Introduction:
There has been an ongoing debate about whether or not health care in the United States is a right or a privilege but what should had never been in question, is the right that American Indians and Alaska Natives carry because they are the only true citizens of the United States who were born with a legal right to health care. Although this sentence carries truth from the very beginning in the making of what the United States is today, American Indians and Alaska natives are still labeled under the term as a “Vulnerable Population”.
Funding:
The term Vulnerable Population defined as, populations or groups whose needs are not fully addressed by traditional service providers. In short, the federal government was given an obligation to provide health care services to members of federally recognized tribes that were developed from a special relationship between the federal government and Indian tribes that was established in 1787. The federal government would exchange health care services for land and resources. Another exchange that the federal government failed to keep with American Indians was to provide quality education and health care to Indian people and tribes. The federal trust responsibility, has been defined in the U.S. Constitution, treaties, statutes, and in Supreme Court decisions and in efforts to fulfill the federal obligation, the Indian Health Service (IHS) was established within the Department of Health and Human Services (HHS) in 1955. Clearly it has failed. IHS has been responsible for providing culturally appropriate and personal and public health services according to the needs of the American Indian and Alaska natives. Yet despite these efforts, IHS has been underfunded and has not been able to keep up with the health demands and needs of Indian Country. Part of this failure and dwindling effect in the recent years can be blamed on the fact that the Indian Health Care Improvement Act expired since 2002. These laws were established to help provide the legislative authority for congress to move funds into specified health care of and for the Indian People. However, because there is still the existence in the belief that American Indians and Alaska Natives are not citizen of their states of residence, they believe they are not eligible for state programs and benefits. The fact of the matter is American Indians and Alaska Natives are citizens of the United States of America and are eligible to participate in all public, private and state health programs available to the general population.
Health Care Issues:
This vulnerable population has many unresolved and conflicting illnesses and issues that need attention. Although, The “Government health care for American Indians, was rooted in the Constitution, it has been a long and bumpy road faced with many obstacles and red tape to receive medical attention. Diabetes, alcoholism, mental illness and suicide, cancer, heart and other chronic diseases, and tobacco-related health problems are much more prevalent among American Indians than any other ethnic group in the United States. For whatever reason, we have failed our promise to them because we choose to look the other way and ignore their issues. There are a lot of factors that come to play as to why they are and continue to be labeled as a vulnerable population to no avail. In more details, Indians have higher alcohol induced mortality rates by 43.0% than 7.0% compared to all races put together. Homicide by assault is at 11.7% when compared to 6.1% compared to all races put together. Infant Deaths is 8.0% in Indians when compared to 6.9% compared as a whole to the general public in all races put together. Pneumonia/Influenza for Indians is 27.1% while the general population with all races put together was 20.3%. Suicide levels in comparison were also high. Indians was 19.8% and all races put together are at 10.9% ("Indian health services," Jan). Such limitations in health care for American Indians and Alaska Natives are a result of the misappropriate actions in funds, inadequate health care in tribal contracts as their own Indians are to be seen by their own Indians regardless of qualifications or not as per failed poor policy making decisions. According to a report by the Utah Department of Health in 2001, 17.3 percent of American Indians and Alaska Natives have been unable to get the health care they need. A major factor is geography stated, Melissa Zito of the Utah Department of Health who serves as the Indian health liaison/health policy consultant. She compared the state of American Indian health to a ripple effect in a pond. “The closer you are to the center, the higher quality you will receive,” she said. Many American Indians live far away from major cities and hospital clinics. The farther they are from a clinic, the lesser their chance of attaining quality health care.” “Zito stated “Diabetes is a problem in the social, cultural and physiological parts of American Indian society.” It is a problem that is especially difficult to combat without modern treatment such as insulin and medications.” Money shortages, bureaucracy and distance can delay treatment of even serious conditions for months, even years. American Indians find the health care system to be fragmented and confusing, and they are frustrated trying to navigate eligibility and insurance requirements. (White Earth Nation February 2012)
Challenges:
Because they have experienced racism and discrimination, they believe they have received substandard services because of their race or because of their insurance status. They struggle with knowing where to go for which services, and have communication barriers with their providers. These issues along with other factors have caused a serious look from Congress to submit an overhaul to bring in the most significant improvements to the Indian health system seen in decades. Recent negotiations, provisions under consideration could, over time, direct streams of money to the Indian health care system and give Indians more treatment options. One unique proposal like exempting Indians from penalties for not obtaining insurance, may meet resistance from lawmakers opposed to expanding benefits for Indians, many of whom already receive free medical care. Finding a balance in health care is the ultimate goal, to include American Indians in such benefits of programs for low-income and uninsured citizens, but they do not want to relinquish the health care they claim as a historical right. And rightfully so, as to do that it would mean to change history as we truly know now what it is and not a made up fabricated story in children’s books about cowboys and Indians. “Indian people have given up a lot,” said Dr. Yvette Roubideaux, director of the Indian Health Service. “They really feel like they have, in a sense, prepaid for this health care with loss of land, natural resources, loss of culture.” (JAMIE A. WELCH). Some Indians have private insurance, often through employers or tribal businesses like casinos, one third of American Indians continue to be uninsured and a quarter still live in poverty. By all accounts, the Indian Health Service continues to substantially be underfunded. Congress’s goal, in using penalty and co-payment exemptions, was said to encourage Indians to enroll in proposed programs like subsidized private insurance or expanded Medicaid, while respecting their sovereignty and the conviction that they are owed health care. But bureaucratic hurdles have kept many eligible Indians from enrolling in Medicaid. “ Senator Tom Coburn, Republican of Oklahoma, said exemptions could discourage insurance enrollment, raise premiums for insured people and further stress the Indian health care system, which he called “poorly managed” and in need of billions of dollars to “keep the promise to Native Americans.”
Health Care Reform
Proposed legislation would not give Indians everything they want, but the overhaul does include grants for preventive care and research. And the Indian Health Care Improvement Act, which stands a good chance of being reauthorized by Congress for the first time since 2001, would enhance programs, physician recruitment and hospital construction. Although it approves no funding, advocates hope it will prompt additional money. So what does the enactment of the health care reform of 2010 promise The Indian population? The Patient Protection and Affordable Care Act, signed into law on March 23, 2010, have made some significant steps toward maintaining and improving programs that support the health of the American Indian and Alaska Native population. The reauthorization of the Indian Health Care Improvement Act, the expansion of Medicaid, and several other provisions show the federal government’s renewed commitment to Indian health. In the past years, IHS provided the majority of health services to the American Indian and Alaska Native community, although not a form of health insurance, it managed a unique health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 564 federally recognized tribes in 35 states. What is new since the enactment of the Health Care reform is that through the Indian Health Service (IHS), Indian tribes can now choose to receive health care in one of three ways: by receiving direct care from HIS or by contracting with IHS to control the administration and funding of individual programs and services that the Indian Health Service would normally run (known as self-determination contracts), or by signing a compact with IHS to design and oversee health care programs that IHS would normally manage (known as self-governance compacts) Through the reauthorizing and amending the Indian Health Care Improvement Act, the health reform law showed the Indian populations the demonstration and effort on the federal government behalf in their commitment to honoring its trust responsibility to Indian tribes as it should had been.
Changes:
Few of the areas seen to have improved thus far in the Indian Health Care Improvement Act (“the Act”) In the past, disproportionately higher rates of poverty, American Indians and Alaska Natives were seen to be under-enrolled in public programs like Medicaid, particularly on reservations. It has been difficult to obtain these services because most tribal communities are in rural or remote areas. Further, due to how the current payment structure is set up, providers in Indian Country may not be adequately reimbursed for the services they provide. Today, the Act will ensure grants, contracts to tribes, tribal organizations, and urban Indian organizations so that they can conduct outreach to enroll eligible Indians in Medicare, Medicaid, and CHIP. In addition to that, there is a new requirement for the Centers for Medicare and Medicaid Services (CMS) to submit an annual report to Congress regarding the enrollment and health status of Indians receiving services. The Act also updates the current law regarding collection of reimbursements from Medicare, Medicaid, and CHIP by Indian health facilities and revises the procedures that allow tribally-operated programs to directly collect such reimbursements for the services that they provide. Another major change seen in most Indian health care facilities that are located in isolated rural areas on or near reservations, difficulty in recruiting and retaining staff in health programs have historically been highly experienced. Data revealed that vacancy rates are 26 percent for nurses, 24 percent for dental professionals, 21 percent for physicians, and 11 percent for pharmacists. The Act strengthens scholarship and loan programs to attract health professionals to, and to retain them at, IHS facilities and tribal sites. It also strengthens scholarship programs to recruit American Indian students into psychology and behavioral health professions, and it establishes a Community Health Representative program for urban Indian organizations to train and employ individuals to provide health care services. Major transformations were seen in areas of facilities and sanitation in IHS health care facilities. It is known that on average, most medical equipment was more than 30 years old. These same medical equipment, was known to have an average life span of six years, but was still being used, possibly misdiagnoses were resulted. IHS responded to this negative report that it did not have the financial resources to address operation and maintenance needs, since they added to the maintenance backlog each year. The IHS and tribal backlog is currently estimated to be $476 million. Due to the health care reform of 2010 it allows IHS and tribal health facilities to come up with innovative ways to address deficiencies within Indian health care facilities, sanitation systems, and construction backlogs. It also authorizes the development of new health programs that provide care in alternative settings or outside of regular clinic operating hours. Among many other changes that were brought on as result of the Health Care reform, help for American Indians and Alaska Natives was developed to ensure funding for Prevention and Wellness among this vulnerable population. The health reform law contains a significant amount of grant funding for prevention and wellness programs. The new law considers tribal organizations, urban Indian organizations, and American Indians and Alaska Natives to be eligible for these grants. The health reform law includes funding for maternal and child health services, such as early childhood home visitation programs, as well as grants for trauma centers, school-based health clinics, and an infant mortality pilot program. In addition, there is grant funding for the improvement of regionalized systems of emergency care response, the establishment of community health teams to support the patient-centered medical home, and oral health care prevention activities. Conclusion: Although the Indian Health Care services have progressed, substantial health disparities continue to exist and excel when compared to the general population. HIS implemented Health and Human Services priorities to be directed towards the accountability and provision of higher quality health services for the urban Indian population. To name a few changes the improvements in the collection process of clinical data were implemented. Enhancements of the Indian Urban program patient record systems were progressed through the electronic technology systems. Although it has not been an easy path to take because of its respect for cultural beliefs, it’s blending of traditional practices with the modern medical models and emphasis on public health and community outreach activities have proven to be beneficial. What has been overlooked is the available places to seek medical attention are limited and must be a clinic or hospital specifically on tribal land. Access to these areas is extremely hard, too far and limited with resources making it difficult to access medical attention all together. American Indians and Alaska Natives have faced many barriers to obtaining quality health care. Their journey in the health care reform and the reauthorization of the Indian Health Care Improvement Act helped to address the health disparities that are prevalent in American Indian issue. The coverage expansions in the health reform law will ensure that more American Indians and Alaska Natives can get the care they need. The Indian Health Care Improvement Act will help to improve the shortage of health care providers, maintain IHS facilities, and create programs to enhance the health of the Indian people. Health reform enables the United States to begin to better fulfill its responsibility to provide quality health care services and resources to American Indians and Alaska Natives.

References
U.S. Department of Health and Human Services.
U.S. Census Bureau. (2000). Population by Race and Hispanic/Latino Status. Retrieved September 25, 2001, from http://www.census.gov/statab/www/part1a.html. Acquiring health care a dangerous struggle for American Indians, Posted on December 9, 2008 by JAMIE A. WELCH. http://voicesofutah.wordpress.com/2008/12/09/acquiring-health-care-a-dangerous-struggle-for-american-indians/ http://www.aolnews.com/2011/04/08/american-indian-tribes-face-struggles-with-federal-shutdown/Aol.news.com by Felicia Fonseca. American Indian Tribes Face Struggles With Federal Shutdown. http://www.nytimes.com/2009/12/02/health/02indian.html?pagewanted=all . By PAM BELLUCK. Published: December 1, 2009
Health care needs assessment for White Earth Nation 1 February 2012