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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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President Proposes 4 Percent Increase in FY 2007 Budget for Indian Health Service

The proposed budget authority for the Indian Health Service (IHS), an agency in the Department of Health and Human Services (HHS), for fiscal year (FY) 2007 is $3.2 billion. This is a $125 million, approximately 4 percent, increase over the FY 2006 enacted budget level. Adding in funds from health insurance collections estimated at $678 million, designated diabetes appropriations of $150 million, and $6 million for staff quarters rental collections, increases the proposed budget for the IHS to $4 billion in program level spending. This increase reflects the impact of the epartment’s tribal budget consultations and a continuing federal government commitment to provide for the health of members of federally recognized tribes.

The challenge for the IHS is to continue to provide access to quality health care for an increasing population. An estimated 1.9 million American Indians and Alaska Natives will be eligible for IHS services in 2007, an increase of 1.6 percent over 2006 and 11.3 percent since 2001. The FY 2007 proposed budget includes new funds to help provide for the additional 30,000 people who are expected to seek services in FY 2007, cover increased pay costs for the federal and tribal employees who provide these services, and meet the rising cost of providing these services. Funds will go primarily to Clinical Services (operation of hospitals and clinics, and purchase of medical care), but also to other IHS programs that are providing additional services and support functions.

The proposed budget includes an additional $41 million toward covering increased federal employee pay costs and to allow tribally run health programs to provide comparable pay raises to their staffs.

A total of $18 million is included for the completion of the construction of the SW Ambulatory Care Center, Phoenix Indian Medical Center, located in Komatke, Arizona. This project will be constructed by the Gila River Indian Tribe under Public Law 93-638. An additional $32 million is included to staff and operate four outpatient facility projects that were funded by Congress in previous years at Red Mesa, Arizona; Sisseton, South Dakota; Clinton, Oklahoma; and St. Paul, Alaska.

The FY 2007 budget request includes $94 million for sanitation construction – an increase of $2 million, or 2 percent, over FY 2006, to provide safe water and waste disposal systems to an estimated 22,500 Indian homes. Approximately 88 percent of American Indian and Alaska Native homes have been provided safe and reliable water since the inception of the IHS sanitation construction program. The IHS credits its sanitation constructions program with playing a key role in the long-term reductions it has achieved in infant mortality, gastroenteritis, and other nvironmentally related diseases.

Tribes continue to increase the number of IHS programs they operate under the authority of the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended). In FY 2007, tribes will control an estimated $1.6 billion, or approximately 54 percent, of the total IHS budget request. To enable tribes to develop the administrative infrastructure necessary to successfully manage these programs, the proposed budget includes a total of $270 million for ontract support costs, an increase of $6 million over FY 2006.

The budget request includes an additional $37 million for contract health service (CHS) costs. The IHS uses CHS funds to supplement the care provided in its own facilities by purchasing medical care from hospitals and health providers. These CHS funds pay for specialty care, including most types of surgery, and are used to purchase medical care for tribes that do not have an IHS facility nearby.

The proposed budget includes an additional $9 million, or approximately 8 percent, increase to provide much needed dental health care services to American Indians and Alaska Natives. Compared to the general U.S. population, American Indian and Alaska Native dental patients experience more oral disease, including both tooth decay and periodontal disease. Studies have shown that almost 32 percent of adults have advanced periodontal disease, compared to only 12 percent of adults in the general U.S. population, and that over two-thirds of Indian adolescents have untreated tooth decay, compared to 24 percent of similar aged children in the general U.S. population.

Included in the budget request is $150 million for diabetes prevention and treatment grants. Through the Special Diabetes Program for Indians, the IHS has awarded $700 million in grants over the past 5 years to over 300 tribes and Indian organizations to support diabetes prevention and disease management at the local level. This program has substantially increased the availability of services such as basic clinical exams, newer treatment medications and therapies, laboratory tests to assess diabetes control and complications, screening for diabetes and pre-diabetes, nutrition education, and physical fitness activities.

The proposed budget does not request funding for the Urban Indian Health Program. Unlike Indian people living in isolated rural areas, urban Indians can receive health care through a wide variety of federal, state, and local providers. One source of health care available to low-income urban mericans is the Health Resources and Services Administration’s Health Centers program, which served 7.3 million urban patients, and 125,000 Native Americans, in 2004. The President’s budget requests $2 billion for Health Centers in FY 2007, sufficient to serve 8.8 million urban patients and 150,000 Native Americans.

FY 2007 Proposed Budget Overview for the Indian Health Service (Dollars in thousands)

Type FY 2006 (Enacted) FY 2007 (Proposed) Change over FY 2006
Clinical Health Services
Hospitals & Health Clinics $1,339,539 $1,429,772 $90,233
Dental Health $117,731 $126,957 $9,226
Mental Health $58,455 $61,695 $3,240
Alcohol & Substance Abuse $143,198 $150,634 $7,436
Contract Health Services $517,297 $554,259 $36,962
Total, Clinical $2,176,220 $2,323,317 $147,097
Preventive Health Services
Public Health Nursing $48,959 $53,043 $4,084
Health Education $13,584 $14,490 $906
Community Health Reps. $52,946 $55,790 $2,844
Immunization AK $1,621 $1,708 $87
Total, Preventive $117,110 $125,031 $7,921
Other Services
Urban Health $32,744 $0 ($32,744)
Health Professions $31,039 $31,697 $658
Tribal Management $2,394 $2,488 $94
Direct Operations $62,194 $63,804 $1,610
Self-Governance $5,668 $5,847 $179
Contract Support Costs $264,730 $270,316 $5,586
Total, Health Services $2,692,099 $2,822,500 $130,401
Indian Health Facilities
Maintenance & Improvement $51,633 $52,668 $1,035
Sanitation Facilities $92,143 $94,003 $1,860
Health Care Facilities Construction $37,779 $17,664 ($20,115)
Facilities & Environmental Health Support $150,709 $161,333 $10,624
Medical Equipment $20,947 $21,619 $672
Total, Facilities $353,211 $347,287 ($5,924)
TOTAL PROPOSED BUDGET AUTHORITY $3,045,310 $3,169,787 $124,477
Insurance (Medicare/Medicaid/Private) $677,831(est) $677,831(est) $0
Staff Housing $6,288 $6,288 $0
Allocations from Other Sources
Special Diabetes Program for Indians $150,000 $150,000 $0
TOTAL PROGRAM LEVEL $3,879,429 $4,003,906 $124,477