your internet resource on facebook on twitter on Google+ on soundcloud
phone: 202 630 8439
Native American Bank - Native people investing in Native communities
Advertise on Indianz.Com
Home > News > Headlines
Print   Subscribe
Mark Trahant: It's past time to reform the Indian Health Service

Filed Under: Health | Opinion
More on: aca, ihcia, ihs, jon tester, mark trahant, scia

At a Billings hearing in May, Sen. Jon Tester expressed frustration about the management of the Indian Health Service.

The Montana Democrat said: “We need to live up to our trust responsibility and offer tribes the health care they deserve. Ongoing issues around service delivery, transportation for critical care, billing and reimbursement issues abound. We need to prioritize these issues and solve them.”

Tester, of course, is chairman of the Senate Indian Affairs Committee. So his call for improving the agency is worth considering.

Then again, when former Sen. Byron Dorgan (D-ND) was chairman of the same committee, he also held hearings and published a report about the poor management record at IHS. “The investigation identified mismanagement, lack of employee accountability and financial integrity, as well as insufficient oversight of IHS' Aberdeen Area facilities.

These issues impact overall access and quality of health care services provided to Native American patients in the Aberdeen Area. Many of these issues may stem from a greater lack of oversight by the area office and IHS headquarters fostering an environment where employees and management are not held accountable for poor performance.” The year was 2010.

So what kind of progress has the Indian Health Service made during those four years? Unfortunately that’s the wrong question.

In the blink of an eye, the very structure of health care has changed and is continuing to change dramatically in the United States. Yet the structure of the Indian Health Service is the same.

Take the name: Indian Health Service. On the agency’s web page it adds the descriptive line, “The Federal Health Program for American Indians and Alaska Natives.”

Yet some 40 percent of the agency funds go directly to tribes, independent medical nonprofits or urban health programs. The federal health program is a mechanism for funding, not a federal health program. And that percentage is likely to grow because the system is no longer equal. The IHS has less access to a variety of funding pots that are available to tribal and urban health clinics.

A second problem with the IHS structure is that the United States for many policy reasons picked an insurance framework under the Affordable Care Act. And much of that insurance is built on an expansion of “entitlement” programs.

But the IHS is a health care delivery system, not an insurance regime. And, unlike the entitlement programs of Medicare, Medicaid, and Children’s Health Insurance, the IHS is funded through congressional appropriations. So the agency’s primary source of funding is subject to the whims of a Congress that is deeply divided about priorities and the role of government.

This funding mechanism was made worse by the Affordable Care Act when the Supreme Court said states could choose to expand Medicaid (an insurance partnership for people on low incomes) or not. State-based “optional” insurance is creating a divide within the Indian health system. Under current law, IHS rewards facilities for bringing in third-party payers from either private insurance or Medicaid dollars. It’s money that’s added to a local clinic or hospital budget. But most of that money is from Medicaid and if a state rejects the expansion, that becomes, in effect, a structural deficit. Almost half of the states, many with large American Indian or Alaska Native populations, have not expanded Medicaid.

So what should the Indian Health Service look like in the age of Obamacare? That is the conversation that should be occurring, but is not. It’s so much easier to blame underfunding or management instead of rethinking the entire IHS organization.

What would IHS look like if it’s primary role was to act as a funding agent with the goal of sending maximum resources — you know, money — directly to tribally-run and other health care delivery agencies? Or what if Medicaid was administered directly for tribes, leaving states out of the equation?

One thing I would change is The Story. As I have written before, it’s important that Congress know that past efforts worked. The creation of the Indian Health Service in 1955 and the Indian Health Care Improvement Act of 1976 both improved the health of American Indians and Alaska Natives. Yes, there remain health care disparities when compared to the general population but the gap is far less than it was. And IHS did this by spending less money than just about any other health care delivery system in the United States.

Sure, there are management challenges at the Indian Health Service as noted by Senators Tester and before that Dorgan. But as we near the 50th anniversary of the Indian Health Care Improvement Act, it’s time to rethink the agency’s structure and demand reform. It’s time to imagine what success looks like.

Mark Trahant holds the Atwood Chair at the University of Alaska Anchorage. He is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

Copyright © Indianz.Com
More headlines...
Stay Connected:
On Facebook

On Twitter

On Google+

On SoundCloud
Local Links:
Federal Register | Indian Gaming | Jobs & Notices | In The Hoop | Message Board
Latest News:
Controversy brews as House takes up Native American Energy Act (10/6)
Native Sun News: Crow Tribe leader advises Rep. Zinke on energy (10/6)
Lakota Country Times: Program for Native students closes down (10/6)
Mark Trahant: Far too many missing and murdered Native women (10/6)
Alfred Walking Bull: Let's open up about suicide in Indian Country (10/6)
Raina Thiele: Alaska Natives share culture with President Obama (10/6)
Mary Pember: Fashion show tackles trafficking in Indian Country (10/6)
Torivio Fodder: Pope Francis ignores sins of Indian mission era (10/6)
Sac and Fox Nation disappointed by denial of Jim Thorpe case (10/6)
Flandreau Santee Sioux Tribe expects big crowd for pot kickoff (10/6)
Colville Tribes pass resolution for small amounts of marijuana (10/6)
Disaster declaration covers Catawba Nation in South Carolina (10/6)
Leader of Comanche Nation disputes removal of administrator (10/6)
Osage Nation accuses former employee of adding non-Indians (10/6)
Donald Trump doesn't think NFL team's racist name should go (10/6)
Supreme Court declines to hear appeals in two gaming cases (10/6)
San Pasqual Band loses claim for damages in gaming dispute (10/6)
New Eastern Cherokee chief takes aim at gaming commission (10/6)
Chemehuevi Tribe hosts public hearing for new gaming facility (10/6)
Little Traverse Bay Bands consider Class II for second casino (10/6)
Supreme Court rejects petitions in four more Indian law cases (10/5)
Senate Indian Affairs Committee weighs seven bills at hearing (10/5)
Senate Indian Affairs Committee schedules business meeting (10/5)
Secretary Jewell heads to Oklahoma for tribal trust settlement (10/5)
IHS reopens comment period for Aquinnah Wampanoag Tribe (10/5)
BIA backs extension of Rosebud Sioux Tribe gaming compact (10/5)
Native Sun News: Code Talker medals seen in traveling exhibit (10/5)
Lakota Country Times: Oglala Sioux Tribe and FEMA cooperate (10/5)
James Giago Davies: Don't let dominant culture dumb us down (10/5)
Vi Waln: Domestic violence comes in many forms on reservation (10/5)
Gyasi Ross: Republicans play games with Native women's rights (10/5)
Rosanna Deerchild: A terrifying reality facing indigenous women (10/5)
Steve Russell: Indians met Christianity at its most violent phase (10/5)
Alex Jacobs: Pope Francis honors symbol of genocide in America (10/5)
Joseph Hamilton: Tribal leaders must talk about disenrollments (10/5)
Tara Houska: Horror film treats Native peoples as relics of past (10/5)
Cow Creek Band employee lost son in deadly shooting in Oregon (10/5)
Flandreau Santee Sioux Tribe fully booked for launch of pot resort (10/5)
Chukchansi Tribe picks leaders and hires gaming commissioners (10/5)
Cowlitz Tribe turned down Donald Trump for gaming partnership (10/5)
Eastern Cherokees see tangible benefits from gaming enterprise (10/5)
Navajo Nation to offer housing for employees of casino in Arizona (10/5)
Poarch Creeks lose ruling over slot machines at Florida racetrack (10/5)
more headlines...

Home | Arts & Entertainment | Business | Canada | Cobell Lawsuit | Education | Environment | Federal Recognition | Federal Register | Forum | Health | Humor | Indian Gaming | Indian Trust | Jack Abramoff Scandal | Jobs & Notices | Law | National | News | Opinion | Politics | Sports | Technology | World

Indianz.Com Terms of Service | Indianz.Com Privacy Policy
About Indianz.Com | Advertise on Indianz.Com

Indianz.Com is a product of Noble Savage Media, LLC and Ho-Chunk, Inc.