American Indians, just like other people in the U.S., are suffering due to a lack of quality health care. Leaders of over 500 major Native American tribes recently told President Barack Obama that one of the highest priorities in their community is gaining access to affordable health insurance. Due to a variety of factors, a disproportionate percentage of American Indians die from health-related causes, including diabetes, the flu, tuberculosis, alcoholism, and pneumonia. The disparity is most striking on reservations, but also impacts those living in cities. Proposals within the healthcare reform bill, as well as separate legislation, seek to remedy this situation; doing so will be a daunting undertaking.
The majority of Native Americans belong to federally-recognized tribes and receive health insurance through the Indian Health Service, a federal program. Obama has pledged to increase its budget by 13% to cover the nearly two million eligible American Indians. However, most are only able to take advantage of such health care if they reside on tribal reservations. An increasing percentage of American Indians live in cities, which have a handful of bare-bones IHS programs. Some have affordable health insurance through their employers (tribal or otherwise), but poverty and being uninsured are familiar to at least one third of the American Indian population.
On the one hand, the travails of the American Indian Service seem to highlight the failings of public entitlement health care. Bureaucracy and underfunding have resulted in rationing and sometimes deadly waits for care. “Life-or-limb” urgent cases are treated first. Other serious cases, such as brain surgery and diabetes treatment, are put on a waiting list. Specialists are hard to come by. Doctors, of which there is a shortage on American Indian reservations, are unable to treat everyone in time, and some people die from that neglect. Those equipment and employee shortages, combined with transportation issues, force many Indians to receive lower quality care: i.e. getting an unnecessary mastectomy to treat breast cancer instead of weekly radiation, because the closest radiation facility is five hours away. Ambulances often take hours to reach their destinations; distances are admittedly long, but such explanations don’t help when critical assistance is too late and the “golden hour” after problems began has passed.
However, many private insurers refuse to sell affordable health insurance in Indian Country (whose span reaches across several states), and many health care providers choose not to work in those areas. The healthcare reform proposed by the Democrats has the potential to make affordable health insurance accessible to the many Native Americans who qualify as low- or moderate-income. They will be able use subsidies for private health insurance, or enroll in a public option. This would expand the network of providers, increasing the availability of health care; an especially important point for the almost half of American Indians living outside tribal lands. Private insurance companies or Medicaid will then reimburse the Indian Health Service for treatment.
Legislators want to increase access to affordable health insurance by bringing more American Indians into the fold. Some doubt this will happen, for several reasons. Past experience has shown that, although a significant portion of Native Americans are eligible for Medicaid, relatively few apply. A major objection is that free health care for Indians is generally respected as a historical right; many feel that their loss of land and natural resources at the hands of the American government over the centuries have already pre-paid for health care. They fear that healthcare reform may cause some to deem the Indian Health Service redundant. While the IHS appears safe so far, the Senate has been scrambling to find costs it can cut from its budget to pay for their bill. Reducing direct payments to the IHS could do that. Also, there is a somewhat controversial proposal that would exempt American Indians from any mandate to buy health insurance, which some oppose since many of them already receive free health care.
Despite some trepidation, American Indians are generally optimistic regarding this issue. Life expectancies have risen for Native Americans, and the Indian Health Service has seen national improvements. Provisions in the healthcare reform bill, along with those providing more affordable health insurance options, include funding for research into disease and its unique impact on the American Indian body, in addition to increased funding for sorely needed preventative care programs. This administration has been praised for being more friendly towards American Indian interests than most others, so the community is hopeful concerning continued strides in health.
