"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."

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

Related Stories:
Mark Trahant: Obama's exciting pick for Medicaid agency (3/30)
Mark Trahant: Delivering promises for Indian health care (3/22)
Mark Trahant: Health care reform vote as a litmus test (3/15)
Mark Trahant: Facebook group gathers IHS war stories (3/8)
Mark Trahant: IHS not mentioned at Blair House summit (3/1)
Mark Trahant: Reaching consensus on Indian health (2/22)
Mark Trahant: Alaska Natives create a model system (2/15)
Mark Trahant: Growing the IHS budget in tough times (2/8)
Mark Trahant: Transparency and Indian Health Service (2/1)
Mark Trahant: Transparency in health care reform bill (1/25)
Mark Trahant: Starting over on Indian health reform bill (1/20)
Mark Trahant: IHS Director Roubideaux on passing IHCIA (1/18)
Mark Trahant: Business model for Indian Health Service (1/12)
Mark Trahant: Some resoluting on Indian tobacco use (1/6)
Mark Trahant: IHCIA now a part of Senate health bill (12/21)
Mark Trahant: Projects improve Indian health care (12/14)
Mark Trahant: Work together for health care reform (12/8)
Mark Trahant: Health care system tied to economy (12/7)
Mark Trahant: Health reform bill tests democracy (11/30)
Mark Trahant: Health reform boosts Indian Country (11/23)
Mark Trahant: Health care reform dead in Senate (11/17)
Mark Trahant: New Republican 'interest' in IHCIA (11/2)
Rep.Hastings objects to IHCIA in health reform bill (10/30)
Mark Trahant: Send Medicaid funds right to IHS (10/29)
Mark Trahant: Health care debate drags on and... (10/26)
Mark Trahant: Guaranteed rights to health care (10/19)
Mark Trahant: Health care debate not over (10/12)
Mark Trahant: Effortless Indian Country care (10/5)
Mark Trahant: Tribal provisions in health reform (9/28)
Mark Trahant: Taxation of tribal health benefits (9/21)
Mark Trahant: Indian Health Service paradox (9/17)
Mark Trahant: Indian exemption and insurance (9/16)
Mark Trahant: Revive the public health hospital (9/14)
Mark Trahant: Grandma and health care reform (9/9)
Mark Trahant: Ted Kennedy steps aside for health (8/31)
Mark Trahant: Tribes, IHS and health coverage (8/25)
Mark Trahant: Ideas for health care reform (8/17)
Mark Trahant: Duality in Indian health care (8/10)
Mark Trahant: Health care from a different view (8/4)
Mark Trahant: Indian businesses and health care (7/28)
Mark Trahant: First Americans are last in health (7/21)
Mark Trahant: Getting into Indian health reform (7/14)
Mark Trahant: Lessons from Indian Country health (7/10)
Mark Trahant: IHS isn't broken, just underfunded (7/9)
Mark Trahant: Indian health care at the local level (7/8)