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Senate Passes Indian Health Care Bill

Image has not been found. URL: /wp-content/uploads/2008/09/dorgan1.jpgSen. Byron Dorgan (WDCpix)

Capitol Hill is a long way from Indian country, but this week tribal leaders and health care advocates took a big stride toward receiving the boost in health funding that Congress last approved 16 years ago.

Congress_4425.jpg
Congress_4425.jpg

Illustration by: Matt Mahurin

By a tally of 83 to 10, the Senate voted Tuesday to approve the Indian Health Care Improvement Act (IHCIA), which would authorize roughly $35 billion for native health services over the next 10 years — a jump, on average, of $170 million annually. The vote follows months of haggling between congressional leaders and the White House, which threatened to veto the bipartisan bill as recently as Jan. 22. Subsequent changes address the administration’s concerns, congressional sources say.

Supporters of the proposal maintain it is long overdue.

“I have traveled around our country and seen the appalling conditions in many Indian health care facilities,” Sen. Byron Dorgan (D-N.D.), chief sponsor of the proposal, said in a statement. “People are literally dying because we have not acted.”

Dorgan is not off the mark. American Indians and Alaskan Natives live sicker and die younger than any other domestic ethnicity. Relative to the rest of the population, Native Americans are about seven times more likely to die from alcoholism, six times more likely to die from tuberculosis and three times more likely to die from diabetes, according to statistics compiled by the administration’s Indian Health Service. Roughly 10 native infants die per every 1,000 live births, IHS says, as compared to 7 per 1,000 for all other domestic populations. Native Americans also die from injuries, homicides and suicides at far higher rates than other Americans, IHS data reveal.

While some of those discrepancies can be attributed to individual behaviors and lifestyle choices, much of the trouble stems from a simple lack of access to services. The dark, perennial joke around reservations is that residents cannot get sick after June, for the health center will lack the funds to provide treatment.

“Many IHS facilities in native communities are so cash-strapped that they’re forced to turn away thousands of severely ill patients every year,” Sen. Max Baucus (D-Mont.) said in a statement following Tuesday’s vote. “This bill is the lifeline that those folks so desperately need.”

Stacy Bohlen, executive director of the National Indian Health Board, said that without the additional funding, Indian communities will “see what we’ve been seeing for years: health disparities that rival third-world countries. That will continue. And it’s not OK.”

First passed in 1976, IHCIA was last renewed in 1992, and its authority expired a decade later. Each year since, Congress has appropriated funds for Indian health services — now roughly $3.3 billion annually — but advocates and a number of lawmakers contend the allocation is woefully insufficient. For roughly 1.9 million Native Americans, IHCIA is the primary source of medical care.

Dorgan, who chairs the Senate Indian Affairs Committee, has been known to drag charts to the chamber floor revealing that, per capita, the federal government spends significantly more each year on Medicare patients ($6,784), veterans ($4,653) and federal prisoners (roughly $3,200) than it does on Native Americans ($2,130).

Among other changes, Dorgan’s bill would expand screenings for cancer, diabetes and infectious diseases among Native Americans; expand recruitment and scholarship programs designed to entice medical professionals to serve in native communities; create programs to target domestic violence and sexual abuse on reservations; address the estimated $1 billion backlog in Indian health facilities, including alcohol treatment centers; and put another $1 billion toward needed sanitation facilities.

The Senate bill also contains a provision — championed by Sens. Norm Coleman (R-Minn.), Amy Klobuchar (D-Minn.), and Barbara Mikulski (D-Md.) — that would delay for a year a controversial White House plan to trim Medicaid coverage for certain social and educational services. Things like foster care, child welfare and some elderly care, the administration argues, are not health related and therefore should not be covered by Medicaid. Coleman on Tuesday issued a statement claiming the change, which is set to take effect March 3, would lead to $61 million in annual cuts to Minnesota’s child welfare services alone. The Senate bill now heads to the House, where leaders will have to scurry to beat the March 3 deadline.

Perhaps recognizing that time is tight, Coleman urged the Centers for Medicare and Medicaid Services to scrap the regulation before it takes hold. “The overwhelming support for this amendment should have sent a clear message to CMS,” he said, “that the Senate will not put up with these slash and burn tactics on the backs of our most vulnerable citizens.”

Meanwhile, Indian health advocates are confident the IHCIA reauthorization will finally become law this year. That’s different, though, than finding an explanation as to why a concept with such broad bipartisan support took so many years to gain momentum in Congress. Bohlen, of the National Indian Health Board, had one theory: “In America, if you’re silent, you’re invisible,” she said. “And we just decided not to be silent.”

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