By Julia Shapero and Michael Korsh
Health care organizations that support Native Americans living in urban areas receive minimal federal funding, even though more than 70% of the Native American population lives in metropolitan areas.
The 41 Indian health organizations that serve them receive only about 1% of federal funding for the Indian Health Service. In the fiscal year 2022 omnibus appropriations bill signed by President Joseph Biden in March, IHS received about $6.6 billion. Indian health organizations in urban areas received about $73 million of this sum.
However, organizations that represent Indigenous people living in cities have stressed that their need for more funding should not be used as a reason to take funding away from the rest of the Indigenous health system, which is itself underfunded. Instead, they said, Congress should increase funding for urban health facilities, as well as other parts of India’s health service.
A historically underfunded system
The Indian Health Service, a federal agency within the Department of Health and Human Services, provides health care services to Native people who are members of the 574 federally recognized tribes.
The federal government is responsible for providing health care to the indigenous population under its treaties with the tribes, in which tribal leaders agreed to cede land in exchange for the government’s promise to provide health care, a education and other services.
The Indian Health Service provides health services through its own facilities, tribal facilities and other Indian health organizations. While the IHS and tribal facilities generally serve Native people living on reservations, other Indian health organizations explicitly serve urban areas.
Despite being responsible for the health care of about 2.6 million people, the Indian Health Service has been significantly underfunded since its inception in 1955, according to Francys Crevier, chief executive of the National Council of Urban Indian Health.
Federal support for the system is about a third of the national average for health care spending per patient, Crevier said: While health care spending in the United States reached $11,172 per person in 2018, the Indian Health Service has received $4,078 per patient, and urban Indian organizations received $672. She added that the Indian health service is currently funded at 12% of its needs.
“There’s an obligation of trust to make sure we’re taken care of, but we’re not funded at all to be able to do that,” she said.
Prior to the 1950s, most Native Americans lived on reservations or in nearby towns, as well as in areas of tribal jurisdiction, such as parts of Oklahoma. But federal policies throughout the 20th century pushed many Native Americans off reservations and into urban centers.
With the passage of House Concurrent Resolution 108 in 1953, Congress sought to terminate its legal obligations to the tribes and end their status as federally recognized tribes – a policy known as termination . Over 100 tribes were suppressed under this policy.
The Indian Relocation Act of 1956 went hand in hand with the redundancy policy, encouraging Native Americans to move to cities for job opportunities. Between 1950 and 1980, approximately 750,000 Native Americans left reservations for urban areas.
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“The government was trying to induce natives to voluntarily leave the reservation for city life, and they did so through pledges,” said Patty Loew, former director of the Center for Native American and Indigenous Research at the Northwestern University. “A lot of times what they got was a one-way bus ticket.”
Despite serving a significant proportion of the indigenous population, health care providers supported by the Indian Health Service face significant hurdles in securing more Congressional funding. The IHS is the only federal health system whose budget must be approved by Congress each year, said Meredith Raimondi, vice president of public policy at the National Council of Urban Indian Health.
“Because of that, it becomes political football,” she said.
The Omnibus Appropriations Bill 2022 provided for a 6% increase in funding for IHS and another 17% for Indian organizations in urban areas. This is the largest increase in funding for urban organizations in 10 years, Raimondi said.
While she views it as a positive move, she said there was a sense Congress would do more in light of the pandemic. COVID-19 has hit the Indigenous population particularly hard, with higher rates of cases, hospitalizations and deaths than the general US population.
“It seemed like the president was listening; it seemed the Senate was listening; it seemed that the House was interested in it. And then when the pressure came, at the end of the day, it fell through the cracks,” she said.
“It’s something that goes against the rhetoric of political leaders,” she added. “That is to say, they want to help the Indian country, and they want to honor the responsibility of the trust, and they want to improve the Indian health system.
This article is published in conjunction with Medill Northwestern University School of Journalism.
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