While the president’s FY2023 budget shows a historic investment in India’s health service, a task force concluded the agency would need five times as much money to be adequately funded.
Indian Health Service (IHS) is a federal agency responsible for providing health care to all federally recognized tribes. The agency has long been criticized for its chronic underfunding.
IHS served 1.7 million people nationwide in 2021. In Montana, IHS served 80,468 people. The report indicates that the agency’s past funding met approximately 48.6% of the health care needs of the population it serves.
The president’s budget for fiscal year 2023 proposes $9.3 billion allocated to IHS. In 2022, the budget appropriation for IHS was $6.8 billion. In 2016, the budget was just under $5 billion.
Budget 2023 proposes to increase funding for IHS to $36.7 billion by 2032.
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According to the report, “additional funding is long overdue”. A 2021 Tribal Budget Formulation Task Force, made up of tribal leaders from across the country, concluded that $49.9 billion was the actual amount needed in fiscal year 2023 to adequately fund the IHS.
Third world conditions
In a 2020 budget request, the National Congress of American Indians said: “Appropriations for IHS have never been sufficient to meet the basic needs of patients, and health care is delivered in conditions mainly from the third world.
IHS is subject to annual discretionary funding from Congress, which the report says makes long-term planning difficult.
The report argues that unpredictable funding creates “long-term uncertainty…and makes it difficult to maintain and upgrade needed healthcare infrastructure.”
Additionally, the average IHS facility is over 40 years old, which poses challenges in providing quality care.
According to the report, “Funding to support infrastructure investments should be ongoing and support ongoing maintenance as well as improvements and upgrades as technology and building standards evolve.”
IHS employs more than 15,000 people but struggles to recruit and retain staff, especially in remote areas. The report says vacancy rates are highest for nurses, doctors and dentists.
In the Billings IHS region, which includes service units in Montana and Wyoming, there is a vacancy rate of 51% physicians, 51% vacancy rates nurses, 48% vacancy rates nurses. practice nurses and 44% medical assistant vacancy rate.
The report says increased funding could address staffing shortages, strengthen prevention programs, modernize health infrastructure and improve access to trauma-informed mental health, treatment for substance use disorders substances and other services that are not currently available.
Native Americans face persistent disparities in health and health care, which the report says “are the result of centuries of structural discrimination, forced relocation, reduced economic opportunity, and chronic underfunding of Health care”.
The report also cited barriers to care, historical trauma, discrimination and poverty as other factors contributing to health disparities.
Compared to the rest of the US population, Native Americans have a lower life expectancy and a higher likelihood of dying from COVID-19, diabetes and other unintentional injuries. Aboriginal people also face high rates of infant mortality, alcohol and substance use disorders, mental illness, suicide, diabetes and obesity.
Despite having the highest percentage of vaccination by race for people receiving at least one COVID-19 vaccine, Native Americans have higher rates of infection, hospitalization and death from COVID-19. From March 2020 to January 2022, Native Americans were more than three times more likely than white people to be hospitalized with COVID-19.
While IHS has received “a historic increase in funding” to address the COVID-19 pandemic, the report asserts that “one-time funding is insufficient to adequately meet the ongoing need for investment.”