Indian health care facing many challenges

DENVER – The director of the U.S. Indian Health Service told tribal leaders Tuesday he wants his agency to eliminate disparities within the American Indian health care system as well as those that exist between tribal and traditional health care.

Access to tribal – and traditional – medical facilities, coordinating insurance payments for both types of care and ensuring Native Americans are adequately insured are among the many challenges facing the agency, Dr. Charles Grim told a congregation of the Direct Service Tribes. The group includes tribes that allow the federal government to regulate their health care and education programs.

Other challenges: Some Native people do not have traditional health insurance; instead, they rely on their tribes, through the government, to provide medical care. And in some poverty-stricken Native communities, limited access to medical facilities can literally become a matter of life and death.

Suicide rates are from one-and-a-half to three times higher among Native people than for any other race in the United States, Grim said. Methamphetamine use is high among Native people as well: Native Americans are more than four times more likely than other races to try the drug, according to a National Institute of Health Study.

“We know we have health disparities out there,” Grim said. “We’ve been focusing on increasing prevention, behavioral health and care of chronic patients.”

Grim noted the U.S. House voted to allocate $15 million toward preventing methamphetamine use and another $5 million toward suicide prevention in the $4 billion IHS 2007 budget.

The Indian Health Care Improvement Act – under consideration by Congress for seven years – may finally be on the cusp of approval and could help remedy situations where care is limited, Grim said. The act would, among other things, provide more facilities and more care for those with tribal affiliations, he said.

That may not be enough for the 1.9 million American Indians and Alaskan Natives who receive IHS health care, said John Steele, president of the Oglala Sioux tribe on the Pine Ridge Reservation in South Dakota.

“Indian Health Service, sir, is bad. It is pathetic,” said Steele. “We talk these words, sir, but I have human people, individuals back home, who are suffering.”

Other tribal leaders at the conference are wary of wording in the act they say would allow individual states to designate who can and cannot get IHS medical care and other government subsidies.

Marcus Wells Jr., chairman of the Three-Affiliated Tribes in North Dakota, expressed concern that there are many medical procedures tribal-affiliated hospitals and doctors cannot perform. Referrals to outside health care providers often depend on the availability of IHS funding, Wells said.

Wells added it can be time-consuming to pay medical bills using both traditional and tribal-supported health insurance – and he counts himself among the lucky ones. Not everyone in his tribe can afford traditional insurance to supplement what they receive from the government.

Direct Service Tribes signed treaties with the federal government and have ceded their land to the United States on the condition the government provide health care and education, said Dawna Hare, executive director of the Pawnee Nation of Oklahoma.

“The government did make a number of promises with tribes to provide care,” Grim said. “They are still holding the government accountable to provide health care to them.”

Darrell Flyingman, governor of the Cheyenne-Arapaho tribes in Oklahoma, said it’s up to both Native people and the government to find solutions.

“We, as tribal leaders, need to accept responsibility,” Flyingman said.