Uncertainty ahead for Indian health care, starting with Massachusetts election

Op-ed by Mark Trahant

The Indian health system is stuck in a world of conditional sentences. That’s a sentence with the phrase, “if … then.” If Congress passes health care reform, then …

There are many variables based on a complex grid of “ifs.”

The most important conditional sentences involve the Indian Health Care Improvement Act. There are slightly different versions in both the House and Senate bills. If the House language is the one to prevail, “then” means one thing. But that meaning changes if it’s the Senate version, or even if it’s a merged bill.

One huge “if” is what happens if voters in Massachusetts say no to health care reform in general by electing the Republican candidate for Senate. “If Scott Brown wins,” Rep. Barney Frank, D-Mass., told the Associated Press, then “it’ll kill the health bill.” In that case, the “if … then,” is the 41st “no” vote when Senate rules require 60 votes for passage of the larger health care reform bill.

But even that is no sure thing. Senate leaders could try to move the bill before the new senator is sworn into office or the House could pass the Senate version without changes. There are many more “if … then” variations to ponder.

For example ABC News says there is the problem of time: “After a final health care deal is struck … it goes to the Congressional Budget Office (CBO) for a cost estimate, a process expected to take 10 days.

The business model for an Indian health system

Op-ed by Mark Trahant

What is the business model for the Indian health system?

On the surface this is a preposterous question because the U.S. government promised to fund the health care needs for American Indians and Alaskan Natives. It’s also supposed to be a simple business: Congress funds the system (the Indian Health Service, tribal contract facilities and urban programs), the agency spends that budget, and patients are treated.

But that’s why the question is not outlandish. The Indian health system has never had enough money – and therefore it’s essential to secure as many resources as possible in order to effectively treat the most patients.

“As we look at the Indian Health Service, we need to think of it as a business,” said Yvette Roubideaux, M.D., director of the Indian Health Service. “A lot of people think of the Indian Health Service as a service. It’s a service that provides health care to American Indians and Alaskan Natives. People who work in IHS think of their positions not just as jobs, but also as something important personally. Many people feel like they are on a mission working for the Indian Health Service – and I think that’s great. But I also think we have to recognize that we are a health care system – and that we’re a business. We have to look at how we run our organization, to improve the way we do business.”

Roubideaux calls this “Internal IHS Reform.” She began the business case by gathering data, listening to tribes and IHS employees.

Up to 1/3 of Western Alaskan native village housing crumbling in the cold

Wow, we’d heard conditions weren’t exactly ideal in the villages that native Alaskans inhabit in the remote western and northern parts of the state. But a new report says that up to one-third of the homes in some villages are filled with mold, buckling, or otherwise potentially unsafe to live in.

Kyle Hopkins of the Anchorage Daily News provided some  context for the report: Many of the homes in question were built in the 1970s without eaves or gutters, causing rain to soak the wooden buildings. In some cases, insulation has trapped water in the walls. He quotes the report:
Widespread use of these homes has created a problem of crisis proportions for the village: they are for all practical purposes unsalvageable,” the report says. “Yet to condemn them all would leave roughly one-third of the village without shelter.
Results presented in the study were based on an investigation of  just 55 homes in the Yup’ik village of Quinhagak, which requested the study. However, Hopkins’ story goes on to show that the very same construction methods were used widely in the farflung native villates.

The report is by the Cold Climate Research Center in Fairbanks. And while we couldn’t locate the exact report Hopkins wrote about on the center’s website, we did find this Alaska housing assessment. It says two-thirds of the really bad homes — they used a highly technical term  here: “falling apart” — are in rural Alaska, mostly in the small native villages.  And many of those buildings are quite small — with one out of every five featuring less than 200 square feet of living space per occupant.

Hopkins spoke with David Fitka, who lives in the Yukon River village of Marshall. He said of his home, built in Idaho in 1978:
From the beginning, you could see that the building was made from low-grade products.

Oklahoma firm stakes massive AK mining claim, angering natives

Wow. What’s shaping up as another fractious Alaskan mining battle — possibly as contentious as those already raging on the Pebble and Kensington mines–  just hit the headlines today.

It’s a little puzzling that this supposed $35 billion gold find in Southeast Alaska — that’s a huge find, if true — has induced only three short news stories since emerging this morning in the Juneau Empire. That’s particularly true considering that this one seems destined to cause a lot of controversy, as  some of the land claimed by Oklahoma City-based Geohedral LLC is revered as sacred by Native Americans. Not to mention that people living in the area, near Yukatat, are heavily dependent on fisheries that they are pretty sure are going to be hurt by the mining. Many are subsistence fishermen.

However, Herb Mee Jr., president of The Beard Co., which owns a 23 percent stake in Geohedral, told Eric Morrison of the Empire:
We envision no environmental problems in what we will be doing.
Now, as we have previously documented, hardrock mines like this have a history of going great guns when metals prices are high — gold’s now trading at nearly $1,000 an ounce, representing roughly a quadrupling in price in the last decade — and then going belly up when metals prices drop. Our work also showed that sometimes, these mines stick taxpayers with massive cleanup bills.

That’s what locals in Yukatat fear. Said Raymond Sensmeier, a fisherman and member of the Yakutat Tlingit Tribe Council:
We’re deeply concerned …

Exempting Native Americans from the health care mandate

Indian Country & Health Care Reform

By Mark Trahant

      There is growing consensus about a key element of health care reform: a requirement that you must buy health insurance. The idea is that the insurance pools would be less expensive if every American were included – especially younger, healthier workers who for a variety of reasons decide not to buy insurance. The reform proposals would require people to sign up for Medicaid, buy subsidized insurance, or purchase a policy at work or on their own.

      This would be difficult in Indian Country. Already Indian Country reflects the highest number of Americans who do not sign up for Medicare, the closest thing we have to universal coverage for the elderly (by my count almost a quarter of Native American elderly are not on the program). The story for Medicaid is similar. Moreover in recent studies one of the reasons for the low participation is the notion expressed by many who did not believe they should have to sign up for any program because health care is a treaty obligation of the United States.

      Speaking at the National Indian Health Board Consumer Conferencein Washington, D.C., Health and Human Service Secretary Kathleen Sebelius said the president supports an exemption from that mandate for individual American Indians and Alaskan Natives. “I’m going to make it very clear,” she said, “the administration strongly believes that the individual mandate and the subsequent penalties don’t apply to American Indians or Alaska Natives.”

      There is consensus that the Senate Finance Committee’s billwhen it surfaces will reflect this notion.

Tribal clinic survives by treating non-natives

Spokane Public Radio’s Amanda Loder has an interesting story about a clinic on an Indian reservation that stays afloat by treating non-natives. The Benewah Medical Center on the Coeur D’Alene tribe’s reservation in Plummer, Idaho, started as a condemned building where a doctor showed up once a week. Now, with income from non-native patients and revenues from the tribe’s casino, it’s been built into a multi-building complex.

B.C. First Nations unhappy with “new relationship” to provincial government

Ownership of about 90 percent of the province of British Columbia is in dispute because of aboriginal land claims. After four years of trying to develop a “new relationship” with the provincial government under the Recognition and Reconciliation Act, First Nations leaders are growing impatient with Premier Gordon Campbell, according to a story today in the Globe and Mail by Justine Hunter. The native leaders are suspicious that Campbell may be stringing them along to buy peace until after the 2010 Olympics are over.

Stimulus brings flush toilets for Native Americans in AK

The days of relieving oneself in a “honey bucket” will soon be over in a number of isolated Native American communities in Alaska, Alex DeMarban reports in The Tundra Drums.  Some $42 million is being spent to bring flush toilets and other sanitation improvements to the towns. In a few cases, sewage lagoons inside floodplains will be relocated to places where they are not in danger of causing widespread contamination in times of high water.