National Council of Urban Indian Health
The National Council of Urban Indian Health (NCUIH) has released the 2018 – 2019 Urban Indian Organization Shutdown Report. The report summarizes and presents the results of a survey the National Council of Urban Indian Health circulated during the 2018-2019 shutdown to capture important metrics and narratives regarding its impacts. The United States federal government shutdown of 2018-2019 occurred from midnight Eastern Standard Time on December 22, 2018 until January 25, 2019. Nineteen out of forty-one Urban Indian Organizations (UIOs) reported. The responses from this survey were used in the National Council of Urban Indian Health’s policy and legislative advocacy initiatives during and after the shutdown. Although the Indian health care delivery system consists of three prongs — Indian Health Service (IHS), Tribal Health Programs, and Urban Indian Organizations — the report focuses on Urban Indian Organizations.
“The 2018-2019 Urban Indian Organization Shutdown Report demonstrates that the longest U.S. government shutdown in history had instant, longstanding, and severe negative impacts on Urban Indian Organizations and the American Indians and Alaska Natives (AI/ANs) they serve across the country. The federal trust responsibility to provide for the healthcare of all American Indians and Alaska Natives mandates that federal funding problems be fixed so that the impacts of any future shutdowns are minimized, and the lives of American Indians and Alaska Natives are not put at risk. Because Urban Indian Organizations operate on very low margins, every aspect of their abilities to deliver essential healthcare was affected by the 2018-2019 shutdown, including their abilities to hire and retain staff, to provide direct services, and, in some cases, even to remain open and available for their patients. Indian Health Service funding at the level of need, an increase in the Urban Indian Health budget line item, advance appropriations, and 100% Federal Medical Assistance Percentage for Urban Indian Organizations are all necessary fixes to protect the delivery of healthcare to American Indians and Alaska Natives,” said Francys Crevier, Executive Director of the National Council of Urban Indian Health.
The interruption in funding precipitated by the shutdown had dire consequences for Urban Indian Organizations and, consequently, on American Indians and Alaska Natives (AI/ANs) across the country. The impact on American Indians and Alaska Natives, many of whom depend on Urban Indian Organizations for their healthcare needs, ranged from patients unable to get vital medication for chronic conditions to fatal overdoses. Urban Indian Organizations had to make difficult decisions regarding cancellation of certain services, reduction in practitioner hours, staff retention, facility operation, and whether to use savings earmarked for other purposes to shield staff and patients from the impact of the shutdown.
The National Council of Urban Indian Health shifted its policy and advocacy focus during the shutdown to limit the disruptions to the daily operations of the Urban Indian Organizations it represents and urged Congress and the administration to immediately end the shutdown and restore funding to Indian Health Service. Following the shutdown and restoration of funding, the National Council of Urban Indian Health remains dedicated to establishing safeguards for Urban Indian Organizations against potential shutdowns in the future. The National Council of Urban Indian Health is working with Congressional officials to raise awareness for bills that would provide the Indian Health Service (IHS) with advance appropriations (H.R. 1128, S. 229) and provide 100% Federal Medical Assistance Percentage (FMAP) for Urban Indian Organizations (H.R. 2316, S. 1180).
Urban Indian Organizations operate on very low margins.
- Urban Indian Organizations operate on very low margins such that even very minor changes to their funding structures lead to devastating impacts on the services they provide to American Indians and Alaska Natives and even affect their abilities to keep their facilities operational.
All aspects of the urban Indian healthcare delivery system were impacted by the shutdown, but the Urban Indian Organizations workforce was the first to experience its disastrous effects.
- The survey results point to a pattern which suggests that among the difficult decisions Urban Indian Organizations were forced to make during the 2013 and the 2018-2019 shutdowns, delaying hiring, reducing hours, and laying off staff were typically the first decisions made.
Urban Indian Organizations services were greatly impacted.
- Another pattern the survey highlighted is that Urban Indian Organizations were forced to cut back on services that were not as consequential as others, such as dental services, transportation, case management, and community outreach services. However, some Urban Indian Organizations were forced to cut even the essential services such as substance abuse services and purchase requests for diabetes and blood pressure medications.
Urban Indian Organizations were forced to use savings designated for other purposes to shield staff and patients from the impact of the last two government shutdowns.
- Yet another pattern illustrated in the survey results suggests that Urban Indian Organization leaders made an effort to protect their staff and current services by using savings earmarked for program growth.
View and download the report here.