If you’re not Native American, chances are you don’t know that Indian Health Service (IHS) even exists. But it’s extensive– IHS runs 29 hospitals and dozens of health centers providing free care to 1.9 million American Indians and Alaskan natives, most of whom live on reservations. However, as the New York Times has pointed out, providing health care to 564 federally recognized tribes, scattered over huge rural areas, has been a struggle:
Too few doctors. Too little equipment. Hospitals and clinics miles of hardscrabble road away.
In cities, where over half of the country’s roughly 3 million Indians now live (and nearly 5 million including part-Indians), only 34 programs get Indian Health Service funding, providing mostly basic care and arranging more advanced care and coverage elsewhere.
By all accounts, the Indian Health Service is substantially underfunded. Money shortages, bureaucracy and distance can delay treatment of even serious conditions for months, even years.
The article talks about one woman with breast cancer who chose to have an unneeded mastectomy, because radiation therapy would have meant months of 5 hour roundtrip drives from her home on the Hopi reservation. Another woman, a single mother with thyroid cancer, had to leave her job in Phoenix and move to an Apache reservation 200 miles away in order to receive care.
Geography is a problem, but so too is funding. Last year Congressional funding for IHS was $3.6 billion, which when combined with other sources of revenue meant that the IHS spent only $2690 per person. Meanwhile, the rest of the country spent over $6800 per person on health care costs.
Back in 1976, the government recognized that Native Americans were facing worse health outcomes than the rest of the country. Congress passed the Indian Health Care Improvement Act (IHCIA) to address these differences and modernize the Indian health care system. As part of the Act funding for IHS was increased.
In 2001 the IHCIA expired, but the health differences still exist. Native Americans compared to other ethnic groups are:
- Three times more likely to die from diabetes;
- Six times more likely to die from TB;
- Five times more likely to die from alcoholism;
- Their life expectancy is 2.4 years shorter;
- They have the poorest cancer survival rate;
- The suicide rate is nearly twice the national average for those between the ages of 15 and 34
The list goes on.
Last year, President Obama allocated $500 million in stimulus money for Indian health, which the website Alternet called, “a good start, but far from anything resembling comprehensive coverage.” Real help will come with the new health care law, which reauthorizes the IHCIA.
The National Indian Health Board has outlined the ways the IHCIA will help improve different aspects of health in Indian country. These include:
- Addressing the shortage of health care providers by strengthening programs to recruit doctors and nurses to tribal sites
- Facilities and Sanitation which are old or nonexistent. Indian Health facilities need an estimated $486 million in repairs. Meanwhile, 10% of Indian homes lack a safe and adequate water supply (compared to 1% in the rest of the country), and there’s a backlog of 3,200 sanitation construction projects. IHCIA provides grant, loan, and joint venture funding for these projects.
- Lack of authority to provide cancer screenings. Before, the IHS only covered mammograms. Preventative services under IHCIA will be expanded to include screenings for prostate, cervical, skin, and colon cancer.
- Reauthorizes diabetes screening and prevention activities
- Authorizes programs to provide prenatal, pregnancy, and infant care
- Promotes the elimination and prevention of environmental contaminants in Indian households
- Consolidates various behavioral health programs to provide a more comprehensive approach
All right this is the last section of the new health care law– we made it! In case you missed them, be sure to check out out other posts on what’s in the Patient Protection and Affordable Care Act here.