NCUIH Testifies at Two Congressional Hearings Regarding Critical Urban Indian Health Funding


WASHINGTON, DC (April 5, 2022) – Sonya Tetnowski (Makah Tribe), President-elect and CEO of the Santa Clara Valley Indian Health Center, National Council of Urban Indian Health (NCUIH), testified before the Domestic Appropriations Subcommittee of the House in connection with the American Indian and Alaska Native (AI/AN) Public Witness Day hearing regarding Fiscal Year 2023 funding for Urban Indian Organizations (UIO). Maureen Rosette (Chippewa Cree Nation), NCUIH Board Member and Chief Operating Officer of the NATIVE Project, testified before the House Natural Resources Oversight and Investigation Subcommittee for a hearing titled ” The Opioid Crisis in Tribal Communities”. In their testimony, NCUIH leaders highlighted the critical health needs of urban Indians and the needs of the Indian health system.

The NCUIH thanks the members of the subcommittees for the opportunity to testify about the needs of Urban Indians and encourages Congress to continue to prioritize the health of Urban Indians in fiscal year 2023 and beyond.

In this release: Homeowners demonstrate strong commitment to Indian health

Also in this version: Congressional leaders voice support for expanding opioid funding to urban Indians

Homeowners demonstrate strong commitment to Indian health

NCUIH President-Elect Tetnowski testified before the House Appropriations Subcommittee along with Ms. Fawn Sharp for the National Congress of American Indians, Mr. Jason Dropik for the National Indian Education Association, and Mr. William Smith for the National Indian Health Board. The House Appropriations Committee is using the evidence provided to inform appropriations decisions for fiscal year 2023.

The NCUIH requested the following:

  • $49.8 billion for Indian Health Service (FY22 passed: $6.6 billion) and $949.9 million for Urban Indian Health (FY22 passed: $73.4 million) for fiscal year 2023 , as requested by the Tribal Budget Formulation Working Group
  • Indian Health Service (IHS) advance credits
  • Mandatory funding support for IHS, including UIOs

Full funding of India’s healthcare system is a priority for Congress

Many members of Congress on both sides of the aisle have noted the need to increase resources for Indian health in order to fulfill the trust responsibility. The federal fiduciary duty to provide health care to Indigenous peoples is not optional and must be provided regardless of where they reside,” Ms. Tetnowski said in her testimony. “Indian health funding must be greatly increased if the federal government is, to finally, and faithfully, fulfill its trust responsibility.

Ranking member David Joyce (R-OH-14) agreed with Ms Tetnowski: “Much remains to be done to fulfill the responsibility of the trust. Rep. Mike Simpson (R-ID-02) also stressed that more needs to be done to “ensure that there is no disparity between Indian health services and other health services provided by the federal government.” “.

President Sharp said: “The jurisdiction of this subcommittee includes some of the most critical funding for Indian Country. As detailed in the 2018 Broken Promises Report, chronically underfunded and inefficiently structured federal programs have left some of the United States’ most basic obligations to tribal nations unfulfilled for centuries. We call on this congressional subcommittee to support the vision of tribal leaders to right these wrongs by providing full and adequate funding for Indian Country.

The Case of Compulsory and Advance Credits for IHS

India’s healthcare system, including IHS, Tribal Institutions and UIOs, is the only major federal healthcare provider funded through annual appropriations. For example, the Veterans Health Administration of the Department of Veterans Affairs receives most of its funding through advance appropriations. If IHS were to receive advance funding, it would not be subject to government shutdowns, automatic sequestration reductions and continuing resolutions (CRs) because its funding for next year would already be in place. According to the Congressional Research Service, since fiscal year 1997, IHS has received full-year appropriations once (in fiscal year 2006) at the beginning of the fiscal year.

“During the last 35-day government shutdown at the start of FY 2019, India’s healthcare system was the only federal healthcare entity to shut down. UIOs are so chronically underfunded that several UIOs have had to cut services, lose staff, or shut down completely, forcing them to leave their patients without adequate care. Advancing appropriations is imperative to keep the IHS system secure and to ensure that unrelated budgetary disagreements do not put lives at risk,” Ms. Tetnowski said.

Many members of Congress wanted to know more about the differences between mandatory and advance appropriations. In her opening remarks, Chair Pingree pointed out that the Mandatory Funding Proposal, if implemented, would remove the jurisdiction of the Appropriations Committee from the Authorization Committees. NCAI Chairman Sharp and SSNA Chairman Smith also expressed support for President Biden’s mandatory funding proposal. Mr. Smith testified that the President’s proposal is “a bold vision to end chronic underfunding and build a comprehensive Indian healthcare system. We urge Congress to support the request and work with jurisdictions and tribes to pass this into law. »

Rep. Simpson sought to clarify whether Advance Credit and Compulsory Credit remain priorities for Indian Country. President Sharp explained that “both [advance and mandatory funding] are of crucial importance” in fulfilling the trust responsibility while noting that basic health care should be a mandatory expenditure of the United States government. President-elect Tetnowski also stated that, “Advance credits would ensure that we are not closed during any type of government shutdown. IHS is currently the only healthcare center [provider] to the federal government, which has no advanced appropriations.


Congressional leaders voice support for expanding opioid funding to urban Indians

“Opioid overdose deaths during the pandemic have increased more in Native American communities than in communities of any other racial or ethnic group,” said Rep. Katie Porter (D-CA-45), “to address this crisis, we must provide more resources for tribal governments and urban Indian health organizations to address the opioid epidemic.

Urban Indians excluded from opioid subsidy funding

Funding to help AI/AN communities deal with the opioid crisis has repeatedly left out urban Indians. UIOs were not eligible for funding to assist Indigenous communities in the reauthorization of the State Opioid Response (SOR) grant included in the recently passed FY2022 Omnibus (HR 2471) despite the inclusion of UIOs in the SOR Bill (HR 2379) which passed the House. on October 20, 2021. The final wording of the omnibus (HR 2471) did not explicitly include “Urban Indian Organizations” as eligible and did not use the language of HR 2379. Although this is likely the result of copying of the statutory text of the previous legislation, this bars urban Indian healthcare providers from accessing critical funding needed to tackle the opioid crisis.

“During the last government shutdown, an UIO suffered 12 opioid overdoses, 10 of which were fatal. That’s 10 parents who are no longer part of our community,” Ms. Rosette pointed out. fathers, uncles and aunts who are no longer present in the lives of their families, they are tribal parents unable to pass on the cultural traditions that make us, as Aboriginal people, who we are.

Responding to a question from Rep. Stansbury (D-NM-01) about what the committee can do to help support the UIO’s work on the ground to address the opioid crisis in Indigenous communities, Ms. Rosette said reiterated: “Funding is always an obstacle for us. Grants, like the State Opioid Response Grant, would allow us to provide culturally appropriate treatment to our community, but we weren’t included. You must specifically say “urban” with “tribal” otherwise we are not allowed to get the funding. “

Opioid epidemic in AI/AN communities

Since 1974, AI/AN teenagers have consistently had the highest rates of substance abuse than any other racial or ethnic group in the United States. Urban AI/AN populations are also at much higher risk for behavioral health problems than the general population. For example, 15.1% of urban AI/AN people report frequent mental distress, compared to 9.9% of the general public.

Additionally, the opioid crisis and the COVID-19 pandemic intersect and present unprecedented challenges for AI/AN families and communities. On October 7, 2021, the American Academy of Pediatrics released a study of caregiver deaths by race and ethnicity. According to the study, 1 in 168 RN/AN children were orphaned or died of a caregiver due to the pandemic and RN/AN children were 4.5 times more likely than white children to lose a parent or child. caring grandparent. Unfortunately, this has exacerbated mental health and addiction issues among our young people. In the 15-24 age group, young AI/ANs have a 172% higher suicide rate than the general population in that age group.


Next steps

NCUIH will continue to advocate for full funding of the Indian Health Service and Urban Indian Health in the amounts requested by tribal leaders, as well as additional resources for the opioid response for Indigenous communities.

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