WASHINGTON, DC—The passage of health care reform in March will benefit American Indians and Alaska Natives (AI/ANs), IHS Director Yvette Roubideaux, MD, told a House subcommittee last month. “We are grateful for the passage of the health reform legislation because what it does is increase access to quality and affordable health care,” she said.

The health care reform law will require that everyone purchase health insurance. Roubideaux told the House Appropriations Subcommittee on Interior, Environment, and Related Agencies that AI/ANs who use the IHS, tribal, or urban health programs do not have to purchase other health insurance if they continue to get care through these avenues.

However, they do have the choice to purchase health insurance through the exchanges if they would like to do so. On her director’s blog on the IHS website she explained that American Indians and Alaska Natives who purchase health insurance through the exchange do not have to pay co-pays or other cost-sharing if their income is under 300% of the federal poverty level.

Health care reform will also expand Medicaid coverage to individuals with incomes up to 133% of poverty level, which she said in her blog should benefit some IHS patients.

“It does seem to me that it is a fairly watershed event here to increase the options that are available to Native Americans and the level of care,” said Subcommittee Chairman Rep James Moran, D-VA, at the hearing.

IHS Programs

House members also had questions for Roubideaux about IHS programs and procedures. Subcommittee ranking member Rep Michael Simpson, R-ID, said that he has heard that the hiring process in IHS is “inefficient and cumbersome,” and that it causes delays that sometimes result in the loss of providers. “What are you doing to address that problem?”

Roubideaux said that IHS recognizes that the hiring process takes too long. “What we are doing right now is getting together our administrative leaders to look at … where we are seeing lags in the hiring process and to try to improve those.”

Roubideaux said that IHS is also examining how much it pays its providers and how IHS can be more competitive in terms of pay, additional incentive pays, or bonuses. “That has really helped us with the dental vacancy rate. The adding of incentive pays, improvements of salaries, along with increased loan repayment awards to dentists has really improved our dental vacancy rate.”

Earlier that day in a separate hearing Dale Walker, MD, a psychiatrist who is the director of the One Sky Center, testified on behalf of the Friends of Indian Health. He said that staff vacancies at IHS should be addressed and that there are more that 900 open positions. In written testimony he said that anecdotal accounts claim that delays in hiring interested candidates can take up to six months and, as a consequence, qualified personnel take positions outside of IHS.

He also told the subcommittee that more funding is needed for IHS’ contract health services (CHS). CHS pays for care outside the IHS system when the IHS facility is unable to provide the service for the patient.

Many facilities run out of CHS funding before the fiscal year ends and so patients often are unable to get the care they need. In 2008, 35,000 health care needs were denied, costing over $130 million, according to Walker’s testimony.

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