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Indian Country Today

The Biden administration is planning a price tag of $4 billion to respond to the pandemic in Indian Country. Federal dollars will be used to increase vaccinations, increase detection and response to infections, and replace lost funding from Medicaid and other government insurance programs.

A fact sheet released Friday morning said the American Rescue Plan “will expand COVID-19 vaccinations, testing, and treatment; increase preventive health services to American Indians and Alaska Natives at higher risk for COVID-19; expand hospitals’ and health clinics’ ability to serve their communities during the pandemic and beyond; and provide the Indian Health Service, tribal health programs, and urban Indian health programs with needed funding to make up for lost reimbursements experienced during the pandemic.”

The release said that the Indian health system has already administered more than 1 million doses of COVID-19 vaccine and “today’s announcement will help IHS, tribal, and urban Indian health programs accelerate this progress.”

One of the most significant elements in the White House announcement is the replacement of $2 billion in funding from private insurance, Medicare, Medicaid, and the Veterans Administration - outside funds that are normally billed through individual units within the Indian health system.

Third-party billing represents a significant share of the Indian health system budget. A study by Kaiser Family Foundation in 2017 estimated the IHS share of third-party billing at $1.3 billion, mostly from Medicaid. But that number is far lower than the actual amount because the data collected in the federal budget is from Indian Health Service-operated facilities and does not always include tribal health centers or those in urban areas.

Last month, for example, Rodney Cawston, chairman of the Confederated Tribes of the Colville Reservation in Washington, told the House Natural Resources Committee that Colville Tribes’ business plan for a clinic in Omak hinged on collection of third-party revenue, most notably Medicaid.

“The pandemic has reduced third-party revenue and has threatened the viability of the Tribes’ business plan,” Cawston said in a statement to the committee. “Any reduction in the number of Medicaid-eligible patients or services will affect the tribes’ revenue forecasts and its ability to service debt for the construction of the clinic. This is coupled with the COVID-19 related decreases in third party revenue in the Indian health system generally.”

Additional details of the White House announcement include:

*$600 Million to increase COVID-19 vaccinations in Indian Country: The American Rescue Plan calls for IHS to spend $600 million for increased vaccinations in Indian Country. The money can be used for “mobile vaccination efforts in rural or hard to reach areas, large scale vaccination events, and other activities to help connect American Indians and Alaska Natives to vaccines on their reservations and in their communities.”

The funding also supports “trusted local voices and medical professionals to conduct outreach into communities and build vaccine confidence.”

The White House fact sheet said a successful example of that was the recent survey by the Urban Indian Health Institute, an IHS-funded tribal epidemiology center, which found that 75 percent of American Indians and Alaska Natives would be willing to get vaccinated and 74 percent believe that getting vaccinated is a responsibility to their community.

*$1 billion to detect, diagnose, trace, monitor, and mitigate COVID-19 infections: IHS will invest $1 billion to increase contact tracing, drive-through and pop-up testing sites, and other public health efforts to stop the spread of COVID-19. Additionally, the funding will support the purchase of personal protective equipment, medical supplies, tests, and therapeutics.

The funding plan also will support more than $84 million in assistance for urban Indian organizations, $140 million for health IT and necessary equipment to provide telehealth services, and $500 million to support overall health care services in Indian Country.

The White House fact sheet said the budget plan followed the tribal consultation and urban “confers” in early March by the Biden Administration about how to most effectively allocate the resources provided by the American Rescue Plan.

American Indian and Alaska Native people are at higher risk for COVID disease and complications. According to a recent report from the Centers for Disease Control and Prevention, American Indians and Alaska Natives were 3.5 times more likely to get COVID-19 than the non-Hispanic white population, and they have had the highest hospitalization rate of any racial or ethnic group. Native people are more than four times as likely to be hospitalized as a result of COVID-19.

American Indians and Alaska Natives also have high rates of certain co-morbidities that have been linked to poor outcomes with COVID-19, including diabetes, hypertension, and obesity. 

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