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IHS summit grapples with agency’s role in national health care reform

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DENVER – Things are looking up for IHS, but the agency must adapt to rapid changes in national health care reform and demonstrate willingness to improve, Dr. Yvette Roubideaux, IHS director, said July 7.

Her assessment of IHS’ future came in opening remarks of a three-day summit that drew an estimated 800 health care providers, tribal leaders and others to what was described as the largest IHS conference of its kind in recent years.

The national health care reform debate is ongoing, complex and occurring rapidly, and it’s not clear what effect such major changes as public option or co-pay revisions and other innovations will have on Indian health care, she said.

Changes in IHS will be in the context of overall health reform, she said, asking, for example, “What if we can’t go for the public option?” She said other changes could affect IHS “either in a positive way or a negative way.”

IHS will not make a decision on a health care reform position until it consults with tribes, she said.

One priority for IHS is to have a “tribal consultation on consultation,” as part of a priority to strengthen the relationship with tribes in areas of government-to-government and federal trust responsibility.

Positive signs in health care for Natives included a 13 percent increase for IHS in President Barack Obama’s proposed 2010 budget and stimulus funds of $500 million for facilities, sanitation, maintenance, improvement, medical equipment and health information technology.

The president is “one of our biggest supporters,” Roubideaux said, noting that when he was a senator Obama co-sponsored the Indian Health Care Improvement Act and stressed that he wanted “First Americans to have accessible and quality care.”

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There is now more bipartisan support for funding and other resources in IHS and for passage of the IHCIA.

Inadequate funding has been a key problem over the years, and IHS has received less money than such federal programs as the Federal Employees Health Benefit program, Medicaid and health benefits for federal prisoners.

She said medical inflation is actually 10 percent to 12 percent yearly rather than 3 percent to 5 percent, as is often used in budget calculations.

The agency also struggles with balancing tribal and urban health programs, rapid Native population growth, rising medical costs, an increase in chronic disease, difficulty in retaining doctors and other medical workers, transportation in rural areas, and aging facilities and equipment.

One problem for tribally operated programs is that contract costs are not fully funded. Another concern for IHS is that enough funding must remain with the agency to implement tribal programs that tribes want the agency, rather than tribal government itself, to continue operating.

Urban Indian health care programs, while under-funded, at least remain in the president’s budget as opposed to their zeroed-out status in preceding years, Roubideaux said, noting they remain “very limited” in terms of dollars projected.

Among Native health improvements since 1973 are decreases of 84 percent in tuberculosis and 75 percent in cervical cancer, with the lowest improvement rate – 14 percent – in the occurrence of suicides, Roubideaux pointed out, while alcohol-related problems and diabetes rates remain above the national average.

The summit’s theme was “Celebrating the Tapestry of Health and Wellness: Sharing Wisdom and Showcasing Information” with broad initiatives on health promotion-disease prevention, chronic care, and behavioral health.

Other topics at the summit ranged from diabetes, trauma, community engagement, emerging issues, tobacco cessation, substance abuse, urban Indian health and traditional medicine.