Urban Indian Health

Flagstaff, AZ – Tucked deep inside the Bush administration's proposed budget for next year is a tiny cut that's generated a heap of controversy. The federal government has proposed eliminating funding for 34 urban Indian health clinics that serve Native Americans who live off reservations. The House appropriations committee wants that money back. Today the full House votes on the measure. From KNAU's Indian Country News Bureau, Daniel Kraker reports.

When Indian tribes signed treaties with the federal government more than a century ago, they gave up their land in exchange for guaranteed services like education and health care. The Indian Health Service was created to deliver that health care, mainly on reservations. But over the past several decades hundreds of thousands of Native Americans have moved to cities for jobs or schools.

AX1: The estimate is that as many, 55 to 60 percent of the total Indian population lives off the reservation.

Dana Russell is Navajo, and CEO of Native Americans for Community Action. NACA is a nonprofit health clinic and social service agency in Flagstaff. Russell says the vast majority of federal dollars goes to reservation clinics, even though most Native Americans now live in cities.

AX2: And that's one of the reasons why urban Indian health programs were established, to meet the health needs of Native Americans, but also to head off any serious illnesses so they don't become a problem and then people rush back to the reservation and the expense is much more serious.

But the Bush administration has proposed eliminating the entire federal budget for urban Indian health programs, about 33 million dollars. NACA alone stands to lose 450 thousand dollars. (start sneaking up ambi here) That's a quarter of its budget, and would force it to make drastic cuts at its tidy clinic in Flagstaff.

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Nurse Manager Carol Barth shows off the clinic's exam rooms, its refrigerator stuffed with insulin the clinic distributes free to its diabetic patients. Barth says she doesn't know where her patients will go if the clinic is forced to close.

AX3: Because the price of gas is what it is, and a lot of our people don't even have vehicles, how are they supposed to get out to the reservation? And that's my biggest fear is that people are just not going to do anything, you're going to see a lot more people with diabetes with their toes falling off and all sorts of complications.

NACA saw about 7 thousand patients last year. Urban Indian clinics nationwide saw just over 100 thousand. The Bush administration believes community health clinics could handle Indian patients more efficiently. At a Senate Finance committee hearing in February, Health and Human Services Secretary Michael Leavitt said community clinics and Indian clinics are often close by, and often serve the same people.

AX4: And probably neither of them are adequate to serve the populations, but if we had one, they could be. We'd have one piece of equipment instead of two. We'd have one lease instead of two That just feels inefficient to me to be creating a separate system for one population of people when we're trying to create a much better system for everyone.

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Just down the street from NACA in Flagstaff, Medical Director Andrew Saal greets the pharmacy staff at North Country Community Health Center.

SFX3: briefly post ambi of dumping pills on the counter, pouring into bottles

Saal admits there's a small overlap in the services his clinic and NACA provide. But he says the federal government is trying to push patients from one financially strapped system to another.

AX5: While it's true that community health centers do serve thousands of Native Americans, we ourselves are under-funded, this agency gave away two million dollars plus in health care last year to the working middle class. We're talking about 34 million dollars to fund the urban Indian clinics, and they work. It just shows a misplaced sense of priority in the whole system.

The Bush administration has proposed increasing the budget for community clinics by 180 million dollars to help pick up the slack. Money that will be divvied up among 5 thousand sites nationwide. The government also supports a four percent budget boost for the Indian Health Service, which does operate some urban clinics, including a large hospital in Phoenix. But most of the urban Indian clinics, which stand to lose funding, are located far from I H S facilities. Cities like Oakland, Seattle, and even New York City. If Congress doesn't restore funding, about half are expected to close.

For Arizona Public Radio, I'm Daniel Kraker in Flagstaff.