Speak Your Piece: Indian ‘Health Reform’

[imgbelt img=IHScounties.gif]The joke in Indian country is that you can’t get sick after June — because that’s when the Indian Health Service runs out of money. Not many people are laughing.


study last month by the U.S. General Accountability Office put this in perspective:  

“Sixty of the 66 federal and 73 of the 103 tribal CHS programs that responded to GAO’s survey reported that in fiscal year 2009 they did not have CHS funds available to pay for all services for which patients otherwise met requirements.”

Moreover 11 of 60 Contract Health Services programs reported running out of money before the end of the fiscal year. Elected officials know this happens. “The joke is if you’re in Indian health care don’t get sick after June,” said Sen. Tom Coburn, the Oklahoma Republican, “because that’s when it runs out of money.”

Some health facilities told the GAO that they found a way to pay after the money ran out. The government reported:

For example, some federal CHS programs reported helping patients locate free or low-cost health care. Tribal CHS programs reported using a variety of strategies not available to federal CHS programs. For example, 46 of 103 tribal CHS programs that responded to GAO’s survey reported supplementing their CHS programs’ funding with tribal funds, which are earned from tribal businesses or enterprises.

So what does GAO think IHS should do about this? For starters, get better data to more accurately reflect the needs of Indian people. I can’t argue with that. But the government investigators also ought to tell Congress to do its damn job and appropriate enough money.

There is a bigger question here, however: What is the business model for the Indian Health Service and the Indian health system? 

The IHS is a federal agency that directly operates clinics and hospitals. The Indian health system is broader. It uses money from IHS (and other sources) to fund tribal and other health providers. 

This puts the IHS in the position of having to act more like an insurance company, limiting or denying claims, rather than acting like a government agency.

It’s that diffusion of mission — IHS as funder, operator and insurance company — that makes it far more complicated to be clear about the meaning of health care reform to American Indians and Alaska Natives. 

This is especially true when the health care reform law and the funding for the Indian health system remain on separate (and unequal) tracks.

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 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.