The federal government shutdown of 2018–2019 occurred from midnight EST on December 22, 2018 until January 25, 2019. This shutdown became the longest federal government shutdown in US history, lasting 35 days and causing severe and detrimental impact on the Indian healthcare delivery system. The interruption in funding precipitated by the shutdown had dire consequences for UIOs and consequently on American Indian/Alaska Natives (AI/ANs) across the country. This brief summarizes the results of a survey NCUIH circulated during the shutdown to capture important metrics and narratives regarding the impacts of the shutdown. The 2018/2019 Government Shutdown: Impacts on your Program survey was fielded January 2 to January 15, 2019 by the National Council of Urban Indian Health.
- UIOs operate on very low margins.
- UIOs operate on margins so low that even the most minor changes to their funding structure leads to devastating impacts on the services they provide to AI/ANs as well as their ability to keep their facilities operational.
- All aspects of the urban healthcare delivery system were impacted by the shutdown, but UIO workforce were the first to experience its disastrous effects.
- The survey results pointed to a pattern which suggests that among the difficult decisions UIOs were forced to make during the 2013 and the 2018/2019 shutdown, delaying hiring, reducing hours, and laying off of staff was usually the first choice.
- Services were also greatly impacted.
- Another pattern highlighted by the survey was that UIOs were forced to cut back on services that were not as consequential as others – services such as dental services, transportation, case management, and community outreach services. However, some UIOs were forced to cut even the essential services like substance abuse services, and purchase requests for insulin and blood pressure medications.
- UIOs were forced to use savings designated for other purposes to shield staff and patients from impact of the last two shutdowns.
- Yet another pattern illustrated in the survey results suggests that UIO leaders make an effort to protect their staff and current services by using savings earmarked for growing their program.
- More research is needed.
- Impacts of the shutdown are ongoing. This study was limited to only 13 days in the field so with further funding support, additional information on the long-term shutdown impacts can be determined. As the nationwide organization representing all Urban Indian Health Programs, NCUIH can assist with coordination of further research. To provide funding resources or inquire further, contact Alejandro Bermudez at firstname.lastname@example.org.
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