Letter to Senators Alexander and Murray in re SDPI

June 12, 2017

The Honorable Lamar Alexander
Senate Committee on Health, Education,Labor and Pensions
428 Dirksen Senate Office Building
Washington, DC 20510

The Honorable Patty Murray
Ranking Member
Senate Committee on Health, Education,Labor and Pensions
428 Dirksen Senate Office Building
Washington, DC 20510

Dear Chairman Alexander and Ranking Member Murray:

On behalf of the National Council of Urban Indian Health (NCUIH), which represents over forty urban Indian health care programs (UIHPs) across the nation which provide high-quality, culturally-competent care to urban Indians, who constitute more than 70% of the nation’s American Indian/Alaska Native (AI/AN) people, I urge the Health, Education, Workforce, and Pensions (HELP) Committee to expeditiously mark up and promote passage of legislation to reauthorize the Special Diabetes Program for Indians (SDPI)--particularly S. 747, a bill introduced by Senator Tom Udall (D-NM), which would extend the program for 7 years through 2024, at no increase in cost other than taking into account health care inflation.

“Urban Indian” refers to AI/AN people who do not live on reservations, often because of forced government relocation or lack of economic opportunity.
NCUIH was established to represent the interests of UIHPs before the legislative and executive branches and it serves as a resource for UIHPs, providing education and training, as well as a resource to stakeholders working to improve the health care of American Indians and Alaska Natives.
As the committee of jurisdiction over S. 747, I want you to know that it is imperative SDPI be reauthorized before its expiration on September 30. Grants to health care providers in Indian Country made pursuant to SDPI have been instrumental in the marked reduction in the incidence rate of diabetes—and the related savings to Medicare, the Indian Health Service (IHS), and third party providers. The failure to reauthorize this program would severely undermine the promising progress UIHPs have made against diabetes.

Quite simply, SDPI must be reauthorized if Indian Country is to continue to educate against, treat, and prevent the terrible scourge that is diabetes.

The statistics of the toll inflicted by diabetes on Indian Country are extraordinarily grim. AI/AN adults are 2.3 times more likely to have diabetes compared with non-Hispanic whites and the death rate due to diabetes for AI/AN people is 1.6 times higher than the general U.S. population. And the costs in dollars are also extraordinary—in 2012 alone 11% of AI/AN with diabetes accounted for 37% of all IHS adult treatment costs.

However, SDPI, which saves money in the long run, has achieved outstanding results. SDPI supports over 330 diabetes treatment and prevention programs in 35 states, which have led to significant advances in diabetes education, prevention, and treatment. In 2000-2011, the incidence rate of End-Stage Renal Disease (ESRD) in AI/AN people with diabetes declined by 43%--a greater decline than any other racial or ethnic group. ESRD is the largest cost-driver of Medicare costs. Reduction in the incidence rate translates into significant cost savings for Medicare, third party payers, as well as IHS.

I attach a copy of NCUIH’s recent testimony to the Senate Committee on Indian Affairs in support of SDPI, which discusses the various innovative and meaningful ways in which UIHPs have used program grants to fight diabetes. I would be delighted to speak with you about the importance of SDPI to Indian Country. Thank you for your consideration of S. 747, which would extend SDPI for seven years and allow this important program to take into account health care inflation.


Ashley Tuomi President
National Council of Urban Indian Health