Urban Indian Health Program funds at risk

As the Bush administration seeks to eliminate funding for a program that provides health care for urban Native Americans, NATIVE Health of Spokane is proceeding with plans to build a new clinic in the West Central neighborhood.

Medical care for American Indians and Alaska Natives is a trust mandated by treaty and by law. The nation’s indigenous population suffers disproportionately from diabetes, alcoholism, tuberculosis, influenza, pneumonia and depression.

President Bush’s fiscal 2007 budget request to Congress seeks to save about $33 million by eliminating the Indian Health Service’s Urban Indian Health Program, which funds 34 clinics, mostly in the West. The administration says Urban Indian Health duplicates other health programs available through the U.S. Department of Health and Human Services.

The nation’s largest urban Indian health clinic is in Seattle, which served nearly 7,000 patients in 2005. Spokane’s NATIVE Project/NATIVE Health clinic served nearly 6,000 patients, 70 percent of whom were Native American. Spokane’s urban Indian population of about 12,000 people is the nation’s eighth largest.

Spokespersons for the HHS and IHS declined to comment on the proposed cuts. Instead, they told The Spokesman-Review that the White House budget speaks for itself.

A March 6 letter to U.S. Rep. Jim Nussle, chairman of the House Budget Committee, calling for continued funding for the Urban Indian Health Program, was signed by 34 representatives, Republican and Democrat, many from Western states. Among the signers were Western Washington Democratic Reps. Jay Inslee, Jim McDermott and Adam Smith. Rep. Cathy McMorris, R-Spokane, who did not sign the letter, was unavailable to comment on the proposed cuts.

Washington Democratic Sens. Patty Murray, who sits on the Appropriations Committee, and Maria Cantwell, who is on the Indian Affairs Committee, oppose elimination of the program, according to their spokespersons.

The Spokane clinic receives about $900,000 a year in Indian Health Service funds, about 40 percent of its budget, said Toni Lodge, executive director of NATIVE Project/NATIVE Health of Spokane.

“I don’t see how eliminating health care for the most underserved and at-risk population in the county is cost-effective,” Lodge said. “I don’t see how other urban clinics can afford to absorb this population.”

The White House budget provides a $181 million increase to fund new or expanded community health clinics across the nation that would presumably be asked to absorb the estimated 430,000 eligible native users of Urban Indian Health clinics nationwide. However, it appears doubtful that existing clinics, such as those run by the Community Health Association of Spokane, would be eligible for those funds.

CHAS director Peg Hopkins said the clinics could not absorb 6,000 patients overnight.

“We would do everything we could,” said Hopkins, whose clinics are still reeling from earlier rounds of budget cuts, “but as it stands, we certainly don’t have any way to do it.”

More likely, Lodge said, urban patients displaced by the health care cuts would go to the Spokane or Coeur d’Alene reservation clinics in Wellpinit, Wash., or Plummer, Idaho. But those clinics also have seen deep cuts in federal funding as a percentage of their total budgets in recent years.

In the six years ending 2004, the Coeur d’Alene Tribe’s community clinic, which is run in conjunction with the city of Plummer, has seen IHS funding decline from 61 percent of its total budget to 53 percent, said Quanah Spencer, legislative director for the tribe. About 51 percent of the clinic’s users are tribal members and 49 percent are non-native.

The White House budget proposes a 2 percent to 3 percent increase in funding for the IHS at a time when the cost of health care, including pharmaceuticals, is rising 4 percent to 5 percent, Spencer said.

Spencer said the clinic would do its best to accommodate urban Indians, but it is already struggling to make ends meet in a community in which one-third of patients are at or below the federal poverty level.

In the 1950s and 1960s, it was government policy to relocate Native Americans off their reservations and into urban areas. Today, about 66 percent of the nation’s 2.4 million American Indian and Alaskan Natives live in cities.

Far from planning on shutting its doors, NATIVE Health of Spokane is in the middle of a fundraising campaign for a new 18,000-square-foot facility at 1803 W. Maxwell in the West Central neighborhood, where there is the highest concentration of the county’s estimated 12,000 urban Indians.

Lodge said NATIVE Project/NATIVE Health has secured $2.4 million toward the $3.1 million cost of the facility, including $1 million raised by the agency and grants from the Gates Foundation and the Paul Allen Foundation among other sources. The clinic is also eligible for a Washington state Health Care Facilities Authority loan.

Urban Indian clinics provide culturally sensitive medical care to a people burdened with “generational trauma” as a result of their historic decimation and loss of native lands, Lodge said.

Many are uncomfortable with non-Indian health care providers, she said. Loss of these clinics would mean many would not get health care outside the emergency room.

NATIVE Health, currently at 505 E. North Foothills Drive, is staffed by native health care providers, including a physician, Dr. Kendra Long, and medical director, Vinetta MacPherson, who is a nurse practitioner.

“We know that there are health disparities among Native Americans, and that having access to culturally appropriate services is very important,” said Lyndia Vold, health assessment director for the health district.