How the Government Shutdown Shredded Indian Health Services

February 8, 2019 | 1:49 pm
Photo: Wikimedia commons
Derrick Z. Jackson

The end of the partial government shutdown last month could not have come soon enough for Native Americans. For them, shutdown equaled full insult.

In President Trump’s attempt to wall off brown immigrants, the shutdown walled in America’s first peoples. That became clear with every report coming out of Native American lands as the president held federal services hostage to his fantasy of a border wall against Latin America.

In Navajo Nation in the Southwest, leaders told the New York Times that snowed-in roads went unplowed for days because Bureau of Indian Affairs staff were furloughed. The conditions blocked residents from making essential trips of up to 100 miles to procure basic needs, including medicine, until unpaid Navajo Nation employees were able to finally clear the roads.

Also in Navajo Nation, the Associated Press wrote about a 68-year-old woman who underwent eye surgery but could not get a referral from furloughed Indian Health Service (IHS) staff to deal with high pressure in her eye. In Minnesota, the Red Lake Nation told the Minneapolis Star Tribune that it suspended construction of a dialysis center.

On January 10, Native American Lifelines, an IHS health care contractor, announced the immediate suspension of dental services, and curtailment of financial assistance programs and ride share services, except in emergencies. Lifelines Executive Director Kerry Hawk Lessard told MedPage Today that the suspension meant halting addiction counseling and advocacy for lonely seniors hospitalized with severe illnesses. She also told the Washington Post: “We have thus far had to deny purchase of care requests that are critical to chronic-care management—insulin, blood pressure medication, thyroid medication and antibiotics—thus impacting the quality of life for the individuals we serve.”

Another unjust abrogation of the federal government’s obligations

During the shutdown, which ended January 25, 60 percent of the IHS workforce—some 9,000 employees—worked without pay to serve 2.3 million Native Americans and Alaska Natives. The Huffington Post featured Anpetu Luta Hoksila, a 35-year-old Native American psychologist from the Indian Health Service who is considered by the government to be “essential,” and thus is providing care without pay in Arizona. Hoksila said if the shutdown persists, he will quit the service to become a barista to pay the bills, noting: “On some level, it’s kind of pitiful, but I don’t care.”

It is more than pitiful what the shutdown did to Indian Country. It was yet another unjust abrogation of the federal government’s obligations to its original peoples. Just before the shutdown began last month, the US Commission on Civil Rights issued a report appropriately titled, “Broken Promises.” It said that despite the 375 treaties signed by tribes that were supposed to result in unique federal support of services in exchange for forced removals and relinquishing of land, the US government has “chronically underfunded” Native American health programs.

Despite chronic health disparities of many kinds suffered by Native Americans, per-person health care expenditures for the Indian Health Service (IHS) in 2017 was only a third that of federal health care spending nationwide. By further comparison, the National Tribal Budget Formulation Group, which makes recommendations to the IHS, said in a report last April that the budget of the Veterans Administration is 14 times that of the IHS while serving only four times the population.

This is particularly appalling since this is old news. The same commission published a report in 2003 that said, “The federal government spends less per capita on Native American health care than on any other group for which it has this responsibility, including Medicaid recipients, prisoners, veterans, and military personnel.” The underfunding has persisted for so long that the backlog for new health care facilities in Indian Country has reached $10 billion. To achieve health care parity, the tribal formulation group and the National Congress of American Indians say the current annual agency budget of a little over $5 billion needs to be increased to $32 billion by 2030.

“Our Indian communities are combating ongoing historical trauma not unlike that of untreated PTSD due to war experiences,” the tribal budget group said. “We have patients who have lost limbs due to untreated diabetes or unintentional injuries associated with the third world environments in which we live. Health care is rationed and expectations for quality care in outdated facilities and equipment are so low that patients have nearly lost all hope . . .The message is clear: the Indian Health System has failed its mission.”

“It’s like doing your job with both hands tied behind your back and blindfolded.”

The shutdown is a dangerous reminder of how thin the agency is stretched in normal times. Last year a report from the Government Accountability Office found that on average:

  • One out of every three and, in some areas, every other IHS physician position goes vacant
  • A quarter of nursing positions are vacant, and up to a third in some areas
  • A third of nurse practitioner positions are vacant, and up to half in some areas

Mary Smith, an acting director of the IHS during the Obama administration, and currently a health care consultant and secretary of the American Bar Association, fears that the shutdown exacerbated the difficulty the service has in attracting committed talent (a parallel to the multitude of federal scientists who wonder if government service is worth the current political instability). Despite its struggles, the service has successfully engaged communities to cut kidney failure from diabetes 54 percent since 1996.

“Forget doing your job with one hand tied behind your back,” said Mary Smith, an acting IHS director during the Obama administration. “It’s like doing your job with both hands tied behind your back and blindfolded.”

During the shutdown, the system’s already grave problems led the Grand Traverse Band of Ottawa and Chippewa Indians in Michigan to issue a press release saying, “People will die because of the shutdown.” The shutdown fortunately ended before reaching that point, at least based on a lack of news reports, but with disproportionate levels of dire illness, distance to care, and under-funded programs that the shutdown ceased altogether, it is much too easy to consider scenarios where another shutdown indeed could cost lives. If there were to be another shutdown, it is imperative that health services to Native Americans be exempt from closure.

In an ominous double-whammy of an example, the Associated Press cited the case of Michelle Begay, who was furloughed from an administrative position at the IHS, then had no health insurance because her application was held up by the shutdown. Begay came down with bronchitis. She paid $600 out of pocket to be treated a first time. When the bronchitis came back, she had to call for three days to get an appointment at an IHS clinic. She told the AP, “I was very fortunate. My situation was treatable. My lung didn’t collapse, that’s what they were really concerned about. But, still, I had to wait two, almost three days to be seen.”

Begay waited at risk of lung collapse, a psychologist threatened to become a barista, and a senior could not get her eye pressure checked, all because Trump wants to erect a wall.

For decades, Native Americans have faced a wall to better health. It’s past time to tear that wall down.

About the author

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Derrick Z. Jackson is a UCS Fellow in climate and energy and the Center for Science and Democracy. Formerly of the Boston Globe and Newsday, Jackson is a Pulitzer Prize and National Headliners finalist, a 2021 Scripps Howard opinion winner, and a respective 11-time, 4-time and 2-time winner from the National Association of Black Journalists, the National Society of Newspaper Columnists, and the Education Writers Association.