Obama administration makes new promise on Indian health

WASHINGTON – The nation’s top health official has told Indian country health leaders that the Obama administration believes American Indians deserve special consideration in any national reform to health insurance.

Speaking on Capitol Hill before an audience of Indian health leaders Sept. 15, Secretary of Health and Human Services Kathleen Sebelius reported that President Barack Obama said in an appearance before a joint session of Congress Sept. 9 that he supports a mandate that individuals must purchase health insurance, much like car insurance.

Such a mandate would require Americans to purchase health insurance with some degree of government assistance, depending on need and income.

But Sebelius said clarification was needed for Indian country, which traditionally has high amounts of uninsured, as well as a special relationship with the U.S. government.

“I’m going to make it very clear. ... this is what was left out on Wednesday night: The administration strongly believes that the individual mandate and the subsequent penalties don’t apply to American Indians or Alaska Natives.

“You have already purchased health insurance, it is already part of the agreement we made.”

Sebelius’ words met with loud applause from the hundreds of Native leaders who gathered in the nation’s capitol for a meeting of the National Indian Health Board advocacy organization.

IHS Director Yvette Roubideaux, a citizen of the Rosebud Sioux Tribe, said Sebelius’ statement was especially noteworthy, since the Obama administration hasn’t laid out many specific health policies; nor has it made many specific policy commitments to American Indians and Alaska Natives.

Mark Trahant, a Kaiser Media Fellow who is examining IHS and its relevance to the national health reform debate, said Sebelius’ promise was important, but he noted that she went farther than both of the current prevailing health reform bills in the Senate and the House.

“The Senate is supposed to exempt individual American Indians and Alaskan Natives from penalties, not the insurance requirement,” said Trahant, a citizen of Idaho’s Shoshone-Bannock Tribes. “The House bill does nothing in this regard.”

Even if final legislation doesn’t include provisions that exempt Indians, Trahant said the administration could still make good on Sebelius’ promise via added regulations.

Trahant also noted that IHS coverage, which meets some of the health needs of some Natives, would not qualify under the bills as acceptable insurance coverage, since it’s not an insurance program.

While questions still linger over how health care reform will impact Natives, some tribes, including those of the United Tribes of North Dakota board, have endorsed Obama’s reform plans. The group is made up of all five federally recognized tribes in the state, including the Three Affiliated Tribes, Spirit Lake Tribe, Standing Rock Sioux Tribe, Sisseton-Wahpeton Oyate, and the Turtle Mountain Band of Chippewa Indians.

In a resolution passed Sept. 10, the board said it didn’t believe the president’s plans would hurt IHS. Members also believe the president will assist Native Americans who do not have access to health care through IHS.

Beyond the health care reform mandate commitment, Sebelius pointed to the Obama administration’s increased funding to IHS as a sign of its commitment to improving health in Indian country. A 13 percent increase in funding for the agency was included in the 2010 budget, the largest amount given in two decades.

“This is long overdue and well-deserved,” Sebelius said.

The health secretary also affirmed the need for a strong government-to-government relationship with tribes, as well as tribal consultation. As an illustration of that promise, she noted that Roubideaux had consulted with several Indian leaders at a town hall meeting in Washington Sept. 14.

Sebelius also said she is committed to assisting tribal governments cope with the H1N1 virus – believed to be especially dangerous in communities with high incidents of diabetes, which is true in much of Indian country.

After Sebelius’ speech, NIHB Chairman Reno Franklin, a citizen of the Kashia Pomo Tribe, told the audience that the 13 percent increase to IHS was quite impressive.

NIHB board member Cathy Abramson, a councilwoman of the Sault Ste. Marie Tribe of Chippewa Indians, was pleased to hear Sebelius repeatedly state the treaty obligations of the federal government to tribes.

“President Obama is determined to make change in health care reform, and I believe he will do so, while making sure he honors our treaty rights,” Abramson said.

Beyond Sebelius’ speech, several members of Congress at the NIHB conference stated their support for improving Indian country health.

In an especially well-received talk, Sen. Lisa Murkowski, R-Alaska, highlighted her understanding of federal trust responsibility.

“Let us never forget that the first people paid in advance through the loss of lands, uprooting of people and culture, and enduring a multitude of ill conceived federal policy towards America’s first people that our Congress has been called upon to apologize for,” the member of the Senate Indian Affairs Committee said.

Later, when discussing the Indian Health Care Improvement Act, Murkowski acknowledged tribes have been waiting and working for 20 years to have it passed, saying, “it’s about time for a signing ceremony at the White House.

“First people first! We can’t reform health systems without fulfilling the commitment to improving the health care of the first people.”