PIERRE, S.D. - The state of South Dakota, as with other states with large Native populations, is directly involved with the health care of American Indians.
The State-Tribal Relations Committee in South Dakota, an interim committee made of both houses, found out recently how Indian Health Service and all health care involving American Indians impact the state.
It was no secret to many legislators that IHS is "grossly under funded," said Tom Van Norman, D-Eagle Butte, and member of the Cheyenne River Sioux Tribe. But because of underfunding, the state and its other residents are expected to pick up some of the tab.
It's not all bad. Indian health care infuses $170 million into the state economy with an estimated total economic impact of $512 million. Those figures are estimated and not based on actual data provided through scientific means.
Although those figures may indicate that health care is properly funded, there are many cases where people are not receiving proper health care because of limited funds. Contract health care for American Indians is care provided off the reservation in hospitals for approved conditions including surgery and life-threatening illnesses that cannot be handled by IHS facilities.
Much of that care can be denied for payment based on the availability of funds in a discretionary fund established by Congress. This leaves the patient responsible for payment, which in many cases is not possible because of lack of employment or limited employment.
Hospitals such as Rapid City Regional have to write off much of the debt. David Goehring, vice president of finance for RCRH said that facility has had to write off $1.5 and 2 million per year from non-collectible debt on American Indian health care.
"A lot of Native Americans off the reservation go to the ER thinking IHS will pay the bill," said Mike LaPointe, R-Mission, and member of the Rosebud Sioux Tribe.
There are other programs provided through the state that many American Indians can apply for that would take care of at least a portion of their medical payments, including Medicaid.
"During routine visits, discharge planners work with patients to look at what the patient is eligible for. This has improved over the years," said Vern Donnell, service unit director for the Pine Ridge IHS Hospital.
Some patients take applications home and never return the paperwork that would make them eligible for other financial programs.
Underfunding also creates a larger pool of people that are placed on credit risk status that makes them ineligible for borrowing for home mortgages and other products. This creates another economic negative for the state.
But what can the state do to help increase health care and economic stability?
"It all goes back to economics. We don't see enough federal funds for health care," Donnell said.
Dale Young, deputy service unit director for Rosebud said that IHS tries to bring in a larger number of specialty care physicians to the IHS facilities and to do so contract health funds are used.
What IHS facilitators in South Dakota try, they said, is to be creative with what funds they have.
The Rapid City Regional facility sees about 10 new American Indian patients a day and has at any time up to 60 in-patients, said Kathy Ducheneaux, patient's rights advocate at RCRH, and member of the Cheyenne River Sioux Tribe.
There is an IHS facility, Sioux San in Rapid City, but services are limited there. Patients are referred from Sioux San to RCRH and Medicare and Medicaid patients usually go directly to RCRH, Ducheneaux said.
RCRH has five reservations within its area and Ducheneaux said that contact must be made with the person's reservation within 72 hours after coming to the emergency room and sometimes it's difficult when the person lives on one reservation and is enrolled on another.
The bottom line is that quality of health care is linked to funding and the federal government has fallen behind in that category, state legislators and IHS officials agreed.
"This is never going to stop unless congress funds IHS like they said," said J.E. "Jim" Putnam, R-Wagner, on the Yankton Reservation.
"This jeopardizes patients and puts them at risk and puts the state's health care at risk. We've had this debate before. You stretch every dollar you have. I don't understand why can't come to this conclusion.
"Congress played games with the Wagner unit like a football and that puts another burden on all of us and the source is the funding, they put us in jeopardy."
The Wagner unit was closed and funding transferred to the Santee Tribe in Nebraska.
"If they funded IHS we would have a good health care system on and off the reservations," Putnam said.
"Prevention is one of our strongest points," Donnell said. Diabetes, heart and lung diseases are major priorities on the reservations. Donnell said that auto accidents took the lives of more people this past year than all other diseases combined.
Most people are living with compromised immune systems, roads are hazardous and alcohol and drug abuse also make health care very difficult. Funding in other areas, such as drug and alcohol treatment, improvement of roads and additional employment opportunities may reduce the financial demand on health care.
This past year Sen. Tom Daschle, D-S.D. failed to add an additional $92 million to the reduced IHS budget.
"We are not going to make a dent in telling Congress to give us another $3 million, but we can make a dent in improved health care," said Jim Bradford, D-Mission.
"We can help getting doctors to the reservations."
Stan Adelstein, chairman of the State-Tribal Relations committee asked IHS officials to develop a set of recommendations that the state legislature can take to Congress.