A narrow escape for the Indian Health Service - for now
Funding cuts at programs surviving on a shoestring
Benjamin Musket felt a scratch in the back his throat. He tried to clear it but the scratch lingered. He coughed. The irritation was still there. He became fatigued as a full-blown illness set in hours later. Soon he would awaken from a long sleep gasping for air – he could barely breathe. He needed medical attention.(1)
Mr. Musket was marine veteran and a loyal church board member. He was older and retired from his career as an auto-mechanic. He was Native American – a member of Navajo Nation. As such, his first stop for care was the Gallup Indian Medical Center run by the United States Indian Health Service (IHS).
Gallup is one of the largest hospitals run by IHS. It contains 99 beds and cares for patients during 250,000 outpatient and 5,800 inpatient visits each year. Despite its large size relative to other IHS facilities, it’s a typical rural hospital. When Mr. Musket’s condition worsened further, he needed to be transferred to a larger more comprehensive medical center 100 miles away in Albuquerque, NM.
Mr. Musket had Covid-19, or “Dikos Ntsaaígíí-19,” meaning cough that kills in Navajo. Tragically, the translation was true in Mr. Musket’s case. He died in early June 2020. His wife died from Covid-19 five days later in the same Albuquerque hospital. In total over one-percent, of Navajo Nation died from Covid-19 in the early years of the pandemic. One out of every one-hundred Navajo people gone within the first three years of the pandemic. Why?
It is not easy to answer this question. Throughout the world, poverty correlates with worse health outcomes from Covid-19 and other illnesses. By US standards Navajo Nation suffers from horrible poverty. The median household income across Navajo Nation is $27,000 per year. About 40 percent of all people and 50 percent of all children live in poverty and more than one-third of all homes lack either running water, electricity, or both. Poverty and the ill-health that accompanies it, is only part of the story, however. Mr Musket and other members of Navajo Nation receive most of their healthcare from the notoriously underfunded Indian Health Service (IHS).
IHS was created in 1955 by the U.S. Department of Health and Human Service (HSS) to provide direct medical care and public health assistance to Native American tribes and Alaskan Native people. In recent years the US Congress has allocated about $6 billion to IHS per year. This amount to about $4,000 per person. It’s a shoe-string budget. The $4,000 allocation is about one-half of the per capita health care spending in the United States. On this budget IHS faces a continuing struggle to provide health care. The medical providers accept lower wages than they could receive at more glamorous posts to help the people they serve. The mission of IHS is important and workers remain at IHS because they believe in that mission.
Friday afternoon IHS director Ben Smith was tasked with informing 950 employees of their termination as part of the Federal Government cuts. This was about 6 percent of the entire IHS workforce. (Initially 2,200 people had been targeted for termination but it was scaled back to 950.) An institution already on a shoestring budget would have suffered dramatically from these cuts. A.C. Locklear chief executive officer of the National Indian Health Board, said the cuts “would be catastrophic for the agency and direct care services” at IHS which already has 30-percent of its positions vacant.
Luckily an outpouring of protest to the Trump administration convinced them to reverse course and HHS announced that the layoffs had been rescinded a few hours after the initial announcement.
These proceedings highlight two things. First, there is an all-around lack of understanding of the principals of government mission by the people making these widespread federal cuts. Other course reversals have taken place recently. Initially PEPFAR funding was eliminated before a partial reinstatement took place a few days later. (And even that reinstatement has been questioned as reports in the field suggest that funding is not actually reaching communities that are normally served.) The same thing happened with portions of USAID. We shouldn’t have tech-bros running around cutting things that they don’t understand willy-nilly. Would Elon Musk or his musketeers at DOGE have been able to tell the public anything of substance about IHS budgets prior to making these cuts on Friday? Did they understand the importance of the work that they do or how drastically IHS was already underfunded? If they are looking for bloated government, IHS is not a place that they will find it.
Second, we can see in the uprising that public voices still matter. We shouldn’t lay down and take cuts to vital life-saving programs like PEPFAR and IHS without a fight. Even in moments when people feel helpless our voices, when expressed collectively, can still help to steer the course of these drastic cuts to essential federal government services. Gregg Gonsalves wrote an article for the New York Times this week expressing the work that needs to be done to oppose the Trump administration’s assault on science and public health. He wrote in part:
“Over the next few years, Americans who hope for something better will have to go toe-to-toe with this administration, at all levels of government, challenging its attacks on science in the courts, finding ways to protect public health through state and local action, educating our communities about what is going on and ways in which they can help push back...”
We can’t take what is happening with passivity. In the case of Mr. and Mrs. Musket, IHS couldn’t save their lives from the Covid-19 pandemic. But IHS will save other lives as long as we work to sustain and fund it at appropriate levels. We simply can’t be passive and allow the Trump administration to have its way and run roughshod over those already sitting on the margin of survival.
Troy Tassier is a professor of economics at Fordham University and the author of The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us during Outbreaks.
1. Mr. Musket’s story is detailed in my book The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us during Outbreaks.