As Congress considers significant cuts to federal Medicaid funding, health centers serving Native American communities are facing a potential crisis. The Oneida Community Health Center in Green Bay, Wisconsin, is one such facility that could be severely impacted. Over 40% of its approximately 15,000 patients rely on Medicaid, and cuts to this program would be a serious blow, according to Debra Danforth, the center’s director and a member of the Oneida Nation.
Danforth explained that the center provides essential services to the Oneida Nation’s 17,000 members, including family practice, internal medicine, and obstetrics. The facility operates with an "open-door policy," welcoming members of any federally recognized tribe. However, Danforth and other tribal health officials warn that reductions in Medicaid funding would lead to decreased services at health facilities for Native Americans.
Medicaid plays a crucial role for tribes, helping to alleviate chronic funding shortages from the Indian Health Service (IHS), which is responsible for health care for Native Americans. The program accounts for about two-thirds of the revenue for tribal health providers, ensuring financial stability and helping cover operational costs. More than one million Native Americans enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) depend on this coverage to access care and avoid significant medical debt.
Liz Malerba, a policy director for the United South and Eastern Tribes Sovereignty Protection Fund, emphasized that Medicaid is a way for the federal government to fulfill its obligations to provide health care to Native Americans. She views any cuts to Medicaid as a failure to uphold that responsibility.
Tribes face challenges in delivering care, as they deal with severe health disparities and a high prevalence of chronic illnesses. In some western states, Native Americans have a life expectancy of just 64 years, the lowest of any demographic group in the U.S. Despite these challenges, some tribes have expanded health services in recent years, partly thanks to Medicaid reimbursements.
In Montana, for example, five urban Indian organizations saw nearly $3 million in funding growth over the last two years, allowing them to enhance services, including behavioral health care. These clinics serve around 30,000 people, including non-Native individuals, and provide a variety of services such as primary care and health education. However, potential Medicaid cuts threaten to reverse these gains and limit their ability to address health disparities.
Data shows that American Indian and Alaska Native individuals under 65 are more likely to be uninsured compared to their white counterparts. Approximately 30% of Native Americans rely on Medicaid, compared to 15% of white individuals. Additionally, over 40% of Native American children are enrolled in Medicaid or CHIP.
A recent report indicated that counties with a significant Native American presence have higher rates of Medicaid enrollment. In rural areas predominantly inhabited by Native Americans, about 28.7% of residents are enrolled in Medicaid, compared to 22.7% in other rural counties.
The Biden administration has previously exempted tribes from some of former President Trump’s executive orders, but officials warn that exemptions alone won’t shield Native Americans from the broader impacts of Medicaid cuts. State leaders are also concerned that cuts would shift costs to their budgets, potentially leading to changes in eligibility requirements that could leave some Native Americans without coverage.
Despite mixed messages from political leaders regarding Medicaid cuts, the proposed budget resolution from the House of Representatives calls for substantial reductions to the program. This has raised alarms among national and state organizations advocating for the preservation of Medicaid funding.
Tribal leaders stress that Medicaid is already a critical lifeline for Native American health programs. They argue that cuts would not just reduce funding but would create significant gaps in care. With Medicaid dollars making up a substantial portion of many facilities’ budgets, the prospect of losing this funding is daunting.
In summary, as Congress debates potential Medicaid cuts, health centers serving Native American communities are preparing for the worst. The outcome of these discussions could have dire consequences for the health and well-being of Native American populations across the country.