A “Historic Failure”: American Indian Health Care Suffers
OpenForum | July 20, 2009 | 2 Comments
The president’s 2010 budget for the Indian Health Service, the organization that provides federal health services to American Indians, tops $4 billion. This includes an increase of $454 million. But Kathleen Sebelius, head of the Department of Health and Human Services, which oversees the IHS, said in a June interview that that’s not enough to provide the agency with what it needs. This was after she called our efforts in American Indian healthcare a “historic failure.”
One day before Sebelius’s interview, another AP piece detailed the shortcomings of the painfully underfunded IHS. Operating with half the necessary funds, some understaffed clinics can’t provide preventive care services, and others can’t handle the high disease rates. Patients recount what they rightly see as subpar care: clinicians dismissing a patient’s pain from advanced frostbite until she threatened suicide; being unable to make appointments; diagnosing a five-year-old who had complained of stomach problems with depression. (After many months, several more clinic visits, and a collapsed lung, she was diagnosed with terminal cancer at a Denver hospital and died weeks later.)
The dismal statistics of American Indian health disparities are well documented (go here, here, here, and here for starters). President Obama cites a couple of the more startling ones on his website, including that men living on South Dakota’s Pine Ridge and Rosebud reservations have the second-lowest life expectancy in the western hemisphere. The health disparities are, as Sebelius says, “unconscionable.” But so are the funding disparities.
This report from the U.S. Commission on Civil Rights compared spending on American Indian healthcare to other groups for whom the government provides care. The numbers are telling: In 2003, the government spent $6,000 for each Medicare recipient, $5,200 for every veteran using the VA, and $3,725 for federal prisoners. American Indians: $1,600 per person. IHS spends less on its patients than any other group providing public care – and about 60 percent less than average per capita healthcare costs nationwide. From the report: “This disparity in spending is amplified by the poorer health conditions of many in the Native American community and represents a direct affront to the legal and moral obligation the nation has to improve Indian health status.”
That “legal and moral obligation” dates back to 1787. Many treaties and much legislation has been passed to ensure healthcare for American Indians, notably the Snyder Act and the Indian Health Care Improvement Act, which states, “It is the policy of this Nation in fulfillment of its special responsibilities and legal obligation to the American Indian people, to assure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy” [emphasis added].
The 2010 HHS budget is $828 billion ($872 billion after additional funding from the American Recovery and Reinvestment Act of 2009) - the amount spent on American Indian healthcare will make up approximately 0.5% of that. And if we funded the IHS at the levels officials say it requires – around $7 billion – that would still make up less than 1% of the entire budget. Obama’s $454 million bump provides the IHS with just over half of “all resources necessary”- ensuring that our historic failure isn’t coming to an end anytime soon.
For more reading:
Native Health Needs and Federal Apathy Are Told at an IHS Conference
Indian Health Care Needs Patient Information and Funds
Tribal Leaders Seek Health Care Reform
State Treasury Must Help Pay What Indian Health Service Doesn’t Provide
The History and Politics of US Health Care Policy for American Indians and Alaskan Natives
Redeeming Hollow Promises: The Case for Mandatory Spending for American Indians and Alaskan Natives
“If You Knew the Conditions”: Health Care to Native Americans
Comments
2 Responses to “A “Historic Failure”: American Indian Health Care Suffers”
rezmed09
“In 2003, the government spent $6,000 for each Medicare recipient, $5,200 for every veteran using the VA, and $3,725 for federal prisoners. American Indians: $1,600 per person. IHS spends less on its patients than any other group providing public care”
Hold on now. I question this figure. Does that include the money spent on Native Americans by Medicare and Medicaid when patients are referred out for care elsewhere? When Eagle Butte, transport a pregnant woman by air to Rapid City, Medicaiid foots the bill for that $100K transport and hospitalization. That is probably not included in the figure. When a Medicare enrolled Native patient shows up at an ER off Rez for emergency care, who pays the majority of the bill? Medicare. How about all the money Medicare and Medicaid are spending paying non-IHS dialysis providers? IHS facilities are billing PI, Medicare and Medicaid for much of the services. Is that included in the sum?
I doubt that they are tallying all the money spent. This is very sick population. I am skeptical that the per capita expenditures on NA’s is half of what the Canadians spend. I don’t buy it.
Reem @ OpenForum
Hi, rezmed09. I wrote the post above. Your question is a good one.
The amounts that Medicare and Medicaid cover for American Indians are not included in the figures you mentioned. Here’s what the report from the U.S. Commission on Civil Rights (report is found here: http://www.tedna.org/usccr/quietcrisis.pdf) says:
“In tallying its Native American expenditures, HHS does not include funding for which Native Americans compete with other groups, those for which all individuals are eligible, and those that are awarded to states and then passed on to Native communities. As a result, and as noted previously, the amount does not include Medicaid and Medicare benefits received by Native Americans.”
Re the IHS billing Medicaid and Medicare for services–here’s a good paper from the American Journal of Public Health (go here: http://tiny.cc/jGOPK) talking about Medicaid’s role in American Indian health care (a very imperfect system) and possible reforms. The authors make a couple points worth mentioning here: 1) There’s a very high rate of poverty among American Indian communities—this is why they’re eligible for Medicaid in the first place. And 2) Medicaid costs are shared by the government and the states. But Medicaid costs are also increasing faster than state revenue, so some states may decide to close the gap by cutting Medicaid budgets (either by tightening eligibility, or not paying providers). Here’s a solid example from the paper on how this affects the IHS and American Indian health care:
“. . . if a state reduces eligibility for pregnant women from 185% of the federal poverty level to the federal minimum of 133% of the federal poverty level, all AIAN pregnant women in this income range will lose Medicaid eligibility along with all pregnant women who are not American Indians/Alaska Natives. For those being treated at IHS or tribal facilities, the facilities will no longer be able to bill Medicaid for their services. Similarly, if a state decides to reduce or eliminate an optional service such as adult dental care, the IHS or tribal facilities that provide such services to Medicaid beneficiaries will no longer be able to bill the state Medicaid program for these services. In both cases, the state does not save any of its own funds by cutting off payment to the IHS or tribal facilities, because 100% of the Medicaid costs of these services would be paid by the federal government. However, the IHS or tribal facilities will lose the federal Medicaid revenues.”
And regarding patients who receive services at non-IHS clinics: IHS often has contracts with outside facilities to provide care that they aren’t equipped to provide (b/c they don’t have the funding). This paper (http://tiny.cc/Mr7EF), also from the AJPH, goes into it a little bit. And an interesting thing to note about this contract care is that IHS often pays more for it then they would pay in-house. And in some rural areas, the lack of competition means IHS may end up paying a lot more. (Though I should note that IHS is the payer of last resort when it comes to contract care (http://info.ihs.gov/CHS.asp) —again, b/c funding is so tight.)
My question is: If the federal government fully funded the IHS, what would happen to the amounts spent on Medicare and Medicaid for American Indians?