The average age of health care facilities run by the Indian Health Service is more than 37 years. The agency's construction program has a need for an estimated $22 billion, an agency official told lawmakers.
Leaders from American Indian tribes pressed federal agencies to make good on billions of dollars in deferred maintenance in federal facilities in Native American communities at a House hearing on June 17.
The Bureau of Indian Affairs, Bureau of Indian Education and the Indian Health Service operate or fund over 1,800 federal facilities, ranging from fire stations to hospitals and schools, said the chairwoman of the Subcommittee for Indigenous Peoples of the United States, Teresa Leger Fernández (D-N.M.).
Many are in need of infrastructure updates.
"We rely on certain federal facilities to provide services to our tribal citizens, including schools and health facilities," said Ned Norris, Jr., chairman of the Tohono O'odham Nation. "Like other tribes, our federal facilities are in very poor condition, and funding to replace or rebuild them is perpetually inadequate."
The discussion comes as lawmakers and the Biden administration are negotiating an infrastructure bill. Biden's proposal for the American Jobs Plan included investments in broadband, clean drinking water and transportation in Indian Country. During the first week of the Biden administration, the president issued a memorandum to agencies on his intent to enforce an executive order from 2000 requiring consultation and coordination with Indian tribal governments.
Lawmakers asked how the fiscal year 2022 budget could address longstanding problems with federal infrastructure on tribal lands.
The FY 2022 budget request for the Indian Health Service includes a $583 million funding increase for IHS facilities programs and an overall 36% increase in discretionary budget authority over FY 2021, said Randy Grinnel, the deputy director for management operations at IHS.
But the total need for its Health Care Facilities Construction Program is about $14.5 billion as of 2016, he said. The department's early drafts to update that estimate show it might now be as high as $22 billion.
The buildings themselves show the effects of underfunding -- the average age of IHS facilities is over 37 years, as compared to an average of nine or 10 in the private sector, Grinnel said.
This also impacts operations.
"Out-of-date facilities and equipment also create challenges for retaining and recruiting high quality health care professionals," he said. "Lack of sufficient resources to address ongoing facility and operation needs also compromise health care."
Many schools are also in need of updates.
The FY 2022 budget request for the Bureau of Indian Education includes $264.3 million in annual funding for construction, said Jason Freihage, the deputy assistant secretary for management in the Office of the Assistant Secretary for Indian Affairs.
The agency is also receiving some mandatory funds from the Great American Outdoors Act, which can be used for priority deferred maintenance projects.
But the current deferred maintenance backlog for education facilities is $823.3 million. Education quarters, a separate category, has its own $102.1 million deferred maintenance backlog.
Of the 86 schools classified by the agency as "poor," 73 currently don't have funding for major replacement or repair, said Freihage.
Several lawmakers, including Fernandez, House Natural Resources chair Raúl Grijalva (D-Ariz.) and subcommittee ranking member Don Young (R-Alaska), signaled their intent to work on these problems.
Truly fixing them will require commitment, said David Hill, principal chief of the Muscogee Nation.
"Repairing the damage done to the tribal capacity by decades of a broken system will not be solved in one budget cycle or one infrastructure bill. We can and must address short-term pressing needs, which are not necessary, but are essential," he told lawmakers. "We are making substantial investment, but we need the federal government to live up to its part of the bargain."
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