Senators fight for Indian health clinics

By NOELLE STRAUB
Star-Tribune Washington bureau
Friday, April 14, 2006

WASHINGTON -- U.S. senators are fighting to stop the proposed elimination of funding for American Indian health clinics in urban areas and to instead provide the dollars vital to keeping such clinics open, including five in Montana.

Officials at clinics in Billings, Great Falls and Helena have said they may have to close if the funding is not restored and said the impact would be devastating.

A group of 14 Democratic and two Republican senators, including Sen. Max Baucus, D-Mont., sent a letter to appropriators to request that funding be restored in President Bush's proposed 2007 budget for Urban Indian Health Programs from nothing at all to $32.7 million, the amount appropriated for 2006.

The funding supports 34 urban Indian non-profit organizations that provide health care services at 41 sites throughout the United States for 430,000 eligible Indian users, the letter states.

The clinics provide affordable treatments for a population more likely than the general population to die from certain diseases, including diabetes, alcoholism, tuberculosis, influenza and pneumonia, it says.

Sen. Craig Thomas, R-Wyo., noted that Wyoming doesn't have an urban Indian health facility and that people living in the service area of the state's two clinics, one in Fort Washakie and one in Ethete, travel to Billings for services such as outpatient surgeries.

Thomas, who sits on the Senate Indian Affairs Committee, said the Billings clinic serves as the regional site for tribal health care and that the closure of such a facility "doesn't help matters."

"What the closure plan does not take into account is that these clinics are the regional facilities serving a large geographic area," Thomas said. "Like rural health care needs in general, people don't realize the needs being met by these regional facilities -- each one is part of a health care network. The closure of a regional facility can have a dramatic impact on what services will be available to patients."

The Bush administration argues that urban Indians live near hospitals and have access to federal, state and local programs and proposed slightly increasing the funding for the Health Centers program.

At a February hearing on the 2007 budget, Health and Human Services Secretary Mike Leavitt said Native Americans who were going to Indian Health Service clinics could go instead to community health centers.

"That just feels inefficient to me to be creating a separate system for one population of people when we are trying to create a much better system for everyone," Leavitt said.

But the group of senators responded that increasing the use of other health centers "will place a much larger burden on a system already operating at capacity to the detriment of both non-Indian and Indian users."

"Without access to affordable and accountable health care centers, we fear that many urban Indian families will go without the services the federal government has been tasked with providing them," the letter states. "It is irresponsible to deny health care access to such to such a large and underserved population."

The letter went to Sen. Conrad Burns, R-Mont., as chairman of the Interior Appropriations Subcommittee, and to the subpanel's ranking Democrat, Sen. Byron Dorgan, D-N.D.

Burns believes that zeroing out the urban health clinics is "not acceptable," said Burns spokesman Matt Mackowiak. He noted that it's early in the congressional budget process and said Burns is working to identify witnesses for a hearing on the subject in early May.

The U.S. House is also expected to hold hearings on the topic in May.

If the administration expects community health centers to fill the need, then more funding should be provided to them through the Health and Human Services budget, Mackowiak said.

"Chairman Burns is not satisfied, he's going to work closely with the administration and the committee to deliver an appropriate and acceptable solution in that area," Mackowiak said.

Dorgan introduced an amendment that Baucus co-sponsored that would provide a total of $1 billion more than the proposed budget for various programs that benefit Native Americans, including $40 million for the urban Indian health program. He said the proposals would be fully funded by closing corporate tax loopholes.

The amendment failed on a largely party-line vote of 42-56 on March 16. Baucus voted for the amendment. Burns voted against.

Republicans argued that the amendment didn't guarantee that the money would go to the tribal authorities.