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NCAI 'State of Indian Nations Address'

WASHINGTON - The steady state of the Indian nations is that they need much more government funding, this at a time of fiscal constraint within the federal budget and Congressional Budget Office projections of an almost 30 percent increase in the national deficit to $477 billion in 2004.

But National Congress of American Indians President Tex Hall soldiered on Jan. 21, demanding adequate funding for Indians in fulfillment of federal trust responsibilities that he termed contractual, based on treaties and the inherent sovereignty of tribes.

"This nation's commitments to tribal nations are just as important as rebuilding Iraq or visiting the moon. Our nation must square its shoulders and make this nation's commitment to the first Americans a priority in this budget process."

The NCAI annual State of the Indian Nations Address followed President George W. Bush's State of the Union speech by one day, and came on the eve of Capitol Hill discussions that will shape the Bush administration's budget request for fiscal year 2005. Ernie Stevens of the National Indian Gaming Association noted afterward that Native Americans view the NCAI annual address as equal in importance to President Bush's speech.

Speaking for 30 minutes with hardly a glance at his typescript, Hall made an energetic case for increased funding commitments in Indian law enforcement, public safety and homeland security, health care, social services and community needs, education and economic development.

He saved his most urgent remarks for health care. "American Indians and Alaska Natives have a life expectancy five years less than all other races in this country. Diabetes has been a particularly destructive force among American Indian and Alaska Native people, with our mortality rates from diabetes at more than three times the national average. Our tribes are stepping forward to take on the health care crisis we face ? Recent increases in diabetes funding will go a long way toward addressing this crisis - but we need a serious across the board commitment to meet the range of health care shortfalls we face in Indian country. In spite of the disproportionate health care needs we face, today the per-capita expenditure for American Indian and Alaska Native medical services is less than one-third of the average annual expenditure for individual Medicaid assistance, and is even less than our per capita health expenditure for federal prisoners."

He went on to call on Congress and the Bush Administration to increase Indian Health Service funding by $2.3 billion in 2005, up to $5.4 billion from the record $3.1 billion approved for fiscal year 2004 - a proposal already rejected by the Republican-controlled Senate, but sure to be pushed in the coming presidential season by co-sponsoring Sens. Tom Daschle and Tim Johnson, D-S.D.

Their advocacy for the increase, and Hall's plea, may have gained credibility less than a week after the State of the Indian Nations Address, when an editorial by H. Jack Geiger in the Jan. 27 Washington Post accused the Department of Health and Human Services of whitewashing the congressionally mandated "first annual national report card on disparities" in health care provided to minority populations in America, including Native Americans.

Geiger, described by the Post as Arthur C. Logan professor emeritus of community medicine at the City University of New York Medical School, begins the essay headlined "Why Is HHS Obscuring a Health Care Gap?" with mention of having read and reviewed with colleagues "more than a thousand careful, peer-reviewed studies documenting systematic deficiencies and inequities in the health care provided for African Americans, Hispanics, Native Americans and members of some Asian subgroups. The evidence is overwhelming. Unfortunately, the Department of Health and Human Services seems intent on papering it over."

The Agency for Healthcare Research and Quality, which is housed within HHS, "did its job well," Geiger writes. "Its draft report was a clear and massive presentation of the data on disparities in care associated with race, ethnicity and socioeconomic status. Its summary was blunt, noting that such disparities are 'national problems that affect health care at all points in the process, at all sites of care, and for all medical conditions' affecting health outcomes and entailing 'a personal and societal price.'

"After 'review' by HHS, those truthful words are gone, as are most references to race and ethnicity, now described as problems that existed 'in the past.'"

The NCAI address had no part in Geiger's Post editorial. But time and again Hall expressed the view that disparities in funding, especially of health care for Native peoples in America, are not a thing of the past.