IHS Reforms Long Overdue

On the Crow Indian Reservation this month, U.S. Sen. Byron Dorgan (D-ND), and Sen. Jon Tester (D-MT), led a hearing of the Senate Indian Affairs Committee, addressing the severe lack of federal funds and management for the Indian Health Service. IHS officials, including acting chief medical officer Dr. Charles North, and tribal members testified to the shortage of qualified health professionals, closure of health facilities and cancellation of programs midway through the fiscal year.

A bipartisan collection of senators primarily from the Senate Indian Affairs Committee are co-sponsoring legislation that would foster improvement within IHS. These changes would include, for example, outreach and enrollment for those eligible for public coverage under programs like SCHIP; cancer screenings; school health programs; and the maintenance and improvement of facilities.

High Needs, Low Resources

IHS needs reform. IHS serves approximately 1.5 million of the 3.1 million American Indian and Alaska Natives from roughly 560 federally recognized tribes. In addition to underfunded facilities, death and disease rates among natives continue to exceed those of the general public -- with diabetes and suicide rates double those of white Americans. These and conditions such as alcoholism, depression and heart disease plague reservation communities.

Inadequacies in coverage, care and facilities are so great that the Census Bureau’s current population survey does not consider American Indian and Alaska Natives "covered" under IHS -- more than a third of American Indian and Alaska Natives went without suitable coverage in 2004. This makes them part of the nearly 47 million Americans without health insurance. In 2004, only 15.5 percent of native adults received medical treatment of any kind. Lack of enrollment in public programs and inadequate services contribute to this predicament. Having access to facilities is not enough.

Navajo Model

Opponents to IHS would prefer to see the Indian Health Care Improvement Act expire. As a more tightly managed agency, however, IHS has the potential to be a leader in culturally specific, community-centered care, in a country with wide variation and regional differences. Glimpses of its promise can be seen in places like the Four Corners region of the U.S. (New Mexico, Arizona, Utah and Colorado). The Navajo Nation, which is the largest Indian tribe in the United States, with the largest reservation of more than 25,000 square miles, has the IHS’s Navajo Division of Health. Though the NDOH suffers from a lack of funds, it is able to provide a variety of services that are tailored to the community and serve needs that would otherwise go unmet.

Reauthorization of the Indian Health Care Improvement Act could accomplish several feats, now and in the future. Turning IHS into a system that is well-managed and adequately funded could reduce the number of uninsured Americans. Establishing mental and personal health programs (with trained professionals) could improve overall health of communities and contain costs. Finally, giving IHS the opportunity to reach the heights of the VA would lay the groundwork for comprehensive health reform that preserves specialized care for unique populations.

This is a promise our government made to American Indian and Alaska Natives -- to provide resources for their well-being. For the past 15 years, Congress has let IHS go unchecked and underfunded. Reauthorization has failed several times in the last decade. Keeping the Indian Health Care Improvement Act alive, along with oversight and skilled management, could put IHS back on course for providing quality care and services to the first Americans.