Shutdown pummels Native American healthcare

Regis Pecos spent much of his holiday week on the icy road between Cochiti Pueblo and Albuquerque.

Disruptions to service at the Cochiti Health Station, a clinic maintained by the pueblo with funds from the federal Indian Health Service agency, had forced one of his family members to seek care at a private hospital nearly an hour away from his home. Snow and ice on the road made the back-and-forth trips particularly perilous and stressful.

"People are going on the road to seek services that typically would otherwise be available in their communities," says Pecos, a permanent member of the Cochiti Pueblo Tribal Council and a former governor. "Now people are having to travel in these treacherous conditions."

Pecos says he knows "several families" also forced to travel from their pueblos to receive care due to the federal shutdown, which national media reports is not close to a resolution. President Trump, whose demand that Congress fund a $5.6 billion border wall created the impasse, is expected to address the shutdown with prepared remarks on Tuesday night.

Eight clinics provide at least some healthcare services for pueblo members roughly between Española and Albuquerque, including in Jemez, Zia, Cochiti, Kewa, San Felipe, Santa Ana, Santa Clara and Sandia. Some care is also provided at the Santa Fe Indian School, and two other clinics in Albuquerque are facing similar disruptions in services.

The clinics are funded by the Indian Self-Determination and Education Assistance Act, a program within the Indian Health Service that allows tribes to contract with the federal government to build and maintain their own healthcare facilities. Jennifer Buschick, a spokesperson for IHS, says these clinics are encouraged to remain open and provide care throughout the shutdown, despite a complete lack of funding.

"All direct service IHS facilities that provide health care will continue to operate," Buschick writes in an email. "However, many administrative activities are impacted due to the lapse in funding for the IHS."

After this story was published, Buschick sent the additional following statement to SFR:

"We acknowledge that [the shutdown] may result in insufficient funds to carry out the terms of their agreement or cause programs to be temporarily suspended until an appropriation or continuing resolution has been approved."

The shutdown has not affected appropriations for Medicaid and Medicare, and tribal clinics can use those "third party revenues" to fund operations. However, in a statement released by IHS days before the shutdown, the agency acknowledges that the closure "may result in insufficient funds to carry out the terms of the agreement and that the [tribally managed healthcare programs and clinics] may cease to operate."

Without traveling directly to each clinic, it is difficult to gauge the full extent of the shutdown's effects on access to care. Leonard Thomas, the director of Albuquerque-area Indian Health Service that covers most of Colorado and New Mexico (except the Navajo Nation), was only able to provide general information to SFR.

"Quite frankly, we have a lot of non-essential administration we can't continue due to a lapse in federal funding for IHS," Thomas says. "We continue to try and keep the public, as far as patients and our tribes, informed in regards to any impacts on our facilities."

Thomas says some tribal members may still be able to access care through IHS' Purchased/Referred Care, a complicated program that allows Native Americans located in their tribe's federally designated geographic area to get care from outside hospitals and bill IHS. However, those bills won't be paid until IHS is funded again.

The shutdown exacerbates decades of underfunding for IHS and a century of poor investment by the federal government to cover Native peoples' healthcare, which has been a condition of multiple treaties since the colonial era in exchange for land. Tribal clinics that have never been able to offer a full spectrum of care in the first place are being pummeled even more.

Gayle Chacon, a physician in Albuquerque and former professor of community medicine at the University of New Mexico, explains that the proliferation of new tribal health facilities since the 1975 Indian Self-Determination and Education Assistance Act without a corresponding proportional increase in funding has been painful.

Under this arrangement, there is less money to go around for both traditional facilities under direct control of IHS, such as the Santa Fe Indian Hospital on Cerrillos Road, as well as tribal-run facilities. The National Congress of American Indians estimates that tens of billions more dollars are needed over the next decade or so to fully fund IHS.

"Indian Health Service facilities don't have the infrastructure to continue providing critical services, then tribal clinics don't have enough funding to build infrastructure or even manpower for appropriate staffing," Chacon tells SFR. "The amount of services overall are downsized, and there is overall less access to services."

Pecos calls the inability of politicians in DC to fund IHS and other services through the Bureau of Indian Affairs "absolutely disgusting."

"People so far removed from us have no inkling with regard to issues that become life and death for so many innocent people," he tells SFR. "So it's really unfortunate and devastating to say the least, when it comes to the most vulnerable people in our country."

Editor's note: Despite a notice from IHS that says tribally managed health programs addressing emergency circumstances "must continue" during the shutdown in cases where human life is imminently threatened, IHS spokesperson Jennifer Buschick called SFR to clarify that these programs are not, in fact, required to operate if they are unable to do so. We have slightly amended Buschick's statement to reflect this small but significant change.