Tribal healthcare, what's missing?

Panel hears of gaps in tribal health care
Senators looking at reform options
WASHINGTON - The statistics paint a grim picture of Native American health: Life expectancy is six years less than any for other ethnic group, the death rate from diabetes is triple that of the rest of the country, and the infant mortality rate is 40 percent higher. From cirrhosis to suicide, few suffer more than Native Americans.

The numbers are not new, but Jefferson Keel, lieutenant governor of the Chickasaw Nation, thought members of the Senate Committee on Indian Affairs should hear them again.

Keel, who also serves as first vice president of the National Congress of American Indians, testified Thursday on Capitol Hill at a hearing on reforming a health system that tribes say is starved for money. It receives only about half of what Congress has authorized, they said.
In addition, Native Americans testified that care is delivered inconsistently from state to state and that the patchwork system is made worse by constant turnover at Indian Health Services, the federal agency overseeing medical care on reservations.

The Senate recently confirmed Yvette Roubideaux, a doctor who grew up in South Dakota as a member of the Rosebud Sioux Tribe, as the latest IHS director.

"It's clear the federal government isn't fulfilling its trust responsibility to provide health care to Indian Country," said Sen. Jon Tester, D-Mont., chairman of the hearing.

Government-paid health care is provided to about 1.9 million Native Americans living on or near reservations in 35 states. They receive care from IHS facilities and from private providers contracted by the government.

It's been about a decade since the Indian Health Care Improvement Act was updated, and tribal leaders say the timing for a new bill might never be better now that President Obama and congressional leaders want to revamp the U.S. health care system.

"Perhaps nowhere in this country is the debate on health care reform more important, or will it have more of an impact, than in tribal communities," Keel said.

Tribal leaders have joined to recommend several changes:

# Increase Native American enrollment in government programs, such as Medicaid.

# Expand options on reservations for long-term care.

# Reduce shortages in the Native American health system work force by providing employee incentives.

# Exempt tribes from penalties, such as a mandatory insurance requirement, that could be part of health care reform working its way through Congress.

Money would help, too, they said. Tribes have been innovative with medical programs because "quite frankly ... we've been forced to," said Valerie Davidson of the Alaska Native Tribal Health Consortium. "We're at a point where we have no more margin."

But Sen. John Barrasso of Wyoming, the top Republican on the committee, said money alone can't fix the problem. Changes are necessary, too, he said.

"We must simply do more than reauthorize a troubled, inefficient system," he said.

Reach Ledyard King at lking@gannett.com.