Senate Democrats

Senate Democrats Work to Improve Access to Health Care for Native Americans

Bush Budget Would Harm Quality of Life in Indian Country

On February 26, 2008, under the leadership of Senators Dorgan and Reid, the Senate passed S.1200, the Indian Health Care Improvement Act (IHCIA) Amendments of 2008, by a vote of 83 to 10.  The passage of the IHCIA in the Senate comes after more than a decade of work by Democrats to modernize and improve health care services for Native peoples.  The failure of prior Republican Congresses to address the health care needs of Native peoples has resulted in a crisis that demands immediate attention by Congress.

While Democrats were working to pass the IHICA, President Bush submitted a budget request for Fiscal Year 2009 that fails to fulfill the federal government’s trust responsibility to Indian Country.  Specifically, the Bush budget calls for the following cuts in programs that benefit Native Americans: health care, public safety, education, economic development, and infrastructure.  These proposed budget cuts reflect misplaced priorities that are wrong not just for Native Americans, but for all Americans. 

This Fact Sheet summarizes the key provisions in the IHICA, highlights amendments that were added to the bill on the Senate floor, and discusses the glaring weaknesses of the Bush budget for Native Americans.

Indian Health Care Improvement Act Amendments of 2008

Improved health care delivery.  The IHCIA will provide better health care services for American Indians by: 

  • Establishing objectives for minimizing the health disparities that exist between Indians and the rest of the U.S. population;
  • Enhancing the ability of the Indian Health Service (IHS) and tribal health programs to attract and retain qualified Indian health care professionals;
  • Developing new mechanisms for completing health facilities and reducing the backlog in construction;
  • Establishing a continuum of care through integrated behavioral health programs to address the substance abuse problems and the social service and mental health needs of Indian people;
  • Facilitating improved decision-making regarding program operations and priorities at the local tribal level in order to improve services to tribal populations;
  • Enabling Native Americans to use modern methods of health care delivery not currently available to them;
  • Improving the efficiency of the IHS; and
  • Facilitating participation in Medicare, Medicaid, and SCHIP by eligible Indians and Indian health programs.

Senate Amendments to the IHCIA

The following amendments were added to the legislation during consideration on the Senate floor:

  • Clarifying the applicability of Davis-Bacon Act prevailing wage requirements for facilities construction projects constructed or renovated directly by Indian tribes or tribal organizations’ employees;
  • Ensuring that the federal government will not be liable in cases of services provided using traditional health care practices that may result in harm to the patient;
  • Acknowledging the long history of official depredations and ill-conceived federal government policies toward Native Americans and offering an apology to Native peoples on behalf of the American people; and
  • Directing the government to conduct numerous studies on the delivery and costs of health services, Medicaid, and SCHIP enrollment activities.

The Bush Budget Threatens Native American Health and Public Safety

Bureau of Indian Affairs.  The President has proposed a 4.4 percent cut in funding for the Bureau of Indians Affairs (BIA) as well as an 8.3 percent $64.3 million decrease in funding for Tribal Priority Allocations (TPA).  The President’s cuts to the TPA target housing ($13.6 million decrease), road maintenance ($12.5 million), and education ($5.9 million).

Indian Health Service.  President Bush’s budget proposes flat funding for the Indian Health Service, maintaining the $4.3 billion appropriated in Fiscal Year 2008.  The budget request would reduce funding by $21 million for construction and eliminate all funding for the Urban Indian Health Programs.  This proposed funding level would only exacerbate the glaring health care needs of Native Americans.

Public safety.  The President’s Fiscal Year 2009 budget proposal would eliminate any “set-aside” funding currently available for tribes through the Department of Justice for tribal correctional facilities, tribal courts, tribal Community Oriented Policing Services (COPS) and other law enforcement programs. 

Tribal colleges and postsecondary institutions.  The Bush budget eliminates funding ($23.2 million) for tribal colleges as well as the Department of Education’s $7.4 million for postsecondary instruction.

Community Development for Financial Institutions.  President Bush’s budget would reduce funding for the Community Development Financial Institutions by $65 million ($94 million to $29 million) from the Fiscal Year 2008 enacted level.  The proposed cut represents a 70 percent cut and the Native Initiative would not receive any funding under the Bush proposal.  The Native Initiative is an effort to increase access to credit in Indian Country.

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