A friend of mine attended six funerals this past year in Indian country. One funeral was for his daughter who committed suicide last month. The others were for friends and family who succumbed to alcohol-related deaths or suicides.

Native Americans have historically experienced some of the worst health outcomes and access to care of all racial and ethnic populations in the United States. The uninsured rate for non-elderly Native Americans is the second highest of any racial or ethnic group in the United States at 28 percent.

In one New Mexico tribal community this year alone, there were more than 69 suicide attempts.

For the providers of behavioral health services in New Mexico’s tribal communities – both on the reservation and off – the current revenue crisis has exacerbated an already under-funded system of care.

Medicaid is supposed to add some $70 million in funding for IHS tribal programs and another $200 million for off-reservation providers who serve Native Americans. But the New Mexico Human Services Department is cutting those Medicaid dollars – and the needed services.

This month, HSD will be conducting “Medicaid cost containment” input meetings throughout the state and have already issued a concept paper that will revamp Medicaid services, cut non-mandatory services like residential treatment centers for adults, cardiac rehabilitation, school-based services, treatment foster care, and renal dialysis, among others.

Since many of New Mexico’s Native Americans have higher incidences of chronic illnesses that require off-reservation (urban) care at New Mexico’s hospitals, clinics, and with other providers, the proposed Medicaid cuts will impact the ability of these facilities to provide care. They may have to lay off health care workers while increasing workloads, all of which would delay New Mexico’s emergence out of the most severe recession since the Great Depression.

For New Mexico’s Native Americans, the Medicaid cuts for services would severely impact their health systems – and mortality rates.

The mortality rates are already staggering. Native Americans have the highest rates of death related to alcohol, diabetes, motor vehicle incidents, suicide, pneumonia and influenza than any other ethnic group in New Mexico. The care that is needed to address many of these health conditions is often found in health systems in Albuquerque, Gallup, Santa Fe, and other “off-reservation” communities, because the Indian health care system does not have adequate funding for critical care services.

While Congress contemplates health care overhaul for the country, there have been few if any improvements for recipients of IHS systems, which continue to be poorly funded. Indian Health Services and tribal programs are so underfunded that they base their care on a “hierarchy of need,” and sometimes that means waiting years for a procedure, like a friend I’ll call Ruthie. She had to carry a “bag” for more than two years while waiting for kidney stone removal. She is just one example of the gaps in health care for the very poor.

The Obama administration supports Medicaid enrollment in tribal communities, but that support may not matter if the state of New Mexico is still moving forward to reduce enrollment rates.

New Mexico cannot afford to consider cuts to Medicaid services for its rural poor. For every state dollar cut, we lose four federal dollars.

Not only that, but emergency care for the uninsured and those with chronic illnesses who access off-reservation providers will generate higher premiums for those who have health insurance. This will also put an extra strain on county indigent funds, which are already stressed.

I propose we raise more revenue.

Other states have worked thoughtfully and strategically to raise revenue to meet the Medicaid match. I believe options like increasing taxes on tobacco and alcohol, closing corporate loopholes (as most other Western states have), adding a surtax on upper-income brackets, and rolling back the 2003 personal income tax cuts are the solutions we need.

We need to consider our “First Americans” and close the health care gap for the very needy all over the state. We should not ask the poor to pay – quite literally – with their lives.

For a schedule of HSD’s public meetings on Medicaid, visit the Web site.

Regina Begay-Roanhorse is a member of the Diné nation and lives in To’Hajiilee, N.M. She is a volunteer advocate for the Total Community Approach: Local Collaborative 15. To learn more, visit www.dinelc.org.