NCUIH-Endorses Bill to Elevate the Health Care Needs of Native Americans Within the Federal Government

On January 13, 2022, Representative Greg Stanton (D-AZ) and Representative David Joyce (R-OH) introduced the Stronger Engagement for Indian Health Needs Act (H.R. 6406). This bill would elevate the Indian Health Service Director to Assistant Secretary for Indian Health within the Department of Health and Human Services (HHS), increasing their authority within the federal government on the health care needs of the American Indian and Alaska Native (AI/AN) population. The National Council of Urban Indian Health (NCUIH) worked closely with Representatives Stanton and Joyce on this legislation and supports their effort to bring better representation for the health needs of AI/ANs.

“The health of our people has suffered due to the failure of the government to uphold the trust responsibility of providing health care to all American Indians and Alaska Natives. The pandemic, which continues to devastate Indian Country, has made it clear that it’s time for the Administration to recognize the importance of Indian health by elevating the position of the Director of the IHS to Assistant Secretary,” said Walter Murillo (Choctaw), President of NCUIH and Chief Executive Officer of Native Health, which is based in Phoenix, Arizona. “We applaud Representatives Greg Stanton and David Joyce for their longstanding leadership to improve health outcomes for Native people and hope this change will usher in a new era where Indian health is a priority and not an afterthought.”

The bill has been endorsed by leading Native American advocacy groups—including the National Congress of American Indians, National Indian Health Board, and NCUIH. The bill was referred to the Committee on Natural Resources and the Committee on Energy and Commerce. It currently awaits consideration.

 

NCUIH-Endorsed Comprehensive Addiction Resources Emergency (CARE) Act Includes Funding for Urban Indian Organizations

On December 16, 2021, Senator Warren (D-MA) and Representative Maloney (D-NY) reintroduced the Comprehensive Addiction Resources Emergency (CARE) Act (S. 3418/H.R. 6311). The CARE Act addresses the substance use epidemic by providing state and local governments with $125 billion in federal funding over ten years, Of the nearly $1 billion, the CARE Act sets aside $150 million a year in funding to Native non-profits and clinics, including to urban Indian organizations, Native Hawaiian organizations, and projects designed to test innovative service delivery and culturally informed care models to tackle addiction.

NCUIH worked closely with Congressional leaders to ensure the inclusion of urban Indians in this important legislative response to the Nation’s substance use epidemic and is pleased to endorse this bill. The bill was originally introduced in 2018 and is currently endorsed by over 175 national, local, and tribal organizations. In the Senate it was referred to the Committee on Health, Education, Labor, and Pensions. In the House it was referred to the Committee on Energy and Commerce, in addition to the Committees on Natural Resources, the Judiciary, and Oversight and Reform. It currently awaits further consideration.

“Many times, critical funding, even when appropriated in equitable amounts, does not reach across AI/AN urban communities, largely in part because when urban Indians are not specifically mentioned in legislative language they are most often excluded or forced to prove their eligibility under the intent of the laws created. NCUIH appreciates that the CARE Act has detailed specific language that ensures urban Indian organizations are listed as an eligible entity in this important legislative act,” wrote Francys Crevier (Algonquin), CEO of the National Council of Urban Indian Health (NCUIH).

 

Additional Information about the CARE Act

Additional funds from the $1 billion include $790 million per year for grants to Tribal governments to help fight this crisis and invest in substance use prevention and treatment; $7.5 million in additional funding for Tribal nations and regional tribal epidemiology centers to improve data collection on overdoses; and 50 million a year to Tribal Colleges and Universities, Indian Health Service-funded organizations, and medical training programs that partner with Tribal nations and Tribal organizations to train Native health professionals to improve substance use disorder treatment services. This Act also provides $1 billion per year to expand access to the overdose reversal drug, Naloxone, to states to distribute to Tribal nations, first responders, public health departments, and the public.

 

Background

to the Indian Health Service, the opioid crisis and COVID-19 pandemic are intersecting with each other and presenting unprecedented challenges for American Indian and Alaskan Native (AI/AN) families and communities. Because of the pandemic, substance and opioid use and fatalities have significantly increased in low-income communities.

AI/ANs continue to be deeply impacted by the opioid crisis and continue to see an overwhelming increase of deaths, addiction, and overdoses above the National average. AI/ANs had the second-highest rate of opioid overdose out of all U.S. racial and ethnic groups in 2017, and the second and third highest overdose death rates from heroin and synthetic opioids, respectively, according to the Centers for Disease Control and Prevention.

Since 1974, AI/AN adolescents have consistently had the highest substance abuse rates than any other racial or ethnic group in the U.S. Staggering statistics such as these do not happen overnight, they are the direct result of intergenerational trauma caused by adverse childhood experiences such as alcoholism, drug abuse and domestic violence in a family, emotional neglect, incarceration of a family member, and physical or sexual abuse— which are known to lead to a higher risk of addiction and other behavioral and mental health problems later in life.

Unfortunately, the majority of the nation’s AI/ANs living on and off reservations have limited access to substance abuse services due to transportation issues, lack of health insurance, poverty, inadequate healthcare facilities and a shortage of appropriate treatment options in their communities. Some of the disparities in treatment that occur within the AI/AN population can be resolved through increased availability of culturally sensitive treatment programs. Studies have shown that cultural identity and spirituality are important issues for AI/ANs seeking help for substance abuse, and these individuals may experience better outcomes when traditional healing approaches (such as powwows, drum circles, and sweat lodges) are incorporated into treatment programs.

NCUIH-Endorsed Bill Reintroduced to Improve Access to Critical Medical Supplies for American Indians and Alaska Natives

On January 4, 2022, Senator Elizabeth Warren (D-MA) and Representatives Ruben Gallego (D-AZ) and Tom Cole (R-OK) reintroduced the Tribal Medical Supplies Stockpile Access Act (S. 3444/H.R. 6372). This bipartisan, bicameral legislation would guarantee that the Indian Health Service (IHS), tribal health authorities, and urban Indian organizations (UIOs) have access to the Strategic National Stockpile, a federal repository of drugs and medical supplies that can be tapped if a public health emergency could exhaust local supplies. The National Council of Urban Indian Health (NCUIH) welcomes the reintroduction of this important legislation to provide critical resources to UIOs amid the current pandemic and future public health emergencies.

 

“We are encouraged by the leadership of Senator Warren, Representative Gallego, and Representative Cole to increase health care access for American Indians and Alaska Natives through the Strategic National Stockpile. As the coronavirus continues to have greater impacts, Congress must do everything possible to uphold its trust responsibility to Indian Country by providing appropriate resources. The stockpile is designed for those who need it most in times of emergency and Indian Country should not be left behind,” said Francys Crevier (Algonquin), Chief Executive Officer, NCUIH.

 

NCUIH supported the original legislation that was introduced in March 2020 by Senator Warren and remains unchanged in the reintroduction. Other organizations that support the bill include the National Indian Health Board, the National Congress of American Indians, United South and Eastern Tribes Sovereignty Protection Fund, Seattle Indian Health Board, and the Friends Committee on National Legislation. This bill was referred to the Senate Committee on Health, Education, Labor, and Pensions and currently awaits further consideration.

 

Background

 

Currently, Indian Country’s access to the Strategic National Stockpile is limited and is not guaranteed in the statute. NCUIH has advocated for UIOs to have access to the National Strategic Stockpile in light of the COVID-19 pandemic. In April 2020, NCUIH and other National Native organizations sent a letter to Members of both chambers of Congress outlining a joint COVID-19 recovery legislative proposal which included a request to include Tribal and UIO access to the Strategic National Stockpile.

 

On June 18, 2020 the Center for American Progress, a Washington DC based think tank, released a report on the COVID-19 response in Indian Country and included recommended policy solutions for better funding and supporting IHS, such as providing all Indian Health Service/Tribal Health Program/UIO facilities access to the Strategic National Stockpile and Public Health Emergency Fund.

Updated CDC Guidance for Pfizer-BioNTech COVID-19 vaccination

On Tuesday, January 4, the Centers for Disease Control and Prevention (CDC) issued two new recommendations on guidance on the administration of the COVID-19 vaccine technology from Pfizer-BioNTech. This guidance follows after the Food and Drug Administration (FDA) gave similar recommendations. The updated recommendations include the following: recommendations include the following:

  • Those who received the Pfizer-BioNTech COVID-19 vaccine as their primary series are not recommended to get a booster after 5 months.
  • Children 5-11-years-old who are moderately or severely immunocompromised should received an additional primary dose of the Pfizer-BioNTech vaccine 28 days after their second shot.

Additionally, following a recent Advisory Committee on Immunization Practices (ACIP) meeting, CDC is endorsing ACIP’s recommendation that people 12-17 years old should receive a booster shot 5-months after their initial Pfizer-BioNTech vaccination series. Currently, this vaccine is the only COVID-19 vaccine authorized for adolescents aged 12-17.

NCUIH Submits Comments to DOI on Boarding School Initiative and the Lasting Impact on Urban Indian Health

On December 23, 2021, the National Council of Urban Indian Health (NCUIH) submitted comments to the Department of the Interior (DOI) regarding the agency’s Federal Boarding School Initiative (Initiative). NCUIH reiterated its ongoing support for the Administration’s efforts to address the legacy of boarding school programs, while urging the Administration to use the Initiative to address the public health impact of boarding schools on urban American Indian and Alaskan Natives (AI/ANs). NCUIH emphasized the importance of studying not only the impact of boarding school programs for survivors, but also the lasting impact of the intergenerational trauma caused by boarding schools within urban AI/AN communities.

Background

On June 22, 2021, DOI Secretary Haaland issued a memorandum directing DOI to prepare a report addressing the “intergenerational trauma, cycles of violence and abuse, disappearance, premature deaths, and other undocumented bodily and mental impacts.” This Initiative came weeks after the discovery of 215 Indigenous children’s remains were found at a boarding school site in Canada. Secretary Haaland noted that to “promote spiritual and emotional healing in [AI/AN] communities, we [DOI] must shed light on the unspoken traumas of the past…no matter how hard it will be.”

Boarding schools and residential schools are a tragic thread in history that the United States and Canada share: The United States Government Indian Boarding School Policy authorized the forced removal of hundreds of thousands of Native children, as young as 5 years old, relocating them from their homes in Tribal communities to one of the 367 Indian Boarding Schools across 30 States. Between 1869 and the 1960s, the United States federal government stole Native children from their families to destroy their indigenous identities, beliefs, and traditional languages to assimilate them into white American culture through federally funded Christian-run schools.

NCUIH’s Role

Following Secretary Haaland’s memorandum, NCUIH issued a statement commending Secretary Haaland for beginning the process of holding the United States to account for the effects of its boarding school policy.  NCUIH also reiterated its support of the Initiative’s ability to address Indian Country’s historical trauma. NCUIH recognizes the deeply sensitive and emotional impact that federal boarding schools have on the AI/AN community at large, including the continued impact on the many UIOs we serve and their constituents. NCUIH exists, in part, because of the historic oppression of the AI/AN population including federal boarding schools that resulted in the growing AI/AN populations in cities.

Additionally, NCUIH endorsed the Truth and Healing Commission on Indian Boarding School Policies in the United States Act. This bill would create a Truth and Healing Commission on Indian Boarding School Polices in the United States. The Commission will provide a space for AI/AN people to speak about their personal experiences in government-run boarding schools and allow them to provide recommendations to the government. NCUIH is in full support of this Commission and hopes to see DOI establish a similar commission in the Initiative that includes a UIO representative to represent AI/ANs who reside in urban settings.

Importance of Including Urban Indians in the Initiative

In its comments, NCUIH urged DOI and the Administration to address the ongoing effects of Indian boarding schools on AI/AN health.  Specifically, NCUIH requested that DOI incorporate the following items into the Initiative:

  • Partner with AI/AN organizations, including UIOs, to fully study and understand the impact of boarding school trauma and assist survivors in healing from this trauma.
  • Study the lasting impact of boarding school policies, including intergenerational trauma, on the social determinants of health of contemporary AI/AN communities, including those in urban areas
  • Include the UIOs representing the seventy percent (70%) of AI/ANs living in urban areas in DOI’s process through urban confer
    • NCUIH’s comments recognized the importance of Tribal sovereignty and the government-to-government relationship as vital to the Initiative, but noted failure to include UIOs in consultation will leave a significant portion of the AI/AN population without a voice
  • Ensure a comprehensive assimilation of data by making all AI/AN communities true partners in the Initiative.

The DOI report on the investigation is scheduled to be finished in April 2022. NCUIH will remain close to the investigation and monitor for updates. NUCIH will also continue to advocate for the inclusion of UIOs in the process and encourage DOI to incorporate a study of the impact of the boarding schools on urban AI/AN health into the Initiative.

Senator Cantwell Highlights Urban Indian Organizations in Senate Committee on Indian Affairs Oversight Hearing on VAWA

On December 8, 2021, the Senate Committee on Indian Affairs (SCIA) held an oversight hearing on “Restoring Justice: Addressing Violence in Native Communities through VAWA Title IX Special Jurisdiction.” Focusing on the successes and challenges of Title IX of the 2013 Violence Against Women Act (VAWA 2013), the hearing coincided with the committee’s release of the Reauthorization draft text.

When Congress passed VAWA 2013, it included a provision for Indian Tribal governments to exercise criminal jurisdiction over certain non-Indians who commit domestic violence against Indian victims on Tribal lands or violate qualifying protection orders. Although VAWA 2013 has been instrumental in these cases, there remain impactful jurisdictional gaps such as, being able to prosecute crimes against children, dating violence, sex trafficking, as well as co-occurring crimes such as assault on a law enforcement officer or DUI.

During the hearing, Senator Maria Cantwell (D-WA) brought to light the work of urban Indian organizations (UIOs) regarding Missing and Murdered Indigenous People (MMIP). Many UIOs conduct home visits and are at the front-line to identify domestic violence and other risk factors for MMIP. The National Council of Urban Indian Health (NCUIH) has been advocating for MMIP efforts and urban Indians to be included in the VAWA reauthorization to strengthen these critical services provided at UIOs for AI/ANs.

VAWA Hearing on Heels of Recent EO from Biden on MMIP

On November 15, 2021, President Biden signed Executive Order 14053 (E.O.) on Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing and Murdered Indigenous People (MMIP) during the White House Tribal Nations Summit. NCUIH is pleased to see that the E.O. specifically mentions the Department of Health and Human Services (HHS) and the Secretary of the Interior conferring with UIOs on developing a comprehensive plan to support initiatives related to MMIP. We are also pleased to see that the E.O. highlights the need for improved data surrounding this crisis as it relates to urban Indian communities. NCUIH has voiced the importance of gathering more data on these communities, specifically on Missing and Murdered Indigenous Women.

CDC strengthens COVID-19 Booster Guidance

On November 29, CDC strengthened its recommendations on who should aim to complete a booster dose of the COVID-19 vaccine. This new recommendation urges that everyone ages 18 and older should receive a booster at least 6 months post completion of a 2-dose regimen, or 2 months post a single dose inoculation.

With the emergence of the Omicron variant, the importance of vaccination, and the use of boosters, as a prevention method is even more important. CDC Director, Dr. Rochelle Walensky also encouraged those who are unvaccinated to change that as soon as possible. Dr. Walensky also highlighted the importance of getting tested should you experience symptoms.

For more information, the Coronavirus Resources Center on the NCUIH website includes links to any recent guidance  or updates from federal agencies about COVID-19.

NCUIH Thanks Julia Dreyer for Her Service

NCUIH would like to thank Julia Dreyer, the Vice President of Public Policy, for her service to Indian Country as she moves on to her next endeavor! For the past four years, Julia has tirelessly advocated on behalf of American Indians and Alaska Natives living in urban settings. During Ms. Dreyer’s tenure, NCUIH has thrived and achieved significant wins for American Indian and Alaska Native health (AI/AN) care, such as more agency engagement on pressing issues, fighting against work requirements for AI/ANs, 100% FMAP for 8 quarters for services at Urban Indian Organizations (UIOs), UIO inclusion within every COVID-19 relief bill, and the amendment to the Indian Health Care Improvement Act to allow UIOs to use their line item funds for facilities related spending. Please join NCUIH in thanking Julia!

Julia Dreyer, NCUIH Vice President of Public Policy (Left) and Francys Crevier, NCUIH CEO (Right)

FY 2022 Update on IHS Special Diabetes Program for Indians: SDPI Funding Levels Reduced and 1-Year Extension of Current Grant Cycle

On November 15, 2021, the Indian Health Service (IHS) sent out a Dear Tribal Leader and Urban Indian Organization Leader letter (DULL) that discussed the Special Diabetes Program for Indians (SDPI) for fiscal year (FY) 2021 and the upcoming changes for the program in FY 2022. As a grant program inclusive of all three components of the Indian Health Service/Tribal Health Program/Urban Indian Organization (I/T/U) system, SDPI has been a resounding and demonstrable success in reducing diabetes and diabetes-related illnesses in Indian Country.

Background

In 2004, Congress established the SDPI Demonstration Projects to translate research-based interventions for diabetes prevention and cardiovascular disease (CVD) risk reduction into AI/AN community-based programs and health care settings. In total,  The SDPI Demonstration Projects successfully translated diabetes science and reduced the risk of diabetes in high risk individuals, and reduced CVD risk factors in people with diabetes. In 2010, the SDPI Demonstration Projects transitioned into the SDPI Initiatives to continue their prevention work and begin disseminating the strategies and lessons learned to other I/T/U health programs.

Since the inception of SDPI, it has achieved real, demonstrable success, with a 50% reduction in diabetic eye disease rates,drops in diabetic kidney failure, and a 54% decline in End Stage Renal Disease.Given the high rates of diabetes and diabetes-related illnesses AI/ANs face, it is imperative that SDPI is administered in a way that continues to reduce these rates – and in a manner that is inclusive of UIOs. AI/ANs have the highest diabetes prevalence rates of all racial and ethnic groups in the United States, with AI/AN adults almost three times more likely than non-Hispanic white adults to be diagnosed with diabetes.According to 2018 data from the Centers for Disease Control and Prevention, AI/ANs were 2.3 times more likely than non-Hispanic whites to die from diabetes and twice as likely to be diagnosed with end stage renal disease than non-Hispanic whites. SDPI is therefore a critical program to address the disparate high rates of diabetes among AI/ANs.

SDPI has directly enabled UIOs to provide critical services to their AI/AN patients, in turn significantly reducing the incidence of diabetes and diabetes-related illnesses among urban Indian communities. funding. Facilities use these funds to offer a wide range of diabetes treatment and prevention services, including but not limited to exercise programs and physical activity, nutrition services, community gardens, culinary education, physical education, health and wellness fairs, culturally-relevant nutrition assistance, food sovereignty education, group exercise activities, green spaces, and youth and elder-focused activities. To continue the path of success in reducing the rate of diabetes in Indian Country, IHS must continue to provide this essential funding to UIOs.

NCUIH has long advocated for an increase in SDPI funds.  NCUIH

 

FY 2022 Changes and Updates

Starting in FY 2022, SDPI funding will reduce from $150 million to $147 million each year. This reduction is due to a mandatory sequester which reflects a required 2% reduction continuing through 2023 under current law. While the SDPI grant cycle was due to end on December 31, 2021, IHS learned of the time intensive requirements and IHS has determined that FY 2022 will constitute a 1-year extension of the current grant cycle, extending it to a seventh year. IHS believes this extension will allow more time to work on the notice of funding opportunity and decrease some of the administrative burden for SDPI grantees.

Tribal Leaders Diabetes Committee Meeting Held on December 8, 2021

On December 8, 2021, IHS held a Tribal Leader Diabetes Committee (TLDC) meeting to discuss the current SDPI Funding Distribution. This funding includes $130.2 million in Tribal and IHS grants. A portion of that total will go to 14 IHS grants as well as Technical Assistance services for 8 IHS areas.  Urban Grants will receive $8.5 million in funding with $100k going to Technical Assistance. The SDPI Funding Formula is used to determine how much of the $130.2 million goes to each Area for Tribal/IHS grants. This formula includes information about diabetes prevalence, user population (AI/ANs who have used IHS services at least once in the past 3 years), and the tribal size adjustment. The meeting also announced a new Notice of Funding Opportunity (NOFO) which allows for new and open competition. Urban Indian health programs operated by UIOs are eligible for this NOFO pursuant to a grant or contract with IHS.

 

The TLDC meeting also outlined a FY 2023 SDPI timeline and issues for consideration, including the potential risk for a decrease in annual SDPI grant amounts due to the open competition, how grantees can be held harmless under the current situation, whether there will be a change in the SDPI funding formula, and what the Tribal Consultation/Urban Confer process will look like moving forward.

NCUIH-Endorsed Protecting Moms Who Served Act Enacted

On November 30, 2021, President Biden signed the Protecting Moms Who served Act (H.R. 958/S. 796) into law. This bipartisan legislation introduced by Representative Lauren Underwood (D-IL-14) and Senators Susan Collins (R-ME) and Tammy Duckworth (D-IL) is the first of 12 bills in the historic Momnibus Act to be enacted. This bill addresses the maternal mortality crisis among Veterans by:

  • Investing $15 million in maternity care coordination programs at the Department of Veterans Affairs facilities; and
  • Commissioning the first-ever comprehensive study of maternal mortality, morbidity, and disparities among Veterans.
    • The report on maternal morbidity and mortality includes an assessment on the barriers to determining the data and recommendations for improvements in tracking maternal health outcomes among pregnant and postpartum veterans who are eligible to use the Indian Health Service, Tribal health programs, or urban Indian health organizations.

The National Council of Urban Indian Health has tirelessly advocated for improving the health of American Indian and Alaska Native (AI/AN) Veterans and is pleased to endorse Rep. Underwood, Sen. Collins, and Sen. Duckworth’s legislation which advances maternal healthcare for Veterans with a focus on racial and ethnic disparities.