Friday, February 29, 2008

S.1200, Indian Health Care Improvement Act Amendments of 2007

The United States Government maintains three distinct medical systems. The first is the health system provided by the Department of Defense to active duty military. Until Bush the military system has been first rate. Of course, Bush being Bush care for our wounded warriors has suffered. Scandals such as those we saw at Walter Reed were, for the most part, DOD system problems related directly to the failures of the Bush administration to properly plan for the consequences of the Iraq war.

The second medical system is provided by the Department of Veterans Affairs for veterans who are no longer eligible for care from the DOD system. The Veterans Health Administration's system was long the butt of jokes, but during the Clinton administration it was upgraded to one of the most efficient patient centered and highest quality health care systems in the world. Some say the rebirth of the VHA was Clinton's most spectacular achievement. The VHA continues to provide some of the best care in America.

Both the military and VA systems are subject to close Congressional oversight. Despite the efforts of the Bush administration to "go cheap" in the last several budget cycles, Congress has worked in a bipartisan way to make sure the Department of Defense and VA health systems are close to fully funded.

The third health care system operated by the United State Government provides care to between 1.9 and 2.8 million Native Americans who are members of over 562 tribes. Indian Health Services operates 48 hospitals and 603 outpatient clinics.

Neglect is the word that best describes Native American health care. The law authorizing health care for Native Americans, The Indian Health Care Improvement Act, 25 USC 1603 et seq was passed in 1976 and hasn't been updated in 16 years. Although the Act expired in 2000, it has been "renewed" annually at reducing funding levels each of the last 7 years.

Earlier this week, after a nearly decade long struggle lead by Sen. Byron Dorgan (D-North Dakota), chairman of the Senate Indian Affairs Committee, the Senate passed S.1200 Indian Health Care Improvement Act Amendments of 2007 83 to 10.

More after the break.

The Senate bill finds the following:

"(1) Federal health services to maintain and improve the health of the Indians are consonant with and required by the Federal Government's historical and unique legal relationship with, and resulting responsibility to, the American Indian people.

"(2) A major national goal of the United States is to provide the resources, processes, and structure that will enable Indian Tribes and tribal members to obtain the quantity and quality of health care services and opportunities that will eradicate the health disparities between Indians and the general population of the United States.

"(3) A major national goal of the United States is to provide the quantity and quality of health services which will permit the health status of Indians to be raised to the highest possible level and to encourage the maximum participation of Indians in the planning and management of those services.

"(4) Federal health services to Indians have resulted in a reduction in the prevalence and incidence of preventable illnesses among, and unnecessary and premature deaths of, Indians.

"(5) Despite such services, the unmet health needs of the American Indian people are severe and the health status of the Indians is far below that of the general population of the United States."

The Senate bill also declares that "it is the policy of this Nation, in fulfillment of its special trust responsibilities and legal obligations to Indians--

"(1) to assure the highest possible health status for Indians and Urban Indians and to provide all resources necessary to effect that policy;

"(2) to raise the health status of Indians and Urban Indians to at least the levels set forth in the goals contained within the Healthy People 2010 or successor objectives;

"(3) to ensure maximum Indian participation in the direction of health care services so as to render the persons administering such services and the services themselves more responsive to the needs and desires of Indian communities;

"(4) to increase the proportion of all degrees in the health professions and allied and associated health professions awarded to Indians so that the proportion of Indian health professionals in each Service Area is raised to at least the level of that of the general population;

"(5) to require that all actions under this Act shall be carried out with active and meaningful consultation with Indian Tribes and Tribal Organizations, and conference with Urban Indian Organizations, to implement this Act and the national policy of Indian self-determination;

"(6) to ensure that the United States and Indian Tribes work in a government-to-government relationship to ensure quality health care for all tribal members; and

"(7) to provide funding for programs and facilities operated by Indian Tribes and Tribal Organizations in amounts that are not less than the amounts provided to programs and facilities operated directly by the Service."

According to Sen. Ken Salazar (D-CO) key provisions of the bill include:

# Funds and expands programs to increase the number of Indians entering the health profession and providing health services.
# Authorizes a wide-variety of health services and programs to expand access to treatment, facilities and address backlogs.
# Implements authority for IHS/tribal programs to collect Medicare and Medicaid reimbursements.
# Establishes and maintains programs in Urban Centers to make health services more accessible and available to Indians living in urban areas.
# Authorizes behavioral health prevention and treatment services.
# Amends the Social Security Act to provide greater opportunities for Native Americans to access Medicare, Medicaid and SCHIP.
The bill was not without opposition. Jerry Reynolds of Indian Country Today reports
The reauthorization effort has met with Republican resistance in four consecutive Congresses. Health services for urban Indians have been a point of contention for a Republican faction, and Johnson said they remain one. ''They're still in the group of concerns that some members still have.''
Notable among the opponents are the two Republican senators from Oklahoma. Sen. Tom Coburn was particularly vocal in his opposition.
“Today the Senate voted to ignore the extensive problems within our Indian Health Services and reauthorized the same, broken system. Without addressing wait lines, rationing and inferior quality in our current system we are violating our trust obligations to tribal members across the country. I will continue my efforts to reward innovation and fix the inferior health services provided some to Indian communities.”
Virtually no other senator whose state has a significant Native American population voted against the bill. You can find the Ayes and Nays here.

Senator Mike Enzi (R-Wyo) issued a statement typical of Republican Senators from western states.
I applaud the Senate for passing the “Indian Health Care Improvement Act,” S. 1200, a bill that will move the country forward in the right direction to improve Indian health care programs.

For too long, we have neglected our duty to review the Indian health care program and ensure that it continues to deliver high quality health care efficiently. This bill is a critical step to renew and reinvigorate Indian health care services.

Indians face significant health care challenges, including higher rates of infant mortality, suicide, and diseases like diabetes, and a shortage of mental health professionals. This bill will begin to improve health care quality by ensuring that Indians have access to the health care services they need.

The Senate bill makes improvements to the Indian Health Care Improvement Act, which has not been updated in 15 years. The original Act expired in 2000 and has been renewed at inadequate funding levels every year since then.

The bill, passed in the Senate today by an 83-10 vote, improves health care services for American Indians, authorizes mental and behavioral health care, and promotes disease prevention and substance abuse addiction treatment as well as improved physical health for American Indians. The bill also allows eligible American Indians to fully participate in Medicare and Medicaid.

Times have changed and so has health care. This bill brings Native American health care, services, and access up to speed with the rest of the nation.

I am pleased that much of the bill passed by the Senate includes provisions from the bipartisan bill I introduced in the last Congress with Senator John McCain (R-Ariz.), Senator Byron Dorgan (D-N.D.) and Senator Lisa Murkowski (R-Alaska).

I’m glad that we have moved forward on this legislation. I look forward to working with others to get this bill signed into law.
Hopefully final passage will come soon. New Mexico's Rep. Tom Udall (D-NM) among others has asked that Speaker of the House Nancy Pelosi (D-CA) move Indian Health Care to the top of the House agenda