An August 22 Fox News report, “ObamaCare Mandate Skips Over Native Americans,” contains inaccurate and misleading assertions about the Indian Health System and the purpose of exempting American Indians and Alaska Natives from the requirement to carry health insurance under the Affordable Care Act (ACA), otherwise known as the “Individual Mandate.”
While portions of the piece are true, it “skips over” some of the most sobering facts about access to care for and the health status of American Indians. Instead, patients who receive “free” health care from the Indian Health Service (IHS) are wrongly accused of double-dipping due to their eligibility for premium subsidies under the ACA while being exempt from having to purchase insurance. United South and Eastern Tribes, Incorporated (USET) feels compelled to set the record straight on this exemption and the federal Government’s trust responsibility to provide health care to our nation’s first people.
It is true American Indians and Alaska Natives, who meet eligibility requirements (just like every eligible American citizen), may receive subsidies to purchase private insurance. Fox is also correct in reporting these same tribal members are eligible to receive “free” health care through the IHS.
However, this is not the whole story, facts are missing. The health care provided to American Indians and Alaska Natives is NOT free. The Federal Government, through force, coercion or “voluntary” consent, removed Native Americans from their homelands. The price of health care provided to American Indians by the Federal Government has been paid, through cessions of vast natural resources and millions of acres of land. Our ancestors paid for these benefits with their hearts, souls and in many cases, with their lives. All of our treaties, which are considered law of the land, the many laws, and various Supreme Court cases collectively support the provision of these services to our people. Yet, the federal government has thus far failed to fully uphold their end of the transaction, the sacred agreements and trust owed to our people.
Fox News reported the amount of federal funding the IHS currently receives yet omitted the disturbing fact that this amount equates to just slightly more than 50 percent of what is required to provide basic health care to American Indians. Access to care remains a persistent problem for Tribal Nations, as IHS-funded facilities are frequently unable to hire and retain qualified health staff. By not fully funding IHS so that it may provide adequate basic health care, the United States government is not fulfilling its obligations and trust responsibility to American Indians and Alaska Natives.
While nearly every other federally funded health care program is exempt from the Sequester, IHS is not. This has compounded the challenges tribes face to gain access to basic health care. Too often IHS funding is expended before the end of the fiscal year and new funds can be received. The IHS has predicted federally mandated reductions to IHS will result in 3,000 fewer inpatient admissions and 804,000 fewer outpatient visits annually. The numbers may be small in comparison to the rest of the country, but American Indians and Alaska Natives have some of the highest per capita incident rates of diabetes, heart disease, and cancer, which result in devastating effects across Indian country.
While drafting the ACA, Congressional leaders took into consideration how the United States has failed to meet its trust responsibility to American Indians and Alaska Natives and the neglect toward providing adequate basic health care to Tribes. Congress was wise in its strategy to provide subsidy to eligible beneficiaries in Indian country to purchase health insurance. By doing this it strengthens the federal investment made in IHS because tribal healthcare facilities may bill private insurance to regain funding spent on treatment. This also alleviates the demand on services as tribal members, who now have health insurance, may seek care from providers outside of IHS clinics. Tribal members will have greater choices in providers, as well as increased access to necessary preventive and specialty care. Through the ACA, the Indian Health System stands to make real progress in closing the gap in health status for its patients.
American Indians and Alaska Natives are not “double-dipping” under the ACA. Many will use the benefits offered by the law to experience the level of care and peace of mind that health insurance brings for the first time. Many will not, citing the Federal Government’s obligation to fund IHS. The Fox News report speaks to the issue of fairness under the ACA. Fox News should work in true fairness in its reporting to understand the history, the treaties, and the differences of why American Indians and Alaska Natives are afforded certain benefits. It is only fair for our people to be exempt from bearing the burden of the government’s failures. ACA is a fair step and action by the United States to uphold its sacred and legal responsibility to tribal Nations. Therefore, USET believes the United States is working to reverse generations of neglect to Indian country. The spirit of the Affordable Care Act, which includes the Indian Health Care Improvement Act, is an action the United States is taking to uphold this sacred and legal responsibility.
A column from the United South and Eastern Tribes, Inc.