WASHINGTON -- American Indians are facing a breakdown in their internal healthcare systems as federal funds remain scarce

Contract Health Services, a federal insurance program for American Indians, will need an additional $333 million next year to meet future needs and past debts, according to the Northwest Indian Health Board, a non-profit tribal advisory organization. The health services program was designed to fill in the gaps left by scant medical services on reservations by paying for private doctors and hospitals.

The numbers don’t even include the debts and needs of smaller tribes, many of whom stopped tracking services because it was too expensive to keep records.

Proposed cuts in funding mean that many serious procedures including chemotherapy and organ transplants are often no longer covered under the plan. It also means that even the services that are still covered aren’t being paid for.

The Senate Committee on Indian Affairs heard testimony Thursday about the impact of shortfalls in an effort to push for action in the U.S. House, according to Sen. Byron Dorgan, D-N.D. The Indian Healthcare Improvement Act was passed by the Senate in February, but is still waiting for committee approval in the House.

Marlene Krein President of Mercy Hospital in Devils Lake, N.D., has seen the unpaid debts rise at her hospital over the past two decades.

“When I took over (in 1984) Indian Health Services owed $170,000 and everyone asked ‘how long can this go on?’ But I said we will do what it takes. We will have a bake sale if we have to,” said Krein, “Now, they owe us millions. At this point there are no more bake sales.”

The cuts in care also put an economic burden on an Indian community with one-third of the people living at or below the poverty line. Many American Indians with untreated injuries are unable to work or go to school.

Tracie Revis, a member of the Creek Nation, was a law student in Kansas when a doctor discovered a cancerous tumor in her chest and removed it immediately. She dropped out of law school with only three weeks until graduation to start chemotherapy treatments.

After Contract Health Services denied her claim she was saddled with over $200,000 in debt—not including student loans.

“There are many more atrocities and I am just one,”said Revis, “You start to feel like a second class citizen.

Revis finished chemotherapy in 2007 and returned to school, but had to start over as a first year student. She just finished her first year at the University of Kansas Law School in May.

“I am still hopeful,” Revis said, “There is no way that this can continue. People have got to move on this--the situation is too desperate.”