Pueblo Health Care Hit

As the federal government shutdown proceeds into its second month, tribal health care services continue to take a hit. Staff at several pueblo clinics aren't receiving salaries, but most are still open to patients. For at least one Native community, that might not last much longer.

Sitting at the juncture where Highway 22 turns west toward Cochiti Pueblo is its visitor center, which was completely deserted of visitors on a recent Friday afternoon. A sign on the road near the center announces that the Kasha-Katuwe Tent Rocks National Monument a few miles away is closed due to a lapse in funds for the Bureau of Land Management.

"Some of the people who do work in the [Indian Health Service], they come here and talk to us, and they tell us what's going on," says a Cochiti tribal member working at the visitor center. "Some of them are trying to look for part-time jobs on the weekend only."

Cochiti Pueblo Gov. Eugene Herrera confirms to SFR that the clinic's employees are going without pay.

According to Anthony Yepa, who the tribe pays as a consultant on health-related matters, two types of employees work at the clinic: Those paid by the tribe through contracts with IHS to provide dental, nursing and community health guidance, and those who are paid directly from IHS, such as physicians who come to the small clinic from the Santa Fe Indian Hospital on Cerrillos Road.

Neither class of employee has seen a paycheck since the shutdown, Yepa says. While patients' access to health services in the tribe has been "more or less" normal, he reports, the clinic has been running on carry-over funds that were unspent from last year and are running out.

"Once those funds are exhausted, or coming to be exhausted, the tribe has to make plans on doing their own internal furlough," Yepa says. "Once funds run out, then [health] services will stop."

Lt. Governor Michael Quintana tells SFR there's no timeline yet.

"We still have to … revisit our [contracts with various federal agencies] and figure out how much carry-over we have in our account to carry staff over," Quintana says. Once there's nothing left, "it's either we shut down our clinic and send staff home, or the pueblos will pick up the bill. … We're not a gaming pueblo. We don't have a whole lot of revenue coming in."

Like the other pueblo clinics visited by SFR, the one in Cochiti was constructed after passage of the 1975 Indian Self-Determination and Education Assistance Act, which allowed tribes to contract with IHS to administer their own health services and programs. In addition to Cochiti, clinics in the Santa Clara, Kewa and San Felipe pueblos operate under the federal Santa Fe Indian Health Service zone.

In absence of those federal dollars, says IHS spokesperson Jennifer Buschick, the government is reminding tribes with casinos and other larger sources of revenue that they're permitted to supplement any missing funds from the feds.

"Tribal health programs and urban Indian organizations are authorized to continue operation; however, contracts with these organizations to provide health services cannot be paid by IHS during a lapse in appropriations," Buschick says.

At the Santo Domingo Health Center in Kewa, where pharmacists are working without pay, the parking lot was nearly at capacity, and a construction crew worked on adding to the facility.

One man, Tyrecs Coriz of Kewa Pueblo, tells SFR his application for benefits from the Social Security Administration has been denied twice, making it difficult to care for himself after suffering a stroke. While the government says appropriations for Social Security have not been affected by the furlough, Coriz steadfastly interprets his denial of coverage as a result of the shutdown.

"I'm not getting any of my coverage that I need," Coriz says as he walked into the clinic to pick up prescription medication. "I would be getting my benefits, but you know, they denied me twice already, and it's all because of Trump. He's of no help to the US."

The shutdown's lasting effects on healthcare for Native Americans has become a significant issue for members of Congress representing constituencies with large Indigenous populations.

Just before Christmas, US Rep. Markwayne Mullin (R-Oklahoma) introduced a bill to fund IHS at the same level as 2018. US Rep. Deb Haaland (D-New Mexico), one of the first Native women elected to Congress, tells SFR in an emailed statement the shutdown "clearly has a devastating and disproportionate effect on tribes."

"I'll be looking at proposals to alleviate the loss of basic services for tribes during unnecessary government shutdowns," Haaland writes.

About 60 miles away from Kewa, at the Santa Clara Health Center near Española, several patients tell SFR they still have access to reproductive and gynecological services from the clinic.

Sitting in a green Lexus as he waited for his wife to finish an appointment, Angelo Sandoval from Ohkay Owingeh says his life had "been normal like everyday" since the shutdown began.

"It's just something between the higher-ups, mainly; let them fight. Shit don't matter to us," he says.

The lapse in federal funding began because of a demand by President Trump that Congress include billions in funding for a wall on the US-Mexico border. At press time, no deal to end the stalemate appeared in reach.