The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to 2.2 million Native Americans belonging to 567 federally recognized Tribes. IHS is the principal federal health care provider and health advocate for Native people, and its mission is to raise their physical, mental, social, and spiritual health to the highest possible level.
On the Tulalip Reservation, the Karen I. Fryberg Tulalip Health Clinic is an extension of IHS. The Health Clinic makes it possible to ensure comprehensive, culturally acceptable personal and public health services are available and accessible to tribal members living on or around the reservation.
On Friday, May 12, the IHS Portland Director’s Recognition of Excellence Ceremony was held in downtown Portland, Oregon. Among the very deserving awardees in attendance were familiar faces from the Karen I. Fryberg Health Clinic. They were there to be recognized for excellence and to accept a Portland Area Director’s Award on behalf of the Tulalip Diabetes Care and Prevention Program.
The IHS Portland Area covers all federal and tribal health clinics servicing Native Americans within the states of Washington, Oregon, and Idaho. Among all those health clinics and programs therein, only fifteen groups were recognized and given a Director’s Award.
“Personally, I feel very humbled and honored to receive this award and am grateful to [Director of Clinical Services] Dr. Cooper for taking the time to nominate our team,” said Monica Hauser, RN, CDE, and Certified Diabetes Educator. “I am extremely proud of our diabetes prevention team and am so happy this team has been recognized for everyone’s hard work and dedication to the people of this community.”
“I thought of all of the people who worked in this program before us. I felt their presence in this ceremony and I thank them for their efforts,” added Veronica Leahy, Diabetes Program Coordinator. “My hope is more of our people will come and receive the care and teachings from these truly caring and knowledgeable providers.”
The Tulalip Diabetes Care and Prevention Program is a culturally-grounded, comprehensive program for the treatment of diabetes, and promotion of long-term holistic health. Increasing community participating in health promotion activities has been a staple of the program. Components including individualized case management by certified diabetes educators, continuing education provider-led classes, support groups, Diabetes Day events, and Wellness Trail activities have all achieved the goal of increasing community awareness and engagement in healthy activities.
The Wisdom Warrior program tailored to local community needs has become a major hit. Wisdom Warriors includes a 6-week Stanford University Chronic Disease Self-Management Plan as well as monthly Provider Classes on holistic health related and medical topics. Activities include field trips to the mountains for low-impact day hikes, Medicine Wheel garden classes, support of six tribal department gardens, cooking demonstrations and classes for all ages.
Upcoming Diabetes Prevention Program events include:
Garden Day – June 3rd (at Youth Services)
Monthly Wisdom Warrior Provider Class – June 8th
Diabetes Day – June 15th
Medicine Wheel Garden Day – June 21st
For more information about the Diabetes Care and Prevention Program please contact Monica Hauser, (360) 716-5725, email@example.com or Veronica Leahy, (360) 716-5642, firstname.lastname@example.org
WASHINGTON (KELO AM) – U.S. Sen. John Thune (R-S.D.) applauded the Senate’s adoption of his amendments to the Every Child Achieves Act (ECAA), a bill that would reduce federal interference in education, and put governors, school boards, parents, and teachers back in charge. Thune’s amendments would require the secretary of education to coordinate with other federal agencies to report on efforts to address youth suicides in Indian Country and expand the use of Project School Emergency Response to Violence (Project SERV) funds to include preventative efforts against youth suicide and other school violence.
“There is no greater tragedy for a family than losing a child, sibling, or friend, especially to suicide,” said Thune. “Sadly, according the Indian Health Service, suicide is the second leading cause of death for Indian youth in Indian Health Service areas, with a death rate four times the national average. While there is a wide range of known factors that contribute to youth suicide, I think it’s important for us to get a better understanding of how we can better address both prevention and response to suicide in Indian Country.”
Thune’s amendment would require, within 90 days from the date of enactment, the secretary of education to coordinate with the secretary of interior and secretary of health and human services to report on a variety of information, including:
The federal response to the occurrence of high numbers of student suicide in Indian Country
A list of federal resources available to prevent and respond to student suicide outbreaks, including the availability and use of tele-behavioral health
Interagency collaboration efforts to streamline access to programs, including information on how the Departments of Education, Interior, and Health and Human Services work together on program administration
Any existing barriers to timely program implementation or interagency collaboration
Recommendations to improve or consolidate existing programs or resources
Tribal feedback to the federal response
The Senate also adopted Thune’s amendment that would expand the authorized use of Project SERV funds to include initiating or strengthening prevention activities in cases of chronic trauma or violence, such as the suicide crisis in Indian Country or gang violence in schools.
Local educational agencies and institutions of higher education seeking approval to initiate or strengthen prevention activities would be required to:
Demonstrate a continued disruption or a substantial risk of disruption to the learning environment that would be addressed by such activity
Provide an explanation of proposed activities designed to restore and preserve the learning environment
Provide a budget and budget narrative
Such requests would be subject to the discretion of the secretary and the availability of funds.
Thune also introduced amendments to ECAA that would exempt K-12 schools and higher education institutions from Obamacare’s employer mandate, allow Tribal Grant Schools to participate in the Federal Employees Health Benefits program, and provide parity for tribal colleges to compete for certain funding sources. These amendments were not adopted during the Senate’s consideration of ECAA.
A national law firm that specializes in Indian law is donating $3.5 million to improve medical care for tribal members. The decision comes after the firm, which has offices in Anchorage, helped win a case before the U.S. Supreme Court involving hundreds of millions of dollars for tribal health organizations.
The law firm Sonosky, Chambers, Sachse, Miller and Munson last year was one of the law firms that successfully fought for back payments to tribes from the Indian Health Service and Bureau of Indian Affairs. Attorney Lloyd Miller, a partner in the firm, says the firm wanted to give back to Indian Country, and recognizes the firm’s 40-year anniversary:
“We wanted to give back to Indian Country,” said Miller. “And since so much of our work involves health care issues, we wanted to focus our charitable contribution program on improving health care facilities, either entire clinics or acquisition of critical equipment such as cat scans, MRI machines and the like.”
Four-hundred-fifty thousand dollars each is going to the statewide Alaska Native Tribal Health Consortium for patient housing, and to the Anchorage-based Southcentral Foundation for construction of a behavioral health clinic. Last year, ANTHC was paid $153 million for contract support costs, or overhead, that had been in litigation since 1990. Southcentral was awarded $96 million. Miller says $200,000 each is going to the Choctaw, Cherokee, and Chickasaw nations:
“For the most part we’re working with tribes we know very well,” said Miller. “Tribes we’ve had a relationship with since the firm’s founding, in the case of some of the tribes we’ve worked with for 40 years.”
Miller says he hopes their donation will inspire other companies that work with tribes on self governance in health:
“We encourage them to come up with matching funds so that the tribes can do more for their people.”
Miller says in the coming year, the firm will be working on grants to other tribes in Oklahoma, and in North Dakota, South Dakota, and Montana.
FARMINGTON — The acting head of the Indian Health Service has highlighted the federal agency’s proposed 2016 funding to provide health care services to Native Americans.
During a teleconference on Thursday, Acting IHS Director Yvette Roubideaux outlined the proposed budget for the agency, which is included in the proposed $4 trillion federal budget announced this week by President Barack Obama.
The IHS is an agency within the U.S. Department of Health and Human Services. It provides health care services to approximately 2.2 million American Indians and Alaska Natives through more than 650 hospitals, clinics and health stations on or near reservation lands.
The proposed budget for the IHS would total $5.1 billion, which is an increase of $461 million from the fiscal year 2015 budget, Roubideaux reported.
Among the funding proposals Roubideaux mentioned is $718 million for contract support costs. She noted that the budget proposes mandatory appropriation for contract support costs starting in 2017.
The budget proposes a $70 million increase to the Purchased/Referred Care Program, which pays for health care services obtained from the private sector or for services not available by the IHS.
A total of $185 million has been requested to provide funding for construction projects listed under the Health Care Facilities Construction Priority List.
Under the proposal, about $20.5 million would be used for the facility design and to start construction of the Dilkon Alternative Rural Health Center in Dilkon, Ariz.
Funding would also be used to complete construction of the Gila River Southeast Health Center in Chandler, Ariz., and to start the construction of the Salt River Northeast Health Center in Scottsdale, Ariz., and the Rapid City Health Center in Rapid City, S.D.
The budget proposes that $115 million be allocated for the Division of Sanitation Facilities Construction, which supplies water, sewage disposal and solid waste disposal facilities to homes.
The budget proposes an annual appropriation of $150 million for the next three years for the Special Diabetes Program for Indians, which started in 1997 and provides diabetes prevention, awareness, education and care programs to IHS, tribal and urban facilities.
Joining Roubideaux for the teleconference was Jodi Gillette, special assistant to the president for Native American Affairs, who said the president’s approach to funding the programs and services that address Indian Country were outlined during the 2014 White House Tribal Nations Conference.
She noted that last year, the president and first lady Michelle Obama visited the Standing Rock Sioux Tribal Nation in North Dakota.
During their visit, they heard from young tribal members who shared stories about dealing with social issues like alcoholism, poverty and suicide.
In response to that visit, a new initiative focusing on Native American young people — Generation Indigenous — was launched, Gillette said.
Investments to start Generation Indigenous were included in the proposed IHS budget, including $25 million to expand the Methamphetamine and Suicide Prevention Initiative.
That funding would go toward increasing the number of child and adolescent behavioral health professionals working to provide direct services to Native youth.
Another $50 million has been requested within the Health and Human Services Department to start the Tribal Behavioral Health Initiative for Native Youth.
Noel Lyn Smith covers the Navajo Nation for The Daily Times. She can be reached at 505-564-4636 and email@example.com. Follow her @nsmithdt on Twitter.
Once again, the federal government is funding “navigators” in Montana to help the uninsured buy private, subsidized health coverage this fall — with a new emphasis on Native American consumers.
Earlier this month, federal officials awarded $609,000 in navigator grants to three Montana groups: Planned Parenthood of Montana, the Montana Health Network and the Montana Wyoming Tribal Leaders Council.
“We had great, great success with the program last year,” Martha Stahl, CEO of Planned Parenthood of Montana, said Monday. “I think it’s a great way to continue our mission of connecting people with affordable health care, which is what we’re all about.”
Stahl said her group will be working closely with the other two grant recipients and other organizations to sign up more people for health insurance under the Affordable Care Act, as well as target Native Americans. Planned Parenthood and the Health Network had navigator programs last year.
Navigators, who must be certified by the state insurance commissioner, help people buy private health insurance through the online “marketplace,” a key part of the ACA, the federal health-care overhaul also known as “Obamacare.”
Individuals buying policies on the marketplace can get federal subsidies to offset the cost of those policies. Lower-income consumers also can get further discounts on certain marketplace policies.
Most consumers who earn less than 400 percent of the federal poverty level — about $79,000 for a family of three — are eligible for the subsidies, which are paid directly to the insurance company.
The Obama administration launched the marketplaces last October in 34 states, including Montana, initially with disastrous results. Beset with technical problems, the marketplaces barely worked.
However, by the end of March, more than 36,000 Montanans gained coverage through marketplace policies, out of 8 million people nationwide.
The marketplaces will open again this year Nov. 15. Customers can shop for and purchase new policies for 2015. Four companies will be offering policies on Montana’s marketplace.
Cheryl Belcourt, executive director of the Montana-Wyoming Tribal Leaders Council in Billings, said the group will use its $142,000 grant to hire some navigators and coordinate with other groups to encourage Native Americans both on and off reservations to buy marketplace policies.
Many Native Americans think the policies are not for them, because they expect to use the Indian Health Service and don’t face a tax penalty if they’re not insured, Belcourt said.
However, the affordable private policies and their low-cost coverage can expand health care for Native Americans, she said.
“This is an opportunity to address the health disparities of Native American people,” Belcourt said. “We want to be able to really make a difference in terms of the quality of life for Indian people.”
Chris Hopkins of the Montana Health Network, a consortium of smaller hospitals and health-care centers, said its $175,000 grant will be used to add nine new navigators to the 20 it already trained with last year’s grant. Most of them are staffers at hospitals and nursing homes.
“Our focus is to have local people providing services in their own community, rather than having someone come in from the outside, do a presentation, and then leave,” he said.
The Montana Primary Care Association, which represents federally funded health clinics, had a navigator program last year but did not get a grant this year.
Amanda Harrow of the association said clinics will continue to work with various groups to help people sign up for ACA-subsidized policies.
Health and Human Services Secretary Sylvia M. Burwell announced last week that individuals eligible to receive health care from an Indian Health Service (IHS), tribal, or urban Indian health program provider are now able to claim an exemption from the shared responsibility payment through the tax filing process starting with the 2014 tax year. This benefit was previously only available to members of federally recognized tribes (including Alaska Native shareholders). American Indian and Alaska Native individuals will continue to have the option of submitting the exemption application through the Health Insurance Marketplace.
Prior to this week’s announcement, only individuals who were members of a federally recognized tribe were able to claim an exemption through the federal tax filing process. Individuals who are eligible to receive services from an Indian health care provider are eligible for a separate hardship exemption but were required to obtain this exemption through the Health Insurance Marketplace by filing a paper application.
The availability of the online tax filing process to apply for the hardship exemption will save time and reduce duplication of effort. Qualification for the Indian exemption can be established by attestation of membership in a federally recognized tribe or eligibility to receive services from an Indian health care provider.
Secretary Burwell first announced this updated rule at the Secretary’s Tribal Advisory Committee meeting on September 18, 2014. This benefit of claiming the exemption through the tax filing process was initiated based on requests by tribal leaders. The IHS worked closely with the Centers for Medicare and Medicaid Services and the Internal Revenue Service to extend these options to individuals eligible to receive services from an Indian health care provider.
The IHS, an agency in the U.S. Department of Health and Human Services, provides a comprehensive health service delivery system for approximately 2.2 million American Indians and Alaska Natives who are members of federally recognized tribes.
WASHINGTON — Tribal health programs working to serve native people are not seeing funding of administrative costs keeping pace with need, and the Indian Health Service and the Bureau of Indian Affairs owe millions to tribal governments.
“The federal government has broken too many promises with tribes and though we have more work to do, I am pleased that we are seeing good progress with Alaska tribes receiving the money they are owed,” Alaska Sen. Mark Begich told the Alaska Native Tribal Health Consortium last month. “Failure to pay the full costs is unacceptable and I will continue to use my position on the Senate Indian Affairs Committee to keep up the pressure on the federal government.”
The IHS, a Department of Health and Human Services agency, provides health service systems for about 2.2 million of the nation’s estimated 3.4 million American Indians and Alaska Natives.
Funds allocated by the IHS, currently $4.4 billion per year, go toward administering medical care to tribes or are turned over to tribes for them to administer the care themselves. The IHS had been failing to provide full payments of contract costs until the Supreme Court ruled in June 2012 that the government must pay, determining that the tribes had been underpaid “between 77 percent and 92 percent of the tribes’ aggregate contract support costs” during previous decades.
Yet, according to Jacqueline Johnson Pata, executive director of the National Congress of American Indians, “payment has not happened.”
“The class action lawyers recently reported to NCAI on the lawyer’s discussions with the Justice Department. Although they couldn’t share much information, they did explain that there are close to 9,000 claim years at issue involving about 500 tribes and 19 years worth of contracts (1994-2013),” she told the U.S. Senate Committee of Indian Affairs last year.
Sen. Begich introduced Senate Bill 2669 in July to the Senate Appropriations Committee
to mandate funding for certain payments to Indian tribes and tribal organization. Additionally, the federal government has treaty and statutory obligations under the Indian Self-Determination and Education Assistance Act of 1975, which requires the government to contract with tribes to operate BIA and IHS programs. The agreement between the government and tribes is embedded in Article I, Section 8, of the U.S. Constitution.
At the end of 2013, less than 1 percent of thousands of claims in more than 200 lawsuits filed by tribes seeking a combined $200 billion had been settled — just 16 claims of an estimated 1,600.
Of the 566 nations the federal government recognizes, 229 are spread across the vast 572,000 square miles of Alaska, where they occupy small villages in remote areas — many only accessible by air or boat. For these tribes in remote areas, seeing a doctor might be inconvenient, to say the least, and almost definitely costly.
Lead counsel in the cases establishing government liability for IHS’s failure to pay, Lloyd Miller, an attorney based in Anchorage, Alaska, said IHS is severely underfunded.
“IHS is a prepared health plan paid for with a lot of blood and millions of acres of land,” Miller said. “Because the government took away their lands, there’s a responsibility.”
IHS gets $4.4 billion from Congress annually for what’s estimated to be a $15 billion need to meet the costs, he said.
Miller represents about 60 tribes, each with several claims filed for the costs owed.
In an August 2007 letter to the Senate Committee on Indian Affairs requesting an oversight hearing, Alaskan tribal health care providers reminded the committee that the Indian Self-Determination Act requires money to provide federal trust responsibilities.
“We write to once again call your attention to the grave crisis we face as a result of insufficient contract support cost appropriations which, together with Indian Health Service policies, have left our tribal organizations with annual shortfalls running from $2 million to over $8 million. We respectfully request that the Senate Indian Affairs Committee convene an urgent oversight hearing this Fall, to review what has become a genuine crisis in Indian country, and a crisis that has seriously eroded the national policy of Tribal self-governance and the delivery of quality health services to Alaska Native people,” the letter stated.
By August of this year, 12 of Alaska’s tribal health providers received $449 million to resolve contract support costs disputes with the IHS. Another 11 providers were still in negotiations. The Alaska Native Tribal Health Consortium, serving more than 143,000 native people, received the largest payment, with a $153 million settlement that includes $115.5 for past-due costs and $37.7 million in interest. At about $128 million, Southcentral Foundation received the next largest settlement.
The NCAI has been working with tribes and the IHS on contract costs since the Indian Self-Determination Act went into effect.
The congress is hosting the annual Tribal Unity Gathering and Legislative Impact Days on Sept. 16 and 17 in Washington. During the event, tribal leaders and representatives will meet with their delegates to the U.S. Congress to encourage action on important delegation before this session ends. IHS appropriations will be among the issues discussed.
“There’s strong support from the House and Senate,” said Amber Eberb, program manager of the NCAI Policy Research Center. “There’s quite a few champions who understand that tribes administering their own programs to respond to their community needs is more effective than a federal agency.”
There’s still progress to be made, Eberb said.
“Contract costs and other treaty issues should not be considered discretionary but mandatory,” Ebarb said. “All program money that uphold treaty agreements should be mandatory. It’s morally correct to do. Perhaps a little difficult to do right now.”
Disparities in well-being
American Indian and Alaska Native (AI/AN) death rates were nearly 50 percent greater than rates among non-Hispanic whites during 1999-2009, according to a study by the Centers for Disease Control.
The study was carried out by the CDC’s Division of Cancer Prevention and Control, the CDC’s National Center for Health Statistics, CDC researchers, the IHS, and partners from tribal groups, universities and state health departments.
Among AI/AN people, cancer is the leading cause of death, followed by heart disease, while the opposite is true for other races studied;
Death rates from lung cancer have shown little improvement in AI/AN populations. AI/AN people have the highest prevalence of tobacco use of any population in the United States;
Deaths from injuries were higher among AI/AN people compared to non-Hispanic whites;
Suicide rates were nearly 50 percent higher for AI/AN people compared to non-Hispanic whites, and more frequent among AI/AN males and persons under age 25;
Death rates from motor vehicle crashes, poisoning, and falls were two times higher among AI/AN people than for non-Hispanic whites;
Death rates were higher among AI/AN infants compared to non-Hispanic white infants. Sudden infant death syndrome and unintentional injuries were also more common. AI/AN infants were four times more likely to die from pneumonia and influenza;
By region, the highest mortality rates were in the Northern Plains and Southern Plains, while the East and Southwest had the lowest.
“Many of the observed excess deaths can be addressed through evidence-based public health interventions,” the report concluded.
In November 2013 testimony before the Senate Committee on Indian Affairs, Alaska Sen. Lisa Murkowski said:
“I listened very intently yesterday at the tribal summit when the President spoke. I went there specifically to hear what he was going to say on the issue of contract support costs. What I heard him say is, we have heard you loud and clear, but we are still working to find the answers. I don’t think we need to work to find any answers. I think that the court laid it out very, very clearly. It said that full reimbursement will be provided. So we have to make that happen within that budget. We have to make that priority.”
Murkowski said she had listened to the stories of the impact of lack of funds, saying, for example, that the regional health provider in Juneau had to close its alcohol treatment facility. Further north, in the Yukon Delta, the regional health provider laid off 20 employees, permanently closed 40 vacant positions, and reduced services for elders, she continued.
The impacts of the sequestration, she said, also meant that tribes would not be able to reduce waiting times at emergency rooms or outpatient and dental clinics.
“The impact, I think we recognize, has been significant,” she said.
Murkowski submitted comments she received from Alaska Natives around the state, including the Association of Village Council Presidents.
Proposed Increase for IHS Budget
“Tribes have not recovered from sequestration that resulted in across-the-board cuts to all federal programs that tribes are reliant upon. Nowhere was this more impactful than to the Indian Health Services, where due to sequestration, continuing resolutions, and the 16 day government shutdown — healthcare to Indian people was jeopardized,” U.S. Senate Committee on Indian Affairs Chairman Jon Tester, of Montana, said in March.
Tami Truette Jerue, tribal administrator and director of social services for the Anvik Tribal Council in Alaska addressed the committee’s oversight hearing in February. The Anvik are an Athabascan village of about 275 members on the west bank of the Yukon River.
Jerue represented the 37 federally recognized tribes that make up the Tanana Chiefs Conference, an inter-tribal health and social services consortium that serves an area of Interior Alaska that is roughly the size of Texas.
She delivered a message from more than 200 tribes across Alaska:
“It is absolutely essential that, without regard to technical land titles and the technical Indian country status of lands or tribal communities, our Tribes must have the tools necessary to combat drug and alcohol abuse, domestic violence, and violence against women. Fighting these scourges in our communities and healing our people cannot be made to stand on technicalities. We need to get to work, and now. And we need Congress’s help to do that. The State is not the problem, because the State is nowhere to be found in most of our Villages….
“Today, the tribes of Alaska come to you, not as victims of a failed governmental policy, but as powerful and responsible advocates for our people. We are stepping up to do what we must do. But without equally firm action from Congress, our people will suffer, we will continue with decades more of litigation battles and loopholes will continue to be found which deny our tribes the funding necessary to improve law and order in our communities.”
In the budget for the 2015 fiscal year, the Obama administration proposed a 4.5 percent increase for IHS, representing a $200 million increase over the current level to $4.6 billion.
The 2015 budget request includes:
An additional $50 million to help obtain health care from the private sector through the Purchased/Referred Care program (formerly known as the Contract Health Services program). This program allows for the purchase of essential health care services that the IHS and tribes do not provide in their local facilities;
An additional $71 million to support staffing and operating costs at four new and expanded facilities;
An additional $30 million to fully fund the estimated amount of contract support costs for new and expanded contracts and compacts in fiscal year 2015. This will help tribes cover the cost of administrative functions for compacts or contracts established under the authority of the Indian Self-Determination and Education Assistance Act;
An additional $31 million to address medical inflation costs;
Additional funding to pay costs for new tribes and restoration of reductions in the fiscal year 2014 operating plan.
In his statement, Tester noted the “positive highlights” in the budget request.
“The Committee is pleased that the Administration finally understands its legal obligation to fully fund Contract Support Costs for the both the Indian Health Service and Bureau of Indian Affairs,” Tester said. “I am particularly encouraged by the $11 million increase for social services and job training to support an initiative to provide a comprehensive and integrated approach to address the problems of violence, poverty, and substance abuse.”
Covering IHS shortfalls with the Affordable Care Act
The Southeast Alaska Regional Health Consortium and more than 50 tribes wrote a letter to President Obama on Oct. 13.
In part, it said, “Among your administration’s most important achievements has been the development of historic settlements with Indian Tribes in several major litigations, its advocacy for amendments to the Indian Health Care Improvement Act and the Violence Against Women’s Act, and its commitment to critical appropriations measures. But when it comes to honoring the Nation’s commitment to the contracting and compacting Tribes who were historically, and illegally, underpaid, and who continue to be underpaid, the administration has permitted fiscal concerns to eclipse the imperative to do justice and to honor the nation’s obligations.”
In July the IHS reached a settlement with the consortium for claims during the years 1999 through 2013. The payment — $39.5 million plus interest — totals about $53 million.
“A lot of tribes had to close down programs because of lack of funds,” Andrea Thomas, outreach and enrollment manager of SEARHC, told MintPress News. “Part of what the settlement can do is bring back what was lost.”
Alaska did not create reservations like the 48 contiguous states, and many Native communities formed consortiums, like SEARHC, to use IHS funding for health care to serve them all.
SEARHC is a nonprofit tribal health consortium of 18 Native communities which serves the health interests of the Tlingit, Haida, Tsimshian, and other Native people of Southeast Alaska. In 1982, the consortium took over operations at the IHS clinic in Juneau, and then took over operations at Mt. Edgecumbe Hospital, formerly an IHS-run facility, in 1986.
“In Alaska we have the highest cost of health care in the nation,” Thomas said. “There’s vast wilderness surrounding each place. In order for me to get out of my community, I’d have to fly or take a ferry. This gets incredibly expensive.”
Many Alaskan villages have a community health clinic, but complicated procedures such as chemotherapy or serious surgeries, require patients to go to hospitals at regional hubs or to the Alaska Native Medical Center in Anchorage. The burden is on the tribal health consortium to pay the costs of a commercial jet, float plane, ferry, or boat.
If a medical evacuation helicopter is needed, it would cost SEARHC about $95,000 — a cost that could be absorbed by the Affordable Care Act.
“The issue is that IHS only provides about half the money for services,” Thomas said. “We rely on other revenues like grants and billing Medicare and Medicaid. If native people enroll, it puts more money back and we could offer more services or expanded services.”
Further, a member of a federally recognized tribe can get a lifetime exemption. Alaska Natives and American Indians are exempt from Affordable Care Act tax penalties because they receive care through the IHS. But through the new health care scheme, they are eligible for subsidies from private insurance. Thomas said that those who fall between 100 percent and 500 percent of the federal poverty level pay a monthly premium, but no deductibles or out-of-pocket expenses.
Yet, of more than 100,000 self-identified Alaskan Natives or American Indians, only 115 had signed up for health insurance through the Affordable Care Act as of April.
“Not a lot of people realize what the Affordable Care Act does for Alaskan Native people,” Thomas said.
Coverage also extends to Native people who are not enrolled members of a federally recognized tribe and meet federal guidelines. Thomas said they can receive a lifetime hardship exemption, rather than a tribal exemption, and there may be some out-of-pocket expense.
Sen. Jon Tester (D-Montana) wants to know why the leadership of the Indian Health Service (IHS) has failed to hire permanent directors in one-third of its regional offices.
Tester, chairman of the Senate Committee on Indian Affairs (SCIA), highlighted his concerns in a letter sent July 24 to Department of Health and Human Services Secretary Sylvia Burwell.
“I write to express my concerns about the unmet needs of the Indian Health Service regarding staffing shortages at all levels of the Agency,” Tester wrote in the letter, which his staff shared with Indian Country Today Media Network. “In particular, I am disturbed by the number of Area Director positions that are now filled with ‘acting’ Directors. It is difficult to understand how the Agency will affect change if it does not have these key leadership positions filled with permanent staff.”
Tester noted to Burwell that of the 12 IHS regions nationwide, four currently have acting area directors, including ones in Billings, Montana, and in Phoenix and Tucson, Arizona.
“These three regions alone represent a significant amount of the IHS service population,” Tester wrote. “The ability of these Regions to deliver quality health care to this population is impacted by the kind of leadership they have, and it would appear to me that the Agency is satisfied with temporary leadership. I can assure you that I am not satisfied.”
Tester asked Burwell to quickly fix this problem. “I urge you to take all necessary measures to fill the vacant Area Director positions,” he wrote. “I also request that you provide a written response detailing what specific actions the Indian Health Service and the Department of Health and Human Services plan to take to remedy the chronic inequitable staffing levels that exist throughout the agency.
“If there are legislative proposals that you believe would allow you to fill these positions more quickly, please feel free to share those as well,” he added.
In a recent interview with ICTMN, Tester discussed his concerns regarding current IHS Director Yvette Roubideaux, and he said that he has asked Burwell to investigate Roubideaux’ leadership.
“I think there are some communication issues that need to be worked out, and I’ve told [Roubideaux] exactly that,” Tester told ICTMN. “There needs to be a lot better communication between tribes and her.”
Tester said that there are “a lot of Native folks out there who don’t like [Roubideaux],” and he has heard from many of them.
“[T]he Indian Health Service is in tough shape, and there needs to be the leadership there that pushes the envelope and listens to the people on the ground…,” Tester said in the interview.
Tester said that he did not know whether Roubideaux would be re-confirmed to her position by the Senate because there has been consternation on his committee about doing so. Her re-nomination has been pending since April 2013. She has served in the job since 2009.
Sen. Mark Begich (D-Alaska) has been one of Roubideaux’ most vocal critics on the committee. “I will continue to push against moving her forward because I want to see some more results here,” he told ICTMN in February, saying that he wished for Roubideaux to resolve more contract support settlements with tribes and to be a more effective advocate on budgetary matters.
Senate staffers of members who sit on the committee have questioned why the White House has continued to support Roubideaux when it is clear that Democrats and many tribal leaders have problems with her leadership.
“It is time for a breath of fresh air at IHS,” said one Senate staffer, who asked to remain anonymous. “Dr. Roubideaux has had her opportunity to serve, and she can be proud of her accomplishments. But she needs to see the writing on the wall. It’s time to move on.”
Tester wrote in his letter to Burwell that at a SCIA field hearing he held earlier this year in Billings, Montana, he heard testimony that “revealed the challenges associated with lack of leadership at the top levels of the agency, including ineffective communication, lack of a strategic vision, uncertainty of purpose, and low employee morale.”
“[T]hese problems directly affect the quality of care that American Indians and Alaska Natives receive and more work must be done to resolve these issues,” Tester wrote. “The federal government must do more to ensure that we are living up to our treaty and trust responsibilities to our first Americans.”
PINE RIDGE, South Dakota — Denise Mesteth signed up for new health insurance through the federal Affordable Care Act, despite concerns that it may not be worth the money for her and other Native Americans who otherwise rely on free government coverage.
Mesteth, who has a heart murmur and requires medication and regular blood work, said she’s cautiously optimistic that the federal insurance will be superior to what she has now. Many other American Indians have been more reluctant to enroll, choosing instead to continue relying on the Indian Health Service for their coverage and taking advantage of a clause in the federal health reform law that allows them to be exempt from the insurance mandate if they meet certain requirements.
“If it’s better services, then I’m OK,” Masteth said of ACA. “But it better be better.”
Mesteth and other American Indians in South Dakota account for 2.5 percent of the people in the state who have signed up for insurance under the federal health care law, according to the latest signup numbers. The state, with nearly 9 percent of its overall population Native American, ranks third for the percentage of enrollees who are American Indian among U.S. states using the federal marketplace.
The Great Plains Tribal Chairmen’s Health Board, which provides support and health care advocacy to tribes, received $264,000 to help Native Americans in South Dakota navigate the new insurance marketplace.
Tinka Duran, program coordinator for the board, said people are primarily concerned about the costs of enrolling. Insurance is a new concept to most because health care has always been free, she said.
“There’s a learning curve for figuring out co-pays and deductibles,” she said.
During a U.S. Senate Indian Affairs Committee hearing in May, tribal leaders chastised IHS as a bloated bureaucracy unable to fulfill its core duty of providing health care for more than 2 million Native Americans and Alaska Natives. IHS acting director Yvette Roubideaux said changes were underway but that more money will be needed than the $4.4 billion the agency receives each year.
She noted that federal health care spending on Native Americans lags far behind spending on other groups such as federal employees, who receive almost twice as much on a per-capita basis. Meanwhile, American Indians suffer from higher rates of substance abuse, assault, diabetes and a slew of other ailments compared to most of the population.
Native Americans and Alaska Natives are exempt from the health insurance mandate if they meet certain requirements. ACA also permanently reauthorized the Indian Health Care Improvement Act and authorized new programs for IHS, which also is starting to get funds from the Veterans Affairs Department to help native veterans.
When American Indians do obtain insurance, it means fewer people are tapping the IHS budget, said Raho Ortiz, director of the IHS Division of Business Office Enhancement.
“If more of our patients have health insurance or are enrolled in Medicaid, this means that more resources are available locally for all of our patients,” Ortiz said in an emailed statement. “This, in turn, allows scarce resources to be stretched further.”
Those who sign up for federal health care can still use IHS facilities but have the option of seeking health care elsewhere, Ortiz said.
State Democratic Sen. Jim Bradford is among the skeptics. The Oglala Sioux member lives on the Pine Ridge reservation, home to two of the poorest counties in the nation.
The U.S. government provides health care to Native Americans as part of its trust responsibility to tribes that gave up their land when the country was being formed. Bradford and others object to the shift in health care providers on the principle that IHS is obligated by treaty to supply that care.
Harriett Jennesse, a member of the Lower Brule Sioux Tribe who lives in Rapid City, said she already has seen the benefits of the new health insurance and doesn’t mind paying a little out of pocket.
Jennesse said she put off treatment for a painful bone chip in her elbow after IHS denied a doctor’s referral to a specialist on grounds that it wasn’t an urgent enough need. She’s now seeing a specialist for dislocation in her other elbow and will also try to get the bone chip fixed when the other arm heals.
The tribe entered into self-determination contracts to manage programs that were formerly run by the IHS. But the agency failed to pay contract supports costs as required by law and as confirmed by two U.S. Supreme Court decisions.
“The settlement is a major milestone for the Cherokee Nation and our health centers. Payment of these millions of dollars from the federal government is long overdue, and now these funds will be utilized to provide expanded and improved health care services to our citizens. We will be able to equip our new centers with state-of-the-art medical devices and technology,” Chief Bill John Baker said in a press release.
The tribe was the plaintiff in the first contract support cost case that went to the Supreme Court. Despite a unanimous decision in 2005, however, it took another lawsuit and a change in administration for IHS to start paying what was owed.
“I am extremely pleased the Cherokee Nation is finally going to recoup funds that were owed to us for so long,” Attorney General Todd Hembree, who negotiated the settlement, said in a press release “These funds will be put to great use in helping meet the needs of the Cherokee people. Many thanks should be given to the dedicated employees in our self-governance, finance and health services departments.”