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By Joaqlin Estus

Indian Country Today

Some of the medical facilities serving Native people may be on the verge of closing their doors. One in Alaska is already laying off hundreds of people. That’s the alert 55 bipartisan members of Congress sent to Senate leadership Tuesday.

If the facilities close, they wrote, “the health disparities that already exist in Indian Country will become further exacerbated.” 

And, they warn, Native communities will be disproportionately impacted by the pandemic. The funding crunch comes as the U.S. death rate from coronavirus rises above 70,000 and the pandemic spreads into rural areas where many Native Americans live.

The letter was signed by U.S. Sens. Kamala Harris, D-California, Dianne Feinstein, D-California, and Tom Udall, D-New Mexico, and Representatives Raul Ruis, D-California, and Markwayne Mullin, R-Oklahoma, among others.

Several types of health organizations exist to provide medical services specifically to Native Americans. The Indian Health Service, tribal health organizations, urban Indian health providers and not-for-profits each run their own hospitals and clinics. The Indian Health Service funds all of these operations, although advocates say the funds are never enough for the need.

The letter said these facilities provide “critical access to health care for 2.6 million American Indians and Alaska Natives across the United States.”

They serve “not only some of the most remote communities in the country but also patient populations that face comparatively higher rates of underlying health issues that make them highly susceptible to COVID-19, including hypertension, asthma, cancer, and heart and cardiovascular disease,” the letter said.

For several years, to add to Indian Health Service funds, these medical providers have been building their capacity to collect revenues from third parties such as Medicare, Medicaid, the Veterans Administration and health insurance.

Those third-party revenues, the authors wrote, equal a fifth of the entire Indian Health Service annual budget. They make up half the annual budget for tribally operated health providers. Third-party revenues bring in more than the entire annual federal appropriation for urban Indian health providers.

Now, those revenues have taken an enormous hit because elective procedures were put on hold, and non-COVID-related services have dropped dramatically. The letter asks Senate leadership to allocate funding to help those entities recover from significant revenue losses related to COVID-19.

Dan Winkelman, Athabascan, is president of the tribally run Yukon-Kuskokwim Health Corporation, the only health service provider for 58 villages in an area in western Alaska the size of South Dakota. With more than 1,400 staff, it is one of the top employers in Bethel and the region. This week, however, that number will sink by 300.

In a memo last week, Winkelman told employees the corporation has seen a 70 percent decline in in-patient numbers, and a 60 percent drop in outpatient visits. Visits to the emergency department, Winkleman said, were down 70 percent. The state of Alaska ordered the cancellation of non-urgent medical travel, further reducing patient load.

Winkelman said relief funding allocated by Congress will help make up for money spent on COVID-19, but is not to be used for anything else. And the Yukon-Kuskokwim region has had only one case of the infectious disease.

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He said revenues are coming back up as restrictions are dropped, but he doesn’t expect them to return to pre-COVID levels for a year or more.

So, the health corporation is furloughing and laying off 300 employees. Notices began going out to employees last week and will continue through this week, said spokesperson Mitchell Forbes, Inupiaq. 

Depending on revenues, some will come back to work after a four-week furlough. If non-COVID demand for services continues to rise, the corporation will bring back as many as it can afford. However, if after four weeks of furlough, income revenues are still depressed, Winkleman said more employees will be let go. And there may be another round of layoffs in a few months if needed.

“I can feel and empathize with the pain people are going to be experiencing,” Winkleman told KYUK’s Anna Rose McArthur.

The health corporation is focusing on keeping staff essential to patient care and cutting back elsewhere. KYUK radio reports the corporation will continue to pay health benefits for employees while on furlough, and Winkleman intends to lobby the state and Congress to extend unemployment insurance for the duration of the pandemic.

The losses extend beyond Native facilities. Dermot Cole, of Reporting From Alaska, reports the Alaska State Hospital and Nursing Home Association has written to Gov. Mike Dunleavy about the staggering losses, some in the $40 million to $50 million range, hospitals are facing. 

The letter states the "financial result to date is catastrophic to hospitals and nursing homes.” The authors went on to say the consequences may be worse. “The questions on all of our minds are what if we cannot recover; what if we lose a facility? ... Alaska’s health care system was already in a fragile state prior to this pandemic.” The association asked the governor to set aside $150 million for hospitals and nursing homes.

These are just a few examples of the dire financial consequences hospitals across the country are facing, according to reporting by Christopher Scragg with Cronkite News - Arizona PBS. He reports hospitals are nearing “financial extinction.”

He quoted advocates as saying, “‘the cancellation of elective procedures meant to free up beds for potential coronavirus patients, combined with a drop in emergency room visits, has deprived hospitals” of necessary revenues.” He said the industry typically has profit margins of only 3-4 percent. Congress allocated $30 billion for hospitals in the Coronavirus, Aid, Relief and Economic Security Act signed in April. But Scragg reports hospitals are losing twice that much every month.

Advocates are asking Congress to consider these needs in a bill that’s been dubbed “CARES II,” which would authorize aid to businesses, individuals, tax-free withdrawals from retirement accounts, deferrals to student loan payments, and other forms of relief.

Native Americans, more than others, have underlying health conditions such as high blood pressure and diabetes that make them particularly vulnerable to having more serious or fatal results from the infection. Even before the coronavirus pandemic, life expectancy for Native Americans was 71, seven and a half years less than the U.S. life expectancy of 78.5 years.

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Joaqlin Estus, Tlingit, is a national correspondent for Indian Country Today, and a longtime Alaska journalist.

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