Under President Bush's proposed fiscal year 2007 debt reduction budget, urban Indian health funding would be terminated and patients would have to seek health care through other federally funded health facilities.
More than 60 percent of all American Indians who live in urban areas use urban Indian health facilities, according to the president's budget information. Those patients could find themselves looking for other health providers, mostly at their own expense.
The Bush budget would cut the entire $33 million from urban Indian health. Federal dollars comprise the majority of funding for urban Indian health organizations and clinics.
It was explained in the budget that ''urban Indians can often access other publicly funded health programs designed to address health disparities in urban areas, such as Community Health Centers.''
Those centers are primarily designed to accommodate homeless, migrant and seasonal workers. The American Indian population is not the primary target group.
Letter to the president
Daniel Hawkins Jr., vice president of the National Association for Community Health Centers, expressed his concern to the president in a Feb. 10 letter.
In the letter, Hawkins stated that the two organizations serve complimentary roles and that the elimination of the urban Indian health program would be detrimental to operations of the health centers in those cities.
He said the two organizations serve different populations in the communities and any increase in the FY '07 budget for the community health centers would allow for only one million American Indian patients.
Clinics as lifeline
Urban Indian health clinics and programs do more than provide primary health care. They are sources of education on diabetes, heart disease, alcohol and drugs and provide personal services.
A diabetic patient who asked for transportation from an Omaha, Neb., urban Indian health clinic was taken to an emergency room instead. The clinic employee assigned to transport the patient knew her and realized the woman was in distress and needed emergency care. That comes from knowing the patients, said Dr. Donna Polk-Primm, executive director of the Nebraska Urban Indian Health Coalition. She said employees at the clinic were familiar with the culture and also knew the patients and their needs very well.
American Indian patients in Sioux City, Iowa, which does not have its own urban Indian health clinic, receive support from the Omaha clinic with transportation to and from the facility. Transportation is financed by the Nebraska coalition.
''We spend two to three thousand dollars a month, what is going to happen to that?'' Polk-Primm asked. The tribes served in that area are the Winnebago and the Omaha. Polk-Primm said she asked the tribes for money to finance the transportation, but the tribes have no money.
The $33 million cut is to be used, as the budget stated, to improve the health status of an increasing population of American Indians and Alaska Natives who live in rural areas and on reservations. The budget report did not provide details as to how the funds would help or be spent.
Future of Pierre’s clinic in doubt
A large American Indian population resides in the South Dakota capital city of Pierre, where an urban Indian health center is located. A federally funded health center is also located in Pierre, but according to Alan DenOuden, finance director, it is not clear if that clinic will be funded after March 1.
The Pierre health center cooperates with the UIHO facility and they share many of the same patients, but DenOuden did not know how many clients would potentially use the health center facility.
The Minneapolis Indian health clinic also functions as the community health center. If the proposed budget is passed, about 25 percent of the funds for that clinic would be cut and would mean a loss of 12 to 13 full-time employees, said Dr. Terril Hart, CEO of the Indian Health Board of Minneapolis Inc. He said he was working on contingency plans.
Cutting the budget for urban Indian health would undercut the patients' ability to access health centers, Hart said. Of the some 6,000 patients treated at the Minneapolis clinic, approximately one-half are American Indian.
Cultural distinctions
Urban Indian health programs provide culturally based health services from medicine men, and the health centers do not, Polk-Primm said.
''There are important differences in what we do. We are culturally sensitive. If one of our patients would benefit from having a medicine man or shaman or minister, we understand and will facilitate that need,'' said Polk-Primm.
The Omaha clinic provides services to the Aberdeen Area tribes in North Dakota, South Dakota, Nebraska and Iowa; it also assists the Prairie Band Potawatomi in Kansas.
''The ramifications [of no funding] are incomprehensible,'' Polk-Primm said.
Patients may return to their reservations for health care if they have adequate transportation and finances. That would put an extra burden on the reservation-based IHS service units, tribal officials said.
Ron Johnson, IHS coordinator for the Urban Indian Health Program in Billings, Mont., would not comment other than to say he was made aware of top-level UIHO officers who were working on efforts to keep the funding.
''As a government employee I have to support the president's budget.''
Hope for resurrection
In past budgets, programs were zeroed out, only to be resurrected by congressional action. Urban Indian officials are also hopeful that FY '07 will be the same.
Hart said he was not so optimistic because of the political climate and the Republican control of both houses of Congress, even though Congress is usually reluctant to cut programs in election years.
An additional $120 million has been budgeted for IHS and will be used for rural and reservation health care. Hart said urban Indian health clinics don't want those funds: ''we just want what we had.
''The part that outrages me is there is an abdication of the government's obligations,'' Hart said.
As part of the opening comments made during the Senate Committee on Indian Affairs budget hearing on Feb. 14, Sen. John McCain, chairman of the committee, expressed concern about the lack of information, data and statistics to support ''such a drastic change in the public policy,'' such as zeroing out the urban Indian health budget.