Urban Health Center Officials Brace for Tougher Times Ahead

PLUMMER, Idaho – The full impact of a proposal by President Bush to terminate funding for urban Indian health centers is unclear, but one anticipated result is an influx of patients to reservation-based facilities, according to testimony received by the Senate Committee on Indian Affairs earlier this year.

That has tribal officials, such as the Coeur d’Alene in northern Idaho, wondering how they will accommodate the new patients. Funding for their Benewah Medical and Wellness Center in Plummer is already inadequate, tribal Vice Chairman Francis SiJohn said.

The nearby NATIVE Project, an urban Indian health center about 40 miles away in Spokane, Wash., is threatened with closure if Congress approves the president’s budget for fiscal year 2007. That would send 12,000 tribal and nontribal clients elsewhere for primary care and outreach services.

“We’re on what we call a shoestring budget, and we’re trying to emphasize taking care of our community health service needs,” SiJohn said. “But when they start shutting down our Spokane urban community health center, those people are going to drive out here, and we’re expected to give them the same level of health care. How are we going to get creative on stretching that dollar, and how are we going to prioritize what community needs get met and what community needs get cut?”

The BMWC provides a variety of services, including primary medical and dental care and a pharmacy, to about 8,000 Indian and non-Indian patients from a five-county area. About one-third of the clients are at or below the federal poverty level, according to the tribe’s Legislative Director Quanah Spencer.

The award-winning facility is the result of a partnership between the tribe and city of Plummer. Believed to be the first collaboration in the nation to serve Indians and non-Indians, the two governments joined forces in the late 1980s driven by a mutual need to address multiple barriers to health care. Previously, tribal members received fragmented care in a dilapidated building. Many non-Indians were, and still are, without insurance, and BMWC was the first health care facility in this rural area to offer them a sliding-scale billing.

About half the center’s $12 million budget comes from annual discretionary funds appropriated by Congress through the IHS; the rest comes from competitive federal grants, third-party billing and sliding-scale payments as low as $10 per visit.

Funding streams are complex, but the issue is simple, SiJohn said: “People need health care. A lot of people don’t have insurance.”

Bush expects Indians living in urban areas to go to other community clinics that provide underserved populations, but opponents say cultural barriers will stop many from seeking help until their conditions become serious. Others will drive to reservation facilities. The tendency to do so is borne out at BMWC, which serves some Native clients who travel hundreds of miles to receive care unavailable closer to home.

Patricia Breiler, acting executive director of health services for the Colville Confederated Tribes in northeast Washington, anticipates that tribal students attending colleges in Spokane and Seattle will be among those returning to their reservations for care.

“They just have to come back here,” she said. “There’s no choice at all.”

Recent cuts in federal funding have already reduced services on the Colville Reservation. The IHS previously paid for uninsured Indians to use a nontribal clinic and hospital in Omak, where many of the reservation’s American Indian residents live.

Today, those who are not in immediate danger of losing their life or a limb must travel over a mountain pass to an IHS-funded clinic 45 miles away.

“It has really created a hardship on the Indian people here,” Breiler said. “I think we’re experiencing what everybody else is: no money, no money, no money.”

Similarly, on the Coeur d’Alene Reservation, IHS appropriations covered 63 percent of BMWC’s budget two years ago. That has fallen to 51 percent, Spencer said. In human terms, that translates to the services of a second dental hygienist.

“Right now we are only getting about $42,000 for our dental program, and we’ve got a service population of 2,672 patients who access it,” he said.

In addition to eliminating urban Indian health centers, the president’s budget cuts $1.2 billion in block grants, reduces some rural health programs and shores up others. With funding being shifted among a dizzying array of Department of Health and Human Services bureaus and programs, the impact of his plan is unclear. However, one thing is certain: The 4 percent increase proposed for reservation clinics won’t keep up with inflation or make up for losses in recent years, let alone cover an influx of new patients.

In her comments to the Senate Committee on Indian Affairs, San Carlos Apache Tribe Chairman Kathy Kitcheyan, who serves on the National Indian Health Board, said officials should understand the impacts of their decisions before acting.

“The federal government should act more prudently when making policies that will clearly create an upheaval for large numbers of American Indians,” Kitcheyan said. “If closing UI health clinics is its goal, the General Accounting Office should first conduct a study to predict the results and a demonstration project should be undertaken in a single area to ensure continuity of care.”