January is over, and still I have no good New Year's resolution. The way I
see it, I already used up all the good ones -- like, um, "fight cancer" --
But compared to Congress, my tendency toward procrastination is amateurish
at best: It has been seven years since the legislation authorizing the IHS
Yet Congress and the Bush administration -- when it gives IHS
reauthorization a thought -- fuss and fight, bicker and stew, huff and puff
... and still nothing.
The bill, which would re-establish the right of the federal agency that
provides medical care to a majority of Native Americans to exist,
languishes in the Senate.
House members haven't even reintroduced the bill this congressional year,
although versions penned by a coalition of tribes have been bouncing around
both houses since 1998.
The reauthorization of the Indian Health Care Improvement Act is critical,
in the era of the Iraq War and Hurricane Katrina, to making sure Congress
keeps sending money IHS' way.
So says Rachel Joseph, co-chairman of the National Steering Committee for
the Reauthorization of the Indian Health Care Improvement Act.
She has lately heard staffers in the House wonder, "Why are we
appropriating dollars for programs that don't have authorization?"
More to the point, why aren't they appropriating the dollars that it would
take to give IHS the teeth it needs to combat the health care disparities
of America's first nations? It would take $8 billion to $9 billion to fully
fund it, according to estimates by the Northwest Portland Area Indian
Health Board, rather than the $3 billion that's currently budgeted.
We are many times more likely to die from alcoholism, tuberculosis, car
crashes, diabetes, injuries, homicide and suicide than other Americans. As
an intertribal community, more than half of us depend on the IHS for our
care, care that is rationed according to whose life or limb is endangered.
If you need care that's comparatively routine, such as knee replacement
surgery, you're in for a long, painful wait because the federal health
program more than likely doesn't have enough money to help you.
Members of Congress -- and their aides -- are stuck somewhere between
don't-want-to and don't-know-why-we-have-to when it comes to living up to
America's promises to its first peoples.
Federal medical care for Indians has its roots in most tribal treaties.
What began with sending in a doctor evolved after the 1921 Snyder Act
directed the federal government to care for Native peoples' health.
The Indian Health Care Act, originally passed by Congress in 1976,
"acknowledged the grave health care disparities Native Americans were
facing," a recent report from the U.S. Civil Rights Commission stated.
So why in 2006, with the pandemics of cancer, heart disease and AIDS raging
in Indian country -- and while poverty keeps the majority of us from
seeking private health insurance -- are leaders in Congress and the
administration shirking this most basic treaty-affirmed duty?
First, they forgot that, as Rachel Joseph quotes the original preamble to
the reauthorization: "Through the cessation of over 400 million acres,
tribes believe we secured a de facto contract that entitles us to health
care." That preamble, a concept which most American Indians could cite in a
pop quiz, was struck from the bill a couple years back because the idea
made lawmakers and the Bush administration queasy.
Second, many members of Congress have spent recent years being glad-handed
by lobbyist Jack Abramoff.
Some members of Congress were so dazzled by the cash that Abramoff was
doling out from a couple of casino-rich tribes that they failed to pay
attention to the reauthorization -- even though the IHS is arguably one of
the federal government's few successful large-scale efforts to fulfill its
trust relationship with tribes.
Third, Joseph hesitated, then spat out: "Duplicity."
"It's extremely frustrating that we are not seeing the activity that
reflects the rhetoric we hear from so many of our congressional
representatives," Joseph said.
Last year, Joseph, 60, decided not to run for re-election as chairman of
the Lone Pine Paiute-Shoshone in California because she wanted to focus her
attention on the reauthorization. She fears that if this Congress doesn't
pass it then even interest among elected tribal leaders will wane -- in
favor of easier-fought battles.
Right now the biggest impediment to the reauthorization, Joseph said, is
that neither political party in Congress nor the administration will
provide a list of their objections to the reauthorization.
Instead, Joseph and her colleagues work to put out one fire -- such as
objections from the American Dental Association about dental assistants
pulling teeth in remote villages of Alaska -- only to find another.
Lately, senators are challenging the bill because they say it violates the
civil rights of other Americans by waiving Medicare and Medicaid co-pays
for tribal members. But those co-pays, said Jim Roberts, policy analyst
with the Northwest Portland Area Indian Health Board, were paid when the
treaties were signed.
The U.S. Justice Department is suddenly worried about federal tort claim
protection for IHS clinics, even though those clinics have operated for
decades without this issue coming up.
Reauthorization won't obligate Congress to give the IHS more money, Joseph
said. The reauthorization is only a menu of programs for Congress, which
has never fully funded the IHS anyway.
A handful of specifics in the reauthorization could help the IHS to
modernize its care, integrate related programs and increase disease
It's time to pass the Indian Health Care Reauthorization Act -- not because
it will solve the health problems in Indian country, but because its
passage will protect us in an era of growing federal deficits, deepening
health disparities and rising medical costs.
Those of us who rely on the IHS, or who have loved ones who do, need to
begin writing our members of Congress, and maybe even our tribal leaders,
and tell them that Indian health care matters.
With new threats, such as the avian flu, around the corner, we can't afford
to leave ourselves vulnerable.
Kara Briggs is a Yakama journalist from Portland, Ore., where she works for
The Oregonian. She chronicles her recovery from breast cancer and also
writes about national health care issues that concern Native peoples in
this biweekly series. She is a former president of the Native American
Journalists Association and winner of the 2004 Award for Investigative
Journalism. Contact her by e-mail at email@example.com or by mail
through Indian Country Today.