Indian Health Service Acting Director Dr. Yvette Roubideaux suggested a dose of cash would cure the federal program that has come under attack for poor care.
But, Indian leaders said money is no panacea.
Roubideaux, testifying at a Senate field hearing in Billings, said IHS has the lowest per-patient funding level of any federal agency and consequently struggles to provide medical services guaranteed to tribes through federal government treaties nearly two centuries old. IHS has a national budget topping $4.4 billion, an increase of 33 percent in recent years, and still it can’t keep up with expectations for medical services.
“What really keeps me up at night is the growing need and the lack of resources,” Roubideaux said. “Comparing our funding to the federal employees health benefits program, we’re only funded at 57 percent of the per capita amount that they’re funded at.”
Health spending per person at IHS is less than $3,000 a year, compared to $7,000 for military veterans and $12,000 for Medicare beneficiaries. As a result, Indians say medical care is not only minimal, but patients who seek care outside the system often end up being turned over to collection agencies for medical bills that IHS is supposed to pay but doesn’t.
Representatives from seven Montana and Wyoming reservations testified that IHS has failed to pay several million dollars in medical bills owed for treating Indians.
The field hearing was scheduled by U.S. Sen. Jon Tester, D-Mont., who is chair of the Senate Indian Affairs Committee. Tester was the only senator at the hearing, though Sen. John Barrasso, R-Wyo., sent a representative. Earlier in May, Tester and fellow Montana Sen. John Walsh, asked the Government Accountability Office to formally investigate IHS after what Tester called years of physician appointment delays, unfilled prescriptions and poor services. Roughly 100 people attended the hearing.
Indians top the list for deaths related to diabetes, suicide and heart disease, and tribal leaders told Tester at Tuesday’s hearing at Parmly Billings Library that poor IHS health care is a contributor.
“We don’t want to be the leaders in heart rate problems and diabetes. We don’t want to be the leaders in suicide. We don’t want to be the leaders in alcohol rates. We don’t want to be the leaders in drug addiction. We don’t want to be the leaders of those types of situations,” said Tim Rosette, Rocky Boy’s Tribal Health CEO. “What I can’t understand is if the Indian Health Service office knows that we’re getting one quarter to one half the funding of other beneficiaries and they know how that lack of funding is resulting in our people suffering from a lack of health care, then how is that they don’t ask for sufficient funds to eliminate the disparity? Are these agencies racist or do they just not care?”
Roubideaux pointed out several areas where funding is increasing. IHS increased funding for referrals to services outside its system by 60 percent in response to concerns put forth by the Crow Tribe.
Still, Darrin Old Coyote, Crow tribal chairman said very little of IHS funding is spent on caring for his tribal members. Much of the money is spent on administrative work that Old Coyote said is duplicated by the Billings Area IHS office and reservation offices.
“The budget remains considerably top-heavy at the Billings Area office. For example, in fiscal year 2013, 66 percent of the $10 million-plus budget went to administration and only 15 percent went to health care services,” Old Coyote said.
Old Coyote requested a forensic audit of the Billings Area IHS office and suggested there would be more funding to go around if the office was eliminated entirely. He also said IHS was relying on old population numbers for the Crow Tribe that ignored a 40 percent increase in the Crow population since 2010. Consequently, the budget is too small for the actual Crow population.
After the hearing, Crow Indian Ada White said she was proud that the tribal chairman had called for an audit of Billings Area IHS and for closure of the office.
Other Crow tribal members faulted IHS for closing the obstetrics department and other services at their reservation hospital after 2011 spring flooding. That service never returned, and others, including surgery, were significantly reduced.
Tester said he would take the information from the meeting and look for ways to empower the tribes.
“There’s been some very good information delivered here today that we can start working to live up to those trust responsibilities that we’re not living up to,” Tester said. “I think there’s been some good thinking and some good concerns and some pretty sobering testimony, quite frankly.”
Tribal leaders from Montana and Wyoming said IHS would benefit from the stability of having its funding budgeted two years at a time. Tester said after the meeting there were already discussions underway to make that happen.
Another difference for IHS could be enrollment in the Affordable Care Act, and more specifically the expansion of Medicaid, which would cover medical costs for tribal members living near or below the federal poverty level. Half of the states, including Montana, chose not to expand Medicaid in 2013, despite an offer by the federal government to pick up the tab. There are now discussions between some Republicans, the medical industry and the governor to take up Medicaid expansion the next time the Legislature convenes.
“It would be huge because (IHC care providers) could do a lot more third-party billing,” Tester said of Medicaid expansion. “It would help a whole bunch.”