Alternative health care revenue sources are little-used

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RAPID CITY, S.D. - Creative thinking, use of third-party payers and preventive medicine education and practices may be the answer to the perpetually inadequate health care budget for Indian country.

Third-party payers, such as Medicare, Medicaid, private insurance, Veterans Administration programs, preventive health care and education are becoming a must-revenue stream for Indian country. The IHS is the payer of last resort.

The first-ever Center for Medicare and Medicaid Services conference to be held in Indian country took place in the Aberdeen Area in Rapid City. The IHS, CMMS, states and tribes are partnering in an effort to come up with methods of generating revenue to supplement congressional appropriations for health care.

The Aberdeen Area IHS budget is $245 million and an additional $71 million is generated from third-party payers; that total is estimated to be 50 percent of what is considered to be adequate funding for the area.

Tribal health officials argue that Congress and the administration will not come to their aid with adequate revenues anytime soon; and in addition to the growing problems, few American Indians have signed up for the alternative health care plans. Medicare comes with a cost to the patient, and that is difficult in an area where the poverty rate is the highest in the nation.

CMS revenue is very important and if more people were available to process the claims, more money may come into the system. Roger Trudell, chairman of the Santee Sioux Tribe of Nebraska, said that for the Santee there is one person knowledgeable about CMS processing and that person is having an impact.

''What could three people do?'' Trudell said.

John Blackhawk, chairman of the Aberdeen Area Tribal Chairman's Health Board and former chairman of the Winnebago Tribe, said tribal leaders go to Washington to testify and make their views known, but they don't have the majority of the Senate or the House of Representatives' attention.

''Someone has to carry the banner,'' Blackhawk said. Sen. Byron Dorgan, D-N.D., is chairman of the Senate Committee on Indian Affairs, and for the moment he is carrying the banner.

But that's for the moment, Trudell and Blackhawk said.

''The people [congressional delegations] from here will support us,'' Trudeau said.

The Aberdeen Area created a film that explains revenue generation and the reasons why. The film is expected to be distributed to congressional staff members in Washington, D.C.

In the meantime, most of the young people are not eligible for Medicare, Medicaid or veterans benefits and they can't afford private insurance, so they are solely dependent on the IHS contract health dollars which, with the current appropriations, run out mid-year. So a referral will be necessary for any health problem that IHS is not equipped to deal with; and when the funds are gone, any referral is based on loss of life or limb.

Cultural beliefs and mistrust of the federal government prevent some people from enrolling in alternative health programs, tribal officials say. Some tribes have attended tribal fairs, pow wows, rodeos or other events and set up booths where people can receive information on the alternative sources of health care coverage and where they can sign up. But word of mouth is always the best method of educating, tribal officials said.

One of the most important health care groups is the Community Health Resource, which can act as the front line of defense for future health care issues. Trudell said he believes that CHR is one of the most important agencies the tribe has when it regards health care.

''There is a natural mistrust, a mistrust of the federal government [by the people],'' Trudell said.

Preventive health care, long known to reduce the need for further medical care, may be what the tribal health care programs can do to lower the costs. The CHR may be the answer to reduce health care costs.

''They are the people central to health in the community; if they are not supporting, they are providing preventative education,'' Trudell said.

The Santee Sioux Tribe has created walking and biking paths around the reservation to promote exercise. And the Winnebago Tribe of Nebraska has created an entirely new healthy community with walking paths and shopping and social event locations within walking distance from residences.

The United Tribes Technical College in Bismarck, N.D., has made bicycles available to all the children of students on campus and provides lessons on healthy lifestyles and bike safety.

If the funding won't increase, the need for health care has to decrease, tribal leaders said.