February 05, 2018

In Letter to House & Senate Leadership, Udall Urges Reauthorization of the Special Diabetes Program for Indians

WASHINGTON – Today, U.S. Senator Tom Udall, vice chairman of the Senate Committee on Indian Affairs, wrote to House and Senate leaders in both parties, urging them to reauthorize the Special Diabetes Program for Indians (SDPI) along with other vital health care programs, which provide treatment and services for millions of Americans, but will soon run out of funding.

“As Congress works to provide security to communities that rely on critical federal health programs, including community health centers, the Maternal Infant and Early Childhood Visitation Program (MIECHV), and Medicare extenders, I respectfully remind you that over 300 Native American communities depend on the Special Diabetes Program for Indians (SDPI), which is set to expire in March,” wrote Udall.

SDPI provides grants for diabetes prevention and management programs throughout Indian Country, but these activities could soon cease thanks to the deadlock in Congress over the budget. Funding for SDPI has been in jeopardy since September, when authorization for the program expired. Congress has kept SDPI running through passage of two short-term reauthorizations, but SDPI grantees report that the continued uncertainty surrounding the program has led to increased turnover of staff and worry among Native American diabetics dependent on the program.

This weekend, Udall convened a roundtable conversation in Albuquerque, N.M., to hear from Tribal and other health care providers about the urgent need to fully fund SDPI. In his letter today, he highlighted the success of SDPI but went on to note that the lack of certainty surrounding funding for the program limits its overall potential. He urged congressional leadership to consider a longer authorization and provide additional funding for SDPI to keep up with rising health care costs. “It is crucial that the Program receive a longer reauthorization and more funding so that the progress seen in Indian Country is not lost due to a funding lapse,” Udall wrote.

Congress created SDPI to address the growing rate of diabetes among American Indian and Alaska Natives (AIAN), who have the highest incidence of diabetes among all U.S. racial and ethnic groups. Since its authorization in 1997, SDPI has resulted in a 40 percent increase in the number of diabetes clinics in Native communities, and the Centers for Disease Control and Prevention have observed a 54 percent decrease in diabetes-related kidney failure in AIANs.

Text of the letter is available here and below.

Dear Senator McConnell, Senator Schumer, Speaker Ryan, and Representative Pelosi:

As Congress works to provide security to communities that rely on critical federal health programs, including community health centers, the Maternal Infant and Early Childhood Visitation Program (MIECHV), and Medicare extenders, I respectfully remind you that over 300 Native American communities depend on the Special Diabetes Program for Indians (SDPI), which is set to expire in March. I ask that you work expeditiously to reauthorize SDPI along with the other important pending health extenders as soon as possible in the next legislation to be signed into law.

American Indians and Alaska Natives (AIANs) are disproportionately impacted by diabetes. Nearly 30 percent of AIANs are pre-diabetic and 16 percent are diabetic – the highest rate of diabetes prevalence of all U.S. racial and ethnic groups. AIANs are also more likely to experience negative complications related to diabetes – Native diabetics are 1.9 times more likely to suffer from kidney failure and 1.6 times more likely to die from the disease.

Twenty years ago, Congress took action to address diabetes in Indian Country by authorizing the SDPI to provide grants through the Indian Health Service (IHS) to Indian tribes and tribal organizations for diabetes prevention and treatment. The Program has received strong bipartisan support throughout its existence, as most recently evidenced by its bipartisan reauthorization in April 2015, a September 2016 letter of support signed by 75 Senators, and an October 2016 letter of support signed by over 356 members of the House of Representatives.

These demonstrations of bipartisan support for the SDPI by Congress are due in large part to the unquestionable success of the Program. At a Senate Committee on Indian Affairs hearing on the Program held in March 2017, SDPI stakeholders and diabetes experts presented strong evidence – both anecdotal and quantitative – that shows the SDPI substantially improves diabetes care and prevention in Native communities while lowering the costly strain on IHS facilities to treat unchecked diabetes-related complications.

A lack of certainty surrounding program funding, however, tempers the SDPI’s success. After its initial five-year authorization, Congress relegated the Program and its grantees to fight for ten short-term reauthorizations ranging from a few months to a maximum of two-years. Grantees report that this stop-and-start approach to funding prevents them from taking on long-term, higher-yield interventions and activities. The SDPI is further constrained by Congress’s flat funding of the Program since 2004. Longer reauthorization and increased funding of at least $50 million per year are thus necessary to ensure programmatic stability and allow the SPDI to meet the remaining level of need in Indian Country.

The SDPI remains an essential public health tool used by Native communities. I thank you for your commitment to its continued success through inclusion of the Program in the September 2017 and December 2017 Continuing Resolutions, but it is crucial that the Program receive a longer reauthorization and more funding so that the progress seen in Indian Country is not lost due to a funding lapse. As we all work to reauthorize other critical federal community health programs, I look forward to working with you to reach a bipartisan agreement to secure the future of this important Program.

Sincerely,