Jul 14, 2005 - 23:17:51 CDT
U.S. Senate leaders agreed Thursday that the long-awaited reauthorization of the Indian Health Care Improvement Act is overdue. The act hasn't been improved since 1992."We should have done it in our last session," said Sen. Byron Dorgan, D-N.D. "We didn't get it done."
In a joint three-hour hearing, the Senate Committee on Indian Affairs and the Committee on Health, Education, Labor and Pensions discussed the pros and cons of Indian health care legislation, Senate Bill 1057, introduced earlier this year by Sen. John McCain, R-Ariz.
Committee members and panelists repeatedly used the word "disparate" to describe health conditions in Indian Country. "We have many health issues in this country, but the disparity in Indian communities is absolutely intolerable," said Sen. Ted Kennedy, D-Mass.
Congress passed the Indian Health Care Improvement Act in 1976 to create parity in the health status of American Indians and other U.S. populations. Yet health care needs seem to be outpacing progress.
American Indians die six years earlier, on average, than the typical U.S. citizen.
"The reauthorization has been long and difficult for us," said Rachel Joseph, co-chair of the National Steering Committee for the Reauthorization of the Indian Health Care Improvement Act. "Since the enactment in 1976, the health care delivery system in America has evolved and modernized while the American Indian-Alaska Native system of health care has not kept up."
Overall, the revised act calls for support or changes in key tribe-related areas, including training of health-care workers, transferring federal control of health-care programs to tribes and urban centersand allowing for collection of insurance money for health-care costs.
While the reauthorization act would make way for policy changes, Indian health is underfunded by about 40 percent, said Dr. Charles Grim, director of the Indian Health Service. Meanwhile, the government spends about twice as much for a federal prisoner than for a American Indian. And a Medicare patient receives $6,168 compared to $2,101 for an Indian Health Service patron.
"We're sending people home with cancer, saying there's no money for chemotherapy," said Richard Brannan, the Northern Arapaho Tribal Business Council chairman of Fort Washakie, Wyo., who testified at the hearing.
Disease and death rates in Indian Country reflect wide disparities in a number of major health and health-related conditions, such as diabetes, tuberculosis, alcoholism, homicide, suicide and accidents.
Recent studies reveal that almost 20 percent fewer American Indian women receive prenatal care than all other races and they engage in significantly higher rates of negative personal health behavior, such as smoking and the consumption of alcohol and illegal substances during pregnancy.
The Indian Health Care Improvement Act would give tribes the ability to create programs that reflect their values and allow for greater collaboration between behavioral health programs.
Dental needs also present a crisis for many tribal communities. For those reasons, a previous amendment to the Indian Health Care Improvement Act allowed for a dental innovation to take place within Alaskan villages.
The measure allows dental health therapists to perform dental work in villages, including extractions and fillings procedures usually reserved for licensed dentists.
The American Dental Association provided testimony objecting to reauthorizing the provision. Robert Brandjord, the association's president-elect, described the Alaska Native Health Board dental program as "second-class care."
"Alaskan Natives deserve better," said Brandjord. "They deserve high-quality dentists."
"Please listen to the people who live and work in these communities and don't limit the scope of the dental health therapists," said Mary Williard of the Yukon Kuskokwim Health Corp. Dental Clinic in Bethel, Alaska.
While tribes were consulted for language in the bill, health service director Grim fielded questions from McCain about his objection to giving tribes greater flexibility in managing health-care programs, even though Grim argued for flexibility for his own department.
While the Senate committees discussed the bill, American Indian health advocates also gathered this week in the nation's capital to mount their own campaign regarding the disparate health needs in tribal and urban communities.
"This is just critical," said Jacqueline Johnson, National Congress of the American Indian executive director. "If Indian Country is going to be able to address our medical and health-care needs, they need this act. The challenging issues that we're dealing with -- teen suicide and mental health -- all those things need this act to be passed."
About 1.8 million American Indians depend upon the Indian Health Service for basic needs.
(Jodi Rave covers American Indian issues for Lee Enterprises. She can be reached at 406-523-5299 or jodi.rave@lee.net.)
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