Mark Trahant has spent the past year as 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 at www.marktrahant.com. His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

What will the Indian health system look like a decade from now?

That’s an impossible question to answer. There is the potential of a court ruling striking down at least part of the Patient Protection and Affordable Care Act. And, there is always the possibility of Congress will rewrite the law (I view this as remote because there would have to be a Super Majority to enact something else.)

But in the meantime there is a new foundation already under construction. The building that will rest on that structure will not be the same as the one in place now.

Let’s start with the patient. Right now, according to the Kaiser Family Foundation, nearly half of all American Indians and Alaska Natives are either uninsured or rely solely on the Indian Health Service. But health care reform changes that. Big time. Beginning in four years, hundreds of thousands of people will become eligible for insurance through government programs (such as Medicaid) because of new income rules. This insurance can be used to pay for services at Indian health system facilities – or at competing health care centers. (Think about how many private walk-in clinics promise no waiting.)

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Tags: Health care reform, Indian Health Service, Kaiser Family Foundation, Mark Trahant, Medicaid, Patient Protection and Affordable Care Act

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 at www.marktrahant.com His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

A single phrase is often used to define the Indian health system: “Government-run.” Add those two words to any discussion about health care or reform and most people reach an immediate conclusion about the merits of the agency.

Now it is time for the phrase to disappear because it no longer accurately describes the Indian health system. After all, tribes or tribally authorized nonprofit agencies administer more than half of the IHS budget, through the Self-Determination Act or Self-Governance compacts.

Certainly the federal government plays a huge role in this health care delivery system – across the country. “As in all industrial nations, the U.S. government plays a large role in financing, organizing, overseeing, and, in some instances, even delivering health care,” said a report last August by the Robert Wood Johnson Foundation.

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Tags: berdeen Area Tribal Chairmen’s Health Board, Everett R. Rhodes, Indian Health Service, Mark Trahant, Medicaid, Medicare, Oglala Lakota, Patient Protection and Affordable Care Act, Robert Wood Johnson Foundation, Sanford Health, Self-Determination Act, Self-Governance compacts, Western Journal of Medicine

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 at www.marktrahant.com. His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

WASHINGTON, D.C. – Every agency that serves American Indians and Alaska Natives must answer these questions in order to fuel the decision-making process: How much will it cost? How many people are served? And, by the way, who is an Indian?

None of the answers are easy. The demand for federal services is growing as resources shrink. And in the health care arena the key to sustainable funding is Medicare and Medicaid (including the Children’s Health Insurance Program) where definitions are complicated by multiple factors.

Consider eligibility: More than 560 tribal communities with members living on or near reservations or spread out in urban areas. Each tribe defines its membership but that data is rarely collected for use in health statistics because it’s often privately held. The U.S. Census allows each individual to define his or her own status by checking a box. (Some 5 million by this count.)

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Tags: Alaska Natives, American Indians, buffalo post, Census, Children's Health Insurance Program, Edward Fox, Indian Health Service, Internal Revenue Service, Kauffman and Associates, Matthew Snipp, Medicaid, Medicare, merican Indian Alaska Native Data Symposium, National Museum of the American Indian, Native Americans, Office of Management and Budge, Patient Protection and Affordable Care Act, Squaxin Island tribe, Stanford University, U.S. Census

Mark Trahant, a member of Idaho’s Shoshone-Bannock Tribes, is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. Comment at www.marktrahant.com. His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard. This column can also be read on the Missoulian website.

There’s an old joke: A Native American student comes home from a geography lesson, shows his grandfather a map, and then asks, “What did we call the United States before it was a country?” His grandfather answers, “Ours.”

I thought of this joke recently in the context of the U.S. Indian Health Service. Perhaps the agency’s history, its shortcomings and its chronic underfunding have all been acceptable to Indian Country because the system itself is “ours.” It’s been “ours” for most of our generation – a little more than five decades – where American Indian and Alaska Natives could receive health care in a system that was, and is, unique.

A quick look at the history: Since 1955 the Indian Health Service was transferred from a rickety network of hospitals and clinics run by the Bureau of Indian Affairs to a real health care system. In that same time frame, the agency went from being a slice of the BIA to being larger than the BIA with a budget of $4.4 billion and some 15,000 employees. During that time there were substantial improvements in Indian health, including reducing overall mortality by 28 percent in the past 30 years, while still falling short in health parity for Native Americans.

That brings me back to the definition of “ours.”

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Tags: BIA, buffalo post, Bureau of Indian Affairs, Centers for Medicaid and Medicare, Federally Qualified Health Centers, Health care, Health care reform, Health Resources and Service Administration, IHS, Indian Health Service, Mark Trahant, Native American, Native American news, Patient Protection and Affordable Care Act

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 at www.marktrahant.com

As we talk about health care: Substitute “either, or” for “if … then”

What’s the most important element missing from our national conversation about health care reform? I’ll boil it down to one word, governance.

Consider the story so far. We’ve known for decades that our health system is unsustainable; there is no question that it cannot continue on its present course. So Congress finally rounds up enough votes to pass the Patient Protection and Affordable Care Act and what happens? The debate starts over as if there’s a magic wand out there somewhere that will let us have everything we want in health care without any cost.

There is no magic wand. What’s more, this whole discussion is a test of our ability to govern ourselves. How can we govern when we’re so divided over complex and philosophical questions? How can we govern ourselves when we don’t even agree on the basic facts?

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Tags: buffalo post, Center for Economic and Policy Researc, CEPR, Concord Coalition, Gwen Florio, Health care reform, Mark Trahant, Medicaid, Medicare, Patient Protection and Affordable Care Act, President Barack Obama, Rep. Eric Cantor

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.

This past weekend the Coeur d’Alene Tribe celebrated the 20th anniversary of the Benewah Medical Center in Plummer, Idaho. “In 1987, the BMC Web site reports, “the Coeur d’Alene Tribe began to search for ways to improve the health care services at their small Indian Health Service satellite clinic. It was located at the Tribal Headquarters, several miles from the City of Plummer, Idaho. Many tribal members were dissatisfied with 15 years of fragmented care delivered in a semi-condemned building and with poor continuity of care.”

Indeed, the complaints about the IHS facility and its operation were similar to those heard across Indian Country. And, like many tribes, the Coeur d’Alene proceeded to create its own health care network. But this was a broader vision, one that went beyond just replacing and recreating IHS; there was also a sense of something new. Prevention was made a priority and a wellness center complimented patient care. There also was recognition of the gap in rural health care services. As Benewah Medical Center describes it: “None of the ambulatory care facilities in the four surrounding counties of the Northern Idaho town were providing services to the medically underserved on a sliding fee basis.”

So a tribal community health center was created – launching two decades of innovation.

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Tags: American Recovery and Reinvestment Act of 2009, Benewah Medical Center, buffalo post, Coeur d’Alene Tribe, Federally Qualified Health Centers, FQHC, Gwen Florio, Health care reform, Health Resources and Services Administration, Indian Health Service, Mark Trahant, Native American news, Patient Protection and Affordable Care Act, President Barack Obama, President George W. Bush, The New England Journal of Medicine, U.S. Department of Health and Human Services

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.

“I need to see a doctor.” These six words have been written into our programming as modern humans. We wait in line at the clinic. We make an appointment. We know instinctively that this is the one person to see who can check out our health, fix us up when it can be done or design a treatment course when we are facing complicated health issues.

But that programming no longer works: There are not enough doctors, and, even if this goes against what we’ve been trained to think, seeing a physician is not always the best medical choice.

The shortage of primary care physicians is one of the larger trends that made health care reform necessary. Some 56 million Americans don’t have a regular doctor. And when you open up more health care access, that scarcity increases. When Massachusetts enacted universal coverage it exacerbated the primary care shortage – something that is expected to occur nationally when some 30 million who have been uninsured seek regular care.

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Tags: buffalo post, Gwen Florio, Health care reform, Indian Health Service, Jack Colwell, Mark Trahant, Native American news, New England Journal of Medicine, Patient Protection and Affordable Care Act, University of Missouri School of Medicine

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.

It’s amazing how fast a year goes by. Last May, when I met with the selection committee for the Kaiser Media Fellowship, I outlined my project. Several folks on the committee said I shouldn’t wait until fall to begin. The health care reform debate might be over by then – or so we thought.

Of course it didn’t work out that way. My year as a Kaiser Fellow has been amazing because it’s paralleled so much of the legislative debate. I started writing columns (or blog posts, depending on your point of view) on July 6, 2009.

The Patient Protection and Affordable Care Act was signed into law on March 23, 2010. And, now a different kind of debate begins. Federal agencies, primarily at the Department of Health and Human Services and Treasury are writing regulations to implement the new law. There will be fights over words like “quality” or how we define and measure success.

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Tags: Congress, Consumer Price Index, Gwen Florio, Health care reform, Kaiser Family Foundation, Kaiser Media Fellowship, Mark Trahant, Medicare, Medicare Part D, Mitch McConnell, Patient Protection and Affordable Care Act

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.

We’re still confused about the new health care insurance law. But there is this twist: More of us are starting to figure out what the Patient Protection and Affordable Care Act means to our families.

The Kaiser Family Foundation reports in a May poll: “Confusion over the new health reform law declined but remains widespread, with 44 percent of the public saying they were confused in May, compared to 55 percent in April. Moreover, more than a third of Americans (35 percent) say they do not understand what the impact of the law will be on themselves and their families, while 61 percent report feeling they do understand what that impact will be.”

It’s also interesting to see how we are learning about this new law. “More than half report having gotten information from friends and family (68 percent), or from cable (63 percent) or broadcast news programs (55 percent). Further breaking down those getting health reform information from cable news, 25 percent of Americans indicated their main cable source on this topic was FOX News, 22 percent named CNN and 6 percent MSNBC. In fact, cable news still tops the list of the public’s “most important” sources of news about the new law, with 30 percent saying they rely on that source more than any other.”

If cable news is teaching America about health care reform, well, let’s just say, there will be a lot more to learn later.
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Tags: CNN, Fox News, Gwen Florio, Heatlh care reform, Indian Health Service, Internal Revenue Service, IRS, Kaiser Family Foundation, MSNBC, Patient Protection and Affordable Care Act, U.S. House of Representatives