As the partial government shutdown drags into its third week, Native American healthcare advocates are warning lawmakers that funding for the Indian Health Service is already drying up for some key programs.
But with both sides firmly settled in their political camps in a White House and congressional Democratic standoff over border security funding, IHS is caught in the middle for now.
The National Council of Urban Indian Health warned in a Monday letter to lawmakers that one of its Urban Indian Health Program facilities is slated to close on Saturday. The facility in question took care of three patients who overdosed on opioids the week the shutdown started. Two of those patients died.
Three clinics may have to close before the end of the month if Congress and the White House can't find a resolution, the council warned, and another will need to cut back on operations two weeks after that. Thousands of patients would get short-changed on treatment, according to the Council's estimate. One-third of the 13 facilities surveyed have started to prepare for closure.
The Urban Indian Health Program comprises 41 different programs across the country and is funded by grants to cover addiction and behavioral health treatment, primary care, dental care, immunizations, HIV treatment and more.
Nearly 80% of American Indians and Alaska Natives live in urban areas, but urban funding for those patients makes up less than 1% of the IHS budget so these programs serve as a supplement to other funding sources.
For broader tribal healthcare operations, individual tribes have to decide how to maintain and manage their programs through the shutdown, according to the National Indian Health Board, an advocacy group. Despite the funding losses, IHS will keep up its direct clinical treatments "because they involve the safety of human life," a statement from the board said. But other programs "not directly related to the safety of the human life" won't necessarily continue.
As spending talks fell apart before Christmas, Rep. Markwayne Mullin (R-Okla.), GOP co-chair of the House Indian Health Service Task Force, introduced a bill to fund the agency through next September, or the end of the current fiscal year. He had to reintroduce the measure at the start of the new Congress, but it isn't likely to go anywhere.
Mullin argued the agency, which is perennially plagued with funding shortages but whose budget doesn't count as mandatory spending from Congress, needs a financial buffer from the politics of the current spending fight.
"Native Americans deserve quality, reliable healthcare services as promised in treaties with the federal government," Mullin said. "My bill, which would provide a stable source of funding for IHS through fiscal year 2019, is a good start."
Mullin's Democratic co-chair on the task force, Rep. Raul Ruiz of California, said he supports "any legislation that recognizes this unique relationship and the need to fund the IHS during government shutdowns."
"When the funds run out, access to life-saving medicine and services may end and it may be a matter of life or death," he added. "Tribes are among the worst impacted by this shutdown because it affects the day-to-day operation of their health clinics and hospitals. This is why we need regular order for our appropriations process and why we need to reopen the government as soon as possible."
On Tuesday Ruiz joined fellow Democratic Reps. Betty McCollum of Minnesota and Yvette Clark of New York as a co-sponsor.
But the legislation isn't likely to go anywhere as the bigger political battle around the shutdown marks House Democrats' first big contest with Trump since they reclaimed the gavels at the start of the year.
On Sunday, House Appropriations Committee Chair Nita Lowey (D-N.Y.) released four individual appropriations bills including for the Interior Department—where IHS gets its funding from—to re-open some lapsed departments one by one. Democratic leadership is expected to bring them to the floor for a vote this week, although it's largely a messaging move that won't pass the Senate.
One Democratic aide said Democrats have done their part to re-open the government and won't likely give Republicans the IHS carve out.
Correction: An earlier version of this story misstated that there were no Democratic co-sponsors. This error has been corrected.
