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F I S C A L I M P A C T R E P O R T

SPONSOR Harrison

ORIGINAL DATE

LAST UPDATED

02/27/07

HM 29

SHORT TITLE Increase Indian Health Service Funding

SB

ANALYST Weber

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY07

FY08

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Indian Affairs Department

Human Service Department (DOH)

SUMMARY

Synopsis of Bill

House Memorial 29 encourages the House of Representatives to adequately fund the Indian

Health Service to ensure that Native Americans in New Mexico receive the health care to which

they are entitled pursuant to treaty and other obligations.

FISCAL IMPLICATIONS

No direct fiscal implications identified. However, if the Indian Health Services were adequately

funded there would be associated savings related to state programs and uncompensated care at

both public and private health facilities.

SIGNIFICANT ISSUES

The Indian Affairs Department reports that the United States government has a federal trust

responsibility established by treaties, legislation, executive orders and court rulings to provide

health care services to members of federally recognized tribes and other qualified individuals.

This obligation is executed primarily via the Indian Health Service (“IHS"), a subdivision of the

House Memorial 29 – Page

2

United States Department of Health and Human Services (“HHS.") Approximately 55% of

Indians rely on IHS for healthcare.

As the memorial’s opening statements illustrate, the IHS has not always provided the best

possible care. This conclusion is not merely anecdotal, but is in fact, reinforced by in-depth and

objective analysis of the issue. According to the July 2003 report, “A Quiet Crisis," released by

the United States Commission on Civil Rights, IHS appears to fall short by a variety of

measures. Some key points:

•

Provision of Care: Health care facilities are inaccessible and obsolete. Preventative care

and specialty services are not readily available.

•

Prioritization: The federal government spends less per capita on Native American health

care than on any other group for which it has this responsibility, including Medicaid

recipients, prisoners, veterans, and military personnel.

•

Closing the Gap: IHS currently operates with an estimated 59 percent of the amount

necessary to stem the Native American healthcare crisis.

•

The Trend: Despite current funding shortfalls – the situation appears to be getting worse.

In 1998, the IHS total budget was 5.6 percent of HHS’ discretionary budget, while in

2003 it was 4.4 percent

.

TECHNICAL ISSUES

HSD offers the following observations.

The first full paragraph on page 2 referring to the impact of IHS funding cuts other providers

likely intends to refer to the fact that the increased use of non-IHS facilities for care that should

be funded through IHS has resulted in an additional burden of uncompensated care costs on other

healthcare providers. If this is the intent, the legislature may wish to consider revision of the

language.

The second full paragraph on page 2 refers to legal and moral basis for funding health care to

Native Americans. It refers, among other things, to “treaty, statute, constitution, and ethics.

The NOW THEREFORE paragraph refers only to a request to receive health care to which

Native Americans are entitled “by treat." This may dilute the impact of the second full

paragraph and if the legislature agrees may wish to simply delete the words “by treat" in the

NOW THERE section.

The third full paragraph refers to a cost of $1,920 per patient prior to cuts in IHS funding. It is

recommended that the first sentence containing that number end with words such as “per year"

or per “fiscal year."

If the cuts have been increasing proportionally over a significant number of years information on

this effect will identify the problems described in a way that emphasizes an escalating crisis

related to deferred health care. The only reference to time is in the first full paragraph on page

one and it is rather general.

MW/mt