Proposed 2016 budget for Indian Health Services outlined

Noel Lyn Smith, The Daily Times

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 nsmith@daily-times.com. Follow her @nsmithdt on Twitter.

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Native American health insurance enrollment surges in South Dakota, but some remain skeptical

In this July 10, 2014 photo, Denise Mesteth poses outside the powwow grounds in Pine Ridge, S.D. Mesteth is a member of the Oglala Sioux Tribe, born and raised on the Pine Ridge reservation. She has signed up for health insurance through the federal marketplace. (AP Photo/Nora Hertel)

In this July 10, 2014 photo, Denise Mesteth poses outside the powwow grounds in Pine Ridge, S.D. Mesteth is a member of the Oglala Sioux Tribe, born and raised on the Pine Ridge reservation. She has signed up for health insurance through the federal marketplace. (AP Photo/Nora Hertel)

By NORA HERTEL  Associated Press

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.