Senate Advances Padilla Amendment to Improve Urban Indian Health Infrastructure

Fix included in bipartisan infrastructure package will allow UIOs to spend appropriated funding on construction and infrastructure projects

Watch: Sen. Padilla delivers remarks in support of the urban Indian health infrastructure amendment

WASHINGTON, D.C. – Today, the U.S. Senate voted to amend the bipartisan infrastructure legislation to include U.S. Senators Alex Padilla (D-Calif.) and James Lankford’s (R-Okla.) Urban Indian Health Providers Facilities Improvement Act to pave the way for increased investment in the renovation and construction of urban Indian health facilities. U.S. Senators Dianne Feinstein (D-Calif.), Tina Smith (D-Minn.), Jerry Moran (R-Kan.), Mike Rounds (R-S.D.), and Brian Schatz (D-Hawai‘i) are cosponsors of the amendment.

The Indian Health System is made up of the Indian Health Service (IHS), Tribal health programs, and urban Indian organizations (UIOs). UIOs provide culturally competent care for the over 70 percent of American Indians and Alaska Natives who live in urban centers, many in low-income, medically underserved areas.

86 percent of UIOs report needing to make facilities and infrastructure upgrades, while 74 percent of UIOs report unmet need for new construction to better serve patients. However, under an existing obsolete provision of law, UIOs are prevented from using the money allocated to them by Congress on these critical infrastructure projects. This amendment changes the law to allow UIOs to spend appropriated funding on construction and renovation projects to improve the safety and quality of care provided to urban Indian patients. These needs include, but are not limited to the construction of urgent care facilities and infectious disease areas, capacity expansion projects, ventilation system improvements, and upgrades to telehealth and electronic health records systems.

“Tribal communities face grave and unjust disparities in access to many kinds of infrastructure, but the disparities in access to health care and health infrastructure are especially stark,” said Senator Padilla. “In California, Urban Indian Organizations are a lifeline to Native Americans living in urban areas, yet they are prohibited from using Indian Health Service funding for facilities, maintenance, equipment, and other necessary infrastructure upgrades. I’m glad to see the Senate take action on my bipartisan amendment today to remove this unjust burden on UIOs as part of the infrastructure package, because no infrastructure package would be complete without robust improvements to tribal infrastructure. Passage of this amendment will ensure that UIOs are able to improve the quality of the culturally competent care that they provide to urban Indians.”

“Oklahoma has the second-largest Urban Indian patient population and is proudly served in both Tulsa and Oklahoma City clinics. 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,” said Senator Lankford.

The Urban Indian Health Providers Facilities Improvement Act will have a critical impact on California, which has one of the largest populations of American Indians in the United States and is home to 723,225 American Indians of sole and mixed race. Unlike American Indian populations in other states, American Indians in California are not linked by a dominant tribal affiliation, nor are they concentrated on reservations. In fact, nearly 90 percent  of the American Indian population in California resides in urban areas. Additionally, between 60,000 and 70,000 out-of-state Native Americans settled in Los Angeles and San Francisco – these cities have two of the largest urban Native American populations in the United States.

“The impacts of COVID-19 will be with our Native communities for a long time to come. It is critical that the Indian Health Care Center of Santa Clara Valley and other UIOs be able to provide a safe environment for the families and patients we serve. We are extremely grateful for Senator Padilla’s leadership in rectifying a longstanding barrier preventing us from using existing funding to make urgent upgrades,” said Sonya Tetnowski (Makah), CEO of Indian Health Care Center of Center Clara Valley, President of California Consortium for Urban Indian Health (CCUIH), and President-elect of National Council for Urban Indian Health (NCUIH).

“It is time to live out this Country’s commitment to each other to live with respect for one another and in community. With this legislation Friendship House in San Francisco will build a home village site for our urban Native Americans, so that our people may contribute to saving and enriching our homeland, which we must now all share and care for or lose. We greatly appreciate Senator Padilla’s leadership on this issue,” said Abby Abinanti (Yurok), President of the Friendship House Association of American Indians Board of Directors. 

“As with the implementation of racist legislations that resulted in generations of cultural displacement of American Indians, this new legislations will be an impetus for urban American Indians to establish a sacred space and place that will restore self-sufficiency, and a critical step towards transitional and social justice that honors and supports the basic principle of Indigenous Sovereignty. We commend Senator Padilla for his leadership on this issue,” said Nelson Jim (Navajo), Acting Chief Executive Officer, the Friendship House Association of American Indians.

A one-page factsheet on the amendment can be found here.

Text of the amendment can be found here.

Read the full text of Padilla’s remarks ahead of the amendment’s passage here:

Mme President, thank you for the opportunity to speak on this important bipartisan amendment, and I want to thank Senators Lankford, Moran, Rounds, Schatz, Feinstein, and Smith for joining me in this effort.

Tribal communities face grave and unjust disparities in access to all kinds of infrastructure, but the disparities in access to health care and health infrastructure are increasingly stark. 

This amendment is very simple: it’s a commonsense, technical fix that would allow Urban Indian Organizations to use the Indian Health Service funds they already receive for infrastructure and facilities improvements. 

Let me be clear, this amendment would not give Urban Indian Organizations more funding or take away funding from anyone else.  It would simply give them additional flexibility to use the funding they already receive for necessary infrastructure improvements.

Urban Indian Organizations provide culturally competent care for the over 70 percent of American Indians and Alaska Natives who live in urban centers. Many of those served live in low-income, medically underserved areas.

According to recent congressional testimony from the Indian Health Service, “expanding the current authority to be consistent with the authority for other government contractors…would allow [Urban Indian Organizations] to make renovations, construction, or expansion of facilities necessary to improve the safety and quality of care provided to Urban Indian patients.”

The Deputy Director of the Indian Health Service went on to state, “Providing UIOs with broader authority…to improve their health care facilities will assist in providing the high quality, safe, and culturally relevant health care for the Urban Indian population.”

This amendment is particularly relevant in the midst of the COVID-19 pandemic when ventilation, social distancing, and other infrastructure upgrades are desperately needed.

This is an easy, no-cost, bipartisan way to help ensure this package bolsters infrastructure in Indian Country, because no infrastructure package would be complete without robust improvements to tribal infrastructure. 

It has the support of the Chairman and Ranking Member of the Indian Affairs Committee, which just held a hearing on this issue last month, and I urge my colleagues to support it.

Thank you, MMe President.  I yield the floor.

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