Cheryl Crazy Bull, President and CEO of the American Indian College Fund
During the confirmation hearing for Indian Health Service Director nominee Mark Cruz (Klamath) last week, he stressed the role tribal colleges and universities (TCUs) play as key partners in building the health workforce Indian Country needs.
Most TCUs serve rural Indian reservation areas—the same areas where Native Americans experience the greatest health divide—where tribal nations are served by the Indian Health Service (the IHS), the federal agency responsible for providing health care to American Indians and Alaska Natives (AIAN). Established in 1955 operating within the Department of Health and Human Services, the agency was created to fulfill the federal government’s trust and treaty obligations to Native nations by delivering health care services to eligible tribal citizens.
Even as IHS serves approximately 2.8 million AIAN people from 575 federally recognized tribes across 37 states through a nationwide network of hospitals, clinics, health centers, and community health programs that provide primary care, behavioral health services, dental care, emergency treatment, and preventive health programs, many parts of Indian Country are underserved. Underfunding and limited availability of skilled health care workers in the regions it serves have created IHS staff vacancy rates hovering around 30%. Facilities are also limited, with IHS hospitals serving reservation communities providing limited beds and other medical services. In addition, per-patient spending by the IHS is significantly lower than that of Medicare, Medicaid, or the Federal Bureau of Prisons.
A two-pronged approach is needed to solve these challenges.
First, Congress must honor its treaty obligations to fund the TCUs. Located in Native communities, these higher education institutions offer students access to an affordable college education in their home communities—and grow skilled, knowledgeable future workers to serve them. TCUs hold the key to developing the future health care workforce needed in Indian Country.
For example, 14 out of 35 AIHEC member TCUs currently offer nursing degrees—ranging from associates to bachelor’s degrees in nursing—within IHS regions identified as high need areas for nursing professionals. Other programs such as dental assisting programs, mental health professional programs, and more, are offered at TCUs.
Second, Congress must remedy the funding challenges that historically plagued IHS and led to severe disparities in health care and health outcomes of Native people. Native Americans have experienced and continue to experience the lowest life expectancy of any U.S. demographic. TCUs can provide skilled workers. However, without a federal investment in IHS to modernize facilities, expand specialty care, address workforce shortages, and improve health outcomes in Native communities where IHS facilities are the primary source of health care, the problem will continue.
The American Indian College Fund joins the American Indian Higher Education Consortium (AIHEC) and TCU leaders in their desire to work with the current Administration and Congress to provide viable solutions to improve the health of Native people in Indian Country. Expanding the health care profession pipelines at TCUs and improving access to modern facilities and expanded health care contributes to the health equity desperately needed among tribal people. To make this vision a reality, Congress must fully fund TCUs, AIHEC-led workforce initiatives, and IHS to close funding gaps to ensure that all Native people have access to the health care they have been promised by treaty and that they deserve.
