The Bush administration does not care about low- and middle-income Americans, and they certainly don’t care about the nation’s indigenous peoples. The Indian Health Service (IHS) recently announced plans to dramatically reduce vital services at its Albuquerque, N.M., facilities using the excuse of “budget deficits,” yet Albuquerque has one of the largest concentrations of urban Indian populations in the United States. Worse yet, the per capita health care funding for reservation-based populations is less than half of what is provided to those on Medicaid or in prison. Even Senate Indian Affairs Committee Chairman John McCain (R-Ariz.) recently charged: “The federal government has continually reneged on its trust and moral obligations to meet the educational, health care, and housing needs of Indians, and these needs far outweigh the imperceptible contribution that the proposed cuts will make to reducing the deficit.”
The federal government has a unique relationship with American Indians and Alaska Natives that is defined by the U.S Constitution, treaties, Supreme Court cases, and legislation. The historic contract was that in exchange for tribal lands, the U.S. government agreed to provide health care to members of federally recognized tribes. The IHS, an agency of the U.S. Department of Health and Human Services, was supposed to have fulfilled that responsibility since 1955, but in reality, it has failed miserably.
American Indians/Alaska Natives are among the fastest growing populations in the United States. In the 2000 Census, 4.1 million people (about 1.5 percent of the U.S. population) identified themselves as American Indian and/or Alaska Native, solely or in combination with one or more other racial or ethnic groups. But at the same time, looking at mortality rates, American Indians and Alaska Natives die sooner than whites at each stage of the lifespan, with persistent disparities in infant mortality, life expectancy, and mortality from a variety of conditions including chronic diseases. There are also serious disparities in health care financing, access to care, and quality of care.
When the IHS was established in 1955, more than 95 percent of Indian people lived on or near their home reservations. Now, despite the fact that more than 60 percent of members of U.S. tribes reside outside their home reservations at least part of the year, only 1 percent of the IHS budget is earmarked for urban Indian health care — and even that meager care is being slashed.
In fiscal year 2003, the Indian Health Service had an operating budget of $2.9 billion to provide or pay for care for approximately 1.5 million of the 4.1 million people who identify themselves as American Indians or Alaska Natives. This amounts to $1,914 per patient per year, which was about $1,600 less per year than the nation spent on other public health care programs serving the non-elderly. According to one study, an additional $1.8 billion is needed to provide current IHS users with services at the same level as those provided to federal employees.
Despite this history of extraordinary neglect by the federal government of Native American health issues, there is one very hopeful development. Most of the Native tribes, villages, and organizations in Alaska have banded together to form the Alaska Native Tribal Health Coalition, which cobbles together a statewide health care system by adding cash from third-party payers such as private health insurance and Medicaid. This looks a lot like a democratically operated non-profit health maintenance organization.
All Americans have to join with American Indians and Alaska Natives in struggle against the decimation of their health care systems. Moreover, we need to support struggles to get local control of health care where they are taking place. Further, we must make sure that any national health plan takes into account these unique considerations and contributions.