1. Update
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Health Care

Preserving Life in Indian Country

October 24, 2017

Medicaid and the Child Health Improvement Program are lifesavers in Indian Country, extending access to health care to thousands of families. The Special Diabetes Program for Indians has a ten-year record of arresting the increase in diabetes among American Indian adults and children, and the rate of obesity among children.

Medicaid and CHIP for Indian Children and Adults

The expansion of Medicaid and CHIP coverage are making more of a difference in Native communities and families than to the general U.S. population. In 2015, 54 percent of American Indian and Alaska Native children were enrolled in Medicaid or CHIP (the Child Health Insurance Program), compared to 39 percent of all children, according to a study just released by the Health Policy Institute at Georgetown University. Between 2008 and 2015, the proportion of American Indian and Alaska Native children without insurance coverage decreased nationally from 25 percent to 15 percent. The largest reductions in uninsured rates were in New Mexico (38 percent to 11 percent) and Alaska (32 percent to 11 percent), according to the study.

Insurance coverage for American Indian and Alaska Native adults also improved dramatically during that time; the percentage of uninsured adults dropped from 36 percent in 2008 to 28 percent in 2015. While Native children and adults are more likely to be uninsured than the general population[1], the expanded access to Medicaid and CHIP since 2008 has been a critical factor in their health care and should be continued.

Medicaid, CHIP and the Indian Health Service

The Georgetown study counts children as uninsured if they are not enrolled in Medicaid, CHIP, other government coverage, or a private health insurance plan. Why not take into account the Indian Health Service? The Indian Health Service is a health care delivery system, with 45 hospitals and 343 clinics in 22 states. Medicaid operates in all 50 states, in places where no IHS facility is available, and where a local IHS facility may not be able to offer the kind of health service that a particular Medicaid enrollee might need. Like other hospitals, whether private, non-profit, or publicly owned, IHS facilities rely on insurance coverage to pay the cost of providing services. The annual appropriations to support IHS facilities have proven over the years to be inadequate even to keep up with the cost of the physical facilities themselves, even without the cost of services.

As the debate continues on access to affordable health care, two issues of are major concern to Indian country:

  • Continue and increase funding for the Indian Health Service, which struggles to keep clinics and hospitals open where other facilities are not available, and are not able to provide culturally-grounded health services.

    Good News: Representative Calvert offered a package of amendments to the House Omnibus Appropriations bill that included one sponsored by Representative O’Halleran to provide funds to staff and operate new IHS facilities that will open in 2018, and another to increase the Bureau of Indian Affairs construction account – covering both schools and health facilities – by $10 million. Amendments were adopted and are now part of the House Omnibus bill. Senate has not acted yet.

  • Continue the expanded coverage available to children and families through Medicaid and the CHIP program, and reach out to the 15 percent of Native children who still have no access to affordable care.

Special Diabetes Program for Indians

Congress set up the Special Diabetes Program for Indians (SDPI) in 1997 to address the high incidence of diabetes in Native Americans and Alaska Natives. It is now a $150 million per year grant program, operating in 35 states, serving 780,000 people. The program focuses on prevention and mitigation of the diabetes epidemic, promoting health life styles, good food choices (often a return to traditional indigenous foods), and improved fitness. Over the last ten years, the program has arrested the increase in diabetes among American Indian adults and children, and the rate of obesity among children. It has cut the rates of diabetic eye diseases and kidney failure in half among Native people in the U.S.

Such a successful – and money saving[2] – program clearly should be authorized permanently. But the SDPI program has not been able to achieve that status. Its authorization ran out on September 30. Supporters in Congress scrambled to find a “vehicle” that could carry re-authorization of the program, and get it done before it expired. A temporary (3-month) extension of the program was added to the disaster-relief bill in the House (H.R. 3223). After some initial procedural hurdles, the bill was passed and signed on September 29.

A longer reauthorization is still in the works. In the House, the Energy and Commerce Committee (which, yes, has jurisdiction over health care plans) approved a 2-year reauthorization for the Special Diabetes program. It was part of a collective bill, known as the ”Champion Act” (H.R. 3922) which also reauthorized the National Health Service Corps, Community Health Centers and other programs.

In the same committee Representative Burgess promoted his HEALTHY KIDS Act (H.R. 3921) which provides a 5-year reauthorization for the Children’s Health Insurance Program. In the running for the longest and perhaps cutest acronym in the 115th Congress, HEALTHY KIDS stands for “Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable.” The committee approved the bill.

The Senate Finance Committee also approved a 5-year reauthorization of CHIP as proposed in Senator Hatch’s bill, S. 1827, called the KIDS Act: “Keeping Kids’ Insurance Dependable and Secure.” There's more work to be done on both of these.

[1]: Nationally, only 5 percent of all children lack health insurance coverage, but 15 percent of American Indian and Alaska Native children are uninsured, even with the improved access to health care through Medicaid and CHIP. For adults, the national “uninsured rate” is 14 percent, while among American Indians and Alaska Natives that rate is doubled: 28 percent.

[2]: For every year that the need for kidney dialysis can be averted, Medicare and Medicaid combined save $89,000 per patient.

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