Reauthorization of health care act could benefit local tribes

After 14 years of debate and hard work, the National Indian Health Board (NIHB) is crossing its fingers this will be the year the Indian Health Care Improvement Act (IHCIA) will be reauthorized by the U.S. Senate and House of Representatives. Usually renewed every five to seven years, the act has lapsed, and health disparities are becoming increasingly obvious between tribal and federal government programs.

The government is responsible for providing health care services to the U.S. tribes from a long-standing trust, said Danette Ives, Port Gamble S'Klallam Tribal Health Service director. The IHCIA was passed in 1976 to provide a program and legal framework for health services, and now requires reauthorization to make Native American coverage comparable to the rest of the country.

"'Healthcare expenditures for Indians are less than half of what America spends for federal prisoners,'" she said, quoting the reauthorization fact sheet. "That one really gets me."

Current statistics also illustrate the inadequacies and the reasons why tribes across the nation are pulling together to get the reauthorization passed. For example, the infant mortality rate is 150 percent greater for Native American citizens than Caucasian individuals. Or the life expectancy rate for Indians is nearly six years less than the rest of the country's population. Statistics like that have Linda Holt, Suquamish Tribal Council member and chairwoman for the Northwest Portland Area Indian Health Board, in Washington D.C. as often as possible to lobby the reauthorization.

"I'm fairly optimistic it will pass," she said. "The primary concern we have is meeting all of the (White House) administration objections and Department of Defense concerns. It's going to be one we aren't necessarily going to see at a local level. It's going to improve, modernize Indian health service, and give us the ability to retract and retain qualified personnel."

A number of provisions authorizing funding have extended the life of the act to support the programs already established by the law, Ives said. Those provisions ended in 2001, but the Snyder Act of 1921 allows for "permanent authority for the appropriation of funds for Indian health, so Congress can and does continue to appropriate funds for these programs."

"We work very hard here in Little Boston on trying to ensure every tribal member is enrolled in some kind of insurance," she said. "We're currently working with (the Department of Social Health and Services) to negotiate or do a pilot program to set up a home health care agency here."

Both the Port Gamble S'Klallam and Suquamish tribes have made an effort to continue providing optimal health care to its members, but with the reauthorization of the IHCIA, the work will become easier. Returning last week from her most recent visit to Washington D.C., Holt said the Bush Administration has felt some of the wording used in the reauthorization is inappropriate, and could veto the measure if it is not changed. She said while she was there senators and tribal representatives were working on a way to restructure some of the questionable sections to avoid a veto.

The act does have an ally in Congressman Jay Inslee (D-Bainbridge Island).

"Congressman Jay Inslee is a co-sponsor of the Indian Health Care Improvement Act, (House Resolution) 1328, and supported the bill in the House Natural Resources Committee last year to improve health care available to American Indians, a chronically underserved population," said Christine Clapp, Inslee's spokesperson. "The legislation is particularly important for tribes in Washington state and Kitsap County because it could allow federal funding for the construction of much needed health care facilities that the Pacific Northwest has been denied for 20 years. Unfortunately, the president recently announced his intention to veto this important bill, stalling its progress."

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