IHS Affirmative

Observation One: Inherency 2

Advantage One: Health 5

Advantage Two: Indigenous Economy 9

Observation Two: Solvency 14

Only federal action can solve the case- denying Indian health care furthers an ongoing policy of American Indian genocide 17

Inherency – Lack of Funding 18

Inherency – Lack of Funding 19

Inherency – Lack of Funding 20

Inherency – Lack of Funding 21

Health Impacts – Disease/Death 22

Health Impacts – Disease/Death 23

Health Impacts – Disease/Death 24

IMPACT: Mental Health and Suicide 25

IMPACT: Mental Health and Suicide 26

Extensions to Genocide/Racism Impact 27

Extensions to Genocide/Racism Impact 28

IMPACT: Moral Obligation/Human Rights 29

Solvency Extension - IHCIA/IHS Solves 30

Solvency Extension - IHCIA/IHS Solves 31

Solvency Extension - IHCIA/IHS Solves 32

Solvency Extension - IHCIA/IHS Solves 33

Solvency Extension - IHCIA/IHS Solves for cultural sensitive health 34

Solvency Extension – Congress Key 35

Solvency Extension – Federal Government Key 36

A2: I.H.S. is Racist 37

A2: Transportation 38

A2: “Structural/Distribution Barriers” 39

A2: No Qualified Professionals 40

A2: Bureaucrats 41

A2: IHS has arbitrary eligibility standards 42

A2: Blood Quantum 43

A2: Medicaid Solves 44

AT: Medicaid Solves 45

AT: Medicaid Solves 46

A2: IHS doesn’t use traditional medicine 47

Tribal Economy Extension 48

Tribal Economy Extension 49

Tribal Economy Extension 50

A2: Casinos Solve Tribal Economies 51

Tribal Economy Extension – Waste 52

Nuclear Waste = Genocide Extension 53

Nuclear Waste = Genocide Extension 54

Nuclear Waste = Genocide Extension 55

Nuclear Waste leads to Extinction Extension 56

Nuclear Waste leads to Extinction Extension 57

Observation One: Inherency

1. The Indian Heal Service (IHS) is the federal health care program designed to provide free health care for Native Americans in the United States. Unfortunately this program is woefully under funded.
CLEVENGER Sep 14, 2009 (SAMUEL, Government’s disservice to Indians is unrelated to health care debate, http://www. cantonrep.com/opinion/letters/x244359597/Government-s-disservice-to-Indians-is-unrelated-to-health-care-debate)
The horror stories of clinics and hospitals on Native American reservations are true and prevalent. The IHS is a grossly underfunded, under-resourced, poorly managed government-run health care system. But the reason is not that the federal government is inherently incapable of running a health care system, but that the government has never provided adequate support and care for Native Americans. On average, while the United States spends more than $6,000 per capita on health care, only $2,100 is spent on IHS funding. Native Americans have lower life expectancy as well as higher rates of HIV/AIDS and diabetes, among other terrible diseases. The list of atrocities the U.S. government has committed against Native Americans is long and exhaustive. The current state of the Indian Health Service has no bearing on the capability of the U.S. government to run a health care system. It’s just a reminder of how the U.S. government still does inadequately support Native Americans.
2. Even though the stimulus act increased the IHS budget by 13% it still is only half of what is needed to meet out obligation to Native Americans.
Associated Press, Jul 10 2009 3:16 PM [Diabetes concern at Colo.'s American Indian summit] (http://www.examiner.com/a-2112192~Diabetes_concern_at_Colo__s_American_Indian_summit.html)
"I think people are excited about this and interested about the ways to improve Indian health," she said, adding that the nearly 13 percent increase in IHS funding approved by President Barack Obama is a start to improving health care in Indian Country. "We really need more resources in the Indian Health Service to effectively meet our mission, but also, just getting more resources isn't going to solve all our problems." The IHS was appropriated nearly $3.6 billion this year, about half of what it needs, the agency said. Roubideax said Indian Country could be used as a model for the rest of the nation on how to combat these tough health issues not only affecting American Indians, but the entire nation. "Take the epidemic of diabetes, it hit this population 20 to 30 years prior to the rest," she said. "As a result we've had more time to address the problems. I definitely think the rest of the country can learn from the lessons that we've learned in the Indian Health Service." The federal government accepts a double standard. Any discussion about rationing – or government care – is off the table unless you’re a member of an American Indian tribe or Alaskan Native community with a sort of pre-paid insurance program (many treaties, executive orders and laws were specific in making American Indian health care an obligation to the United States). But the federal management of its health care network is full of inconsistencies, including the way the government pays itself. Medicare only reimburses IHS or tribal health facilities for 80 percent of the costs. So an already underfunded IHS essentially subsidizes Medicare. According to NCAI, fixing this problem would add $40 million a year to the budget.

Plan: The United States Federal Government should reauthorize the Indian Health Care Improvement Act of 1976 and provide an increase in discretionary funding for the federal Indian Health Service, including funds for culturally-specific health care programs and Indian Health Service affiliated services provided through both on and off-reservation health service programs.
Advantage One: Health

1. The result of IHS under funding is that American Indians receive the worst health care of any US population– death rates from preventable causes are skyrocketing. Even prisoners receive twice as much health care funding.
Warne 2008, President and CEO of American Indian Health Management & Policy, (Donald, Indian Country Today, “Indian Health a legal right”, 6/13/08, http://www.indiancountrytoday.com/archive /28397974.html, Accessed 6/28/09, CAF)
The media recently shined a spotlight on life expectancy rates in the United States. One obvious but unstated element in most news stories is that longevity correlates with health status, which directly correlates with economic status. American Indians suffer alarming gaps in life expectancy. Death rates from preventable causes like diabetes, alcoholism and mental illness are dramatically higher among American Indians than the rest of the population. Nearly one-third of our people live in poverty, compared to approximately 12 percent of the rest of the country. In Arizona, where I live, the average age at death is 72.2 years for the general population and 54.7 years for American Indians. Even people in Bangladesh and Ghana live longer. Despite this gross inequality, American Indians are the only population born with a legal right to health care in this country.The treaties between the tribal nations and the federal government - involving exchanges of vast amounts of Indian land and natural resources - resulted in federal guarantees for social services including housing, education and health care. The BIA and IHS were established to administer the federal government;s trust responsibility to provide health care and other vital services to American Indians. In the 2005 federal budget, per capita expenditures for IHS were $2,130, a fraction of the federal funding for other health care programs like Medicare ($7,631), Veterans Administration ($5,234) and Medicaid ($5,010). Even the Bureau of Prisons allocation is higher, at $3,985.So what would it take to fix the funding shortfalls in the IHS budget? The number of American Indians actively using IHS services is about 1.5 million, and clinical services for the IHS are funded at approximately $3 billion per year. Several studies have shown that the IHS is funded at approximately 60 percent of need.

2. Without treatment, diabetes alone will cause American Indian extinction.
Couto and Eken 2002 (Richard & Stephanie, Professor of Leadership Studies at Antioch College and Stephanie C. Eken, Adolescent Psychiatry & Pediatric Psychiatry, To Give their Gifts: Health, Community, and Democracy, p. 28-29).
Diabetes afflicts Native Americans at an alarming rate. Twenty-six out of every 1,000 people in the United States had diabetes in 1987. The United States Public Health Service hoped to lower this incidences to 25 per 1,000 by the year 200. However, the rate of diabetes actually increased to 31 per 1,000 by 1996. The rate among Native Americans served by IHS increased from 69 to 90 cases per 1,000 during the same period. This conservative estimate is almost three times the corresponding rate of the general population (Public Health Service 2001b:245; 1999). Diabetes occurred in epidemic portions in the Rosebud community, yet the community remained far too complacent in DeCora’s view, as the disease killed relatives and friends: I didn’t know whether or not Indian people even knew that they were in the midst of an epidemic, despite the fact that probably everybody had at least one relative or friend that had diabetes or they had it themselves. I worked in IHS, living in this comfort zone; inside I was dying because I didn’t feel like I was using my potential to really make some long-term positive change…[in] our people’s health. I felt like my time in IHS was spent applying Band-Aids and really not getting to the root problem of the disease. I believed then, as I believe not, that if we don’t come up with creative ways to combat this diseases, we’re going to be extinct as a people by the middle of the next century. With the time I have left, I need to be working on the way I believe this disease should be approached amongst our people and that is through our culture. The answer to this disease and other disease, including social ills, lie in our tradition.

3. Denying Indian health care furthers an ongoing policy of American Indian genocide
Valentine, PhD Candidate, Sociology, Texas A&M, 08
(Shari, “The Genocide that Never Ends: Bush to Veto Indian Health Services Bill,” Racism Review, http://www.racismreview.com/blog/2008/02/03/the-genocide-that-never-ends-bush-to-veto-indian-health-services-bill/)
The headline on the New York Times Editorial on January 28 reads “Vetoing History’s Responsibility.” The story unfortunately is not about history, but the entirely too current engagements in the 400 year old American Holocaust against American Indians. The latest strategic strike is a Presidential Veto of Indian Health Services Legislation. Here’s the opening paragraph from the NYTimes editorial: “President Bush’s threat to veto a bill intended to improve health care for the nation’s American Indians is both cruel and grossly unfair. Five years ago, the United States Commission on Civil Rights examined the government’s centuries-old treaty obligations for the welfare of Native Americans and found Washington spending 50 percent less per capita on their health care than is devoted to felons in prison and the poor on Medicaid.” The NYTimes piece goes on to make note the fact that: Studies have established that Native Americans suffer worse than average rates of depression, diabetes and cardiovascular disease. The Senate bill would improve treatment for these problems, as well as address alcohol and substance abuse, and suicide among Indian youth. It would expand scholarship help so more American Indians could pursue careers in health care. Actually according to Indian Health Service and the National Center for Health Statistics “worse than average” is a gross understatement. American Indians have:
Infant mortality rate 300% higher than the national average
Tuberculosis rates 500% higher than the national average
Diabetes 200% higher than the national average
Cervical Cancer 170% higher than the national average
Maternal death in childbirth 140% higher than the national average
Influenza and pneumonia 150% higher than the national average
Teenage suicide rates 150% higher than the national average
Overall suicide rates 60% higher than the national average
These rates have increased over the rates reported by the IHS in 1996. Only diabetes has declined and that only slightly. These are diseases that are highly preventable and treatable, unless you are a Native American held hostage to a centuries old policy of genocide. Native American health expenditures are half as much as that spent on prisoners and Medicaid patients and we are all too familiar with the intolerable health care provided to those groups. Federal appropriations are the only source of health care funds available to Native Americans. Outside philanthropy is bureaucratically prohibited. Some years ago I worked with an organization that donates medical equipment and supplies to underserved populations. A retiring doctor wanted to donate cutting edge mammogram, catscan and MRI machines as well as some other equipment to serve Native Americans. A national corporation agreed to transport the equipment free of charge and a medical supply company agreed to set it up and service it. The appraised value of the equipment was over 3 million dollars. For months working with then Senator Ben Nighthorse Campbell, we waded through red tape and forms to get permission for the equipment. In the end, the equipment was sent abroad because the Bureau of Indian Affairs would not approve the $575 necessary to build a pad for the MRI machine and $700 to upgrade a room for the catscan. When we raised the money to pay for these items, we were told that the individual clinics could not accept contributions and the BIA would need more than 9 months to process the contributions and could not guarantee expenditure of the funds on the purpose for which we were raising them. In spite of the investigation and recommendation of the Civil Rights Commission the President will continue this long tradition. Native Americans have only the Indian Health Service. No amount of public concern or private philanthropy can even be offered to mitigate the health effects of the government’s centuries of racist policy. The American public likes to think that tactics like giving smallpox infested blankets to native people are “history.” The centuries old oppression and systematic extermination of Native Americans continues and remains invisible to most Americans. In Germany, Turkey, Sudan, we call that genocide.
4. Genocide causes war and extinction.
Kenneth J Campbell, Professor of Political Science & International Relations at the University of Delaware, '01
(Genocide and the Global Village, p. 15-6)
Regardless of where or on how small a scale it begins, the crime of genocide is the complete ideological repudiation of, and a direct murderous assault upon. the prevailing liberal international order. Genocide is fundamentally incompatible with, and destructive of, an open, tolerant. democratic, free market international order. As genocide scholar Herbert Hirsch has explained. The unwillingness of the world community to take action to end genocide and political massacres is not only immoral but also impractical … [W]ithout some semblance of stability, commerce, travel, and the international and intranational interchange of goods and information are subjected to severe disruptions.3 Where genocide is permitted to proliferate, the liberal international order cannot long survive. No group will be safe: every group will wonder when they will be next. Left unchecked, genocide threat-ens to destroy whatever security, democracy, and prosperity exists in the present international system. As Roger Smith notes : Even the most powerful nations - those armed with nuclear weapons may end up in struggles that will lead (accidentally, intentionally. insanely) to the ultimate genocide in which they destroy not only each other. but mankind itself, sewing the fate of the earth forever with a final genocidal effort.4 In this sense, genocide is a grave threat to the very fabric of the international system and must be stopped, even at some risk to lives and treasure.

4. Inaction is tantamount to genocide denial and results in extinction.
Lilian Friedberg. 2001. Doctoral Candidate in German Studies at University of Illinois. http://muse.jhu.edu/ journals/american_indian_quarterly/v024/24.3friedberg.html
Most importantly, perhaps, what distinguishes the American Holocaust from the Nazi Holocaust is what is at stake today. The Nazi Holocaust represents a historical event that threatened the entire Jewish population of Europe. Relegating this event to the archive of oblivion would involve a fatal miscalculation resulting in wholesale moral bankruptcy for the entire Western world. But the worldwide Jewish population can hardly be said to be at risk of extermination today--certainly not in the United States. American Jews stepped up their efforts to direct attention to the Nazi Holocaust at a time when they were by far the wealthiest, best-educated, most influential, in-every-way-most-successful group in American society--a group that, compared to most other identifiable minority groups, suffered no measurable discrimination and no disadvantages on account of that minority status. 48 Norman Finkelstein cites the Jewish income in the United States at double that of non-Jews and points out that sixteen of the forty wealthiest Americans are Jews, as are 40 percent of Nobel prizewinners in science and economics, 20 percent of professors at major universities and 40 percent of partners in law firms in New York and Washington. 49 Native Americans, by contrast, have long been subject to the most extreme poverty of any sector in the present North American population, and still have the highest rate of suicide of any other ethnic group on the continent. 50 High-school [End Page 365] dropout rates are as high as 70 percent in some communities. As Anishinabeg activist and Harvard-educated scholar Winona LaDuke notes with regard to the Lakota population in South Dakota: "Alcoholism, unemployment, suicide, accidental death and homicide rates are still well above the national average." 51 Alcoholism, intergenerational posttraumatic stress, and a spate of social and economic ills continue to plague these communities in the aftermath of the American Holocaust. This is not to deny or diminish the clear and present danger in the ominous resurgence of anti-Semitic sentiments reflected in isolated incidences of racial violence against Jews and Jewish institutions both here and abroad. However, the material realities confronting the Native American population remain, in many instances, comparable to those prevailing in Third World countries. The Native American experience of persecution is not a vicarious one. For substantial portions of this population, it is a lived reality. What is more, an unrelenting sentiment of Indian-hating persists in this country: There is a peculiar kind of hatred in the northwoods, a hatred born of the guilt of privilege, a hatred born of living with three generations of complicity in the theft of lives and lands. What is worse is that each day, those who hold this position of privilege must come face to face with those whom they have dispossessed. To others who rightfully should share in the complicity and the guilt, Indians are far away and long ago. But in reservation border towns, Indians [End Page 366] are ever present. . . . The poverty of dispossession is almost overwhelming. So is the poverty of complicity and guilt. In America, poverty is relative, but it still causes shame. That shame, combined with guilt and a feeling of powerlessness, creates an atmosphere in which hatred buds, blossoms, and flourishes. The hatred passes from father to son and from mother to daughter. Each generation feels the hatred and it penetrates deeper to justify a myth. 54 Attempts on the part of American Indians to transcend chronic, intergenerational maladies introduced by the settler population (for example, in the highly contested Casino industry, in the ongoing battles over tribal sovereignty, and so on) are challenged tooth and nail by the U.S. government and its "ordinary" people. Flexibility in transcending these conditions has been greatly curtailed by federal policies that have "legally" supplanted our traditional forms of governance, outlawed our languages and spirituality, manipulated our numbers and identity, usurped our cultural integrity, viciously repressed the leaders of our efforts to regain self-determination, and systematically miseducated the bulk of our youth to believe that this is, if not just, at least inevitable." 55 Today's state of affairs in America, both with regard to public memory and national identity, represents a flawless mirror image of the situation in Germany vis-à-vis Jews and other non-Aryan victims of the Nazi regime. 56 Collective indifference to these conditions on the part of both white and black America is a poor reflection on the nation's character. This collective refusal to acknowledge the genocide further exacerbates the aftermath in Native communities and hinders the recovery process. This, too, sets the American situation apart from the German-Jewish situation: Holocaust denial is seen by most of the world as an affront to the victims of the Nazi regime. In America, the situation is the reverse: victims seeking recovery are seen as assaulting American ideals. But what is at stake today, at the dawn of a new millennium, is not the culture, tradition, and survival of one population on one continent on either side of the Atlantic. What is at stake is the very future of the human species. LaDuke, in her most recent work, contextualizes the issues from a contemporary perspective: Our experience of survival and resistance is shared with many others. But it is not only about Native people. . . . In the final analysis, the survival of Native America is fundamentally about the collective survival of all human beings. The question of who gets to determine the destiny of the land, and of the people who live on it--those with the money or those who pray on the land--is a question that is alive throughout society. 57 [End Page 367] "There is," as LaDuke reminds us, "a direct relationship between the loss of cultural diversity and the loss of biodiversity. Wherever Indigenous peoples still remain, there is also a corresponding enclave of biodiversity." 58 But, she continues, The last 150 years have seen a great holocaust. There have been more species lost in the past 150 years than since the Ice Age. (During the same time, Indigenous peoples have been disappearing from the face of the earth. Over 2,000 nations of Indigenous peoples have gone extinct in the western hemisphere and one nation disappears from the Amazon rainforest every year.) 59 It is not about "us" as indigenous peoples--it is about "us" as a human species. We are all related. At issue is no longer the "Jewish question" or the "Indian problem." We must speak today in terms of the "human problem." And it is this "problem" for which not a "final," but a sustainable, viable solution must be found--because it is no longer a matter of "serial genocide," it has become one of collective suicide. As Terrence Des Pres put it, in The Survivor: "At the heart of our problems is that nihilism which was all along the destiny of Western culture: a nihilism either unacknowledged even as the bombs fell or else, as with Hitler or Stalin, demonically proclaimed as the new salvation." 60
Advantage Two: Indigenous Economy

1. Poor health care creates systematic cycles of economic depression and federal dependence – IHS funding is necessary to improve social and economic development
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Pages 7-8, MAG)
Consequently, not only is reduced health status a burden to Native Americans, but a cumulative drain on the entire Native American existence. Poor health inhibits the economic, educational, and social development of Native Americans and establishes an inescapable cycle of disparity. Nevertheless, not all news regarding health status is bad news. The IHS, which has been given primary responsibility for eliminating this disproportionate health status, has been largely successful in reducing mortality rates, while making significant improvements in other areas.5 Dr. Perez explained that the incidence and prevalence of many infectious diseases have been dramatically reduced through increased clinical care and public health efforts such as vaccination for infectious diseases and the construction of sanitation facilities. Today, Native Americans continue to experience significant rates of diabetes, mental health disorders, cardiovascular disease, pneumonia, influenza, and injuries. Specifically, Native Americans are 770 percent more likely to die from alcoholism, 650 percent more likely to die from tuberculosis, 420 percent more likely to die from diabetes, 280 percent more likely to die from accidents, and 52 percent more likely to die from pneumonia or influenza than the rest of the United States, including white and minority populations.7 As a result of these increased mortality rates, the life expectancy for Native Americans is 71 years of age, nearly five years less than the rest of the U.S. population.8 A comparison of earlier life expectancy data illustrates one of the problems facing IHS in eliminating disparities. In 1976, the life expectancy for Native Americans was 65.1 years, compared with 70.8 years for other Americans.9 Consequently, while life expectancy for Native Americans has improved by six years, the difference in life expectancy relative to other Americans has changed very little. Another problem facing health care providers is the increasing importance of the behavioral component of health status. During the October briefing, Dr. Perez explained that fully seven of the top 10 causes of high morbidity and mortality rates are “directly related to, or significantly affected by individual behavior and lifestyle choices.”

2. Poverty dehumanizes its victims
Sengendo 2008 [Ahmad Kawesa, Rector at University of Uganda] http://www.e astsym.org/documents/
P1Kawesa_CentralityofSTI.pdf.
As Jack DeGioia of Georgetown University put it, “The moral challenge of our times is to eliminate extreme poverty.” Socio-economic transformation remains a mirage as long as the majority of our people continue to live in abject poverty. Poor people have no capacity to benefit from the great opportunities that advances in S&T as well as R&D may put on their door steps. Poverty is dehumanizing and cheats its victims of the minimum positive self-image and self-confidence necessary to face life’s challenges.
3. Dehumanization is the biggest impact in the debate— it makes all of their impacts inevitable
David Berube 1997, professor of speech communication, NANOTECHNOLOGY MAGAZINE, June/July http://www.cla.sc.edu/ENGL/faculty/berube/prolong.htm
Assuming we are able to predict who or what are optimized humans, this entire resultant worldview smacks of eugenics and Nazi racial science. This would involve valuing people as means. Moreover, there would always be a superhuman more super than the current ones, humans would never be able to escape their treatment as means to an always further and distant end. This means-ends dispute is at the core of Montagu and Matson's treatise on the dehumanization of humanity. They warn: "its destructive toll is already greater than that of any war, plague, famine, or natural calamity on record -- and its potential danger to the quality of life and the fabric of civilized society is beyond calculation. For that reason this sickness of the soul might well be called the Fifth Horseman of the Apocalypse.... Behind the genocide of the holocaust lay a dehumanized thought; beneath the menticide of deviants and dissidents... in the cuckoo's next of America, lies a dehumanized image of man... (Montagu & Matson, 1983, p. xi-xii). While it may never be possible to quantify the impact dehumanizing ethics may have had on humanity, it is safe to conclude the foundations of humanness offer great opportunities which would be foregone. When we calculate the actual losses and the virtual benefits, we approach a nearly inestimable value greater than any tools which we can currently use to measure it. Dehumanization is nuclear war, environmental apocalypse, and international genocide. When people become things, they become dispensable. When people are dispensable, any and every atrocity can be justified. Once justified, they seem to be inevitable for every epoch has evil and dehumanization is evil's most powerful weapon.
4. Collapsing economies make reservation targets for nuclear waste disposal – the impact is radioactive genocide
Brook, Contributer to Harper’s and Boston Globe, 1998
(Daniel, Contributer to Harper’s and Boston Globe, “Environmental Genocide: Native Genocide: Native Americans and Toxic Waste. “American Journal of Economics and Sociology 1998 Vol. 37, No. 1” 7/1/09, M.E)
GENOCIDE AGAINST NATIVE AMERICANS continues in modern times with modern techniques. In the past, buffalo were slaughtered or corn crops were burned, thereby threatening local native populations; now the Earth itself is being strangled, thereby threatening all life. The government and large corporations have created toxic, lethal threats to human health. Yet, be- cause "Native Americans live at the lowest socioeconomic level in the U.S." (Glass, n.d., 3), they are most at risk for toxic exposure. All poor people and people of color are disadvantaged, although for Indians, these disadvantages are multiplied by dependence on food supplies closely tied to the land and in which [toxic] materials . .. have been shown to accumulate" (ibid.). This essay will discuss the genocide of Native Americans through environmental spoliation and native resistance to it. Although this type of genocide is not (usually) the result of a systematic plan with malicious intent to exterminate Native Americans, it is the consequence of activities that are often carried out on and near the reservations with reckless disregard for the lives of Native Americans.1 One very significant toxic threat to Native Americans comes from governmental and commercial hazardous waste sitings. Because of the severe poverty and extraordinary vulnerability of Native American tribes, their lands have been targeted by the U.S. government and the large corporations as permanent areas for much of the poisonous industrial by-products of the dominant society. "Hoping to take advantage of the devastating chronic unemployment, pervasive poverty and sovereign status of Indian Nations", according to Bradley Angel, writing for the international environmental organization Green- peace, "the waste disposal industry and the U.S. government have embarked on an all-out effort to site incinerators, landfills, nuclear waste storage facilities and similar polluting industries on Tribal land" (Angel 1991, 1). In fact, so enthusiastic is the United States government to dump its most dangerous waste from "the nation's 110 commercial nuclear power plants" (ibid., 16) on the nation's "565 federally recognized tribes" (Aug 1993, 9) that it "has solicited every Indian Tribe, offering millions of dollars if the tribe would host a nuclear waste facility" (Angel 1991, 15; emphasis added). Given the fact that Native Americans tend to be so materially poor, the money offered by the government or the corporations for this "toxic trade" is often more akin to bribery or blackmail than to payment for services rendered.2 In this way, the Mescalero Apache tribe in 1991, for example, became the first tribe (or state) to file an application for a U.S. Energy Department grant "to study the feasibility of building a temporary [sic] storage facility for 15,000 metric tons of highly radioactive spent fuel" (Ak- wesasne Notes 1992, 11). Other Indian tribes, including the Sac, Fox, Yakima, Choctaw, Lower Brule Sioux, Eastern Shawnee, Ponca, Caddo, and the Skull Valley Band of Goshute, have since applied for the$100,000 exploratory grants as well (Angel 1991, 16-17). Indeed, since so many reservations are without major sources of outside revenue, it is not surprising that some tribes have considered proposals to host toxic waste repositories on their reservations. Native Americans, like all other victimized ethnic groups, are not passive populations in the face of destruction from imperialism and paternalism. Rather, they are active agents in the making of their own history. Nearly a century and a half ago, the radical philosopher and political economist Karl Marx realized that people "make their own history, but they do not make it just as they please; they do not make it under circumstances chosen by themselves, but under circumstances directly found, given and transmitted from the past" (Marx 1978, 595). Therefore, tribal governments considering or planning waste facilities", asserts Margaret Crow of California Indian Legal Services, "do so for a number of reasons" (Crow 1994, 598). First, lacking exploitable subterranean natural resources, some tribal governments have sought to employ the land itself as a resource in an attempt to fetch a financial return. Second, since many reservations are rural and remote, other lucrative business opportunities are rarely, if ever, available to them. Third, some reservations are sparsely populated and therefore have surplus land for business activities. And fourth, by establishing waste facilities some tribes would be able to resolve their reservations' own waste disposal problems while simultaneously raising much-needed revenue. As a result, "[a] small number of tribes across the country are actively pursuing commercial hazardous and solid waste facilities"; however, "[t]he risk and benefit analysis performed by most tribes has led to decisions not to engage in commercial waste management" (ibid.). Indeed, Crow reports that by "the end of 1992, there were no commercial waste facilities operating on any Indian reservations" (ibid.), although the example of the Campo Band of Mission Indians provides an interesting and illuminating exception to the trend. The Campo Band undertook a "proactive approach to siting a commercial solid waste landfill and recycling facility near San Diego, California. The Band informed and educated the native community, developed an environmental regulatory infrastructure, solicited companies, required that the applicant company pay for the Band's financial advisors, lawyers, and solid waste industry consultants, and ultimately negotiated a favorable contract" (Haner 1994, 106). Even these extraordinary measures, however, are not enough to protect the tribal land and indigenous people from toxic exposure. Unfortunately, it is a sad but true fact that "virtually every landfill leaks, and every incinerator emits hundreds of toxic chemicals into the air, land and water" (Angel 1991, 3). The U.S. Environmental Protection Agency concedes that even if the . . . protective systems work according to plan, the landfills will eventually leak poisons into the environment" (ibid.). Therefore, even if these toxic waste sites are safe for the present generation-a rather dubious proposition at best-they will pose an increasingly greater health and safety risk for all future generations. Native people (and others) will eventually pay the costs of these toxic pollutants with their lives, "costs to which [corporate] executives are conveniently immune" (Parker 1983, 59).
5. Social Service programs are key to solving Indigenous poverty.
Cobb, Assistant Professor of History, Miami University, 2004
(Daniel, Poverty in the United States: An Encyclopedic History, Gwendolyn Mink & Alice O'Connor (eds.) p. 492).
In order to alleviate poverty in Native America, the federal government will need to continue to support on- and off-reservation Indian communities with sustained social services. Meanwhile, tribes will continue to explore new strategies to promote long-term economic development and seek ways to diversity their economies. The long history of poverty and social welfare among Indians has shown, however, that tribes will not sacrifice their rights as sovereign nations in order to gain economic parity. Therefore, the continued shift toward compacting and self-governance, in addition to the retention of tribe’s federal trust status, will play a crucial role in creating an administrative structure reflective of these larger economic aspirations.

Observation Two: Solvency

1. Only reauthorizing the IHCIA solves Indigenous health.
Garcia, President of the National Congress of American Indians, 2006
(Joe, The Native Voice, “NCAI President Joe Garcia Delivers Fourth Annual State of Indian Nations Address” 2-20-06, http://proquest.umi.com/pqdweb?index=3&did=1054628221&SrchMode=2&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1246255456&clientId=10553, 6-29-09)
Number Two: Healthcare Second of the Steps is healthcare: Because of inferior healthcare, the quality and length of life for American Indians falls well below the rest of the US American Indians have a life expectancy five years less than the rest of the country. A typical American Indian is 650 percent more likely to die from tuberculosis, 420 percent more likely to die from diabetes, 280 percent more likely to die in an accident, and 52 percent more likely to die from pneumonia or influenza than the rest of the US population. Native American healthcare is often no more than emergency treatment, which means that our people are getting care only when they can't wait anymore. There's little preventive healthcare and little education for healthier living. Healthcare expenditures for Indian are less than half what America spends for federal prisoners. Let me repeat that: Healthcare expenditures for Indian are less than half what America spends for federal prisoners. And remember that there are real people behind these numbers. The Ute Mountain Ute tribe in Towaoc, Colorado, recently lost three tribal elders in a van accident because the only way these elders could get dialysis was to drive two-and-a-half hours each way to the nearest hospital with the right equipment. What they needed wasn't close enough. Because of this, I call upon Congress and the President to uphold their historic and contractual obligation by reauthorizing the tribally proposed Indian Health Care Improvement Act during this session of Congress. This legislation is no less than the framework for the Indian healthcare system. It will bring our outdated and inadequate system into the 21st Century - addressing mental health, substance abuse and youth suicide, and support for attracting and retaining qualified healthcare professionals. Basic things such as in-home healthcare are becoming commonplace. But they are not yet a common part of the system of Indian healthcare. They ought to be.
2. IHS funding increases indigenous control over health care.
IHS funding increases indigenous control of health care.
Empsall, Bachelor’s Degree from Dartmouth in Government and Native American Studies, 2008 (Nathan, The Episcopal Public Policy Network, “On the Issue: American Indian Healthcare”, August 2008, http://www.cuac.org/3654_101099_ENG_HTM.htm, 7-1-09)
Since its creation in 1954, the Indian Health Service (IHS) has attempted to respond to these needs through a broad range of services. Because of the federal government’s official trust relationship with Indian tribes, members of the 562 federally recognized tribes are entitled to free health care. IHS serves approximately 1.9 million (out of 3 million) American Indians and Alaskan Natives on or near reservations in 35 states. Congress appropriated $3.2 billion for IHS in 2008, which was supplemented by an additional $628 million in third party collections (Centers for Medicare and Medicaid Services, private insurance companies, etc). Approximately half this budget authority and a majority of health services are administered by tribes rather than the IHS itself. IHS services include inpatient, ambulatory, emergency, dental, and preventative care. Specific focuses include general clinic services, maternal and child health, diabetes, hepatitis B, alcoholism, and mental health. IHS provides for medical facilities, including the construction, equipping, and maintenance of hospitals, health centers, clinics, and sanitation facilities. Despite the remaining health disparities that persist in Indian Country, IHS has achieved significant results. Since 1974, life expectancy has risen from 63.5 years to 71, and mortality rates for pneumonia, alcoholism, chronic liver disease, tuberculosis, gastrointestinal disease, injuries, and poisoning have significantly decreased. The U.S. Commission on Civil Rights credits these successes to improved access to quality health care and increased public efforts to control infectious diseases, but cautions that the rate of improvement has diminished in recent years, and without more IHS funding, could be reversed.
3. Reauthorizing the Indian Health Care Improvement Act massively improves Native health care and enhances self-determination
Barry et. al., Chairwoman of the U.S. Commission of Human Rights, 2004 (Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System” September. Pages 125 & 126)
Among the pending changes identified thus far, the reauthorization of the Indian Health Care Improvement Act appears to hold the most promise for improving the lives of Native Americans. The proposal for reauthorization of IHCIA is a tribally prepared, far-reaching proposal for addressing every aspect of providing medical care to Native Americans. Tribal leaders initiated the proposed legislation; the final version is the product of years of consultation between tribal leaders and federal government representatives. Anticipating the expiration of IHCIA, IHS organized regional consultation meetings with tribal leaders in 1998 to solicit input on changes to the Act. Based on the outcome of the regional consultation meetings, the tribes formed a National Steering Committee (NSC) of tribal leaders to draft a comprehensive proposal that would address a range of health care concerns using the reauthorization of IHCIA. The NSC specifically sought to make IHCIA more responsive to current real-world needs, to increase opportunities for attracting more revenue into the health system, and to facilitate greater exercise of self-determination in health care program decision-making and regulations. There is no single change in the reauthorization of IHCIA that will close the health status gap for Native Americans. Instead, the House and Senate bills, as proposed, attempt to address many of the contributing problems by including provisions aimed at increasing access to appropriate health facilities, increasing access to and enrollment in health insurance programs, increasing federal funding, improving the quality of care, decreasing poverty, and increasing the level of educational attainment for Native Americans.
4. Only the Federal Government can solve.
Only federal action can solve the case- denying Indian health care furthers an ongoing policy of American Indian genocide
Valentine, PhD Candidate, Sociology, Texas A&M, 08 (Shari, “The Genocide that Never Ends: Bush to Veto Indian Health Services Bill,” Racism Review, http://www.racismreview.com/blog/2008/02/03/the-genocide-that-never-ends-bush-to-veto-indian-health-services-bill/) The headline on the New York Times Editorial on January 28 reads “Vetoing History’s Responsibility.” The story unfortunately is not about history, but the entirely too current engagements in the 400 year old American Holocaust against American Indians. The latest strategic strike is a Presidential Veto of Indian Health Services Legislation. Here’s the opening paragraph from the NYTimes editorial: “President Bush’s threat to veto a bill intended to improve health care for the nation’s American Indians is both cruel and grossly unfair. Five years ago, the United States Commission on Civil Rights examined the government’s centuries-old treaty obligations for the welfare of Native Americans and found Washington spending 50 percent less per capita on their health care than is devoted to felons in prison and the poor on Medicaid.” The NYTimes piece goes on to make note the fact that: Studies have established that Native Americans suffer worse than average rates of depression, diabetes and cardiovascular disease. The Senate bill would improve treatment for these problems, as well as address alcohol and substance abuse, and suicide among Indian youth. It would expand scholarship help so more American Indians could pursue careers in health care. Actually according to Indian Health Service and the National Center for Health Statistics “worse than average” is a gross understatement. American Indians have: Infant mortality rate 300% higher than the national average Tuberculosis rates 500% higher than the national average Diabetes 200% higher than the national average Cervical Cancer 170% higher than the national average Maternal death in childbirth 140% higher than the national average Influenza and pneumonia 150% higher than the national average Teenage suicide rates 150% higher than the national average Overall suicide rates 60% higher than the national average These rates have increased over the rates reported by the IHS in 1996. Only diabetes has declined and that only slightly. These are diseases that are highly preventable and treatable, unless you are a Native American held hostage to a centuries old policy of genocide. Native American health expenditures are half as much as that spent on prisoners and Medicaid patients and we are all too familiar with the intolerable health care provided to those groups. Federal appropriations are the only source of health care funds available to Native Americans. Outside philanthropy is bureaucratically prohibited. Some years ago I worked with an organization that donates medical equipment and supplies to underserved populations. A retiring doctor wanted to donate cutting edge mammogram, catscan and MRI machines as well as some other equipment to serve Native Americans. A national corporation agreed to transport the equipment free of charge and a medical supply company agreed to set it up and service it. The appraised value of the equipment was over 3 million dollars. For months working with then Senator Ben Nighthorse Campbell, we waded through red tape and forms to get permission for the equipment. In the end, the equipment was sent abroad because the Bureau of Indian Affairs would not approve the $575 necessary to build a pad for the MRI machine and $700 to upgrade a room for the catscan. When we raised the money to pay for these items, we were told that the individual clinics could not accept contributions and the BIA would need more than 9 months to process the contributions and could not guarantee expenditure of the funds on the purpose for which we were raising them. In spite of the investigation and recommendation of the Civil Rights Commission the President will continue this long tradition. Native Americans have only the Indian Health Service. No amount of public concern or private philanthropy can even be offered to mitigate the health effects of the government’s centuries of racist policy. The American public likes to think that tactics like giving smallpox infested blankets to native people are “history.” The centuries old oppression and systematic extermination of Native Americans continues and remains invisible to most Americans. In Germany, Turkey, Sudan, we call that genocide.
Inherency – Lack of Funding

Tribal health care is funding well below the national average – More Federal IHS funds are necessary to improve Native American health care access
Lillie-Blanton, DrPH, Henry J. Kaiser Family Foundation and Roubideaux, MD, MPH, Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, 2005
(Marsha & Yvette, “Understanding and Addressing the Health Care Needs of American Indians and Alaska Natives,”American Journal of Public Health http://www.pubmedcentral.nih.gov/ articlerender.fcgi?artid=1449250)
In the 2000 US Census, 4.1 million people (about 1.5% of the US population) identified themselves as AIAN, solely or in combination with 1 or more other racial/ethnic groups.1 When mortality rates are used as the indicator of health outcomes, American Indians and Alaska Natives face a disadvantage, relative to Whites, at each stage of the life span, with persistent disparities in infant mortality, life expectancy, and mortality from a variety of conditions including chronic diseases.2 There is also sufficient evidence of disparities in health care financing, access to care, and quality of care to conclude that American Indians and Alaska Natives are disadvantaged in the health care system. The federal government has a unique relationship with American Indians and Alaska Natives that is defined by the US Constitution, treaties, Supreme Court cases, and legislation.5 In exchange for tribal lands, the US government agreed to provide health care to members of federally recognized tribes. The Indian Health Service (IHS), an agency of the US Department of Health and Human Services, has fulfilled that responsibility since 1955. The AIAN health system has evolved greatly since then and now consists of IHS hospitals and health centers managed by the federal government, tribally managed services, and urban Indian health programs. While IHS is the hub of the AIAN health system, AIAN people also qualify for private and other public sources of health financing and services. In fact, about half (49%) of American Indian and Alaska Natives younger than 65 years have job-based or private coverage.6 An estimated 17% of the AIAN population has coverage through Medicaid or other public programs. Medicaid is playing an increasing role in financing AIAN care and as a revenue source for IHS providers.7 However, large disparities exist in the funding and availability of health services for AIAN people relative to other Americans. In fiscal year 2003, IHS had an operating budget of $2.9 billion to provide or pay for care for a service population of approximately 1.5 million of the 4.1 million people who identify themselves as AIAN. This amounts to $1914 per patient per year,8 which was less than the nation spent per capita in 2002 on public sector health care financing programs serving the nonelderly population ($3545) (unpublished data from the Kaiser Family Foundation analysis of the 2002 Medical Expenditure Panel Survey, available from the authors). According to one study that used the Federal Employees Health Benefits Plan (FEHP) as the primary benchmark, an additional $1.8 billion would be needed to provide active IHS users with services at the same level as those provided in a mainstream health plan such as the FEHP.9

Inherency – Lack of Funding

Health care is too expensive for Native Americans
Ho, Reporter at Hearst Seattle Media, 09
(Vanessa, seattlepi.com, “Native American death rates soar as most people are living longer”, 3-12, http://www.seattlepi.com/local/403196_tribes12.html, accessed: 6-29-09 , KEH)
On the Okanogan plains in northeast Washington, the Colville tribes recently buried a man who died after facing a bleak decision: spend his money on trips into town for dialysis, or buy food for his family.
It was a variant of a fate that has doomed many people on the stark, remote reservation, causing the timber-dependent tribes to increasingly spend their money on burials. "It's a choice between feeding your family and living," said Andy Joseph Jr., a Colville Confederated Tribes council member. "Our people can't afford to pay for their funeral services." From isolated reservations across the state to urban pockets around Seattle, Native Americans are dying at higher rates than a decade ago, at a time when people in Washington are living longer, healthier lives. A recent state Department of Health most report showed that the march against cancer, heart disease and infant mortality has largely bypassed Native Americans. In 2006, the latest year studied, Native American men were dying at the highest rate of all people, with little change since the early '90s. Their life expectancy was 71, the lowest age of all men, and six years lower than that of white men. The news was just as grim for Native American women. Their death rate had surged by 20 percent in a 15-year period, while the overall death rate had decreased by 17 percent.
But the starkest health disparity was among babies. Native American babies were dying at a rate 44 percent higher than a decade ago, while the overall rate of infant deaths had declined.
"People are suffering," said Marsha Crane, health director of the Shoalwater Bay Tribe in Western Washington. "It's, 'Here's the bad news, here's your diagnosis. But here's the worse news: We can't afford to pay for your drugs, or your surgery.' That's happening every day with tribes across the country."
The trends are a reversal of the progress made in the past century, when the Indian Health Service, a federal agency, made great strides in sanitation, disease control and vaccinations. Deaths nationwide largely fell from the 1950s to the '80s.
"It's astounding what the agency did, in terms of life expectancy," said Joe Finkbonner, executive director of the three-state Northwest Portland Area Indian Health Board. "But what I'm starting to see, in some of the data, is that that progress has either stagnated or is starting to reverse itself."
Health experts say the downward drift, which reflects national trends, stems from entrenched health disparities exacerbated by years of inadequate funding.
Treaty obligations and acts of Congress require the United States to provide health care for Native Americans, but experts say funding chronically falls short of medical inflation.
Inherency – Lack of Funding

There is chronic under-funding of current Native health care provisions.
Senator Cantwell, Wisconsin Democrat on Senate Indian Affairs, 2008
(Maria, States News Service, “Summery of the Hearing on the Indian Health Care Improvement Act,” Febuary 26, 2008, no p. CME)
Cantwell co-sponsored two amendments that were included in the final version of the bill. The first amendment adds an official resolution of apology for the federal government' long history of ill-conceived policies regarding Indian Tribes. Currently, Washington state tribes are in desperate need of additional health care facilities and health care staff. Cantwell's second amendment aims to correct the facilities construction funding structure that currently uses outdated criteria for allocating federal dollars to health facilities. With passage of the reauthorization bill, Cantwell will now turn her attention to the [there is] chronic under-funding of the Indian Health Care Improvement Act. It is estimated that its programs are funded at only 40 percent of need, leaving Northwest Tribes with annual resources that fall far short of service demand.

Native Americans in the status quo lack necessary healthcare funding.
Bresko, Department of Public Administration and Political Science, 2008
(Peter, Indian Country Today, “Obama for Indian healthcare,”9-19-08, http://www.indiancountrytoday.com/opinion/letters/28654134.html, 6-28-09, ESM)
You probably would not be surprised to learn that Haiti’s life expectancy rate is the lowest in the Western Hemisphere. But you might be – and should be – shocked to find out that the populations with the second and third lowest rates are located right here in the United States, the richest country on the planet. They are the Pine Ridge and Rosebud Indian reservations in South Dakota. The health issues facing American Indians in the United States make them the most at-risk minority in the country, and yet the IHS receives only 55 percent of the funds that it needs. The IHS only has roughly 15,000 employees and 31 hospitals, and barely 200 dentists, to serve the 1.9 million American Indians within its jurisdiction (there are 3.2 million American Indians in all). The Bush administration has been pushing to eliminate urban Indian health centers altogether, which would leave Native people who do not reside on a reservation without access to the health care they are entitled to. The Indian Health Care Improvement Act, currently pending in Congress, would increase funding in the IHS by $1 billion per year through 2017, which it desperately needs if the United States is to honor the treaties that require it to provide health services to 1.9 million Natives. Its co-sponsor is Sen. Barack Obama. It is not clear whether increasing funding for the IHS alone would be a sufficient response to the health problems in the Native community, nor is it clear how best to address these health issues without impeding on the sovereignty of the reservations. But Obama’s demonstrated recognition of the problems and commitment to addressing them make his election critical for American Indian health.

Inherency – Lack of Funding

I.H.S. is severely underfunded
Giago, Grand Forks Herald Columnist, 2009
(Tim, “will health reform bypass Indians?” Grand Forks Herald, June 28, 2009, no p. CME)
Health care in America is a failing proposition. An estimated 47 million Americans do not have health insurance. And yet Health and Human Services Secretary Kathleen Sebelius calls the health care of American Indians “historic failure.” What about health care in the rest of America? The efforts to introduce universal health care can be traced to the days of Woodrow Wilson and more recently to the political fiasco during the Bill Clinton administration in 1993 and 1994. The most powerful opposition to universal health care can be found in the medical profession and the insurance companies. They present a formidable lobby on Capitol Hill. Those Americans opposed to it compare it to Canadaʼs or Britainʼs health care systems, which they say are nothing but socialized medicine. The Indian Health Care system has also been labeled as socialized medicine, and the fact that Sebelius would label it as a failure does not place much faith in an even larger universal health care system. It just seems that every time the federal government takes total control over anything, failure is almost assured. Watch out, General Motors. Key Senate committees will begin writing legislation this month. President Barack Obama expects to have a bill on his desk by the end of the year, and he is confident that universal health care will become the law of the land. If this legislation passes, how will it impact the Indian Health Service? If all Americans are provided health insurance, will that include Indians? How will it affect the Indian hospitals in urban areas and out on the Indian reservations? President Obama has called for an increase in funds for Indian health care of 13 percent in Fiscal Year 2010. This would bring the largest funding increase in 20 years to the Indian Health Service. Will the introduction of universal health care change any of this? There is not an Indian alive today who has not witnessed the many shortcomings of the Indian Health Service, but as the head of the Indian Health Service, Dr. Yvette Roubideaux, has said, most of the failures were because of an extreme shortage of funds. An article in Time magazine asks some important questions. Will there be a big, new government system? How can a nation already deeply in debt afford health care reform, too? Can we really cover everyone? And if so, what will be covered? How will we bring down the costs? With a deficit nearing $1 trillion, this last question is very relevant. I believe Sebelius and Roubideaux are stepping into a situation that, for the first time in the history of the Indian Health Service, will be dramatically swayed by what is happening on the national scene. Fighting for funding every year for the Indian Health Service was a given. It was an ongoing battle that never changed, and the IHS was often the loser. But with universal health coverage looming on the horizon, the funds now available will become even more stretched because the federal government will be looking for ways and means to cover health care for everyone, not just the Indians. Some experts predict the cost of universal health care will be somewhere around $1.5 trillion. Drastic budget cuts in other areas will have to occur to free up more money to cover the costs. As I asked earlier, how will that affect the Indian Health Service? This brings us full circle to the old saying, “If you think the government can solve all of our problems, ask an Indian.”

IHC is underfunded, greatly decreasing life expectancy- only plan solves
Modern Healthcare, 09
(Lexis Nexis, “Leaders say status quo for CDC despite pandemic announcement”, 6-15, http://www.lexisnexis.com/us/lnacademic/search/homesubmitForm.do, accessed: 9-30-09, KEH)
The Senate Indian Affairs Committee hosted a hearing to learn about suggestions for improving the nation's American Indian healthcare system. According to Sen. Jon Tester (D-Mont.), who opened the hearing, estimates show that the Indian Health Service, an HHS agency, is funded at about 52% of need. ``We must do something to address the appalling health statistics among Native Americans,'' Tester said. He added that American Indian women in Montana have a median life expectancy of 64 years compared with the average of 81 years for the general population. Type 2 diabetes, infant mortality and suicide rates are also higher in the American Indian population as compared with the general population, Tester said. IHS is a big recipient of both federal stimulus money and a proposed budget boost (June 1, p. 6). The purpose of the hearing was to inform committee members before they draft a ``concept paper'' that they will send to tribes for review and reaction, said Barry Piatt, spokesman for the committee. Piatt said that the committee could introduce a new Indian Healthcare Improvement Act next month. Last year, the Senate passed the act, but the House did not approve the bill. Paul Carlton, a physician and retired lieutenant general in the U.S. Air Force, testified before the committee about strategies used in Iraq that could be applied to the Indian Health Service to improve services, such as using mobile surgical vans.
Health Impacts – Disease/Death

American Indians are several times more likely to die of curable diseases because they lack proper healthcare.
Senator Cantwell, Wisconsin Democrat on Senate Indian Affairs, 2008
(Maria, States News Service, “Summery of the Hearing on the Indian Health Care Improvement Act,” Febuary 26, 2008, no p. CME)
Improving the delivery of health care services for American Indians is long overdue, said Cantwell. Overall trends in the health of this population are simply unacceptable. American Indians and Alaskan Natives across the country are 400 percent more likely to die from tuberculosis, 291 percent more likely to die from diabetes complications, and 67 percent more likely to die from influenza and pneumonia than other groups. Passage of this bill in the Senate is a critical first step to strengthening health care services for American Indians, and living up to our long-standing trust responsibility to provide for their well-being.

American Indians are 517% more likely to die from alcoholism than the average American; have the poorest health status compared to any other group in the U.S.
Allen, Tribe Chairmen of the S’Klallam Tribe of Washington, 2009
(Ron, Committee Report, “HOUSE ENERGY AND COMMERCE SUBCOMMITTEE ON HEALTH ON COMPREHENSIVE HEALTH REFORM DISCUSSION DRAFT”, DAY 2, PART 2 CME)
Here are some of the challenges that tribal leaders face every day. Many American Indian and Alaska Natives live in the poorest and most remote communities in the Unites States. Indian people have among the highest rates of disease and poorest health status of any other group in the United States. Over the past 50 years, the Native population diseases have transitioned, along with the U.S. general population, from infectious diseases pandemics to those of aging and lifestyle disease, such as diabetes and cardiovascular disease, cancer, and alcohol and drug abuse. Data for the Indian people is often incomplete. However, some of the comparisons with the non-Native population are quite disturbing: We die at higher rates than other Americans from: alcoholism (517%), tuberculosis (533%), motor vehicle crashes (203%), diabetes (210%), unintentional injuries (150%), homicide (87%) and suicide (60%); ? Our people have a life expectancy that is almost 4 years less than the U.S. all races population (72.9 years to 76.5 years, respectively; 1996-98 rates), and our infants die at a rate of 8.8 per every 1,000 live births, as compared to 6.9 per 1,000 for the U.S. all races population (1999-2001 rates).

Native Americans have significantly higher mortality rates and health problems than any other ethnic group.
U.S. Commission on Civil rights,2004.
(U.S. Commission on Civil Rights, commission of the U.S. federal government charged with the responsibility for investigating, reporting on, and making recommendations concerning, civil rights issues that face the nation, NATIVE AMERICAN HEALTH CARE DISPARITIES
BRIEFING, “Tribal-Federal government relationship,” February 2004, p. 5, ESM) Despite the funds appropriated by Congress to deliver health care services for Native Americans, a wide range of public health status indicators demonstrate that Native Americans continue to suffer disproportionately from a variety of illnesses and diseases.18 Dr. Jon Perez, director of behavioral health for IHS, described these health disparities as .real and highly visible. to Native Americans.19 He explained that while the incidence and prevalence of many infectious diseases have been dramatically reduced through increased clinical care and public health efforts such as vaccination for infectious diseases and the construction of sanitation facilities, Native Americans continue to experience health disparities and higher death rates than the rest of the U.S. population.20 IHS has been given primary responsibility for eliminating this disproportionate health status and has been largely successful in reducing mortality rates, while making significant improvements in other areas.21 Today, Native Americans continue to experience significant rates of diabetes, mental health disorders, cardiovascular disease, pneumonia, influenza, and injuries. Native Americans are 770 percent more likely to die from alcoholism, 650 percent more likely to die from tuberculosis, 420 percent more likely to die from diabetes, 280 percent more likely to die from accidents, and 52 percent more likely to die from pneumonia or influenza than other Americans, including white and minority populations.22 As a result of these increased mortality rates, the life expectancy for Native Americans is 71 years of age, nearly five years less than the rest of the U.S. population.23 Dr. Perez pointed out some of these health disparities as well as some of the mortality rates during the briefing.
Health Impacts – Disease/Death

Numerous Native Americans die and are harmed because their health system lacks enough money to provide service to all but those on the brink of death.
Baucus, Senator, 2007
( Max, Capital Hill Hearing Testimony, “Health Care and Child Welfare Services for Native Americans”, 3-22-07, Lexis-Nexis, MEL)
But for the last 13 years, Native Americans have been waiting for Congress to fulfill those promises. For the last 13 years, we have seen Congress fail to reauthorize the law. As a result, the current funding level for the Indian Health Service system is only 52 to 60 percent of the need. That means that in any given year, by the month of June, the only patients who can receive treatment in Indian Health Service hospitals are those with conditions that "threaten life or limb." Listen to the story of one 25-year-old Native American, a veteran of the Gulf War. He was diagnosed with a problem that required removal of his gall bladder. Now, gall bladder removal has become a pretty routine operation. But this young man could not be referred for surgery in an Indian Health Service hospital. His condition did not "threaten life or limb."So he had to wait. So his gall bladder became inflamed. His kidneys and other organs shut down. Because of this needless delay, he will be on dialysis for the rest of his life. And we can trace that result back to a lack of adequate funding for his care. Listen to some other results of inadequate health care funding in Indian country: Native Americans younger than 25 years of age die at a rate three times that nationwide. Native Americans are three times more likely to die in accidents. Native Americans are four times more likely to die from diabetes. And Native Americans are seven and a half times more likely to die from tuberculosis.

American Indians also suffer from some of the worst rates of diabetes in the world.
U.S. Commission on Civil rights, 2004.
(U.S. Commission on Civil Rights, commission of the U.S. federal government charged with the responsibility for investigating, reporting on, and making recommendations concerning, civil rights issues that face the nation, NATIVE AMERICAN HEALTH CARE DISPARITIES
BRIEFING, “Tribal-Federal government relationship,” February 2004, p. 5, ESM)
Diabetes Diabetes is one of the most serious health challenges facing Native Americans, resulting in significant morbidity and mortality rates.27 In fact, Native Americans have the highest prevalence of Type 2 diabetes in the world, and rates are increasing at .almost epidemic proportions..28 The National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) defines diabetes mellitus as a group of diseases characterized by high blood levels of glucose stemming from defective insulin secretion and/or action.29 Most Native Americans with diabetes have Type 2 diabetes, also known as adult onset diabetes, which is caused by the body.s resistance to the action of insulin and impaired insulin secretion. Type 2 diabetes can be managed with healthy eating, physical activity, oral medication, and/or injected insulin.30 In fact, Dr. Jon Perez stated that one of the most distressing aspects of Type 2 diabetes is that with lifestyle changes it is largely preventable.31 Despite the fact that the rates of diabetes in the Indian community are .staggering,. the rates do not paint a true picture of how devastating the disease can really be, according to Dr. Dee Ann DeRoin, board member of the Association of American Indian Affairs.32 This is because the leading cause of mortality in the Indian community is heart disease, and hidden in that statistic is the fact that the largest percentage of deaths from heart disease are caused by diabetes. Thus, diabetes is both devastating the community in terms of quality of life and .maiming and killing. Native Americans.33 Another startling fact regarding the prevalence of Type 2 diabetes is that it has recently become a significant threat to Native American children.34 Its incidence is rising faster among Native American children and young adults than any other ethnic population.35 IHS has documented a 54 percent increase in the prevalence of diagnosed diabetes among Native American youth 15 to 19 years of age since 1996.36 Historically, Type 2 diabetes has been restricted to adults, at least partially as a result of declining insulin sensitivity with age.37 Its presence among children foreshadows the early arrival of more serious complications.38 Another national health care authority expressed concern about the challenges that diabetes presents for Native Americans of all ages. In 2000, Dr. David Satcher, the Surgeon General of the United States, testified that .the diabetes rate for American Indians and Alaska Natives is more than twice that for whites.
Health Impacts – Disease/Death

American Indians have higher cancer mortality rates than the rest of the U.S. population.
U.S. Commission on Civil rights, 2004.
(U.S. Commission on Civil Rights, commission of the U.S. federal government charged with the responsibility for investigating, reporting on, and making recommendations concerning, civil rights issues that face the nation, NATIVE AMERICAN HEALTH CARE DISPARITIES
BRIEFING, “Tribal-Federal government relationship,” February 2004, p. 5, ESM)
Cancer among Native Americans is a growing concern.82 While some statistics indicate lower cancer mortality rates for Native Americans in some regions of the United States than for whites, African Americans, Asians, and other races, it has become the leading cause of death for Alaska Native women and is the second leading cause of death among Native American women.83 Among health care professionals there is concern that lower mortality rates obscure important regional and cancer-specific differences in mortality, knowledge of which could assist local cancer prevention and treatment strategies.84 Specifically, higher rates of cancer mortality appeared in Alaska and the Northern Plains region of the United States, with 217.9 deaths (per 100,000 population) and 238.6, respectively, from 1994 through 1998.85 The overall cancer mortality rate for the rest of the United States for this period was 164.2 deaths per 100,000.86 These Native American cancer mortality rates in Alaska and the Northern Plains region are attributed to colorectal, gallbladder, kidney, liver, lung, and stomach cancers.87 Similarly, cervical cancer mortality rates were higher among Native Americans than among all racial and ethnic populations (3.7 versus 2.6, respectively), especially in the East and Northern Plains regions of the United States.88 A startling fact about cancer in Indian Country is that Native Americans have the lowest cancer survival rates among any racial group in the United States.89 Though some data are available, there is insufficient research on cancer among Native Americans.90 Nevertheless, experts have suggested that Native American cancer patients experience the disease differently from non-Native populations.91 Reasons for the difference include genetic risk factors, late detection of cancer, poor compliance with recommended treatment, presence of concomitant disease, and lack of timely access to diagnostic or treatment methods.92 Lyle Jack, a representative of the Lakota Sioux, testified that misdiagnosis and late diagnosis were especially prevalent on his reservation.93 Accordingly, additional research must be conducted to more fully explore the magnitude and causes of cancer disparities among Native Americans.

Infant mortality rates among American Indians are higher than the general population, and American Indian women also receive less prenatal care.
U.S. Commission on Civil rights, 2004.
(U.S. Commission on Civil Rights, commission of the U.S. federal government charged with the responsibility for investigating, reporting on, and making recommendations concerning, civil rights issues that face the nation, NATIVE AMERICAN HEALTH CARE DISPARITIES
BRIEFING, “Tribal-Federal government relationship,” February 2004, p. 5, ESM)
Infant mortality and maternal health rates are also considered to be indicators of health status for a particular community.94 Historically, Native Americans have suffered inordinately high infant mortality rates.95 Despite recent improvement, disparity persists. Native American infants continue to die at a rate two to three times higher than the rate for white infants.96 Moreover, Georgetown University.s Center for Child and Human Development, National Center for Cultural Competence, reported that for Native Americans, the incidence of sudden infant death syndrome (SIDS) is more than three to four times the rate for white infants.97 Not surprisingly, maternal health factors also indicate lower health status. Pregnant Native American women consistently hold the lowest percentage of women receiving early prenatal care when compared with women of other races and ethnicities. For example, the percentage of Native American women receiving early prenatal care was 66.7 percent in 1995, compared with 83.6 percent of white non-Hispanic women.98 In sum, the health indicators discussed above document the reality that Native Americans have significantly higher mortality rates and markedly lower health status than the general population. To understand why these health disparities persist, despite the federal government.s promise to provide quality health care, we examine the health care programs, services, and facilities available to Native Americans.

IMPACT: Mental Health and Suicide

Protective factors such as psychological assistance may assist native adolescents in suicide prevention, positive alcohol and drug decisions and coping with sexual abuse
Barney, assistant professor at the University of Oklahoma School of Social Work, 2001
(David, “Risk and Protective Factors for Depression and Health Outcomes in American Indian and Alaska Native Adolescents,” Wicazo Sa Review, Volume 16: Number 1, Spring 2001, pp. 135-150, CME)
Numerous other studies of adolescents have shown that protective factors may reduce suicide, reduce symptomatology in the adolescent with alcoholic parents, positively influence alcohol and drug use help in coping with sexual abuse, and, in general, protect against a constellation of problems related to inner-city life (Rubenstein et al. 1998; Roosa et al. 1990; Chandy, Blum, and Resnick 1996; Safyer 1994; Hawkins, Catalano, and Miller 1992).

There is severe lack of mental health services
Simmons, Indian Country Today Writer, 05
(Jeramiah, Indian Country Today, “Simmons: A looming mental health crisis in Indian Country”, 6/9/05, http://www.indiancountrytoday.com/archive/28165204.html, Accessed 6/28/09, CAF)
However, there is now a movement to shift away from conventional counseling and move in the direction of culturally sensitive mental health approaches that integrate American Indian cultural values into treatment to better interface with the Indian patient population. IHS mental health clinics are geographically isolated and pose complicated utilization barriers such as unconscious physician bias and prejudice. Also, the socio-demographic and cultural differences between American Indian communities create challenges to the development of comprehensive, coordinated and sustained quality services specific to individual tribes. More than half of all American Indians live in urban areas and receive little or no support from the IHS. The remaining half live on reservations or rural non-reservation areas and receive support through IHS facilities. Unfortunately, funding is not divided proportionally between these service areas.A majority of the IHS budget is directed towards serving American Indians on reservations or rural areas near reservations. The IHS operates on a $2.4 billion budget with $370 million directed at IHS facilities. Under the fiscal year 2004 budget, only 2 percent of that budget is directed for the Urban Indian Health Programs, which has been the norm since 1979. Only a fraction of this 2 percent will be allocated to serve more than 50 percent of the Indian population;s mental health needs in urban areas. As a result, a lack of professional specialty services and fewer comprehensive helper networks contribute to the mental health crisis for urban Indians.

IMPACT: Mental Health and Suicide

Due to lack of funding, the IHS cannot help many Native Americans with mental health problems
Empsall, Bachelor’s Degree from Dartmouth in Government and Native American Studies, 2008
(Nathan, The Episcopal Public Policy Network, “On the Issue: American Indian Healthcare”, August 2008, http://www.cuac.org/3654_101099_ENG_HTM.htm, 7-1-09, KS)
IHS reports that mortality rates for diabetes, tuberculosis, cervical cancer, pneumonia, influenza, SIDS, alcoholism, homicide, and unintentional injuries are all disproportionately higher among Indians than the general population. Heart disease and stroke mortality rates remain constant for now, but are on the rise in Indian country despite a decline in the general population. Indian women’s health lags behind the national average. Not only does cervical cancer occur among Indians at a higher rate than any other race, but prenatal care occurs at a lower rate than any other ethnicity. Only 69% of pregnant Indian women get prenatal care, as compared to 85% of Anglo women. Perhaps as a result, the infant mortality rate is 150% greater than among white infants, and sudden infant death syndrome (SIDS) occurs three to four times more often. Indian diabetes rates are among the highest in the world. 15% of IHS patients have officially been diagnosed as diabetic, and the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) estimates that as many as 70% of Indians between the ages of 45 and 74 may have diabetes. The age-adjusted death toll from diabetes is an astonishing 350 times that of the greater population. Sadly, these numbers are increasing rather than decreasing, and the rate of Type 2 diabetes among Indian children is climbing faster than that of any other child population. Alcoholism affects Indian Country at a rate three times the national average, with a mortality rate mortality rate 550% higher, according to IHS. Alcohol was introduced to Indian communities with the arrival of European fur-trappers, and the combination of a possible genetic disposition for alcoholism, the fur-trappers’ poor examples, a lack of experience with alcohol, and a federal ban on selling alcohol to Indians led to the current health crisis. Poor mental health is another cause of high dependency and suicide rates. In 2004, the U.S. Commission on Civil Rights reported that, “IHS is mostly limited to basic psychiatric emergency care, due to budget constraints and personnel problems… IHS does not provide ongoing, quality psychiatric care. Instead, the approach adopted by IHS is one of responding to immediate mental health crises and stabilizing patients until their next episode.” And while there are 173 mental health professionals for every 100,000 whites, the rate is only 101 per 100,000 for Indians.

Native Americans have a suicide rate 50% higher than other groups
CNN.com, 2001
(CNN, “Report: Minorities lack proper mental health care”, 8-27-01, http://www.cnn.com/2001/HEALTH/08/26/mental.healthi?related D. C., 7-6-09, KS)
American Indians and indigenous Alaskans living in isolated, rural communities have "severely" limited mental health treatment options, the report said. The report noted these groups have a suicide rate 50 percent higher than that of the general U.S. population. But a lack of research into mental health issues surrounding Native Americans makes it difficult to design and evaluate appropriate mental health care, the study said.

Several Mental Health Factors cause high suicide rates among Natives -
Blount, Doctoral Student at the School of Social Work at Florida State University, 1996
(Mary, Cultural Diversity and Social Work and Practice, p.281, KS)
Developmental psychologists working with the THS have speculated on suicide causality in light of Erickson's model which focuses on the adolescent tasks of identity versus identity diffusion. For example, Neligh (1990) suggests that the lack of viable adult identities for Indian adolescents from tribes experiencing extreme cultural stress may well be a factor contributing to unusually high-risk behaviors during this developed mental phase. Bachman (1992) speculates that negative self-images are due to school racism, abuse and neglect at home, or other environmental factors that increase the frequency of depression and other symptoms of mental health problems that contribute to suicide.
Suicide research has identified several mental health factors that help identify youth at highest risk for self-destruction. Some of these factors are: psychiatric disorders, affective disorders such as bipolar disorder or major depression, personality disorders, and a family history of psychiatric disorder (Hollinger et al., 1994). IHS mental health professionals cite major depression, bipolar disorder, and schizophrenia as significant mental health problems among American Indian youth, and these factors are commonly documented in the majority of Indian suicides and homicides (Neligh, 1990).
Extensions to Genocide/Racism Impact

Denial of Indian health care is a part of an ongoing legacy of genocide and institutional racism against American Indians
Belcourt-Dittloff and Stewart, Professors of Psychology, University of Montana, 2000
(Annjeanette & J. “Historical Racism: Implications for Native Americans,” American Psychologist, 55, 1166-1167)
After reading this article, we were struck by the similarities that exist between this cultural group and Native Americans. Native Americans have historically been and currently are highly affected by intergroup racism, racism being the existence of “beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics or ethnic group affiliation” (Clark et al., 1999, p. 805). One long-standing example of intergroup racism that continues to have pervasive effects is historical racism. It is our belief that historical racism has had and continues to have a profound impact on Native Americans. We outline below some possible ways in which historical racism constitutes a stressor with biopsychosocial implications for American Indians. The concept of historical racism is an outgrowth of the fact that American Indian people have long been known to experience racism and oppression as a result of colonization and its accompanying genocidal practices (Brave Heart & DeBruyn, 1998). It is estimated that the population of Native American peoples was decreased to only 10% of its original number by the end of the 18th century (Sue & Sue, 1990). The massive loss of lives, land, and culture is believed to have resulted in a long legacy of chronic trauma and unresolved grief for Native Americans (Brave Heart & DeBruyn, 1998). Similar to the lasting effects of slavery on African Americans, the historical legacy of trauma and unresolved grief experienced by Native American peoples because of historical racist acts has become an unfortunate foundation of the American Indian experience. Also similar to the experiences of African Americans, this foundation has had tragic ramifications on the well-being of Native American peoples. As stated elsewhere, “the trauma and intergenerational grief and despair associated with these experiences is still readily evidenced in most tribal cultures and is still taking a toll in many tragic ways” (Sommers-Flannagan & Sommers-Flannagan, 1999, p. 376). In addition to the overt racism and discrimination experienced by Native Americans, many American Indians continue to encounter more subversive racial discrimination. Examples of institutionalized discriminatory practices abound. One illustration of this practice exists in the area of health care for American Indian peoples. Despite the fact that Native Americans are plagued by disproportionately high rates of suicide, homicide, accidental deaths, domestic violence, child abuse, alcoholism, and mental health problems (Brave Heart & DeBruyn, 1998; Indian Health Service, 1995), Native Americans are both an underserved and underrepresented health care population.

Extensions to Genocide/Racism Impact

Racial discrimination plays a big part in the healthcare disparities among American Indians.
U.S. Commission on Civil rights, 2004.
(U.S. Commission on Civil Rights, commission of the U.S. federal government charged with the responsibility for investigating, reporting on, and making recommendations concerning, civil rights issues that face the nation, NATIVE AMERICAN HEALTH CARE DISPARITIES
BRIEFING, “Tribal-Federal government relationship,” February 2004, p. 5, ESM)
The causes of the disparities in the health status of Native Americans are many and varied. Among the causes identified by the director of IHS is racial discrimination.99 Analyzing the effects of that discrimination proves difficult as the unique racial or ethnic status and political history of Native Americans introduce unique emotional variables. According to Michael Bird, .when you dispossess people of their land or labor, their culture, their language, their tradition, and their religion you set into force powerful forces that impact in a very negative and adverse way..100 These comments on discrimination echoed the findings of the Commission’s 1999 report on health care disparities,101 as well as those of several other government agencies. The National Institutes of Health recognized that racial bias contributed significantly to differences in health care among people of color in its Strategic Plan for Health Disparities Research,102 while the Institute of Medicine established that .whites are more likely to receive more, and more thorough, diagnostic work and better treatment and care than people of color, even when controlling for income, education, and insurance..103 Few studies, however, have addressed how racial bias systematically affects the health of Native Americans. Though the categorization of discrimination in general terms is possible, the nature of that discrimination has changed to become subtle and more difficult to address.104 Consequently, identifying all areas in which racial bias and discrimination influence or contribute to existing health disparities proves difficult. Current research indicates that there are five primary contributors to disparities in health status and outcomes for Native Americans. It must be observed that these factors are not beyond the influence of racial bias and discrimination, either systemic or individual. The five factors include: Limited access to appropriate health facilities. Poor access to health insurance, including Medicaid, Medicare, and private insurance. Insufficient federal funding. Quality of care issues. Disproportionate poverty and poor education.105 These five factors are not mutually exclusive; in fact, there is substantial overlap. As heard throughout the briefing, this is particularly true when funding considerations are implicated. For example, a person may arrive at a health facility only to find that lack of funding has prevented the facility from providing the necessary services or that there is an extended waiting period before services will be available. Lyle Jack, councilman of the Oglala Sioux, stated that although his tribe has what is considered to be one of the best rehabilitation centers, it does not have sufficient funding to staff the facility properly.106 Regardless of the reason, health care access remains limited. Thus, we turn to a discussion of the five factors that sustain the disparities in health status.
IMPACT: Moral Obligation/Human Rights

The USFG has a moral obligation to provide Native Americans with the necessary healthcare.
U.S. Commission on Civil rights, 2004.
(U.S. Commission on Civil Rights, commission of the U.S. federal government charged with the responsibility for investigating, reporting on, and making recommendations concerning, civil rights issues that face the nation, NATIVE AMERICAN HEALTH CARE DISPARITIES BRIEFING, “Tribal-Federal government relationship,” February 2004, p. 5, ESM)
TRIBAL-FEDERAL GOVERNMENT RELATIONSHIP
Native Americans are dying of diabetes, alcoholism, tuberculosis, suicide, unintentional injuries, and other health conditions at shocking rates. Beyond the mortality rates, Native Americans also suffer significantly lower health status and disproportionate rates of diseases compared with all other Americans. During the briefing, Michael Bird, executive director of the National Native American AIDS Prevention Center, made evident how long these devastating realities have afflicted the Native American peoples as he quoted from an address to Congress by President Nixon in 1970: The First Americans.the Indians.are the most deprived and most isolated minority group in our nation. On virtually every scale of measurement: employment, income, education, and health, the condition of the Indian people ranks at the bottom. This condition is the heritage of centuries of injustice. From the time of their first contact with European settlers, the American Indians have been oppressed and brutalized, deprived of their ancestral lands, and denied the opportunity to control their own destiny.4 The conditions described by President Nixon, which still exist today, are the result of the federal government.s failure to respect promises made to Native Americans over the past 300 years in exchange for 400 million acres of tribal land and the unfulfilled .trust. relationship that requires the government to protect tribal lands, assets, resources, treaty rights, and health care, among other obligations. The legal source of this trust obligation, however, is imprecise as the boundaries and duties of the trust relationship have evolved over the past two centuries. Pursuant to the power .[t]o regulate Commerce . . . with the Indian tribes.5 a series of treaties, judicial decisions, and statutes has shaped federal trust responsibility. Accordingly, the federal government has accepted many obligations, including education, construction, law enforcement, and medical services. This health care obligation requires the government to provide medical treatment to all Native Americans living in the United States.

Health Care is a human right
National Health Care for the Homeless Council, date unknown
(NHCHC, “Human Rights, Homelessness and Health Care”, date unknown, http://www.nhchc.org/humanright.html, 6-28-09, MEL)
The Universal Declaration of Human Rights, adopted by the United Nations in 1948, proclaimed that “everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including food, clothing, housing, and medical care.” Although this statement of high principle was adopted at the urging of the United States, and although it reflects the truths of our nation’s founding documents, our government has achieved neither formal recognition nor practical realization of these rights. Mass homelessness and the escalating health care crisis in the US are compelling evidence of our disregard for human rights. Sadly, our country is but one of many nations where grave offenses against the dignity of human beings are commonplace, and global enforcement of human rights remains a distant goal. In the US, however, the twin advantages of democratic institutions and great wealth provide the opportunity for our nation to implement the principles human rights. Implementation of human rights principles will lead inexorably to the elimination of mass homelessness.
Solvency Extension - IHCIA/IHS Solves

Reauthorized of the Indian Health Care Improvement Act is crucial to removing American Indians from the bottom of every health care indicator in the US.
Stockes, Indian Country Today Writer, 01
(Brian, Indian Country Today, 2/28/01, “Healthcare gets new scrutiny” http://www.indiancountrytoday.com/archive/28194149.html , Accessed 6/28/09, CAF)
Late last year, the law which authorizes federal health care for all Indians expired. Since then, Congress, the administration and the tribes have worked to redraft and update new legislation. The result of that work was introduced as a bill, along with other Indian health care initiatives, by Sen. Ben Nighthorse Campbell, R-Colo., chairman of the Senate Committee on Indian Affairs. The Indian Health Care Improvement Act was initially authorized by Congress in 1976 and enables the Indian Health Service (IHS), to provide a variety of health care services to Indian people."American Indians rank at or near the bottom of every health care indicator in the United States today," Campbell said. "Infant mortality, diabetes, substance abuse and cancer rates plague Native people at rates much higher than any racial or ethnic group in the nation. I am hoping that by incorporating the lessons we have learned over the past 30 years we can help turn this situation around." In 1999, the administration, through the IHS, sponsored a number of regional meetings between tribal health care providers, both on reservation and in urban areas, to discuss various health care concerns and to gather recommendations on the reauthorization of the Indian Health Care Improvement Act. Following initial meetings, tribes, tribal organizations, and urban Indian organizations formed a National Steering Committee.

The IHCIA includes a laundry list of new measures to increase quality of American Indian healthcare.
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System” September. Pages 125 & 126. MAG)
Title II: Health Services. The changes in Title II, in broad terms, aim to improve the quality of health service programs providing care to Native Americans. Improvement will be accomplished by: institutionalizing the national diabetes program that is currently funded by special appropriations; decentralizing control of the Catastrophic Health Emergency Fund to the area level; expanding preventive services to cover all cancers, instead of limiting coverage to mammography screening for breast cancer; establishing epidemiology centers in all 12 areas; requiring staff in tribally operated facilities to meet the same licensing requirements as IHS facilities; strengthening the prohibition against contract health service providers holding individual patients responsible for payment for contract health services obligations; establishing a program to monitor nuclear and environmental health hazards; and designating the entire state of Arizona as a Contract Health Service Delivery Area. Title III: Health Facilities. As a starting point, Title III will institutionalize tribal consultation for facilities expenditures. This change will ensure that facilities decisions accurately reflect the needs and priorities of the affected populations. In addition, the consultation will result in a priority system that encompasses all facilities, not just a “top 10.” This change ensures that a true and complete spectrum of unmet need in Indian Country is presented. Concerning accreditation, Title III will authorize accreditation under any nationally recognized accrediting authority. Doing so will expand the ability of smaller facilities to meet eligibility requirements for public insurance programs, increasing the funding available to purchase additional health care for Native Americans. Several of the other changes involve the creation of more flexible funding options. These include the creation of IHS-tribal joint ventures; allowing for innovative financing by tribes, coupled with an IHS commitment to equipment and staffing; the creation of a Health Care Facilities Loan Fund; and express permission to use any “other source” of funds for tribal services to provide health care. A provision is included to ensure that the use of other sources by tribes will not jeopardize their positions on the priority list for future construction projects. These flexible funding options have the potential to significantly increase the operating funds available to tribally operated facilities and will serve as a multiplier for federal funding.
Solvency Extension - IHCIA/IHS Solves

Increasing funding for the IHS to $18 billion solves
Roubideaux, MD, MPH, professor of Public Health at the University of Arizona, 2002
(Yvette, “Perspectives on American Indian Health”, American Journal of Public Health. 92.9: 1401-1403, EKC)
The federal government has a trust responsibility to provide health care for American Indians and Alaska Natives, based on multiple treaties, court decisions, and legislative acts. However, the IHS is critically underfunded. Although its budget for fiscal year 2002 is $2.8 billion, tribal leadership has estimated that a needs-based budget for Indian health care should be closer to $18 billion. Per capita expenditures for Indian health care were approximately one third as much as expenditures for individuals in the US general population in 2001.4 Lack of adequate funding and services is a constant stress on the Indian health system and plays a significant role in the continuing health disparities in Indian communities.

*The Indian Health Care Improvement Act would directly increase funding
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Pages 129 & 130, MAG)
As mentioned above, the proposed reauthorization of IHCIA recognizes that many, and in some areas most, tribes have assumed responsibility for administering their own health programs under contracts and compacts. While tribes rely on government funding, the reliance is to varying degrees. Many tribes have found it necessary to access tribal money, charitable grants, and other funding sources. The new bill will allow for additional and more flexible funding options, as explained above. In addition to these options, the reauthorization will produce gains in direct funding for health care. Specifically, the improvements identified above would generate at least an additional $6.9 billion for direct spending on Native American health care over the next 10 years.

Solvency Extension - IHCIA/IHS Solves

All I.H.S. problems can be solved by more federal funding.
Kauahquo, Native American Times writer, 2005
(Michelle, Native American Times, “Fixing Indian health services—some suggestions,” 3-16-05, http://proquest.umi.com/pqdweb?index=0&did=836919181&SrchMode=2&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1246255456&clientId=10553, 6-29-09, ESM) Free Health Care for all Native Americans! The Federal Government allocated funds specifically for the Indian Health Service (IHS) in 1921, in order to provide Natives with Health Care. The notion of "free" paired with healthcare sounds very appealing. I am a Native American and am entitled to this free healthcare, however I have not utilized this system since I was a young child. Why, you ask, would I pay for something that I can get for free? I have grown up going to a private physician rather than going to the "Indian clinic." From family members that use and work for IHS, I have always had this preconceived idea that IHS provides less than average healthcare. Is the care provided through the IHS necessarily insufficient or is this just a reputation that I have assumed? Seeing that IHS is the only form of "national" healthcare available in the United States, it is actually run pretty well; although there are many improvements that could be made through our efforts, as the Natives that utilize this service. According to the IHS mission statement, their purpose is to uphold the Federal Government's obligation to promote healthy American Indian and Alaska Native people and also to achieve this at the highest level. However, looking at the IHS, it is apparent that the highest level is not being achieved across the board, with some service units receiving better care than others. Also, the care being provided at a majority of the clinics is not even close to the highest quality level of care. Almost two-thirds of the care needed for American Indians and Alaska Natives is not available through Indian Health Service (IHS) or Tribal programs. The Pawnee Benefit Package(PBP) is a program that has been established by IHS and being run by the Pawnee Nation that has been an attempt at solving this remaining two-thirds problem. The PBP works as a sort of insurance plan for the community served by the Pawnee Area Hospital. Each member receives a PBP card that is accepted by predetermined private doctors so that they may receive care, which is not provided by HIS. The PBP is a fairly new program, which works at solving this problem. It is an excellent start that can be tweaked to provide maximum care. IHS funding is actually 40% less than the average that it costs for mainstream health insurance plans.3 This 40% deficit accounts for the racial disparities in health among Native Americans. The IHS does provide the baseline money needed to fund programs such as Diabetes Awareness and AIDS Prevention. However, this money does not take into account the ancillary costs of these programs. The Director of Facilities for IHS-Lawton, Frank Kauahquo, suggests that the money and initiative is there for the new programs but there just isn't enough space in which to host these programs. Space, being one of these ancillary costs, can also be attributed to the problem of waiting time at certain "Indian clinics," such as the Lawton Area Hospital. At this hospital, in particular, there is one exam room per doctor. This lack of space slows down the whole outpatient process. Even though the space isn't there, the doctors are available. The IHS Scholarship program has been established to attract undergraduate, graduate, and medical students to the Medical Field, and more particularly, to work for the IHS. The scholarship is meant to attract Native Americans to give them the means to get a professional degree to enable them to come back and work for their people. However, the number of Native Americans applying has been declining. All the above statements describe problems within IHS that can be solved. They all can be solved with extra funding. The Federal Government supplies us with funding for our "Free" basic health care needs; it is our job, as Native people, to take the initiative to help pay for the extra costs. With our increase in funding from gaming endeavors, we have the resources to do so.

Solvency Extension - IHCIA/IHS Solves

IHS solves- since they’ve been put in charge of American Indian health, mortality rates have dropped.
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Pages 7-8, MAG)
Consequently, not only is reduced health status a burden to Native Americans, but a cumulative drain on the entire Native American existence. Poor health inhibits the economic, educational, and social development of Native Americans and establishes an inescapable cycle of disparity. Nevertheless, not all news regarding health status is bad news. The IHS, which has been given primary responsibility for eliminating this disproportionate health status, has been largely successful in reducing mortality rates, while making significant improvements in other areas.5 Dr. Perez explained that the incidence and prevalence of many infectious diseases have been dramatically reduced through increased clinical care and public health efforts such as vaccination for infectious diseases and the construction of sanitation facilities. Today, Native Americans continue to experience significant rates of diabetes, mental health disorders, cardiovascular disease, pneumonia, influenza, and injuries. Specifically, Native Americans are 770 percent more likely to die from alcoholism, 650 percent more likely to die from tuberculosis, 420 percent more likely to die from diabetes, 280 percent more likely to die from accidents, and 52 percent more likely to die from pneumonia or influenza than the rest of the United States, including white and minority populations.7 As a result of these increased mortality rates, the life expectancy for Native Americans is 71 years of age, nearly five years less than the rest of the U.S. population.8 A comparison of earlier life expectancy data illustrates one of the problems facing IHS in eliminating disparities. In 1976, the life expectancy for Native Americans was 65.1 years, compared with 70.8 years for other Americans.9 Consequently, while life expectancy for Native Americans has improved by six years, the difference in life expectancy relative to other Americans has changed very little. Another problem facing health care providers is the increasing importance of the behavioral component of health status. During the October briefing, Dr. Perez explained that fully seven of the top 10 causes of high morbidity and mortality rates are “directly related to, or significantly affected by individual behavior and lifestyle choices.”

Solvency Extension - IHCIA/IHS Solves for cultural sensitive health

Funding is necessary for culturally-sensitive programs
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Page 36 MAG)
Unfortunately, the dissatisfaction found by the focus group indicates that the cultural training IHS provides may be insufficient for addressing cultural barriers for Native Americans. Despite the recognized importance and need for cultural competency training, IHS does not have a specific budget set aside for training its IHS direct or contract health service providers. The IHS reports that some formal and informal training is conducted at the area or local level.76 However, IHS did not provide specific information as to how managers have sought to incorporate culturally competent care into the delivery of health services at IHS and non-IHS facilities. In addition, IHS did not provide the requested information on the impact or outcome of its efforts to incorporate culturally competent care into the delivery of care on the health status and outcomes for Native Americans. Overall, despite requests for detailed and specific information on IHS training and policy implementation efforts to ensure culturally competent care, IHS was unable to identify monitoring mechanisms, training initiatives, or targeted funding indicative of the commitment needed to develop cultural competency in the delivery of health services at IHS and non-IHS facilities.

The IHS has a commitment to respecting native cultures & healing practices
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Page 34 MAG)
Generally, IHS recognizes the importance of culturally competent care. Dr. Charles W. Grim, director of IHS, cited cultural and language barriers as factors that affect health disparities and access to health care. He added that IHS is working to make its programs culturally relevant, and as a result, cultural competence is losing significance as a factor for accessing IHS services. Dr. Richard Olson, acting director of Office of Clinical and Preventive Services, also acknowledged that cultural competence is an aspect of quality of care. IHS defines “culturally competent care” as “a term implying that IHS programs and staff should be aware, sensitive, and accommodating of a wide diversity of Native languages, customs, beliefs, values, and traditions of healing and wellness.” While IHS acknowledges that culture and language can be barriers to care for over 560 federally recognized tribes, many with their unique cultures and languages, IHS claims that, because it employs a high percentage of Native American staff, cultural competency is not a major issue at IHS. According to IHS, it “recognizes the value of traditional beliefs, ceremonies, and practices in the maintenance of wellness and the healing of the body, mind and spirit.” Therefore, IHS encourages an atmosphere where traditional beliefs are upheld and respected to ensure that they are a vital force within Indian communities and that those traditional beliefs remain an integral component of the healing process. Furthermore, IHS makes traditional medicine, as defined by tribal or village traditional culture, accessible in all its service delivery locations. IHS is also designing and constructing its new clinics and hospitals to include space for spiritual healing practices. In terms of whether IHS facilities are successfully delivering culturally competent health services, a focus group of Native Americans in Albuquerque, New Mexico, revealed that participants were generally satisfied with IHS providers’ awareness of the significance of Native American culture. This finding tends to support Dr. Grim’s testimony that cultural and language barriers have become less of an issue for IHS services
Solvency Extension – Congress Key

Health care specifically targeted at Native Americans is uniquely key to their cultural integrity and self determination, and represents a fundamental shift away from assimilation strategies
Ignance, President of the National Council of Urban Indian Health (NCUIH) and member of the Menominee Tribe, 2006
(“Plea For Urban Indian Health.” Native American Law Digest May 2006. Accessed 30 Jun 2009. EKC)
3 "The American Indian has demonstrated all too clearly, despite his recent movement to urban centers, that he is not content to be absorbed in the mainstream of society and become another urban poverty statistic. He has demonstrated the strength and fiber of strong cultural and social ties by maintaining an Indian identity in many of the Nation's largest metropolitan centers. Yet. at the same time, he aspires to the same goal of all citizens--a life of decency and self-sufficiency. The Committee believes that the Congress has an opportunity and a responsibility to assist him in achieving this goal. It is, in part, because of the failure of former Federal Indian policies and programs on the reservations that thousands of Indians have sought a better way of life in the cities. His difficulty in attaining a sound physical and mental health in the urban environment is a grim reminder of this failure."
"The Committee is committed to rectifying these errors in Federal policy relating to health care through the provisions of title V of H.R. 2525. Building on the experience of previous Congressionally-approved urban Indian health prospects and the new provisions of title V, urban Indians should be able to begin exercising maximum self-determination and local control in establishing their own health programs."

The IHS needs 50% more funding to function properly and modernize its services
COCHRAN, Bilings Gazette News Journalist, 2009
(Diane, Tribes keep eye on health care reform, Missoulian, June 29, 2009, CME)
“We don't know what health care reform is going to look like, so it's hard to position ourselves,” said Pete Conway, a director for the Indian Health Service in Billings. Whatever Congress decides to do about health care, tribes want to gain ground, not lose it. And that means achieving at least two goals - keeping their status as sovereign nations and improving the Indian Health Service system. “The most important thing that needs to happen for American Indians and Alaska Natives is for our (health) system to be protected and, at the same time, improved,” said Jennifer Cooper, legislative director for the National Indian Health Board in Washington, D.C. Some 1.9 million American Indians get medical care through IHS, an often-criticized health care delivery system that historically has been funded at about 50 percent of need. Tribal advocates have been lobbying Congress for 10 years to renew the Indian Health Care Improvement Act, legislation that would increase IHS funding and modernize its services.
Solvency Extension – Federal Government Key

All I.H.S. problems can be solved by more federal funding.
Kauahquo, Native American Times writer, 2005
(Michelle, Native American Times, “Fixing Indian health services—some suggestions,” 3-16-05, http://proquest.umi.com/pqdweb?index=0&did=836919181&SrchMode=2&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1246255456&clientId=10553, 6-29-09, ESM) Free Health Care for all Native Americans! The Federal Government allocated funds specifically for the Indian Health Service (IHS) in 1921, in order to provide Natives with Health Care. The notion of "free" paired with healthcare sounds very appealing. I am a Native American and am entitled to this free healthcare, however I have not utilized this system since I was a young child. Why, you ask, would I pay for something that I can get for free? I have grown up going to a private physician rather than going to the "Indian clinic." From family members that use and work for IHS, I have always had this preconceived idea that IHS provides less than average healthcare. Is the care provided through the IHS necessarily insufficient or is this just a reputation that I have assumed? Seeing that IHS is the only form of "national" healthcare available in the United States, it is actually run pretty well; although there are many improvements that could be made through our efforts, as the Natives that utilize this service. According to the IHS mission statement, their purpose is to uphold the Federal Government's obligation to promote healthy American Indian and Alaska Native people and also to achieve this at the highest level. However, looking at the IHS, it is apparent that the highest level is not being achieved across the board, with some service units receiving better care than others. Also, the care being provided at a majority of the clinics is not even close to the highest quality level of care. Almost two-thirds of the care needed for American Indians and Alaska Natives is not available through Indian Health Service (IHS) or Tribal programs. The Pawnee Benefit Package(PBP) is a program that has been established by IHS and being run by the Pawnee Nation that has been an attempt at solving this remaining two-thirds problem. The PBP works as a sort of insurance plan for the community served by the Pawnee Area Hospital. Each member receives a PBP card that is accepted by predetermined private doctors so that they may receive care, which is not provided by HIS. The PBP is a fairly new program, which works at solving this problem. It is an excellent start that can be tweaked to provide maximum care. IHS funding is actually 40% less than the average that it costs for mainstream health insurance plans.3 This 40% deficit accounts for the racial disparities in health among Native Americans. The IHS does provide the baseline money needed to fund programs such as Diabetes Awareness and AIDS Prevention. However, this money does not take into account the ancillary costs of these programs. The Director of Facilities for IHS-Lawton, Frank Kauahquo, suggests that the money and initiative is there for the new programs but there just isn't enough space in which to host these programs. Space, being one of these ancillary costs, can also be attributed to the problem of waiting time at certain "Indian clinics," such as the Lawton Area Hospital. At this hospital, in particular, there is one exam room per doctor. This lack of space slows down the whole outpatient process. Even though the space isn't there, the doctors are available. The IHS Scholarship program has been established to attract undergraduate, graduate, and medical students to the Medical Field, and more particularly, to work for the IHS. The scholarship is meant to attract Native Americans to give them the means to get a professional degree to enable them to come back and work for their people. However, the number of Native Americans applying has been declining. All the above statements describe problems within IHS that can be solved. They all can be solved with extra funding. The Federal Government supplies us with funding for our "Free" basic health care needs; it is our job, as Native people, to take the initiative to help pay for the extra costs. With our increase in funding from gaming endeavors, we have the resources to do so.

A2: I.H.S. is Racist

The IHS isn’t racist – only private health care providers link
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Page 35 MAG)
However, despite Dr. Grim’s statement that IHS provides training for non-IHS providers at contract facilities,66 the findings from the Albuquerque focus group revealed Native American patients’ dissatisfaction with biased behavior and cultural insensitivity toward the importance of traditional medicine by health care providers from the private sector.67 Supporting the general findings of the Albuquerque focus group, tribal representatives and leaders with whom the Commission spoke agreed that, generally, cultural competency is not a major concern when accessing IHS direct services. The sense of dissatisfaction with a lack of cultural sensitivity derives primarily from services provided to Native Americans by contract health providers. When asked to provide specific information on the number and the types of administrative and judicial complaints concerning the IHS direct, tribal, and contract health services, IHS merely responded that the Contract Health Services program does not maintain complaint-related data. Because of IHS’ failure to provide requested information on any complaints concerning the quality of care provided at IHS direct, tribal, and contract health facilities, it is difficult to assess the degree to which the lack of culturally competent care is affecting the quality of care Native Americans receive.
A2: Transportation

The Indian Health Care Improvement Act solved transportation issues, but after it lapsed, it has resurfaced.
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Page 70 & 71 MAG)
For the more than 538,000 Native Americans living on reservations or other trust lands where the climate is inhospitable, the roads are often impassable, and where transportation is scarce, health care facilities are far from accessible. Anslem Roanhorse, director of the Division of Health for the Navajo Nation, testified that on the Navajo reservation 78 percent of the public roads are unpaved and 60 percent of the homes lack telephone service.216 Even worse, for those who can get to the facilities, the equipment, medicine, and services are often not available for necessary treatment. Traveling to more distant facilities and delaying treatment are the only options. For example, in Eagle Butte, South Dakota, the Cheyenne River Sioux Tribe does not have an obstetrics unit in its hospital and is worried that the new proposed hospital will not have one. “Obstetrics services for the tribe’s approximately 210 births a year are contracted out, ‘and last year there were five births in the ambulance on the way to Pierre,’ 90 miles away,” according to tribal leaders. IHS has announced that the new facility will have an obstetrics unit, however, there is concern that there will be insufficient funding to hire an obstetrician. For the Kalispel Tribe in Usk, Washington, the problem extends beyond specialty services. They have no on-site primary care at this time; tribal members must travel 75 miles to receive care at the Wellpinit Service Unit IHS clinic or use an IHS contract facility, if available. Geographical access problems are not limited to remote, rural areas. For the 25,000 urban Indians living in Denver, Colorado, the closest IHS hospitals are in Albuquerque, New Mexico (450 miles away) and Rapid City, South Dakota (400 miles away). The geographical access problem is not a new problem facing IHS. It has long been recognized that geographic location and the resulting transportation problems hamper IHS efforts to provide health services. In 1976, by passing the Indian Health Care Improvement Act to raise the health status of Native Americans, Congress acknowledged the grave health disparities Native Americans were facing. Among other access problems, Congress explained that many Native American patients were “hitchhiking” or relying on costly rides from neighbors to get to IHS facilities.223 This situation, unfortunately, has not changed today. Many Native Americans continue to depend on others traveling to IHS facilities. Because of unpredictable travel arrangements, they are unable to plan ahead and make appointments at the IHS facilities; thus, many show up without appointments, leading to long wait times at the facilities. The problem is magnified as many facilities are unable to accommodate walk-in patients and limit their services to appointment-only services.225

IHS solves: Telemedicine solves transportation issues, allows for better levels of care.
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Page 73 & 74. MAG)
Where IHS locates its facilities ultimately affects how accessible its services are to Native Americans. As stated, IHS is developing new criteria and guidelines to determine its plans for IHS facilities and soliciting input to ensure that the placement of facilities and the types of services to be provided are determined based on community needs. One notable step IHS has taken to address the geographical barrier between remote communities and health care providers is telemedicine. IHS is applying technology to bring primary care and specialty medicine to remote locations. Telemedicine “refers to the use of electronic communication and information technologies to provide or support a diverse group of health-related activities that may include health professionals’ education, community health education, public health research, and the administration of health services.” There are about 40 telemedicine programs and partnerships within IHS that are delivering care to smaller, more isolated communities. For example, clinical engineers are equipping small remote villages in Alaska with telemedicine systems to transmit digital images of patients’ eardrums, skin conditions, and even tonsils to distant health care providers. Through telemedicine, small rural communities can communicate during emergencies with social workers via video conferencing when transportation is difficult or impossible. Telemedicine allows pre- and post-operation services to be provided at the local facility and eliminates trips to regional medical centers. The local on-site primary care provider can receive quick consults from regional medical centers, which results in a faster treatment time. It also provides access to continuing medical and community education. Telemedicine has the potential to eliminate some of the geographical access issues for Native Americans in rural communities.
A2: “Structural/Distribution Barriers”

Past I.H.S. failures are a result of insufficient resources not structural barriers
Pfefferbaum et al., Ph.D. Director of Gerontology, Phoenix College, 1997
(Rose L., “Providing for the Health Care Needs of Native Americans: Policy, Programs, Procedures, and Practices,” American Indian Law Review, Volume p. 238)
IHS success in the provision of a comprehensive range of services within a system that permits local and regional involvement has depended to no small extent on the ability of the IHS to integrate services both regionally and nationally. It would be a mistake to think that transferring responsibility for service provision to tribes will leave IHS successes undisturbed - particularly when they depend on systemic characteristics - while freeing up resources for attention to its failures. This is especially true to the extent that IHS failures have been the result of insufficient resources rather than structural factors.

I.H.S. problems are a result of funding insufficiency not distribution structure
Pfefferbaum et al., Ph.D. Director of Gerontology, Phoenix College, 1997
(Rose L., “Providing for the Health Care Needs of Native Americans: Policy, Programs, Procedures, and Practices,” American Indian Law Review, Volume 21, p. 241)
The IHS is frequently criticized, internally and externally, for its resource allocation methods and the resulting distribution of health facilities, personnel, and services. To a large extent, these criticisms reflect the inadequate levels of congressional appropriations for IHS services and facilities. It also reflects, however, a belief among many that the IHS is not distributing resources equitably or cost-effectively.103 The lack of consensus among critics as to what would constitute an equitable resource distribution attests to the difficulty inherent in attempting to resolve issues of equity so as to satisfy the many varied and competing interests.

A2: No Qualified Professionals

IHS solves: they have effective methods of recruitment and a substantial percentage of their health care professionals are American Indian.
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Page 79-80. MAG)
Improvements in recruiting, training, and compensation are necessary to reduce the shortage of health professionals at IHS facilities. To reduce staff shortages, IHS has been implementing a system of special pay, bonuses, and allowances. IHS also has scholarship and loan repayment programs. Both of these programs provide benefits to health professionals in exchange for serving in IHS. Through IHS Indian Health Professions programs, IHS has been recruiting and retaining Native American health professionals. These recruitment and retention activities are essential to staffing and managing IHS’ health care delivery system. Under the authorization of IHCIA, IHS administers the IHS Health Professions Scholarship Program. This program includes Section 103 Health Professions Preparatory Scholarship Programs for Indians, which authorizes two scholarship programs for Native American students in pre-professional education and pre-medicine or pre-dentistry education, and Section 104 Indian Health Professions Scholarship, which authorizes scholarships to Native American students in health professional schools. In addition, authorized by Section 108 of IHCIA and funded through appropriations, IHS offers loan prepayment programs. Through scholarships and loan repayment programs, from 1981 to 2003, the total number of IHS professional staff members grew 51 percent and the number of Native American federally employed health professionals increased 230 percent. The proportion of the Native American professional staff has increased 125 percent over the same period. In 1981, 84 percent of the IHS health professional staff was non-Indian and by 2003, 64 percent of the staff was non-Indian and 36 percent Indian. In addition, acknowledging that a monetary incentive is sometimes necessary to retain health professionals in remote IHS facilities, HHS announced $1.7 million in new grants to tribal communities to assist in recruitment and retention programs. The objective of these grants is to recruit, place, and retain health professionals in areas with high vacancy and staff turnover rates.
A2: Bureaucrats

Physicians and Indian health professionals will decide coverage not bureaucrats or government officials
Pfefferbaum et al., Ph.D. Director of Gerontology, Phoenix College, 1997
(Rose L., “Providing for the Health Care Needs of Native Americans: Policy, Programs, Procedures, and Practices,” American Indian Law Review, Volume 21, p. 248)
Rationing affects, and is affected, by the services provided. Hence, decisions about what services will be available go hand in hand with decisions about the distribution of those services. A relatively limited package of benefits serves more individuals than do more comprehensive packages at comparable costs. There are no universally accepted criteria for determining what constitutes a comprehensive package of basic health services. After much debate, the IHS has adopted a concept of a benefits package defined as those services which in the judgment of the attending physician are necessary to preserve life, limb, and sensory organs or to prevent clear deterioration of health status. This has the advantage of leaving the decision with the attending physician rather than with a lower level health professional, a clerk, or a bureaucratic list or manual, and accords with the comprehensive thrust of the IHS.
A2: IHS has arbitrary eligibility standards

The tribes not the IHS determine eligibility for services – always deferring to tribal not federal standards for eligibility
Pfefferbaum et al., Ph.D. Director of Gerontology, Phoenix College, 1997
(Rose L., “Providing for the Health Care Needs of Native Americans: Policy, Programs, Procedures, and Practices,” American Indian Law Review, Volume 21, p. 248)
Most tribes have appeared reluctant to draw the inference that tribal membership is not the same as eligibility for a limited number of services, arguing that tribal membership - not the IHS - should determine eligibility for health services. The IHS would have no interest in eligibility criteria if there were sufficient funds to meet the great demand for services. It has had a tradition of inclusion rather than exclusion that has grown out of its emphasis on community care and a history in which the Indian community was fairly well defined. The problem, of course, is that decisions regarding eligibility become critical when limited resources have to be allocated across competing demands. The issue is complicated by the lack of a common definition of membership across tribes. Unfortunately, any advantages associated with relatively permissive eligibility requirements must be balanced against budget considerations, a continuing dilemma that will only grow more acute.

The I.H.S. uses the least restrictive means to determine eligibility that favors broad definitions of “Indian”
Pfefferbaum et al., Ph.D. Director of Gerontology, Phoenix College, 1997
(Rose L., “Providing for the Health Care Needs of Native Americans: Policy, Programs, Procedures, and Practices,” American Indian Law Review, Volume 21, p. 248)
The Snyder Act, with its lack of specificity regarding legal rights and responsibilities, contains no express language identifying beneficiaries other than "Indians throughout the United States." Courts have ruled repeatedly that the Snyder Act is to be construed liberally in favor of Indians. Exactly what this may mean with respect to eligibility requirements is unclear except that there appears to be considerable latitude for agency discretion in determining who qualifies for services designed to benefit Indians. While ruling against the BIA in its restriction of eligibility for services in the landmark case Morton v. Ruiz, the U.S. Supreme Court did acknowledge the importance of agency decision making in allocating limited funds.
A2: Blood Quantum

The I.H.S. does not apply a blood quantum to distribute services
Pfefferbaum et al., Ph.D. Director of Gerontology, Phoenix College, 1997
(Rose L., “Providing for the Health Care Needs of Native Americans: Policy, Programs, Procedures, and Practices,” American Indian Law Review, Volume 21, p. 250-1)
The current IHS eligibility criteria remain very loose, requiring only that a person be of Indian descent and have close socioeconomic ties to the Indian community served by the local facilities and program.134 In the mid-1980s, criteria were made more restrictive by ending the previous eligibility of non Indian wives of Indians (non-Indian male spouses had long since been excluded). An exception was made in the case of a non-Indian woman pregnant with an eligible Indian child in order to ensure care for that unborn eligible Indian. The non-Indian mother remains eligible for care throughout the puerperium and therefore care is afforded for six weeks after delivery. An obvious difficulty in interpreting eligibility rules is the vague language "close socioeconomic ties," which has never been precisely defined. For most purposes, the IHS regards individuals within the scope of its services if they are regarded as Indian by the community in which they live, as indicated by factors such as tribal membership, enrollment, residence on tax-exempt land, ownership of restricted property, or active participation in tribal affairs. These rules apply to those eligible for medically-necessary direct care services. Because of the increased reliance on high-cost contract care, additional criteria have been adopted for receipt of contract services. In addition to meeting the criteria for direct care services, individuals must also reside within a specific contract health service delivery area (CHSDA), generally comprised of counties on or near reservations. Indians who have moved from a CHSDA do not qualify for contract care in the new locations and when these individuals return to a CHSDA, it is necessary to reestablish residence and remain there for 180 days before again becoming eligible for contract services.136
A2: Medicaid Solves

Medicaid and other programs don’t solve- there’s too much confusion about the application process.
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System” September. Pages 113 & 114. MAG)
Many Native Americans are hindered by the confusing and difficult nature of the enrollment process. Very few Native Americans understand the Medicaid and SCHIP eligibility requirements; in fact, many IHS employees are equally confounded. At least one state, Oklahoma, has solved this problem by placing state employees in Indian health facilities to facilitate Medicaid enrollment. In other states, IHS and tribal officials encounter resistance working with county and state workers. One frequent misunderstanding in the enrollment process involves Native Americans being asked for co-payments for programs such as SCHIP, when they are specifically exempt from the co-payment requirement. Any form of cost sharing acts as a barrier to enrollment in public programs, more so when the co-payment is neither required nor necessary. In addition, at least four states (California, Oregon, Washington, and Idaho) are debating co-payment and/or premium provisions to their state Medicaid programs. In a very encouraging development, the state of Washington attempted to implement a special provision to allow a waiver of co-payments for Native Americans. However, the Centers for Medicare & Medicaid Services (CMS) recently notified Washington that doing so violated Title VI of the Civil Rights Act. Another historical error has been the application of liens to enforce payment of medical bills. Many Native Americans in northern Nevada, and elsewhere, refuse to apply for Medicaid for fear they will lose their property. Compounding the overall lack of knowledge is inconsistent guidance provided by CMS. Because CMS regulations are seen as unclear and incomplete with respect to Native American health care—since they are not aligned with IHS regulations and policy—CMS policy is frequently interpreted by telephone from CMS headquarters. Therefore, the answer to a specific question, and consequently, policy at the local level, may depend on which CMS official answers the telephone on that specific occasion.

The Indian Health Care Improvement Act solves Medicare issues- it waives fees for American Indians
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System” September. Pages 115 & 116. MAG)
In addition to the system and facility requirements, individual eligibility requirements can also impose barriers. In the context of Medicare, the requirement for 40 quarters of Social Security–covered employment excludes many elderly applicants who would otherwise qualify for Medicare. With high unemployment rates on reservations and the disproportionately high number of persons failing to meet the 40-quarter requirement, tribes have sought a Native American exemption. Such an exemption from the 40-quarter requirement would markedly increase Medicare eligibility. Furthermore, confusion and insufficient information about the availability of Medicaid to purchase Medicare Part B coverage have excluded an additional undefined number of elderly Native Americans. In many of these cases, “patients did not have access to Medicare advisors or were not fully informed of this option” and its benefits. Consequently, IHS has pursued equitable relief in the form of special enrollment for potential Medicare beneficiaries in selected locations. For those who have passed the age of enrollment, CMS applies a late fee. This prevents individuals from waiting until they are ill with costly health conditions before they enroll. Title II, Section 419(b)(2), of the Indian Health Care Improvement Act would waive the Medicare late enrollment penalty, as discussed in more detail in the next chapter.
AT: Medicaid Solves

Medicaid spending is being cut short causing a reduction in available services to Native Americans
Marquez, a Co-investigator on the Wellness Circles Project at the Center for American Indian Research and Education, 2001
(Carol A., The Challenges of Medicaid Managed Care for Native Americans, p.151-154 , KS)
However, because of federal and state changes that have attempted to limit Medicaid expenses over the past decade, Medicaid beneficiaries have been enrolled in managed care plans that control access to provider sites as well as the level of reimbursement for services (Kauffman et al. 1997). Rolin (1998) noted the disparity in cost per IHS beneficiary in contrast to that of the typical Medicaid beneficiary; $1,403 for an IHS beneficiary versus $3,369 for each Medicaid user was reported per year 1993–1997. Rolin also highlighted the difficulty of decreasing disparities in health status of racial and ethnic populations because the IHS has fallen far behind other agencies in the Department of Health and Human Services in funding level increases in recent years (Rolin 1999). Since 1967, the IHS has taken steps to increase tribal involvement in the administration of health care programs to the present level of contracts and federal compacts (Kauffman, Johnson, and Jacobs 1997). Tribal self-governance is an IHS policy that allows for tribal control of Indian health care facilities. Developed after years of tribal requests for participation in the planning and implementation of health care services, tribal self-governance has seen much success in areas of Alaska, where local control with full participation by consumers helped to build a strong system of managed care (Dixon et al. 1997). In other states, however, diminishing state Medicaid reimbursement levels resulted in service reduction through contract and compact tribal health programs (ibid.). Recently, these clinics have adopted stricter service eligibility requirements, which further limits services to members of their service populations. Prior to the passage of P.L. 93-437, little if any Indian Health Service funding was available for health care services to urban American Indians (Kauffman, Johnson, and Jacobs 1997). The relocation policy of the Bureau of Indian Affairs in the late 1950s through the early 1960s resulted in a mass exodus from tribal lands to major cities. The relocation program was geared toward training programs for young Indians; however, it resulted in isolating Indians from their families, tribes, and homeland while assimilating these youth to American values and ways. The other significant event that led to the development of urban Indian populations was the end of World War II. The return of WWII veterans and especially a significant number of young Indian veterans to urban locations tended to ensure that these young Indian veterans settled in urban locations. Today there are 41 urban Indian health programs (I/T/U) located in 34 sites across the country. These programs provide primary and preventive health care services with few resources. Urban programs estimate that less than 25% of their service needs are met with IHS appropriations (Waukazoo 2000).

AT: Medicaid Solves

Because many Native Americans live in more isolated areas, help from Medicaid is needed greatly, but hard to access
Marquez, a Co-investigator on the Wellness Circles Project at the Center for American Indian Research and Education, 2001
(Carol A., The Challenges of Medicaid Managed Care for Native Americans, p.154-156 , KS)
Tribal and urban programs continue to face challenges to their healthcare delivery system—that of the ever changing managed care environment (Fleury 2000). Fleury noted that neither the Indian Health Service, tribally operated clinics, nor urban Indian health programs had populations well suited to participate in the typical managed care organization (MCO). Factors such as geographic isolation, population mobility, case mix, and maintenance of continuous Medicaid eligibility previously identified in Roundtable Reports (Rosenbaum 1996) are key factors that contribute to the unsuitability of enrolling Native American Medicaid beneficiaries in MCOs. Both Fleury and Clain characterized these factors as barriers to the feasibility of Medicaid managed care models succeeding in Indian Medicaid reimbursement for services to AI/AN Medicaid beneficiaries. I/T/U providers struggle to seek reimbursement of services to Medicaid beneficiaries (Clain 2000; Fleury 2000). In general, states’ expectations of managed care organizations are based on the medical model. In contrast, I/T/U organizations provide more preventive types of services for response to the needs of their clients (Waukazoo 2000). Despite the challenges, I/T/U organizations continue to seek Medicaid reimbursement because it supplements IHS funding of health care services to American Indian/AN patients. Further limitations placed by local MCOs on assignment of Medicaid beneficiaries to I/T/U organizations create additional hardships for these clinics. Waukazoo (2000) and Bushyhead (2000) noted that urban Indian health clinics were seeing increasing numbers of uninsured American Indian patients not eligible for Medicaid coverage. However, urban Indian health programs are required to serve these patients. In order to address this issue, the Minneapolis clinic has challenged Hennepin County to reimburse the Indian Health Board (IHB) for estimated lost Medicaid reimbursements over a seven-year period due to reassignment of Indian Medicaid beneficiaries to other primary providers (gatekeepers) under the Hennepin County Managed Care Plan. When some former IHB patients sought care at IHB, the center was unable to seek reimbursement because it was not their designated provider. IHB could not be reimbursed for its services unless the patient requested a change of primary care site (Bushyhead 2000). This situation resulted from the establishment of Hennepin County as one of the counties involved in a statewide demonstration project to control and reduce the cost of Medicaid expense for eligible beneficiaries in Minnesota. This demonstration was approved by the Health Care Financing Administration under an 1115 waiver that not only restricted “freedom of choice” of provider by Medicaid beneficiaries but implemented other changes aimed at modeling managed care plans for Medicaid patients (Marquez 1996). This IHS action resulted in a loss of income for the Indian Health Board because it was not reimbursed for services provided to these patients. Furthermore, the IHB was not assigned many of its former patients eligible as Medicaid beneficiaries under the Hennepin County plan. This is only one example of a situation common to many urban Indian health clinics. This situation remains a critical issue across the country as is noted in the points made by Michael Mahsetky, IHS Chief of Legislation (2000). Recent health indicators reported by the Indian Health Service reveal premature death rates and tuberculosis rates higher than those of the general population (Kunitz 2000). Rolin, of the National Indian Health Board, reported substantial unmet health needs in IHS 1998 testimony before the Senate’s Indian Affairs Committee (1998). The current trends in state-run Medicaid managed care plans present a dismal future for any significant decreases in the health disparities between American Indians, Alaska Natives, and the general population. An area not often considered in the AI/AN health care delivery system arena is that of patient satisfaction. Dixon et al. (1997) discuss the Indian patients’ conflicts in attitudes and satisfaction with services in a study of provider choices made by patients in selected sites.
A2: IHS doesn’t use traditional medicine

I.H.S. provides both modern and traditional health care
Pfefferbaum et al., Ph.D. Director of Gerontology, Phoenix College, 1997
(Rose L., “Providing for the Health Care Needs of Native Americans: Policy, Programs, Procedures, and Practices,” American Indian Law Review, Volume 21, p. 241)
Availability and usability of health care for Indians are influenced significantly by the organization of the IHS and its service delivery system. Affordability of care within the IHS system has generally been ensured for those services which are provided to eligible Indians. Acceptability of modern health care has grown with the help of visionary Indian leaders and with the acknowledgement of Indian healing methods as potentially complementary to modern medicine.

Tribal Economy Extension

Poor health care undermines reservation economies
Belcourt-Dittloff and Stewart, Professors of Psychology, University of Montana, 2000
(Annjeanette & J. “Historical Racism: Implications for Native Americans,” American Psychologist, 55, 1166-1167)
Inadequate health care, along with the aforementioned high morbidity and mortality rates, is exacerbated and perhaps precipitated by the high poverty and unemployment rates that exist for Native Americans. Perhaps the best indicator of the current Native Americans health status is the fact that American Indians do not live as long as other U.S. populations. Heart disease, liver disease (cirrhosis), diabetes mellitus, and accidents constitute leading causes of death for this population (U. S. Congress, Office of Technology Assessment, 1990). The bleak current health status of Native Americans leads to the question “What stressors are contributing to the high rates of morbidity and mortality?” Clark and his colleagues (1999) have outlined the manner in which racism may constitute a stressor with negative biopsychosocial ramifications for African Americans. Because of the inherent similarities between the experiences of racism of African Americans and Native Americans, we believe that such a model helps explain why Native American health is marked by high morbidity and mortality rates. By gaining a better understanding of the way in which racism as a stressor can negatively affect the biopsychosocial functioning of Native Americans, clinicians may be able to formulate more effective therapeutic and preventative tools.

Poverty is caused by lack of healthcare
Duffié, doctorate in cultural anthropology from Washington State University, 01
(Mary Kay, Project Muse, “A Pilot Study to Assess the Health Needs and Statuses among a Segment of the Adult American Indian Population of Los Angeles”, 11-16, http://muse.jhu.edu/login?uri=/journals/wicazo_sa_review/v016/16.1duffie.html, accessed: 6-29-09, KEH)
The 1952 Federal Relocation Program, sponsored by the Bureau of Indian Affairs, lured thousands of Indians to Los Angeles and other metropolitan areas in the West. Government officials promised high-paying jobs, job-training programs, and housing assistance. The federal goal was assimilation. It is well documented, however, that the program failed to assimilate American Indians and resulted in devastating social consequences. After federal funding for the relocation programs dried up, for example, large Indian ghettos formed, where unemployment and poverty created a socioeconomic pattern of abuse and despair. Disconnected from cultural roots and illequipped for modern city life, many urban Indian families in the 1970s and 1980s broke under the stresses of urban existence. Today, urban Indian centers across Southern California report high rates of poverty and alcoholism, low educational attainment, domestic abuse, and support system deficits (particularly for elders and children). To validate these observations scientifically, however, has proved a difficult task. To begin with, there is a paucity of statistically significant data relevant to the health care statuses and needs of American Indians, even less pertaining to urban Indians. Indeed, most of the available information comes from studies of rural and reservation-based Indians. As a result, researchers and program planners tend to rely almost exclusively on data taken from a few specific regions and tribes. The situation is made worse by the lack of adequate representation of the Indian population in national surveys and databases. However, what data there are seem consistent with the observations of the urban Indian Centers. Available data indicate that American Indians have a disproportionate pattern of social problems, chronic illness, accident, homi- cide, suicide, and other conditions, unparalleled among other racial and ethnic minorities in the United States. Because of substantial limitations to medical care, we can surmise (but not fairly conclude) that these problems are exacerbated in urban settings. Unlike their reservation-based counterparts, Los Angeles’s urban Indians do not have appropriate access to an Indian Health Service facility. (Indian Health Service is the major federal health care program for American Indians.) In many ways, urban Indians are the orphans of Indian Health Service, left to depend on minimal and fragmented resources available from the state government.
Tribal Economy Extension

Health assistance promotes sustainable development/the economy on Native American lands
White 07
(Bristol Bay Native Association, July, “White Paper on the Native American Challenge Demonstration Project Act”, EKC)
Because Native economies are often plagued by the same challenges as the economies of the developing world, Native economies are likely to benefit from the application of proven models employed in international development efforts.
Of these, the President’s Millennium Challenge Corporation is most appealing. Having undertaken a comprehensive review and analysis of post-World War Two efforts by the U.S. And other developed nations to invigorate the economies of the developing world, the Bush Administration took exception with the notion that additional financial resources was all that was needed. Instead, the President sought to identify and emphasize those traits found in successful economies and to encourage their use by other developing countries.
Created pursuant to the Millennium Challenge Act of 2003, the Millennium Challenge Corporation aims to create ongoing, bilateral relationships between the United States and eligible countries to pursue those policies that are known to be effective and in the process reduce poverty and promote sustainable economic growth in the host country. Typically, the activities that are funded by the Corporation are related to agriculture, irrigation, and related land practices; physical infrastructure development to facilitate marketing of goods and services; and a variety of health care programs. In addition, because the Millennium Challenge Corporation model leaves the major decisionmaking in regard to economic development objectives and the selection of specific projects to achieve those objectives up to the countries seeking a development compact with the United States, we believe a domestic analog will appeal to Native leaders and their citizenry.

Lack of health care lowers reservation standard of living
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System,” September. Page 38 MAG)
Lower income and educational levels are associated with poor overall health status and health outcomes. Due in part to past and present discrimination in education and employment, Native Americans and other people of color achieve lower levels of educational attainment and income. Native Americans, however, have the highest poverty rate of any ethnic group. They have a poverty rate of 25.9 percent, while the poverty rate is 22.1 percent for African Americans, 10.8 percent for Asian/Pacific Islanders, and 21.2 percent for Hispanics. In comparison, while the national poverty rate is 11.3 percent, only 7.5 percent of whites live below the poverty level. Native Americans remain at the bottom in almost every measurable economic category and earn only about half of that earned by the average American. On Indian reservations, poverty levels for Native Americans are significantly worse. Among the Navajo, for example, over 50 percent live below the poverty level and almost 50 percent are unemployed. More than 50 percent of homes rely only on wood burning for heating, 32 percent lack adequate plumbing, and 60 percent lack telephone service.92 On the Pine Ridge Reservation in South Dakota, the unemployment rate hovers around 80 percent and two out of three residents live below the poverty level.

Tribal Sovereignty and self-determination are key to help development
Smith, Professor of Economics and Applied Indigenous Studies, 2000
(Dean Howard, Modern Tribal Development, p. 68, KS)
Tribal sovereignty and self-determination are the mainstays of current development plans. These goals can only be truly realized if and when the population becomes self-supporting and the tribe overcomes its dependency on the federal government. By developing a vigorous cycle of economic growth, the tribe will be able to fulfill these goals.
Tribal Economy Extension

Self-determination is key to economic self-sufficiency
Matheson, member of the Coeur d'Alene Indian Tribe and is a tribal chairman and lawyer, 09
(David, “Self-determination”, Arizona State Law Journal, no page listed, KS)
An economic means of attaining self-determination and self-sufficiency may be accomplished through the operation of tribal businesses, which may be a tribe's only source of income apart from federal subsidies. Tribes operate commercial enterprises to sustain their economies and thereby gain independence from federal support. In that way, the businesses are an integral aspect of tribal sovereignty, as they enable tribes to realize the goal of self-determination. A recent book chronicling the economic "success stories" of four tribes explains this relationship between economic independence and sovereignty: Without the means to establish economic sovereignty, most Native Americans remain America's internal exiles, living within confines established by their conquerors hundreds of years ago. The tragedy is that Indian destitution is entirely unnecessary. Many Native communities hold the raw materials of true self-determination in their hands. . . . In the last two decades, several tribes have recognized the extraordinary value of these assets, not only in terms of their material worth but in terms of what they mean for the quality of Native life. After centuries of decline as the objects of subjugation and neglect, these tribes have established and sustained profitable tribal economies -- internally generated, not federally imposed -- as a strategy for addressing longstanding social problems and establishing authentic independence. Employing every strategy from congressional lobbying to leveraged buy-outs, each community, in its own way, has learned to play white society's games, but by different rules and according to different scorecards. These communities are beginning to enter the mainstream economy so long denied them to mount a quiet economic revolution, which has the potential for reestablishing a Native American independence based on economic sovereignty or for global survival.

Native American sovereignty is key to tribal economies
Abdel-Monem, Research Specialist for the University of Nebraska, 2005
(Tarik, University of Nebraska, “Economic Development and Native American Sovereignty”, 3-31-05, http://ppc.unl.edu/SorensenSeminar/EconomicDevelopmentandNativeAmericanSovereignty&year=2005, 6-28-09, KS)
Although it is still true that some of the poorest communities in the US are tribal communities, in the past several decades numerous American Indian tribes across the country have been developing extremely successful commercial and entrepreneurial enterprises. This economic growth is related, although by no means completely due, to changes in how sovereign nations are treated by the federal and state governments. In a continually changing and complex legal environment, there is value in examining and assessing the current state of Native-American commercial and economic activity, the varying degrees of success, and its legal and social connections. This seminar focused on Native-American economic development and sovereignty in Nebraska, as well as discussing the legal environment, perspectives, success stories, and challenges to further tribal economic development in Nebraska.

A2: Casinos Solve Tribal Economies

Casinos have done next to nothing for the economies for tribes.
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, “Broken Promises: Evaluating the Native American Health Care System” September. Pages 87. MAG)
Because the Native American gaming industry has grown to encompass 220 tribes, 377 facilities, and more than $16 billion per year in revenue, a perception exists that Indians have been given everything they need and that federal “handouts” are no longer necessary. This perception is inaccurate on several levels. First, it ignores the federal trust obligation discussed earlier in this report. Second, it overstates the magnitude and impact of gaming profits. A report prepared for the American Indian Program Council provides a clearer picture of the impact of casinos in Indian Country: • Only half of all tribes have casinos. • Thirty-nine casinos produced the majority of casino-generated income. More specifically, 39 percent of casinos accounted for 66 percent of revenue. • Casinos in five states, with more than half the total Native American population, accounted for less than 3 percent of all casino revenue. • Casinos in three states, with only 3 percent of the Native American population, accounted for more than 44 percent of all casino revenue. • Dozens of casinos barely break even because of inadequate size or location. The overall effect is that only a relatively small number of tribes have been very successful—successful enough to establish health care systems independent of federal aid. For most tribes, gaming has brought increased administrative, legal, and lobbying expenses along with impressive gains for non-Indian investors and state governments who have taken as much as 16 percent of revenue. After other expenses are covered, some percentage of the successful tribes has appropriately applied some portion of their increased revenue to health care. Nevertheless, the vast majority of tribes, and Native Americans, must continue to rely on the inadequate funds appropriated to the IHS.
Tribal Economy Extension – Waste

Economic inequality makes Native American lands vulnerable targets for polluting industries.
Brook, Cal Berkeley Sociology Professor, 98
(Dan, "The Environmental Genocide: Native Americans and Toxic Waste." American Journal of Economics and Sociology, January 1998, http://findarticles.com/p/articles/mi_m0254/is_n1_v57/ai_20538772/pg_1?tag=artBody;col1, 7/1/09, M.E)
One very significant toxic threat to Native Americans comes from governmental and commercial hazardous waste sittings. Because of the severe poverty and extraordinary vulnerability of Native American tribes, their lands have been targeted by the U.S. government and the large corporations as permanent areas for much of the poisonous industrial by-products of the dominant society. "Hoping to take advantage of the devastating chronic unemployment, pervasive poverty and sovereign status of Indian Nations", according to Bradley Angel, writing for the international environmental organization Greenpeace, "the waste disposal industry and the U.S. government have embarked on an all-out effort to site incinerators, landfills, nuclear waste storage facilities and similar polluting industries on Tribal land"

Poverty in Native American land leads to toxic waste dumping on reservations
Brook, American Journal of Economics and Sociology writer, 98
(Daniel, American Journal of Economics and Sociology, “Environmental Genocide: Native Americans and Toxic Waste”, 1/98, http://findarticles.com/p/articles/mi_m0254/is_n1_v57/ai_20538772/, accessed 6/29/09, SP)
One very significant toxic threat to Native Americans comes from governmental and commercial hazardous waste sitings. Because of the severe poverty and extraordinary vulnerability of Native American tribes, their lands have been targeted by the U.S. government and the large corporations as permanent areas for much of the poisonous industrial by-products of the dominant society. "Hoping to take advantage of the devastating chronic unemployment, pervasive poverty and sovereign status of Indian Nations", according to Bradley Angel, writing for the international environmental organization Greenpeace, "the waste disposal industry and the U.S. government have embarked on an all-out effort to site incinerators, landfills, nuclear waste storage facilities and similar polluting industries on Tribal land" (Angel 1991, 1). In fact, so enthusiastic is the United States government to dump its most dangerous waste from "the nation's 110 commercial nuclear power plants" (ibid., 16) on the nation's "565 federally recognized tribes" (Aug 1993, 9) that it "has solicited every Indian Tribe, offering millions of dollars if the tribe would host a nuclear waste facility" (Angel 1991, 15; emphasis added). Given the fact that Native Americans tend to be so materially poor, the money offered by the government or the corporations for this "toxic trade" is often more akin to bribery or blackmail than to payment for services rendered.(2) In this way, the Mescalero Apache tribe in 1991, for example, became the first tribe (or state) to file an application for a U.S. Energy Department grant "to study the feasibility of building a temporary [sic] storage facility for 15,000 metric tons of highly radioactive spent fuel" (Akwesasne Notes 1992, 11). Other Indian tribes, including the Sac, Fox, Yakima, Choctaw, Lower Brule Sioux, Eastern Shawnee, Ponca, Caddo, and the Skull Valley Band of Goshute, have since applied for the $100,000 exploratory grants as well (Angel 1991, 16-17). Indeed, since so many reservations are without major sources of outside revenue, it is not surprising that some tribes have considered proposals to host toxic waste repositories on their reservations. Native Americans, like all other victimized ethnic groups, are not passive populations in the face of destruction from imperialism and paternalism. Rather, they are active agents in the making of their own history. Nearly a century and a half ago, the radical philosopher and political economist Karl Marx realized that people "make their own history, but they do not make it just as they please; they do not make it under circumstances chosen by themselves, but under circumstances directly found, given and transmitted from the past" (Marx 1978, 595). Therefore, "[t]ribal governments considering or planning waste facilities", asserts Margaret Crow of California Indian Legal Services, "do so for a number of reasons" (Crow 1994, 598). First, lacking exploitable subterranean natural resources, some tribal governments have sought to employ the land itself as a resource in an attempt to fetch a financial return. Second, since many reservations are rural and remote, other lucrative business opportunities are rarely, if ever, available to them. Third, some reservations are sparsely populated and therefore have surplus land for business activities. And fourth, by establishing waste facilities some tribes would be able to resolve their reservations' own waste disposal problems while simultaneously raising much-needed revenue.
Nuclear Waste = Genocide Extension

The nuclear industry’s practices against American Indians is genocide.
Endres, Assistant Professor of Communication at the University of Utah, 2009
(Danielle, “The Rhetoric of Nuclear Colonialism: Rhetorical Exclusion of American Indian Arguments in the Yucca Mountain Nuclear Waste Siting Decision,” Communication and Critical/Cultural Studies. March, Vol. 6, No. 1, Pages 41 & 42, MAG.)
Before attending to the rhetorical nature of nuclear colonialism, it is important to emphasize the scope and material effects of nuclear technologies on indigenous peoples and their lands. This is a history of systematic exploitation and indigenous resistance, spanning from the 1940s to present. As the Indigenous Environmental Network writes, “the nuclear industry has waged an undeclared war against our Indigenous peoples and Pacific Islanders that has poisoned our communities worldwide. For more than 50 years, the legacy of the nuclear chain, from exploration to the dumping of radioactive waste has been proven, through documentation, to be genocide and ethnocide and a deadly enemy of Indigenous peoples… United States federal law and nuclear policy has not protected Indigenous peoples, and in fact has been created to allow the nuclear industry to continue operations at the expense of our land, territory, health, and traditional way of life… This disproportionate toxic burden-called environmental racism- has culminated in the current attempts to dump much of the nation’s nuclear waste in the homelands of the Indigenous peoples of the Great Basin region of the United States.” From an indigenous perspective, the material consequences of nuclear colonialism have affected the vitality of indigenous peoples. This can be seen clearly in both uranium mining and nuclear testing. Uranium mining is inextricably linked with indigenous peoples. According to LaDuke, “some 70 percent of the world’s uranium originates from Native Communities” Within the US, approximately 66 percent of the known uranium deposits are on reservation land, as much as 80 percent are on treaty-guaranteed land, and up to 90 percent of uranium mining and milling occurs on or adjacent to American Indian land. To support the federal government’s desire for nuclear weapons and power production, the Bureau of Indians Affairs (BIA) has worked in collusion with the Atomic Energy Commission and corporations such as Kerr-McGee and United Nuclear to negotiate leases with Navajo, Lakota and other nations for uranium mining and milling on their land between the 1950s to the present. BIA-negotiated leases are supported by the complex body of Indian Law, which I will demonstrate enables federal intrusion into American Indian lands and governmental affairs. These leases are heavily tilted in favor of the corporations so that American Indian nations received only about 3.4 percent of the market value of the uranium and low paid jobs. Uranium mining has also resulted in severe health and environmental legacies for affected American Indian people and their lands. From uranium mining on Navajo land, there have been at least 450 reported cancer deaths among Navajo mining employees. Even now, the legacy of the 1000 abandoned mines and uranium-tailing piles is radioactive dust that continues to put people living near tailing piles at a high risk for lung cancer. The history of exploitation and resistance continues with nuclear weapons production. As nuclear engineer Arjun Makhijani argues, “all too often such damage has been done to ethnic minorities or on colonial lands or both. The main sites for testing nuclear weapons for every declared nuclear power are on tribal or minority lands.” From 1951 to 1992, over 900 nuclear weapons tests were conducted on the Nevada Test Site (NTS)- land claimed by the Western Shoshone under the 1863 Treaty of Ruby valley. The late Western Shoshone spiritual leader Corbin Harney proclaimed Western Shoshone to be “the most nuclear bombed nation in the world.” According to Western Shoshone Virginia Sanchez, indigenous people may have suffered more radiation exposure because of their land-linked lifestyle of “picking berries, hunting, and gathering our traditional foods,” resulting in “major doses of radiation.” Yet, the federal government and legal system have made only token gestures toward compensating victims of nuclear testing. The Radiation Exposure Compensation Act (RECA) has strict qualification guidelines that have excluded many downwinders from receiving compensation. In addition to the effects on human health from nuclear testing, there is also an environmental toll through contaminated soil and water, which could harm animal and plant life.
Nuclear Waste = Genocide Extension

Nuclear dumping is genocide
Thorpe, President, National Environmental Coalition for Native Americans, 1996
(Grace, “Our Homes are not Dumps: Creating Nuclear-Free Zones,” Natural Resource Journal, Volume 36, Number 4, p. 715)
The Great Spirit instructed us that, as Native people, we have a consecrated bond with our Mother Earth. We have a sacred obligation to our fellow creatures that live upon it. For this reason it is both painful and disturbing that the United States government and the nuclear power industry seem intent on forever ruining some of the little land we have remaining. The nuclear waste is cause American Indians to make serious, possibly even genocidal, decisions concerning the environment and the future of our peoples

Uranium mining brings about exploited communities, environmental degradation, and a radioactive plague of cancers and disease.
Kuletz, award winning author of works dealing with technology and humanism, 2000
(Valerie, award winning author of works dealing with technology and humanism, "Tragedy at the Center of the Universe" from "Learning to Glow." 2000, ed. John Bradley, pg. 145-147, 7/1/09, M.E)
Indian lands under uranium mining and milling development were, extensive, with the Navajo Reservation, Laguna Pueblo, and Acoma Pueblo carrying some of the heaviest burden and consequently suffering some of the most severe health repercussions. Though the uranium booms helped the destitute Indian economy to some extent and for a brief time they also transformed these Indian lands (almost overnight) from a pastoral to a mining-industrial economy, resulting in a mining-dependent population. Indians did not get rich off the uranium development their lands because they lacked the capital and the technical knowledge to develop them and, at least initially, they were kept ignorant of the value of their land. Instead, development was contracted out to large energy companies. Because "national security" and energy consumption needs (read "national competitiveness") were at stake, Indians were given the right to stipulate conditions for development and reclamation for decades-and then the right was never sufficient. Unchecked and unmonitored production was excused during World War II and the Cold War: on the grounds of national security and, in the 1970s, on the basis of the energy crisis and the ongoing arms escalation that mushroomed in the 1980s. Throughout the postwar period, American Indian populations were exploited as a cheap source of labor. For example, Indian miners were paid at a rate two-thirds that of off-reservation employees. In addition, Indians were not compensated adequately for the uranium taken from their lands. "As of 1984, stateside Indians were receiving only an average of 3-4 percent of the market value of the uranium extracted from their land." The median income reported in 1970 (at a boom time for uranium mining) at the Laguna Pueblo was only $2,661 per year-a little more than $220 a month, or $50 per week. And Indians paid a high price for the right to work the mines. Uranium development's legacy has been one of a severely polluted environment, human and nonhuman radiation contamination, cancers, birth defects, sickness, and death. Health risks associated with uranium mining and milling have been identified and examined by different investigators, and reported in a variety of sources including the Southwest Research and Information Center publications and the New England Journal of Medicine as well as others. Since large amounts of water are used in the mining process and mountains of uranium tailings are produced as a by-product, uranium pollution poisons the earth, air, and water. Radioactive particulates (dust particles containing uranium-238, radium-226, and thorium-230) blow in the desert winds, and radioactive elements travel in both surface and ground water. Radioactive materials from the mining of uranium produce radon and thoron gases, which combine with the molecular structure of human cells and decay into radioactive polonium and thorium. The dust irritates cells in the lining of the respiratory tract, causing cancer. Radioactive materials can also damage sex cells, causing such birth defects as cleft palate and Down's syndrome." In seeking federal assistance to study the effect of low-level radiation on the health of their children, Navajo health officials called attention to at least two preliminary studies-one conducted by the March of Dimes (principal investigator Dr. L. Shields) and the other by the Navajo Health Authority (principal investigator Dr. D. Calloway). Calloway's study suggested that Navajo children may have a five times greater rate of bone cancer and a fifteen times greater rate of ovarian and testicular cancer than the U.S. average." However, despite these preliminary findings, no funding was granted for extended epidemiological studies of the impact on Navajos living near uranium tailings and mines. IS Further extending the nuclear landscape and causing harm to those who live there, millions of gallons of water in the Four Corners area were subjected to radiation pollution by the extractive processes of uranium mining. Accidents, such as the Rio Puerco incident, cause serious water pollution in an already water-scarce environment.

Nuclear Waste = Genocide Extension

A. Nuclear dumping treats Native peoples as disposable – justifying extermination of the periphery
Reed, Professor of English and American Studies, Washington State University, 2009
(T. V., “Toxic Colonialism, Environmental Justice, and Native Resistance in Silko’s Almanac of the Dead,” MELUS: Multi-Ethnic Literature of the U.S., Volume 34, Number 2, Spring 2009
The founding document of the environmental justice movement, the manifesto that grew out of the First National People of Color Environmental Leadership Summit in 1991, the same year in which Almanac of the Dead was published, reads like a summary of the themes driving Silko’s epic. Among the seventeen sections of the manifesto, the following are particularly striking in their parallels to Almanac’s positionings: Environmental justice affirms the sacredness of Mother Earth, ecological unity and the interdependence of all species, and the right to be free from ecological destruction . . . . Environmental justice calls for universal protection from extraction, production and disposal of toxic/hazardous wastes and poisons that threaten the fundamental right to clean air, land, water and food . . . . Environmental justice affirms the fundamental right to political, economic, cultural and environmental self-determination to all peoples . . . . Environmental justice affirms the need for an urban and rural ecology to clean up and rebuild our cities and rural areas in balance with nature, honoring the cultural integrity of all our communities, and providing fair access for all to the full range of resources . . . . Environmental justice opposes military occupations, repression and exploitation of lands, peoples and cultures. Almanac ties all these threads together in a critique of toxicity, militarism, and economic exploitation; like the manifesto, it calls for recognition of species interdependence, cultural independence, and the self-determination of peoples modeled on indigenous communities rooted in intimate relation with the land. As environmental justice critics have long noted, Western capitalist discourse frequently has drawn a symbolic association between subaltern peoples and “waste,” and declared the lands of subalterns to be “wastelands.” From the beginning of the European colonial era to the present, dominant cultures have argued that the lands of indigenous peoples are underdeveloped and empty (terra nullius) and that the people on them are less than human, less than “civilized.” The wasting of peoples and lands has, as Silko’s map puts it, gone on unabated but always resisted, from the [End Page 29] expropriation of Native lands by guns and disease in the sixteenth century to the toxic colonialism of the twenty-first century imposed on, for example, the Shoshone people, whose resistance to the dumping of nuclear waste on their non-waste lands Valerie Kuletz brilliantly chronicled. The euphemisms may change (“national sacrifice zones” of the recent past in the US are now being displaced by “national security” rhetoric),5 but the waste- or wasted-lands seem inevitably to coincide with the boundaries of Indian reservations (and the ghettos and barrios of others outside the sacred circle of whiteness). What remains the same is who is making the “sacrifice” (or being sacrificed) and who is making the decisions. As Native activist and former vice-presidential candidate Winona LaDuke trenchantly notes: “What happened when the best scientific minds and policy analysts in the world spent 20 years examining every possible way to deal with problem of nuclear waste? They decided the solution was to ship the radioactive stuff thousands of miles from all over the country and dump it on an Indian reservation.” (LaDuke is referring to Yucca Mountain, Nevada, a sacred site of the Shoshone people, chosen as the main nuclear waste site of the military-industrial-scientific-governmental colonizers.).
Nuclear Waste leads to Extinction Extension

Rendering Natives discardable populations results in systemic genocides necessitating cycles of violence that culminate in extinction.
Santos, professor at the University of Coimbra, School of Economics, 2003
(Sousa, professor at the University of Coimbra, School of Economics, April 2003, http://bad.eserver.org/issues/2003/63/santos.html, 7/1/09, M.E.)
According to Franz Hinkelammert, the West has repeatedly been under the illusion that it should try to save humanity by destroying part of it. This is a salvific and sacrificial destruction, committed in the name of the need to radically materialize all the possibilities opened up by a given social and political reality over which it is supposed to have total power. This is how it was in colonialism, with the genocide of indigenous peoples, and the African slaves. This is how it was in the period of imperialist struggles, which caused millions of deaths in two world wars and many other colonial wars. This is how it was under Stalinism, with the Gulag, and under Nazism, with the Holocaust. And now today, this is how it is in neoliberalism, with the collective sacrifice of the periphery and even the semiperiphery of the world system. With the war against Iraq, it is fitting to ask whether what is in progress is a new genocidal and sacrificial illusion, and what its scope might be. It is above all appropriate to ask if the new illusion will not herald the radicalization and the ultimate perversion of the Western illusion: destroying all of humanity in the illusion of saving it. Sacrificial genocide arises from a totalitarian illusion manifested in the belief that there are no alternatives to the present-day reality, and that the problems and difficulties confronting it arise from failing to take its logic of development to ultimate consequences. If there is unemployment, hunger and death in the Third World, this is not the result of market failures; instead, it is the outcome of market laws not having been fully applied. If there is terrorism, this is not due to the violence of the conditions that generate it; it is due, rather, to the fact that total violence has not been employed to physically eradicate all terrorists and potential terrorists. This political logic is based on the supposition of total power and knowledge, and on the radical rejection of alternatives; it is ultra-conservative in that it aims to reproduce infinitely the status quo. Inherent to it is the notion of the end of history. During the last hundred years, the West has experienced three versions of this logic, and, therefore, seen three versions of the end of history: Stalinism, with its logic of insuperable efficiency of the plan; Nazism, with its logic of racial superiority; and neoliberalism, with its logic of insuperable efficiency of the market. The first two periods involved the destruction of democracy. The last one trivializes democracy, disarming it in the face of social actors sufficiently powerful to be able to privatize the state and international institutions in their favor. I have described this situation as a combination of political democracy and social fascism. One current manifestation of this combination resides in the fact that intensely strong public opinion, worldwide, against the war is found to be incapable of halting the war machine set in motion by supposedly democratic rulers. At all these moments, a death drive, a catastrophic heroism, predominates, the idea of a looming collective suicide, only preventable by the massive destruction of the other. Paradoxically, the broader the definition of the other and the efficacy of its destruction, the more likely collective suicide becomes. In its sacrificial genocide version, neoliberalism is a mixture of market radicalization, neoconservatism and Christian fundamentalism. Its death drive takes a number of forms, from the idea of "discardable populations", referring to citizens of the Third World not capable of being exploited as workers and consumers, to the concept of "collateral damage", to refer to the deaths, as a result of war, of thousands of innocent civilians. The last, catastrophic heroism, is quite clear on two facts: according to reliable calculations by the Non-Governmental Organization MEDACT, in London, between 48 and 260 thousand civilians will die during the war and in the three months after (this is without there being civil war or a nuclear attack); the war will cost 100 billion dollars, enough to pay the health costs of the world's poorest countries for four years. Is it possible to fight this death drive? We must bear in mind that, historically, sacrificial destruction has always been linked to the economic pillage of natural resources and the labor force, to the imperial design of radically changing the terms of economic, social, political and cultural exchanges in the face of falling efficiency rates postulated by the maximalist logic of the totalitarian illusion in operation. It is as though hegemonic powers, both when they are on the rise and when they are in decline, repeatedly go through times of primitive accumulation, legitimizing the most shameful violence in the name of futures where, by definition, there is no room for what must be destroyed. In today's version, the period of primitive accumulation consists of combining neoliberal economic globalization with the globalization of war. The machine of democracy and liberty turns into a machine of horror and destruction
Nuclear Waste leads to Extinction Extension

Nuclear genocide leads to extinction
Churchill, Associate Professor of Communications & Coordinator of American Indian studies, 2002
[WARD, “STRUGGLE FOR THE LAND: NATIVE AMERICAN RESISTANCE TO GENOCIDE, ECOCIDE, ANDCOLONIZATION” PAGES 278]