SIOUX FALLS, S.D. - Tribal chairmen and members of the Aberdeen Area Tribal Chairmen's Health Board rededicated themselves to work for the people on health care in light of the fact that many health care disparities exist in the American Indian communities and funding is always inadequate.
When tribal health officials gather, the two main topics of discussion are funding and the disparity of health care. Health care funding in Indian country has frequently been compared to that of federal prison inmates who receive nearly $2,000 more per inmate than each American Indian.
Even though health care funding for fiscal year 2008 has been increased in the White House budget, the bottom line received a boost in the House, but the final mark-up still falls short of the need.
Mary Lou Stanton, deputy director of Indian Health Policy, told the chairmen and health officials that with the increases, a $13 million reduction in facilities expenditure is in the budget. That means the Cheyenne River Sioux Tribe clinic and hospital will not receive funding until possibly 2009. CRST has been waiting for several years for this facility.
''There are 76 tribes signed up for the joint ventures, but we can only fund two,'' Stanton said. The joint venture means the tribe and IHS will work together to build the facility. The tribe usually constructs the building and IHS provides the staff and equipment.
Stanton said there is an emphasis on the collection of third party payer funds, such as Medicare and Medicaid. In the Aberdeen Area that amounts to $60 million per year and nationwide the figure reaches $700 million. But that figure still doesn't equal the need.
Stanton said at this time the Indian Health Care Improvement Act is up for reauthorization. The IHCIA has not been reauthorized since 1999 and this version has some provisions included that will benefit Indian country. The bill includes the elevation of the IHS director to assistant secretary of Indian health, and it would also exempt Medicaid patients from any co-pay, as an example.
She said it is expected that the FY '08 budget will be passed this year.
''We live on the four poorest counties in the United States. The U.S. government has people on Pine Ridge with cancer, and they can't get treatment because their life and limb are not threatened,'' said John Yellow Bird Steele, president of the Oglala Sioux Tribe.
''What is the IHS responsibility to the individual when they can get to the hospital and then have to wait? People are misdiagnosed and they receive the wrong prescriptions.
''People talk about funding, but nobody does anything. Being poverty-stricken, it is hard to live and you put an additional burden on them. It seems the IHS doesn't care,'' Steele said.
Steele pointed out that if health care was funded properly, many of the problems, such as suicide, drug addictions and others, would go away by themselves.
The Aberdeen Area tribes are direct service tribes and do not compact their health services. Steele reminded the IHS that the tribes do not want to let the government off the hook for their fiduciary responsibility that was written into the treaties.
''Health care should be at today's standards. Our people want to catch up with the rest of America,'' Steele said.
Stanton assured the summit attendees that she understood the frustrations and that it would be necessary to educate the congressional delegations from those states that do not have an American Indian population.
''We put in the budget needs, Congress appropriates and it's not enough,'' Stanton said.
''We have to depend on the tribes to plea for more funds. IHS is funded at 60 percent of need,'' she said. Some tribal leaders use the funding level of 40 percent or 50 percent of need.
The frustrations caused by underfunded health care run deep.
''The government gives $65 million for farmers not to farm. Then they give peanuts for Indian health. The government gives farmers $85 million to buy surplus food that return to us as commodities and that is a cause of our health problems,'' said Matthew Pilcher, chairman of the Winnebago Tribe.
The frustrations expressed by the tribal chairmen are caused because the message they convey to Congress and the IHS is repeated year after year. Steele used the loss of road construction funding to the self-
governance tribes as an example of what might happen to the health care dollars also.
Caution was expressed that tribes could be pitted against one another in the overall debate for more money and adequate health care. Leaders of the treaty tribes, which include all tribes in the Aberdeen Area, claim to be in a struggle for funding for many programs and argue that some self-governance tribes do not have the same land base or physical responsibilities as do the treaty tribes.
''Treaties are legal obligations. Self-governance tribes hurt us,'' Steele said.