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More bad news about health care funding

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IHS official: Don't expect increases

BILLINGS, Mont. - A Bush administration official told tribal leaders here
that they need not look for any additional funding for health care in the

Instead Michael O'Grady, assistant secretary of the Health and Human
Services Department said the tribes should look for ways to do more with

Tribal health officials and elected leaders have fought for better health
care funding for generations and under the Bush administration they
continue to talk about the same issue, lack of funds that they have
discussed for many years. Health program officials have become creative to
provide health care in the face of inadequate budgets.

The word from the Health and Human Services Department is less than
encouraging. Tribal officials gathered for a Montana-Wyoming Tribal Leaders
Conference were told not to expect any increased funding in the near
future. O'Grady did not shy away from the fact that IHS is currently under
funded and that future funding may not improve the situation.

O'Grady said cooperation between the tribal health programs and the IHS
could work to prevent long-term health problems that would benefit both the
people and the budget.

In the Rocky Mountain Region and the Great Plains, closure of IHS clinics
or changes that eliminate emergency care or in-patient services have
plagued the regions for many years. Complaints about referrals to other
health facilities or specialists requiring the threat of loss of limb or
life have been at the center of criticism against the IHS system. Many
families have trouble establishing any type of credit because they have
been billed by non-IHS facilities for treatment when the IHS should have
paid the bill.

It all comes down to lack of funds, and O'Grady put the blame squarely on
Congress for not fully funding the IHS.

Sen. Tom Daschle, D-S.D. drew exception to O'Grady's comment. Daschle said
the assistant secretary's comments were an example of "political
doublespeak." Daschle said that congressional Democrats repeatedly proposed
full funding clinical care in the IHS budget, but the Bush administration
blocked the funding.

"Now in an election year, they are trying to shift the blame," Daschle

"It is a national disgrace that the federal government spends twice as much
per person on health care for federal prisoners as it spends for Native

Per capita expenditure for American Indian health is $1,900. For federal
prisoners it is $3,800 and for the general population, $5,600 is spent
annually on health care.

Daschle also said that instead of bemoaning the injustice both parties
should work together to adequately fund the IHS and honor the federal
government's treaty and trust obligations to tribes.

O'Grady suggested that more use of Medicare and Medicaid would relieve the
financial pressure on IHS budgets and that preventive medicine will reduce
the cost of emergency room expenditures.

He said the recent changes in Medicare that cover 75 percent of
prescription drug costs would help. Screening for heart disease and
diabetes will also help to reduce long-term care expenses, he said.

Tribes have to deal with many areas of health care; addictions to drugs and
alcohol, fetal alcohol syndrome and effect, kidney dialysis, cancer,
diabetes and a growing problem with heart disease. With an estimated $2.5
billion shortfall each year it creates health care problems that become
long term and more costly in the future, tribal leaders argued.

Tribal officials asserted that a larger long-term commitment by the federal
government is necessary and that commitment is a trust responsibility
obligated by treaty and the constitution. Some tribes are taking a
progressive approach to the situation by contracting with the federal
government to manage their own health care programs.

Under a 238 contract the tribes receive funding directly from the federal
government and manage it according to the tribe's needs. Yet the funds are
still inadequate and most tribes do not have the resources to pay the
bills, tribal leaders said.

Tribes and tribal health programs do not have the ability to bill
third-party payers, such as Medicare and Medicaid or insurance companies.
If they could adequately bill third parties the money would then go to the

Daschle also complained that the Bush administration and the Republican
Congress failed to approve the Indian Health Care Improvement Act, the act
that authorizes funding for the IHS. The previous act approved in 1992,
expired three years ago.

Congress has had to pass appropriations on a yearly basis since the act
expired. The new version, written by tribal leaders, would help the
reservations recruit health care professionals and establish preventive
health care programs that would go a long way to solve issues of alcoholism
and diabetes, tribal leaders said.

The act would put the tribes in charge of decision making for their own
health care. But funding is still the problem. Sen. Daschle proposed a
substantial increase in that funding that would be appropriate for adequate
health care.

While the battle over the budget continues, patients are not receiving
proper medical care. The tribes can apply for grant money to help fill the
gap, but tribal leaders said that only takes care of short-term needs and
does not fulfill the long-term need.

O'Grady did admit the federal government needed to find better long-term
funding for programs that have a demonstrated success rate. He also said
that federal health officials need to open the lines of communication with
Indian country to create a coordinated effort that will make health care
more efficient.