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<font size="1"><a href="https://www.politico.com/news/2020/03/20/coronavirus-american-indian-health-138724?fbclid=IwAR3Xczu1Qt0letv5vg971FjIdKUn1qKR2tKoQjpS7_crplbKI8EfNs_qr2s">https://www.politico.com/news/2020/03/20/coronavirus-american-indian-health-138724?fbclid=IwAR3Xczu1Qt0letv5vg971FjIdKUn1qKR2tKoQjpS7_crplbKI8EfNs_qr2s</a></font>
<h1 class="gmail-reader-title">Exclusive: Emergency coronavirus funds for American Indian health stalled</h1>
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By <span class="gmail-vcard"><a href="https://www.politico.com/staff/adam-cancryn">ADAM CANCRYN</a></span> - 03/20/2020
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<p>“For months, we watched this virus from afar,“ said Cherokee Nation
Principal Chief Chuck Hoskin Jr. “We hope people understand this has now
hit home and is a very real pandemic that can affect anyone of us.”</p>
<p>But a widespread shortage of tests has largely prevented tribes from
monitoring for the virus, which they worry could spread rapidly through
their tight-knit communities. And most American Indians and Alaska
Natives now live in urban areas, where American Indian health
organizations are already running low on medical supplies and funding.</p>
<p>In hard-hit Seattle, for example, one health center anticipates
losing $734,000 a month during the response effort — assuming it doesn't
first run out of supplies and be forced to close. Other frontline urban
American Indian facilities reported receiving fewer than a dozen
coronavirus tests.</p>
<p>The initial $8.3 billion coronavirus response package President
Donald Trump signed into law March 6 allocated $40 million to help
support American Indian care providers. Administration officials have
since touted to tribal leaders the cash infusion as extraordinary for
its inclusion of urban American Indian organizations and indicative of
how serious Washington is approaching the outbreak.</p>
<p>Yet the money remains hung up as officials at IHS and the CDC debate
how to solve an obscure appropriations hurdle. Congress initially
allocated the aid as grants through the CDC, despite warnings from
tribal organizations and some House staffers that it could invite
bureaucratic snafus, two people with knowledge of the process said.</p>
<p>Congressional appropriators say they inserted specific language to
avoid issues and ensure tribes were eligible for the funding. </p>
<p>“We checked with CDC when we were finalizing the language,” said Evan
Hollander, a spokesperson for the House Appropriations Committee. </p>
<p>But the CDC has since told tribal organizations that it can’t
distribute the funds because it doesn’t have the necessary funding
relationship with the IHS hospitals, tribal-run health facilities and
urban American Indian organizations that are supposed to receive it. </p>
<p>Tribal leaders said the CDC has also balked at their idea to set up
an inter-agency transfer that would deliver the money to IHS directly,
questioning whether it has the authority for such a transfer</p>
<p>A CDC spokesperson did not respond to specific questions about the
funding, saying only that the agency is working across the
administration and with tribal organizations to “finalize a plan to
allocate these funds and maximize public health impact and reach to
tribal populations.”</p>
<p>The IHS has also said there's another problem. Even if it received a
direct funding transfer from the CDC, it could not simply hand over the
money to tribes and urban American Indian organizations because the
legislation structured the funds as grants, which requires a more
complex process. </p>
<p>Federal officials haven’t yet offered other alternatives for freeing up the money, and<b> </b>have remained vague about the funding’s status in conversations with tribes.</p>
<p>“Health providers across Indian Country are risking their lives on
the front lines of this crisis,” said Meredith Raimondi, a spokesperson
for the National Council of Urban Indian Health, which supports health
services for American Indians living in urban areas. “We don’t know what
the delay is.”</p>
<p>The delay comes as the Trump administration races to pour resources
into the broader national response, promising a “whole-of-government”
effort aimed at reinforcing frontline hospitals and ramping up
production of ventilators and face masks.</p>
<p>On a conference call last Friday, IHS officials, led by chief medical
officer Michael Toedt, told House and Senate staffers that the agency’s
health system had 625 hospital<b> </b>beds available nationwide,
including just six ICU beds and 10 ventilators, according to three
people with direct knowledge of the discussion. There are another 772
beds available across tribal-run health programs, he said, according to
one person on the call. </p>
<p>Tribes rely heavily on IHS facilities, which provide many health care
services to American Indians and Alaska Natives at no cost under the
federal government’s long-held trust responsibility. Over a quarter of
the tribal population in the U.S. is uninsured, more than double the
national rate.</p>
<p>Toedt days later <a href="https://www.greatfallstribune.com/story/news/2020/03/17/indian-health-service-coronavirus-covid-19-native-american-tribes-montana/5070324002/" target="_blank">reportedly revised</a>
IHS’ capacity figures on a press call for media outlets that cover
Native issues. But IHS also warned at least one Hill office that the
agency doesn’t have accurate information readily available because
reporting is optional for tribal programs, and IHS was still collecting
data from its regional offices, according to a person briefed on the
call.</p>
<p>IHS has since told POLITICO that as of Thursday, the agency had 37
ICU beds and 1,257 hospital beds across both IHS facilities and ones run
by tribal organizations themselves, as well as 81 ventilators.</p>
<p>Pressed further on IHS’ readiness, one IHS official characterized the
agency as a “shoestring operation.” At another point, Toedt downplayed
the threat by telling staffers that “IHS believes this virus will be
slower to reach Indian country,” according to a person on the call. </p>
<p>“It was quite scary, to be very frank,” said the person, who left the discussion shaken.</p>
<p>Another person on the call blamed chronic underfunding of the IHS for
the agency’s dire assessment. “They’re working out of a hole that is so
deep it’s really kind of unfathomable,” that person said.</p>
<p>An IHS spokesperson noted that the agency’s annual budget is less
than one-sixth what tribal leaders estimate is needed to fully fund the
American Indian health system. When asked about Toedt’s comments on the
virus’ spread, the spokesperson emphasized that IHS has “always been
clear that this is a rapidly evolving situation.”</p>
<p>The IHS has also made few promises to organizations running low on
critical protective equipment and medical needs, just as the rest of the
health care industry struggles to stock up ahead of an expected wave of
patients.</p>
<p>Unlike states, American Indian organizations cannot easily draw on
the federal Strategic National Stockpile designed specifically to aid
the response to a public health emergency. Instead, the IHS told tribal
organizations in recent weeks that its National Supply Service Center,
created in 1981 to aid tribal needs, will release two models of
respirators to help bridge the gap. However, it warned, the respirators
are already expired.</p>
<p>IHS confirmed those details, telling POLITICO that the broader health
department is “inundated” with supply requests from all over the
country.</p>
<p>“To address ongoing nationwide shortages IHS has offered, at no cost,
N95 respirators that have exceeded their manufacturer-designated shelf
life, in accordance with CDC guidelines,” the IHS spokesperson said. The
CDC has said expired N95 respirators may offer more protection than
surgical masks.</p>
<p>In a survey published Tuesday by the National Indian Health Board,
just 16 percent of its tribal leaders, providers and partners reported
receiving federal resources of any form to aid the response. Even fewer —
4 percent — had received basic protective equipment.</p>
<p>“We don't know what this really looks like,” Bohlen said of the
virus’ impact on Indian country. “Because we don’t have the tools
necessary — like the rest of America — to figure out what is going on
here.”<br></p></div>
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