Posts Tagged ‘Indian Health Care Improvement Act’

Mark Trahant is a writer, speaker and Twitter poet. He is a member of the Shoshone-Bannock Tribes and lives in Fort Hall, Idaho. Trahant’s recent book, “The Last Great Battle of the Indian Wars,” is the story of Sen. Henry Jackson and Forrest Gerard.

Will Republicans muster enough votes to repeal the health care bill? A Michigan Republican said over the weekend that he sees “significant” bipartisan support for repeal, possibly even enough votes to override a presidential veto.

U.S. Rep. Fred Upton, R-Michigan, said on Fox News Sunday, “If we pass this bill with a size-able vote, and I think that we will, it will put enormous pressure on the Senate to do the same thing.”

An outright repeal, however, requires two-thirds majority in both the House and the Senate. A hurdle that is about as close to impossible as it gets in Washington, D.C.

That’s why the Republican strategy includes three other elements: Investigate, repeal sections and refuse to limit the money needed to implement the law.

“The so-called Patient Protection and Affordable Care Act (PPACA) has been widely criticized by the American public, and for good reason,” Upton wrote last month. “… Real oversight is needed, and the Energy and Commerce Committee will work closely with other committees of jurisdiction to reveal, repeal and replace this law.”

And to use Upton’s phrase, these “so-called” probes already know what they will uncover. As Upton himself put it: “Our investigations will demonstrate the need to repeal this law and replace it with common sense reforms that lower costs and increase accessibility to health care without increasing government.”

But this is where the story gets complicated. Too bad there’s not that same passion for oversight when it comes to the historical underfunding for Indian health programs. Or, in general, what will any of these investigations say about American Indian and Alaska Native health? Will there even be a question about the impact of “reveal, repeal and replace” for Native American communities?

I doubt it.

Yet many Republicans – often with districts with large numbers of American Indian or Alaska Native voters – say they don’t like and will vote to repeal the health care reform law, but they do like the Indian Health Care Improvement Act. New South Dakota Rep. Kristi Noem said as much during her election campaign.

But that logic is flawed: if there is a repeal of the health care reform bill, there also will be a repeal of the “permanent” status found in the Indian Health Care Improvement Act. The two laws are one.

There is no way, politically at least, to repeal health care reform except for the Indian health care provisions (or for that matter, other popular measures, such as relief for the donut-hole in Medicare). This is a simple way of pleasing folks back home that means nothing. There is no exception; there is only a divide between those who would work with this law, complicated as it is, and those that would start over with nothing.

Beyond that stark rhetoric however is a practical question: Will the new Republican majority support stable funding the Indian Health Care Improvement Act? The law is only an authorization to spend money – it must be implemented by an appropriations from Congress.

This is where the seeds of tragedy are being planted. The Republicans are creating a new powerful budget post, chaired by Paul Ryan from Wisconsin. He will have the authority to set a ceiling for federal spending. The spending committees, then, would have to spend below that ceiling. Some Republicans in Congress have promised to roll back that spending as much as 20 percent. Imagine the impact on an already starved Indian health system. (Ryan has also called for abolishing Medicare for those under 55 years old as well as the Children’s Health Insurance Program and Medicaid. All three are key elements of funding the Indian health system.)

Republicans promised a frugal government. If that’s really what they want, then the Indian health system should be fully funded because it’s the most efficient health care delivery system in the country.

But that would require an exception to flawed logic.

Tags: , , , , , , ,

Pete Rouse, President Barack Obama’s chief of staff. (Courtesy of the White House)

Pete Rouse, President Barack Obama’s chief of staff. (Courtesy of the White House)


Indian Country Today‘s Rob Capriccioso got a first-of-its-kind interview with White House Chief of Staff Pete Rouse this week, as Rouse answered questions for the Native American publication in advance of the White House Tribal Nations Conference in Washington, D.C. this week.

Rouse answers questions about his comfort level with Indian issues, as well as what might be scheduled as far as more direct talks with President Barack Obama and individual Tribal governments in the near future. Rouse says in his answers that Obama will work hard to protect important legislation like Indian Health Care Improvement Act, passed by Congress this year and continues to be committed to getting to reservations to have direct, intimate talks with tribes.

    Here’s Capriccioso’s full Q&A:

    Indian Country Today: Many folks in Indian country know you worked for former Sen. Daschle. Did that experience help inform you on Indian issues?
    Pete Rouse: It certainly did and, actually, my first job. … I’ve been working in government, primarily on the Hill, for 39 years, and my first job was in 1971 with Jim Abourezk, who was a congressman from South Dakota. That was my first exposure to Native American issues and, actually, Tom Daschle and I were staffers together for two years with Jim Abourezk in the Senate, when he was a senator. Then, for 19 years, I was chief of staff for Tom in the House and Senate. So, that’s how I became espoused of Indian issues – and, hopefully, somewhat knowledgeable.

    ICT: When you encounter Indian policy issues, do they come naturally for you, or do you need a lot of outside briefing – not that there’s anything wrong with that.
    PR: Well, I need a lot of outside briefing on everything. [Laughs] I am familiar with these issues going way back to Wounded Knee in South Dakota in the early ’70s. Elouise Cobell, I’ve known since the ’80s when she was trying to reform the management of Indian trust. And, of course, in South Dakota, where you have Pine Ridge and Rosebud and Standing Rock – and a lot of the issues of unemployment, need for economic development, education, health care. … those were always prominent on Tom Daschle’s agenda, so I’ve been talking to tribal leaders and Native Americans for years.

    Read the rest of this entry »

Tags: , , , , , , , ,

Mark Trahant

Mark Trahant


Mark Trahant is a writer, speaker and Twitter poet. He is a member of the Shoshone-Bannock Tribes and lives in Fort Hall, Idaho. Trahant’s new book, “The Last Great Battle of the Indian Wars,” is the story of Sen. Henry Jackson and Forrest Gerard.

The election is over. Now what? What are the next steps when it comes to health care reform? Just what did the people say Nov. 2?

As you would expect there is no agreed answers. Republicans say this election was about health care. Tea party favorite Sen. Jim DeMint, R-S. C., said on NBC’s Meet the Press this weekend. “We have to stop the funding of Obamacare and over the next two years show the American people what the real options are to improve the system we have now.”

But President Barack Obama, in his news conference said, “I think we’d be misreading the election if we thought that the American people want to see us for the next two years relitigate arguments that we had over the last two years.”

The polls are interesting. The Kaiser Family Foundation surveyed the surveys. “Over the course of the past month, at least eight well-respected polls have asked Americans whether they support the idea of repealing health reform, and” Kaiser reports, “responses have been all over the map, ranging from a high of 51 percent in an NBC News/Wall Street Journal poll to a low of 26 percent in our September Kaiser Health Tracking survey. Why the wide range? After a close look at the data collected below, our take is that question wording is driving the differences. At the same time, recent polling suggests that for at least some Americans, a vote for repeal means a vote to eliminate certain provisions of the health reform law while also keeping many of its benefits, rather than representing a desire to overturn the law completely.”

But the political divide remains stark. So we are going to (as the president puts it) relitigate the health care law.

Read the rest of this entry »

Tags: , , , , , , , , , ,

Dr. Yvette Roubideaux, director of the Indian Health Service, penned the following opinion piece on Mark Trahant’s yearlong series of columns on Indian Country and health care reform. Trahant’s work has been featured every Monday in Buffalo Post, as well by news organizations, websites and other publications around the country:

By Yvette Roubideaux, M.D., M.P.H.

yvetteMark Trahant is completing a comprehensive and unprecedented series of columns on health reform and the Indian health system. These columns have shed new light on the Indian Health Service (IHS) and how it is influenced by and impacted by the rest of the U.S. healthcare system. These columns were made more timely and relevant by the historic passage of the Affordable Care Act and reauthorization of the Indian Health Care Improvement Act that occurred during Mr. Trahant’s work this past year

These columns have helped put the spotlight on the IHS, which is a health care system that serves 1.9 million American Indians and Alaska Natives from 564 Tribes in 35 states. The IHS rarely is mentioned in the national media, but it serves a critically important role to address the health disparities faced by American Indians and Alaska Natives. Many Americans do not understand the role of this health care system, or the treaty obligations and trust responsibilities that led to its formation over 50 years ago.

Read the rest of this entry »

Tags: , , , , , , , , , , , , ,

A visitor walks through the new health clinic on the Flathead Indian Reservation in Montana. Such state-of-the-art facilities are in sort supply. (Linda Thompson/Missoulian)

A visitor walks through the new health clinic on the Flathead Indian Reservation in Montana. Such state-of-the-art facilities are in sort supply. (Linda Thompson/Missoulian)

For months, the Health Rights Organizing Project had a mission – the coalition of 30 grass-roots community organizations around the country worked hard to convince Congress to pass the Indian Health Care Improvement Act.

Among its pitch, writes Susan Olp of the Billings Gazette, was a publication by the group titled “An American Debt Unpaid: Stories of Native Health.”

The legislation became effective when in March, when President Barack Obama signed the the Patient Protection and Affordable Care Act, which permanently reauthorizes the Indian Health Care Improvement Act.

Just one thing:

    The act is no longer dependent on annual reauthorization. And the new law authorizes the Indian Health Service to continue its programs and add some new ones, such as mental and behavioral health services, long-term care, dialysis, health care for Indian veterans and urban Indian health programs.

    What the bill didn’t do was allocate the money to fully fund the present programs or any new ones.

So the coalition is back at work with a new booklet: “Native Health Underfunded & Promises Unfulfilled: The Importance of Investing in the Indian Health Service.”

“I have seen people walking around with severe pain, with orthopedic malformations that were never addressed, people addicted to painkillers because they can’t get procedures, people who need substance abuse treatment but can’t receive it, and even people taking their own lives because of a number of factors, including depression,” says Kevin Howlett, health director of the Confederated Salish and Kootenai Tribal health Department.

To read the publication, go to http://www.nnaapc.org/publications/20100814NativeHealthUnderfunded.pdf.

Gwen Florio

Tags: , , , , , , , , , , , , ,

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes and writes from Fort Hall, Idaho. Comment here.

Mark Trahant

Mark Trahant

A philosophical question: How much medical training is needed to treat patients? Some say it’s the full course as proscribed by existing medical, nursing or dental schools. But when the shortages of doctors, nurses and dentists are ginormous, does the need require a different answer?

Consider oral health. “Shortages of dental practitioners and affordable dental care are hurting the health of millions of Americans, many of whom live with pain, miss school or work, and, in extreme cases, face life-threatening medical emergencies that result from dental infections. The situation is particularly severe for poor children and families and in communities of color,” writes Burton L. Edelstein, DDS, MPH Columbia University and Children’s Dental Health Project in a Dec. 200, report for the W.K. Kellogg Foundation.

And, like most health issues, the data shows that Indian Country is at the low end of the spectrum. One study described it this way: “The American Indian / Alaska Native “population has the highest tooth decay rate of any population cohort in the United States: 5 times the US average for children 2–4 years of age. Seventy-nine percent of AIAN children, aged 2–5 years, have tooth decay, with 60% of these children having severe early childhood caries (baby bottle tooth decay). Eighty-seven percent of these children, aged 6–14 years, have a history of decay—twice the rate of dental caries experienced by the general population.”

Read the rest of this entry »

Tags: , , , , , , , , , , , , ,

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

Mark Trahant

Mark Trahant

Passing health care reform was easy. Sure it was a legislative mess: It was too slow, too fast, too many pages and too short on specifics, too open to the influence of special interest lobbies – and too secretive, partly because the language was so complicated and difficult to translate into a simple narrative. Yet enacting health care reform was easy. Executing on real reform, now that’s a challenge.

It’s the same in Indian Country. The Indian Health Care Improvement Act is included as a section of the Patient Protection and Affordable Care Act. But this is only one item to check off on a long to do list, not the goal itself. The next steps are just as important as the law itself: Producing regulations that put the policy choices into action, funding by Congress to make the law work, and execution of the law by the employees of the Indian Health Service, the federal government, as well as by tribes and provider organizations.

Read the rest of this entry »

Tags: , , , , , , , , , , , , ,

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

Mark Trahant

Mark Trahant

Has the Indian Health Service been an effective, government-run delivery system?

Consider this from a White House memo: “While there has been improvements in health status of Indians in the past 15 years, a loss of momentum can further slow the already sluggish rate of approach to parity. Increased momentum in health delivery and sanitation as insured by this bill speed the rate of closing the existing gap in age at death.”

In other words progress is slow. But Dr. Ted Marrs wrote the memo on April 26, 1976, and the subject was about the original Indian Health Care Improvement Act. “In 1974 the average age at death of Indians and Alaskan natives was 48.3. For white U.S. citizens the average age of death was 72.3. For others, the average age was 62.7.”

Dr. Marrs wrote that the “bottom line” was an unavoidable connection between “equity and morality” when there is a more than twenty year differential in age at death between Indians and non-Indians.

So what do the numbers look like now?

Read the rest of this entry »

Tags: , , , , , , , , , , ,

A.J. Longsoldier, 18, who died after falling ill in jail. (Fort Belknap photo)

A.J. Longsoldier, 18, who died after falling ill in jail. (Fort Belknap photo)


A lot was going on yesterday at the Montana Wyoming Tribal Leaders Council meeting.

The group heard from Jefferson Keel, president of the National Congress of American Indians, who made a rare visit to Montana.

And, it asked Montana Attorney General Steve Bullock to look into the circumstances surrounding the death of 18-year-old basketball star A.J. Longsoldier, who died shortly after he was taken from a northern Montana jail to a nearby hospital.

Susan Olp of the Billings Gazette has the story here:

Keel, who is Chickasaw, spoke about the Indian Health Care Improvement Act; the problem of inadequate and deteriorating reservation housing, and the overwhelming issue of under-funding for Indian Country issues in general.

Tribal Leaders Council James Steele Jr. of the Confederated Salish and Kootenai Tribes, talked about the difficulty of maintaining reservation roads with federal funding.

But perhaps the most emotional issue was the approval of the resolution calling for action surrounding the death of Longsoldier, from the Fort Belknap Reservation and a former basketball standout at Hays-Lodgepole High School. He was jailed on an alleged probation violation. During his two days in jail, he complained of feeling ill, and was twice taken to the hospital and died the second time:

    While in jail, he appeared to be hallucinating, was talking to himself and pulled out some of his hair. An autopsy determined that LongSoldier died from acute alcohol withdrawal. A coroner’s inquest in March found that the detention officers were not criminally liable in the death.

    Tracy King, president of the Fort Belknap Tribal Council, who attended the inquest, raised the issue at the meeting. King said more should have been done for LongSoldier to help save his life.

    He called the handling of the youth in jail “a civil rights violation.”

“I see too many of our youth being railroaded by systems that don’t work in their favor,” King said.

Dr. Kathleen Masis, who works for the Tribal Leaders Council, calls his death a warning.

“It means we need to make sure what is represented as happening never happens again, to an Indian or non-Indian.”

Gwen Florio

Tags: , , , , , , , , , , , , , ,

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment here.

Mark Trahant

Mark Trahant

This is simple math: Health care equals jobs. And the new health care reform law means even more jobs. In many communities across the United States, the health care industry is the region’s top employer. Indeed, if you put this in a global perspective, the National Health Service in the United Kingdom now employs 1 in every 23 workers in that country, some 1.3 million people. (The NHS is the third largest employer in the world, only ranking behind the Chinese army and India Rail.)

The numbers in Indian Country show that same kind of growth. Look at the figures before President Johnson’s Great Society (and the expansion of federal programs): The Bureau of Indian Affairs employed 16,035 full time employees in 1969, while the Indian Health Service employed 5,740 people. That trend is now reversed. In 2009 the BIA employed 8,257 full time workers and the IHS had grown to 15,127 employees. These are just the number of federal employees, because tribes or organizations administer roughly half of the Indian health system.

The demand for health care workers in Indian Country represents a public policy paradox: We need jobs in communities where the official unemployment rate is about 50 percent and yet the Indian Health Service reports shortages of health professionals.

Read the rest of this entry »

Tags: , , , , , , ,