American Indians set to gain in healthcare reform

American Indians

Last month saw the leaders of 564 American Indian tribes being invited to Washington to talk with President Obama and cabinet members, in what Congress called, "the largest and most widely attended gathering of tribal leaders in our history." They were their to discuss their need for better healthcare.

"Native Americans die of illnesses like tuberculosis, alcoholism, diabetes, pneumonia and influenza at far higher rates. We're going to have to do more to address disparities inhealthcare delivery," Obama said, The New York Times reported.

The healthcare overhaul now being debated in Congress appears ready to bring the most significant improvements to the Indian health system in decades. After months of negotiations, provisions under consideration could, over time, direct money to the Indian healthcare system and give Indians more treatment options.

Proposals

Some proposals, like exempting Indians from penalties for not obtaining insurance, may meet resistance from lawmakers opposed to expanding benefits, many of whom receive free medical care.

But advocates say the changes recognize Indians' unique status and could ease what Senator Byron Dorgan, Democrat of North Dakota, calls "full-scale health care rationing going on on Indian reservations."

"We've got the 'first Americans' living in third world conditions," Dorgan said.

Obama has emphasized Indian issues more than most presidents. He campaigned on reservations, created a senior policy adviser for Native American affairs and appointed Kimberly Teehee, a Cherokee, to the post, and gave Indians other high-ranking positions.

He has proposed a budget increase of 13 percent for the federal Indian Health Service, which provides free care to 1.9 million Indians who belong to federally recognized tribes, most of whom live on tribally owned land. The service, which had a budget this year of $3.3 billion, has also received $500 million in stimulus money for construction, repairs and equipment.

On Thursday, the Senate Indian Affairs Committee is scheduled to discuss other Indian health issues that could end up in the overhaul bill.

Indians could benefit from broader overhaul programs for low-income and uninsured citizens, but they do not want to relinquish the healthcare they claim as a historical right.

Indian struggle

In the vast, varied territory called Indian Country, healthcare is stung with struggle.

They struggle with too few doctor, too little equipment, and hospitals and clinics miles of hardscrabble road away.

In cities, where over half of the country's roughly three million Indians now live (and nearly five million including part-Indians), only 34 programs get Indian Health Service funding, providing mostly basic care and arranging more advanced care and coverage elsewhere.

While some Indians have private insurance, often through employers or tribal businesses like casinos, a third are uninsured and a quarter live in poverty. By all accounts, the Indian Health Service is substantially underfunded.

Despite the Indian healthcare system improving nationally and Indians living longer, there are still improvements to be made which will be extremely beneficial to them.

Even if more Indians become insured, it will not end the problems, especially if providers and insurers, continue avoiding Indian Country.

Proposed legislation would not give Indians everything they want, but the overhaul does include grants for preventive care and research. And the Indian Health Care Improvement Act, which stands a good chance of being reauthorized by Congress for the first time since 2001, would enhance programs, physician recruitment and hospital construction. Although it approves no funding, advocates hope it will prompt additional money.

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