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Health Subcommittee Holds Hearing on Indian Health Care Bill

On October 20, the House Energy and Commerce Subcommittee on Health held a hearing on the Indian Health Care Improvement Act Amendments (IHCIA) (H.R. 2708).

The legislation contains several provisions related to physical, mental, and behavioral health that are designed to improve the health of Indian women and their families. The measure provides:

  • mammography screening;
  • monitoring and improved quality of health care for Indian women of all ages;
  • outreach to, and assistance for, families of Indian children likely to be eligible for the State Children’s Health Insurance Program (SCHIP);
  • behavioral health prevention and treatment services for child care (including physical, mental, and sexual abuse), family care (including treatment for sexual assault, domestic violence, and “the promotion of healthy approaches relating to parenting”), adult care (including treatment services for Indian women at risk of giving birth to a child with fetal alcohol disorder and sex-specific treatment for sexual assault and domestic violence), and elder care (including sex-specific mental health and substance abuse treatment, as well as treatment for sexual abuse, domestic violence, neglect, and physical and mental abuse);
  • specialized residential treatment for high-risk populations, including pregnant and postpartum women and their children;
  • grants to establish programs to reduce fetal alcohol disorder;
  • programs to prevent and treat child sexual abuse; and
  • programs to prevent and treat domestic and sexual violence.

Chair Frank Pallone (D-NJ), the bill’s sponsor, said, “A 2004 report on Native American health issued by the U.S. Commission on Civil Rights found that inadequate federal funding was a major obstacle to eliminating disparities in Native American health care. The report stated that annual increases in funding for the Indian Health Service did not include adjustments for inflation or population growth and were significantly less than those allocated to other arms of the Department of Health and Human Services (HHS). This is an important point. Indeed, less is spent on providing health care to American Indians per capita than any other sub-population. In fact, we spend more to provide health care to federal inmates than we do for American Indians, which is a statistic that I continue to be shocked by.”

“The Indian Health Service (IHS), as you well know, is also in need of updates and modernization,” said Jefferson Keel, president of the National Congress of American Indians and lieutenant governor of the Chickasaw Nation. “The current House bill, H.R. 2708, is a starting point for reforming the IHS. As with the national health reform bills, its goal is to provide cost saving features for health care delivery by shifting the health delivery paradigm in IHS to preventative health. The following is a sample of some of the reform features in H.R. 2708:

  • Improved standards for mammography and other cancer screening.
  • Authorization for modern methods of health care delivery, including authority for IHS and tribes to operate hospice, long-term care, and assisted living programs.
  • Upgraded [authorizations] for epidemiology centers so that they are expressly authorized to access the data they need to assist tribes and urban Indian organizations.
  • Establishment of convenient care demonstration projects to provide primary health care, such as urgent services, non-emergen[cy] care services, and preventive services outside the regular hours of operation of a health care facility.
  • The integration of mental health, social services, domestic and child abuse, youth suicide, and substance abuse services into the Indian health delivery system.”

Mr. Keel continued, “Indian country has been waiting for and asking for these updates for over ten years. We do not believe that national health insurance reform should be used as an excuse for abandoning the effort to reauthorize the IHCIA. We now come before the committee to get an assurance that as the nation moves forward with health reform, Indian country will be included – and our bill, the IHCIA, will be passed.”

Dr. Patrick Rock, president-elect of the National Council of Urban Indian Health (NCUIH), said, “The Indian health delivery system is well positioned to comprehensively address the high rates of health disparities facing American Indians and Alaska Natives. No other health delivery system blends public health and community-based interventions with culturally competent health care better than the Indian health delivery system.” He noted that “American Indians and Alaska Natives continue to face the highest levels of health disparities for all races combined. The infant mortality rate is 150 percent greater for Native Americans than that of Caucasian infants. For a quick comparison, the rate of Sudden Infant Death Syndrome for Native American infants is the same as for infants in Haiti.”

In making additional recommendations for the legislation, Dr. Rock explained that H.R. 2708 omitted several provisions that he urged the committee to reconsider: “Section 213 – Indian Women’s Health: This provision directs the secretary [of Health and Human Services] to specifically monitor the health status of Indian women and work to improve the quality of health care for all Indian women. Given that the disease knows no boundaries, urban Indian women suffer the same health disparities and the same high disease burden as women living on the reservations. We respectfully ask the committee to consider re-including urban Indian women in this provision.” He also urged the committee to make the Indian Health Care Improvement Act permanent federal law: “NCUIH believes that the concept of using ‘sunset’ dates to spur congressional review and revision of major laws has not worked in the context of the Indian Health Care Improvement Act. While the Indian Health Care Improvement Act is a major law for Indian people and the people who serve them, it is often not considered a major law next to issues, such as national health care reform.”

Yvette Roubideaux, director of the Indian Health Service, Rachel Joseph, co-chair of the National Tribal Steering Committee for the Reauthorization of the Indian Health Care Improvement Act and on behalf of the National Indian Health Board, and Andrew Joseph, chair of the Human Services Committee of the Direct Services Tribe Advisory Committee, also testified.