Mark Trahant: Should Native Americans buy own insurance?
"The enactment of health care insurance reform raises a thorny (and complicated) question for Indian Country: Should American Indians and Alaska Natives eligible for services in the Indian health system buy their own insurance?

The first answer ought to be a resounding “no.” Clearly the United States has an obligation for health care because of promises made through treaties and statutes. Indeed, the very enactment of the Indian Health Care Improvement Act is a legal restating of this principle. Health and Human Services Secretary Kathleen Sebelius said it this way on March 26: “This administration is intent on honoring the obligations of our government-to-government relationship with American Indian tribes, including the promise of adequate health care.”

But adequate health care is not an insurance plan; especially when that promise is so limited by money. And there is no possibility that Congress will fully fund the Indian health system anytime soon.

So where does that leave us? The Government Accountability Office said in a 2005 report: “There remain concerns about the extent to which health care services are available—that is, both offered and accessible—to Native Americans served by IHS.” One key issue here is the underfunding of Contract Health Services, money that is used to pay for health care providers outside of the Indian health system. Remember unlike Medicare, Medicaid or the Children’s Health Insurance Program, IHS operates on an annual budget instead of an entitlement and it’s a limited source of funds. This budgeting notion will not change with health care reform."

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A thorny question: Should American Indians and Alaska Natives buy their own insurance? (Mark Trahant 4/5)

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