By Andrew Westney

Law360 (May 7, 2020, 8:44 PM EDT ) A bipartisan group of more than 50 senators and representatives has urged Senate leaders to furnish specific funding for federal, tribal and urban Indian health programs to help them cover their heavy losses of third-party revenue due to the COVID-19 pandemic.

Sens. Kamala Harris, D-Calif.; Dianne Feinstein, D.-Calif., and Tom Udall, D-N.M., joined Reps. Raul Ruiz, D-Calif.; Markwayne Mullin, R-Okla., and many others in a letter Tuesday to Senate Majority Leader Mitch McConnell, R-Ky., and Minority Leader Chuck Schumer, D-N.Y., saying that vital Indian Health Service, tribal and Urban Indian Health Organization programs are at risk in the pandemic.

Those programs and their facilities serve 2.6 million Native Americans around the country, including in many remote areas, but have seen a steep drop-off in reimbursements from Medicare, Medicaid, the Veterans Health Administration and private insurers because the programs have had to stop offering many services unrelated to COVID-19 in order to focus on the crisis.

"Without funding to address these operations funding shortfalls, Tribal and Urban Indian health care facilities may be in danger of closing, and the health disparities that already exist in Indian Country will become further exacerbated," the lawmakers said. "Failure to secure the necessary funds and resources to provide COVID-19 related care is putting these communities at risk."

Patient visits for routine health care have plunged at health facilities serving Native American communities, and some types of care, such as dental hygiene and physical therapy, have been canceled altogether.

As the lawmakers were putting together their letter last week, an IHS official told Law360 that the agency was seeking additional funding from the U.S. Department of Health and Human Services' $100 billion COVID-19 relief fund, beyond the $400 million allocated for IHS and tribal and urban programs.

In Tuesday's letter, the lawmakers said that funding in the Families First Coronavirus Relief Act, the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act provided support targeted to the Native health programs, but that funding is not expected to be enough.

The funding is especially critical because Native communities already suffer from health disparities that make them more vulnerable to the effects of COVID-19, including asthma, cancer and heart disease, and losing the health programs would worsen those impacts, according to the letter.

The third-party revenues are "integral to the financial stability" of the IHS, tribal and urban Indian health organization system, since congressional appropriations for Indian health routinely fall short of what's needed and the third-party payments make up the balance, the lawmakers said.

Those revenues amounted to over $1.1 billion last year just for IHS facilities, "equaling roughly a fifth of the entire IHS budget for that year," and the proportion can be more than half for tribal programs, according to the letter.

The IHS said in a statement Thursday that it doesn't comment on proposed legislation, but it said the agency is "grateful that Congress, the White House and the Department of Health and Human Services have made American Indian and Alaska Native communities a priority for resources during this public health emergency."

Schumer said in a statement Thursday that "Democrats fought for significantly more than the $10 billion included in the CARES Act to support IHS and tribal governments" and "will fight for even more resources in the next bill to ensure tribes can recover from the economic impact and continue providing essential COVID-19 related care."

McConnell did not immediately respond to requests for comment Thursday.

—Additional reporting by Emma Whitford. Editing by Peter Rozovsky.

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