Health Impact Assessment: Indian Health Services Budget and Urban Indian Budgeting Decisions – Examining the Health Effects of IHS Underfunding on the Santa Fe Urban Indian Community

Graphic by Taslim van Hattum

From 1998‐2010, the Indian Health Service (IHS) was forced to operate on its 1998 budget, during a time when healthcare spending per capita more than doubled. This under funding forced the IHS to make serious cuts to available services at facilities throughout the country. The Indian Health Care Improvement Act was permanently enacted into law with the passage of the Affordable Care Act, and currently an annual budget is submitted with projected costs based on consultation with tribal leaders and key stakeholders ( The existing budget allocates funding for only 54,000 urban American Indians residing in 57 sites nationwide, providing basic healthcare services for only 1.3% of the urban American Indian population. Approximately 78% of American Indians do not live on their home reservations, making the estimated budget for urban IHS facilities at far below need. Although the Affordable Care Act mandates health insurance coverage for all Americans, enforced by penalty, 26.5% of Urban American Indians are without health insurance, compared to only 17.6 of the general US population. Very little data exist that describes the impact of IHS under funding on the urban American Indian population, locally or nationally.

This HIA will examine the impact of underfunding of the Santa Fe Indian Health Service Hospital on the Santa Fe Urban Indian community. At this time, there is very little documentation of the health effects from the under funding and defunding of IHS facilities on urban American Indian communities. This HIA will provide important information on the health effects of the budgetary decisions made by the federal government on IHS, and this information can be used to inform future budgetary proposals. Specifically, this research will quantify the extent to which Santa Fe’s Urban American Indian community is impacted by chronic illness and other conditions that require specialty care not eligible for contract health payment, and provide a summary of the health needs not being met by the IHS clinic at the time of the HIA.

Contact Info

Santa Fe Indian Center

Emily A Haozous, PhD, RN, FAAN
Associate Professor
Phd Program Director
Regent’s Professor
UNM College of Nursing
UNM College of Nursing

(Graphic by Taslim van Hattum)