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Pelosi’s promise on health care reform and Indians

WASHINGTON – House Speaker Nancy Pelosi has vowed to protect the rights of Native Americans in her quest to reform health care.

In a letter to the National Congress of American Indians dated Oct. 13, Pelosi promised to exempt tribal members from having to pay for any health insurance mandate that is part of health care reform legislation she will oversee to become law. The letter was timed to be received by the group as it held its annual conference in Palm Springs, Calif.

“[W]e cannot ask Indian people to be penalized for choosing to use the Indian health care system,” Pelosi wrote.

“The House bill will ensure that the exemption from the financial penalties is extended to members of federally recognized Indian tribes, and that the tribally provided health care benefits are appropriately protected.”

Pelosi, like President Barack Obama, supports legislation that says individuals must purchase health insurance, much like car insurance.

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

Pelosi’s promise would ensure that Native Americans do not have to pay for health care costs imposed under any reform legislation.

Many lawmakers, both Republicans and Democrats, agree that American Indians have already paid for the cost of their health care many times over due to wrongful loss of lands, broken treaties, bad federal policy and other historical injustices imposed on tribal nations.

Kathleen Sebelius, secretary of the Department of Health and Human Services, publicly promised tribes in September that Obama supports special consideration for American Indians – a reprieve from the mandate – in terms of health care reform.

“The administration strongly believes that the individual mandate and the subsequent penalties don’t apply to American Indians or Alaska Natives,” Sebelius said at the time.

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

Tribal leaders and Indian health officials were largely supportive of Sebelius’ proclamation, but some noted at the time of her announcement that her language went farther than both of the current prevailing health reform bills in the Senate and the House.

That reality is one reason Pelosi’s promise is all the more important, said Mark Trahant, a Kaiser Media Fellow who is examining IHS and its relevance to the national health reform debate.

“This is good because [similar language] is already in the Senate bill,” said Trahant, a citizen of Idaho’s Shoshone-Bannock Tribes.

“So when they go to conference, now both Houses will agree this should be done. The Senate language is awfully flexible. It follows the person, whether or not they live on or near a reservation.

“The Pelosi promise (and that in the legislation) is far more important than [Secretary Sebelius’] simply because it could become part of the statute.”

While Pelosi’s words were welcomed by some, others had misgivings.

“My initial reaction is that this is ridiculous because Indian Health Service is the ‘payer of last resort’ under federal regulations, and the funds provided by Indian Health Service clearly do not cover the current obligations that the U.S. has towards Indian people to provide health care,” said Derek Bailey, chairman of the Grand Traverse Band of Ottawa and Chippewa Indians.

“I guess the premise of Pelosi and Sebelius’ Indian option out of the insurance mandate is that Indian Health Service currently covers Indians and therefore there is no need for Indians to follow within the ‘employer mandate.’

“If that is the case, then the facts on the ground at tribal clinics clearly do not reflect that premise. Indian Health Services has never met all the needs of Indians; rather Indian Health Service is primarily a ‘last resort; when it should be the first place that Indian people look to for health care. When tribes achieve success financially, they immediately fund health care because of the inadequate funding of health by the feds.”

Bailey believes the promises of Pelosi and Sebelius only make sense if they are coupled with an increase in all line items of the IHS budget.

“If there is no increase in the Indian Health Service budget then most tribal employers will continue the current practice of providing independent health insurance for all employees, both tribal and non-tribal, regardless of the mandate,” Bailey said.

The chairman said his tribe provides health insurance to all of its employees not based on a mandate, but on recognition that healthy employees are a primary asset of the tribal nation, and in recognition that IHS has never provided sufficient coverage for Indian employees.

Pelosi expressed general support for protecting IHS in her letter. She said amendments introduced by Rep. Frank Pallone Jr., D-N.J., which are aimed at shielding the system, will be included in the final House reform bill. She did not address the fact that many Indians view the system as broken as it now stands.

Pelosi also pledged to work to pass the Indian Health Care Improvement Act. The House under her leadership failed to do so last year, although it did pass the Senate.