Legislators Raise Health Concerns About Low Funds for IHS Including Sanitation Improvement

By Sandra Basu

WASHINGTON — Members of a House subcommittee questioned recently whether the Obama administration’s proposed budget for the Indian Health Service is sufficient to cover critical health needs, especially the lack of adequate sanitation facilities in the majority of homes.

Rep. Mike Simpson, R-ID, chairman of the House Subcommittee on Interior, Environment and Related Agencies, said the budget request “takes a step backward on already underfunded programs that the United States has a legal and moral obligation to fund.”

“The FY13 budget for the Indian Health Service is markedly different from the request just a year ago,” Simpson added. “Whereas last year’s request was a 14% increase, including full funding to maintain current services, this year’s budget is a 2.7% increase, which doesn’t even cover the full cost of medical inflation.”

Simpson was speaking at a hearing on the proposed FY 2013 budget for IHS, which includes $4.42 billion in budget authority, a $116 million increase over the IHS FY 2012 budget appropriation.

Rep. Jim Moran, (D-VA), said he was concerned that the budget request “flat funds” sanitation-facilities construction. He pointed to the high number of American Indian and Alaska Native homes in need of sanitation facilities and potable water and how the lack of those facilities can affect health.

“In this day and age, about 231,000 or approximately 60% of AI/AN homes are in need of sanitation facilities, including nearly 33,000 AI/AN homes without potable water,” Moran pointed out. “Most Americans don’t even think about it; they just take it for granted.”

IHS budget documents noted that IHS provided service to 21,984 homes in 2011. Projects that provide sanitation facilities to homes “are selected for funding in priority order each year from the Sanitation Deficiency System (SDS) inventory of all needs in Indian Country,” the document explained.

“Maximum health benefits will be realized by addressing existing sanitation needs identified in the backlog and by providing sanitation facilities for new homes when they are constructed,” it stated.  

Yvette Roubideaux, MD, director of the Indian Health Service (second from left) met recently with the United South Eastern Tribes, Inc. to discuss health care reforms within the agency. Photo from IHS website.

Increases in Contract Health Service Funding

IHS Director Yvette Roubideaux, MD, MPH, meanwhile, touted increases in funding for contract health services (CHS), which she said has had a positive impact on patient care.

 When an IHS or tribal-health facility is unable to provide needed services for a patient, CHS is designed to purchase healthcare services from the private sector. This includes hospital care, physician services, outpatient care, laboratory, dental, radiology, pharmacy and transportation services.

“When I first became the director, I would have a stack of appeal documents on my desk for patients whose care had been denied because of a lack of funding or they were ineligible or they haven’t met medical priority,” Roubidueax told a House subcommittee. “I haven’t seen one in quite a while and, I think, because of increases in funding, we have received over the last couple of years, more of the patients are getting their referrals paid for.”

Over the years, tribes have complained that the program is underfunded and that when budget funding for this program runs out in any given year, patients are denied referrals for care.

Roubideaux has acknowledged the challenges regarding the CHS program. At a hearing in December 2009, she explained to the Senate Committee on Indian Affairs that, when CHS funding is depleted, CHS payments are not authorized and that, when CHS funding is not available to authorize payment for a referral, “that does not mean that the referral is not medically necessary,” she said in written testimony.

“If a medical provider identifies a need to refer a patient, we assume the referral is medically necessary. The challenge we have, in many cases, is finding funding to pay for these referrals with our annual appropriation for the CHS program.”

For FY 2013, the president’s budget request includes a program increase of $54 million for the CHS program. Of that amount, $34 million is the calculated amount needed to address a 3.6% medical-inflation rate for the program. The remaining $20 million increase would provide additional healthcare services by purchasing approximately 848 inpatient admissions, 31,705 outpatient visits and 1,116 one-way transportation services, according to budget documents.

While Roubideaux noted that this would expand the number of referrals for medical services in the private sector, she also pointed out in her written testimony that the “estimated need for the CHS program, defined as denied and deferred services, remains high.”

“Reduced increases for inflation and population growth in recent appropriations results in less buying power,” she wrote.

President’s budget request

The budget proposal also includes:

  • an additional $6 million to help the IHS Health Information Technology system provide and enhance essential HIT services for third-party reimbursement and support for the electronic dental records program;
  • an increase of $49 million to support staffing and operating costs for six new and expanded health facilities;
  • $81 million for healthcare-facility construction to continue construction of two outpatient facilities in Arizona; and
  • a $1.7 million increase for maintenance and improvement of healthcare facilities.

“I believe that we need to keep making as much progress as we can to try to improve the Indian Health Service, both in the way we manage it and in the care we provide,” Roubideaux said. “The budget that we proposed for 2013 acknowledges the overall needs related to addressing the budget deficit, but it still makes IHS a priority, and I am grateful for that.”

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