Medicaid

Op-ed by Mark Trahant

President Barack Obama answered an important philosophical question last week: How will the federal government fully fund a starved Indian health system?

The answer is budget by budget: The administration boosted spending by 13 percent in fiscal year 2010 and is proposing another 9 percent increase for 2011. But this budget does not resolve the contradiction between “historic underfunding” and the larger reality about federal spending. The proposed budget calls for $5.4 billion in spending for Indian health care, ranging from clinical services to facility maintenance and construction. (The bulk of that money, $4.4 billion would be from appropriations, the rest comes from health insurance collections and special grants.)

HHS Secretary Kathleen Sebelius said: “Our budget also contains a significant increase in funds for the Indian Health Service as we continue to work to eliminate health disparities. It is the principle that we are trying to establish in our healthcare system – that regardless of race, ethnicity, gender or geography every American deserves high quality and affordable care.”

But while spending on Indian health is increasing – is it growing fast enough to catch up? There remains a significant gap between what is spent on an American Indian/Alaska Native patient than a federal prisoner, $2,130 per person versus $3,985. One measure used by the federal government is a benchmark based on spending for federal employees. The Indian Health Service is currently appropriated about 55 percent of that standard on per person basis.

Indeed, last April a tribal task force recommended a $2.1 billion increase in the budget authority for IHS in fy 2011. The tribal leaders called for a ten-year phase in of $21.2 billion to reach spending parity.

Op-ed by Mark Trahant

Op-ed by Mark Trahant

A generation ago Indian Country wasn’t included in the conversation about health care reform. When Congress enacted Medicaid and Medicare it pretended that the Indian Health Service didn’t exist. It was as if it had never occurred to the government, that it, too, ran a major health care delivery system.

Say what you like about health care reform, the fact is that Indian Country is included in a big way this time around. If either the House or the Senate bill becomes law, there will be a significant boost in resources for the Indian Health system.

The largest single line item is the reauthorization of the Indian Health Care Improvement Act, included in H.R. 3962, the Affordable Health Care for America Act. The Congressional Budget Office “scores” the cost at $100 million through 2014 and $200 million over a decade. Most of that cost is attributed to the “expansion of payments under Medicare.” This is important because American Indians and Alaskan Natives have the highest percentage of any population over 65 not currently enrolled in Medicare programs.

But the bigger ticket is the expansion of eligibility for Medicaid and the Children’s Health Insurance Program.

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.

By Mark Trahant
You hear a lot about grandma now that Congress is back to work on health care reform legislation.

"Poor old grandma" is a reason opponents say they will fight health care reform. Grandma will lose services, her Medicare will be less than it is, and some bureaucrat far away will decide when it's her time to die.

This is not the first time this debate has surfaced. In the 1960s opponents of Medicare used the phrase "poor old grandma" to warn that the legislation would rob elderly of their Social Security or provide insufficient care. They were wrong, of course. Medicare has probably become the most popular government program ever. These days it's common to speak as if Medicare is the universal coverage for American elderly. (Medicare is for the elderly and disabled, Medicaid is partnership with the states aimed at some people with low-income.)

And that's mostly true. Mostly. But Indian Country was largely left out of the original Medicare and Medicaid, plan, a problem that was fixed when President Ford signed the 1976 Indian Health Care Improvement Act into law.

Rick Lavis, a Republican, who was working for Arizona Sen. Paul Fannin, sent a memo to the Ford White House raising the question why it was even necessary to amend the law to include American Indians and Alaskan Natives. Then Lavis answered his own question by saying the act would "permit Indian Medicare and Medicaid beneficiaries to utilize their benefits in IHS facilities, which under present law is disallowed."

Lavis also argued that the IHS should be reimbursed at 100 percent rates in their facilities because "the federal government has obligations to provide services to Indians.

Today's topic:  The health care debate.

Category: Making stuff up.

Timing: August

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."  -- Sarah Palin

"Death panels? Seriously? Could Palin see the Soviet gulag from her house?" Asks Denver Post columnist Mike Litwin.

Writing in the LA Times, columnist David Lazarus points out the anti-ad featuring the Canadian woman who fled fled to the U.S. to get treated for a brain tumor. "I'm here today because I was able to travel to the U.S., where I received world-class treatment," she says. "Government health care isn't the answer." Lazarus points out that the problems with this ad include the fact that no one is proposing Canadian style health care for the U.S. Canada offers it citizens a single-payer insurance program, not medical treatment, and a single-payer insurance system isn't part of the leading proposals now on the table here.

The recession is driving more people than ever to seek state assistance with health care in Colorado, reports Tim Hoover in the Denver Post. The state saw a 14 percent spike in Medicaid enrollment in the budget year that ended in June, a "record-setting rate that capped a year with the largest-ever number of people in the health insurance program." In June alone, there were 80,000 more Coloradans on Medicaid than the previous month. Nearly 10 percent of the state's residents are now enrolled in Medicaid, which covers low-income pregnant women, children, the elderly and disabled.

State officials say they are seeing a pattern of unemployed people laid off from good jobs who have never sought state assistance before being driven to seek assistance from Medicaid and other programs in order to get health insurance for themselves or their children.