Senate OKs bill for Indian health care

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WASHINGTON – The Senate on Tuesday passed an act aimed at improving health care programs and facilities for American Indians, bringing help to more than 7,000 in Maine alone.

“This is finally a step in the right direction,” said Patricia Knox-Nicola, health director for the Penobscot Nation. “We’ve spent eight years working hard nationally to get this passed.”

The Indian Health Care Improvement Act was originally passed in 1976 and acknowledged that the United States had a legal obligation to provide health care for American Indians. The act expires every 10 years and last expired in 2000. Though the programs within the act were funded since then through annual appropriations of about $3 billion, there have been no changes or updates to the law.

The changes are “long overdue,” said John Dieffenbacher-Krall, executive director of the Maine Indian Tribal-State Commission.

The bill reauthorizing the act, sponsored by Senate Indian Affairs Committee Chairman Byron Dorgan, D-N.D., adds scholarships to encourage American Indians to become doctors, nurses and health care workers; improves access to health care and to local clinics; expands drug, mental health and sexual abuse programs; and creates and updates health clinics, substance abuse centers and sanitation facilities in tribal communities.

“This legislation is very important to the health and well-being of Native Americans,” said Dorgan, “It is also an important step in meeting our obligation to provide adequate health care for American Indian and Alaskan Native communities.”

American Indians have a lower health status when compared to other Americans. Nationwide, the number of American Indians who die from alcoholism is 550 percent higher than other Americans, according to the federal Indian Health Service. The rate of deaths due to diabetes is 200 percent higher, homicides 100 percent higher and suicides 60 percent higher.

The life expectancy for American Indians is 74.5 years, but life expectancy for all other U.S. citizens is 76.9 years. Maine’s American Indians die on average at the age of 60 as opposed to the statewide average of 74, according to a study by the Maine Center for Disease Control and Prevention. The report points to inadequate funding and a lack of accessibility to health facilities as possible explanations for the problems American Indians face in Maine.

“The health disparities that Indians across the country experience are huge, and that isn’t any different in Maine, either. In fact, we may be higher,” said Elizabeth Neptune, a Passamaquoddy tribal council member and the tribe’s former health director. “A lot of our population is under 35. Only 10 percent is elderly.”

Neptune explained that “elderly” means 55 or over. The age was lowered from 65 to 55 because so few tribal members make it to their 65th birthday.

Yet while the health care disparities experienced by Maine’s American Indians can be worse than those seen by other tribes, Neptune said, the Mainers receive less money to build new facilities.

The facility-funding formula used by the Indian Health Service allots money based on the age and condition of a health care facility, costs of repair, location of the facility and the number of persons being served. Using these factors as guidelines, the Indian Health Service places tribal areas on a priority list, forcing them to compete for facility funding.

Maine is in one of four tribal areas that have received no facility funding from the Indian Health Service since 1991, according to an Indian Health Service funding chart.

There are five health clinics in Maine and more than 600 in the United States. The ages of Maine’s clinics range from 30 years old to less than five, but the number of people using them is increasing. Maine’s American Indian population has increased from about 4,000 in 1980 to more than 7,000 today, according to the Census Bureau.

“The tribes are going out and getting loans to expand or renovate facilities because IHS [Indian Health Service] is so far behind in allocating for construction,” said Knox-Nicola of the Penobscot tribe.

This may change with Monday’s 56-38 passage of an amendment sponsored by Sens. Gordon Smith, R-Ore., and Maria Cantwell, D-Wash., that provides an alternative method for funding the building and renovating of health care facilities for those having trouble gaining funding from the Indian Health Service.

“I am extremely pleased that the voices of over 400 tribes were heard today in an effort to end the inequity in the distribution of construction funding for Indian health care facilities,” Smith said in a statement. “With passage of my amendment, regardless of where a tribe is located, the government will fulfill its responsibility to improve access and care throughout all of Indian Country with the fair and equitable distribution of facilities funding.”

The bill passed the Senate 83-10. Sens. Susan Collins, R-Maine, and Olympia Snowe, R-Maine, both voted for the act and Smith’s amendment.

The cost of the reauthorized 2008 Indian Health Care Improvement Act is about $118 million for direct spending and $35 billion in discretionary spending from 2008 through 2017, according to Dorgan’s office.

Similar legislation cleared the House Natural Resources Committee and a House Energy and Commerce subcommittee last year. It still must be approved by the full Energy panel and the House Ways and Means Committee before it heads to the House floor.

The Associated Press contributed to this report.