Native health advocates have been pressing for years for a permanent reauthorization of the Special Diabetes Program for Indians (SDPI), but the federal government says tribes and Indians will have to settle for another one-year extension.
SDPI was created in 1997 by Congress, and it has been administered by the Indian Health Service (IHS) since that time. The program has been funded at $150 million per year since 2002, and it provides diabetes program support grants to nearly all federally recognized tribes, according to IHS officials.
Congress members in various hearings and in communications with tribes have widely agreed that the program is useful because it addresses the well-known diabetes epidemic still facing Indian country.
On March 31, Congress once again stood behind the program, with the Senate passing a one-year $150 million renewal of SDPI that had already cleared the House. President Barack Obama is expected to soon sign the legislation into law.
But Indian health advocates had been asking for permanent reauthorization, so that they would not have to spend time and resources each year asking for Congress’ support for a program that most everyone agrees is working in combatting diabetes in Indian country. They have said, too, that permanent reauthorization would ensure that tribal SDPI programs could offer uninterrupted care to tribal citizens.
Tribal health officials have additionally been making the case that $150 million per year is no longer enough to fund the program. “While we understand an increase in funds during this budgetary environment is difficult, SDPI has been level-funded since 2002,” according to testimony offered March 26 by the National Indian Health Board (NIHB) to the Senate Committee on Indian Affairs. “Calculating for inflation, $150 million in 2002 would be about $115 million in 2014—or 23 percent less…. When taking into account additional tribes that have gained federal recognition since 2002, the dollars are even scarcer.”
Officials with the National Council of Urban Indian Health noted in December that the Senate Finance Committee was initially considering a reauthorization of the program this time around that would have funded it through fiscal year 2019, yet that goal ultimately could not pass muster with a majority.
While the tribal requests fell on deaf ears, Indian health officials remain committed to the long-term goal of permanent reauthorization at higher funding levels, especially because Congress in the past has been willing to reauthorize the program in five-year increments.
“As happy as we are today, we will continue fighting for long-term renewal tomorrow,” said Cathy Abramson, chair of the NIHB, in a March 31 statement. “We will continue fighting for the long-term renewal of this program so that improved prevention and treatment, hiring more health care professionals and health educators in Indian country continues to grow.”
The Obama administration is partially on board, desiring longer funding intervals, but still at level funding levels. In its fiscal year 2015 budget request to Congress, the administration asked for the program to be renewed at $150 million for three years.
According to statistics highlighted by the NIHB to Congress, SDPI has been working strongly, particularly as evidenced by declining incident rates of diabetes-related kidney disease. “Between 1999-2006, the incident rate of end-stage renal disease (ESRD) due to diabetes in American Indians and Alaska Natives fell by 28 percent—a greater decline than for any other racial or ethnic group,” according to a recent NIHB press release. “This reduction in new cases of ESRD translates into almost $90,000 per patient per year in cost savings for Medicare, the Indian Health Service and third-party payers.”
The IHS concurs that there have been quantifiable gains in preventing and treating Native diabetics since the program began.