WASHINGTON, D.C. — As the first Americans continue to feel the disproportionate impacts of the coronavirus pandemic, a bipartisan group of lawmakers is seeking to bring more resources to urban Indian communities.

Although the majority of American Indians and Alaska Natives live in urban areas, barely 1 percent of the Indian Health Service budget has gone to urban Indian health providers Funding has finally started to increase and only as a result of COVID-19 relief legislation passed by Congress.

Lawmakers from both parties are now hoping to expand on those efforts. A bill being introduced on Tuesday offers a simple solution that will help improve the facilities and clinics that serve urban Indians across the nation.

“Urban Indian Organizations are a lifeline to Native Americans living in urban areas across California,” Sen. Alex Padilla (D-California), a new member of the U.S. Senate, said in introducing the Urban Indian Health Providers Facilities Improvement Act. [PDF]

“Yet, UIOs are prohibited from using Indian Health Service funding for facilities, maintenance, equipment, and other necessary construction upgrades,” added Padilla, whose home state of California is home to the largest population of American Indians and Alaska Natives in the United States.

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The Urban Indian Health Providers Facilities Improvement Act is just two pages long. Yet it finally resolves the situation by allowing urban Indian providers to utilize IHS funds to improve, update or renovate their facilities.

“During the pandemic, many UIOs couldn’t get approval for ventilation upgrades, heaters, generators, and weatherization equipment,” observed Padilla. “Removing this unjust burden on UIOs is a commonsense fix, and would allow them to improve the quality of the culturally competent care that they provide.”

The National Council of Urban Indian Health (NCUIH) has been among the many voices pushing for the facilities fix. According to the organization, UIOs will need at least $80 million to start improving the spaces that serve their patients and clients.

“Facility-related use of funds remains the most requested priority for UIOs,” Francys Crevier, a citizen of the Algonquin First Nation who serves as NCUIH’s chief executive officer, said in testimony to Congress in March, a year into the COVID-19 pandemic.

The Urban Indian Health Providers Facilities Improvement Act does not allocate any money for UIOs. But by lifting the restriction in existing law, it paves the way for Congress to approve funding, which supporters are hoping can happen as soon as this year.

“Despite having extremely limited resources, Urban Indian organizations have been on the front lines of the COVID-19 pandemic, and for long before that have provided comprehensive, culturally competent care to urban Indians and other medically underserved patients across the country,” said Rep. Ruben Gallego (D-Arizona), who is introducing the companion version of the bill in the U.S. House of Representatives.

“Congress must immediately end this erroneous restriction on UIOs’ ability to spend the money Congress gave them on the projects that will best serve their patients,” said Gallego, who serves on the House Subcommittee for Indigenous Peoples of the United States. “We must pass this bill without delay.”

Like a number of urban Indian initiatives that NCUIH has championed throughout the pandemic, the Urban Indian Health Providers Facilities Improvement Act enjoys bipartisan support. Sen. James Lankford (R-Oklahoma) is co-sponsoring Padilla’s bill.

“Oklahoma has the second-largest Urban Indian patient population and is proudly served in both Tulsa and Oklahoma City clinics,” said Lankford. “We should continue to improve health care access for our Urban Indian population and broaden the flexibility for Urban Indian Organizations’ use of facilities renovation dollars, in addition to those for accreditation, to meet patient needs.”

Additional sponsors include Sen. Dianne Feinstein (D-California) and Sen. Tina Smith (D-Minnesota), who serves on the Senate Committee on Indian Affairs.

“We should finalize these changes to ensure we provide more, quality options for tribal health care,” Lankford said. “I look forward to the support from the leadership of the Senate Committee on Indian Affairs on this important legislation.”

Over on the House side, Rep. Don Bacon (R-Nebraska) is signing onto Gallego’s version of the Urban Indian Health Providers Facilities Improvement Act.

“Like many community healthcare centers, Urban Indian Organizations have been hit financially because of COVID and have struggled to renovate their facilities and expand capacity requirements,” said Bacon. “Under current law, UIOs cannot use federal funds to pay for these improvements and keep their doors open. Our bill lifts that restriction and grants access to these funds.”

“These health centers care for so many members in our Nebraska community,” Bacon added. “It’s only right we close this loop hole so they can provide quality care to their patients.”

The prohibition on UIOs utilizing IHS funding for facilities improvement is tied to the Indian Health Care Improvement Act, also known as the IHCIA. The law has hindered all but one of the dozens of urban Indian providers, Crevier said in her testimony to the House Subcommittee for Indigenous Peoples of the United States on March 23.

“The IHCIA limits renovation funding to facilities that are seeking to meet or maintain Joint Commission for Accreditation of Health Care Organizations accreditation (only 1 of 41 even have this type of accreditation), leaving most UIOs forced to use their limited third-party funds for necessary facility improvements,” Crevier said in a written statement.

The Urban Indian Health Providers Facilities Improvement Act, which amends the IHCIA to eliminate the limitation, is a critical piece of an ongoing effort to bring more resources to urban Indians and their communities. NCUIH is already asking the House Committee on Appropriations, which writes federal funding bills, to step in with support with funding in fiscal year 2022, which begins this October.

“We will be requesting $80 million in facilities funding for UIOs from the Appropriations Committee for fiscal year 2022 and ask your support of that request to make long needed upgrades to address gaps that have been exacerbated by COVID-19,” Crevier noted.

Congratulations to our 2021 Urban Indian Health Congressional Champion Award recipients: @SenatorLankford (R-OK), @SenTinaSmith (D-MN), @RepRubenGallego (D-AZ), and @repdonyoung (R-AK)! Thank you for your leadership on #UrbanIndianHealth and for speaking at our Keynote tomorrow! pic.twitter.com/qS8k657kgL

— NCUIH (@NCUIH_Official) May 24, 2021

Historically, only about 1 percent of the IHS budget has gone to UIOs. In fiscal year 2020, which started in the October prior to COVID-19, only about $58 million went to these providers.

The American Rescue Plan Act, which was pushed by President Joe Biden and Democrats in Congress, mandated at least $84 million for UIOs. Last month, the IHS announced it would be distributing a total of about $250 million for urban Indian programs, a significant increase.

The law provided an additional $6 billion to the IHS, of which $4.3 billion in distributions were announced in the April 16 letter to tribes and UIOs. Another $1.7 billion will also be distributed by the agency.

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