In Utah, Dexter Pearce, deputy director of Community Health Centers Inc., said he wasn't sure about the current proposal, but a federal funding increase of $1 million over the past five years all went to rural areas.

Community Health Centers has a $200,000 contract to provide primary care for the Indian Walk-in Center.

"If there's not a dollar-for-dollar exchange, we would have to make that up somehow," he said. "Someone would go without services."

Ned said she's optimistic that Congress won't let the budget cut stand. However, if the center were to lose its $1.1 million in federal contracts, it would also lose grant funding, effectively cutting 90 percent of the center's $1.5 million budget, she said.

The Indian Walk-in Center's free health and behavioral health services include diabetes education, immunizations, substance abuse treatment, mental health counseling, holistic care, HIV testing and counseling, and youth programs. It also operates a United Way-funded food pantry, which handed out some 5,200 boxes of food to both Indians and non-Indians last year.

Ned questioned whether many of the area's American Indians would use other community health facilities, since they tend to seek health care only when they are in crisis. They then contribute to crowded emergency rooms. As American Indians, they would still qualify for care at tribal health facilities on reservations, but for most who live in the cities, such a lengthy trip might not be realistic, she said.

Nationally, some 60 percent of American Indians and Alaska natives live in urban areas, according to the Census Bureau. And for years — decades in some cities — they have been receiving health care at clinics in or near the cities where they live. Providing health care to all Indians is part of the government's trust responsibility.

Sen. John McCain, R-Ariz., noted during a Senate Indian Affairs Committee hearing last month that even though the proposed cuts could be restored, "I think some of these cuts . . . clearly send out the wrong signal to Indian Country as to what our belief and our fulfillment of our obligation to Native Americans is all about."

Sen. Bob Bennett, R-Utah, who sits on the Senate Appropriations Committee, did not respond to interview requests.

Forrest Cuch, director of the Utah Division of Indian Affairs, said eliminating the urban health clinics would violate treaty agreements.

"We can't even provide adequate health care to our elderly . . . , much less to the indigenous people who originated here," Cuch said. "Our government has reduced them to their present status, which is very deplorable health conditions. If they're not going to honor the treaty, they should give the land back to the Indians."