WASHINGTON—Congress must make reauthorizing the Indian Health Care Improvement Act (IHCIA) a priority, organizations representing American Indians and Alaska Natives told a Senate committee last month.

The IHCIA is the primary law that governs the current healthcare system for American Indians and Alaska Natives (AI/AN). Indian groups have been working for years to see the law—which has not been reauthorized since 1992—revised to provide a more modern framework for Indian healthcare. Last year, such groups were initially hopeful when the Senate approved a bill for reauthorization, but the House did not pass a companion bill.

Representatives from organizations representing AI/AN told the Senate Committee on Indian Affairs at a hearing that the reauthorization of the Act should not be delayed further. “Immediate attention should be given to passing the Indian Health Care Improvement Act,” David Rambeau, president of the National Council of Urban Indian Health, told the committee.

Reauthorizing Legislation

Rachel A. Joseph, co-chair of the National Steering Committee to reauthorize the Indian Health Care Improvement Act, told the committee that the majority of illnesses and deaths from disease in Indian country could be prevented if the needed funding and contemporary programs for healthcare were available to American Indians and Alaska Natives.

“Passage of the Indian Health Care Improvement Act reauthorization is a vital component of any healthcare reform,” Joseph told the committee.

The bill to reauthorize the IHCIA that passed in the Senate last year would have improved healthcare for the elderly, among others, she said. It “would have provided for the authorization of IHS and tribally operated health systems to provide hospice care, assisted living, long-term care and home- and community-based services,” Joseph said. “Indian elders need to receive long-term care and related services in their homes, through home- and community-based service programs, or in tribal facilities close to friends and family. We need necessary authorities to provide long-term care and related services to our elders that are currently available to the general U.S. population.”

Andrew Joseph, chairperson for the Northwest Portland Area Indian Health Board and Colville Tribal Council Member, told the committee about the need for better suicide prevention programs on his reservation.

“It is estimated that the national Indian suicide rate is four times greater than the national average; however, on the Colville Indian Reservation the suicide rate is 20 times higher than the national average this past year alone,” he said in a written statement. “The Senate-passed IHCIA (S. 1200) has an expanded emphasis on behavioral health for HIS and Tribal health programs. The improvements contained in S. 1200 provide for a comprehensive approach to behavioral health, providing important prevention and treatment programs for AI/AN people. The bill also emphasizes the coordination of services related to alcohol and substance abuse, child welfare, suicide prevention and social services.”

Revising Legislation

Those testifying said, however, that before the present IHCIA reauthorization bill is moved forward in Congress, it should be revised.

“The Choctaw Nation asks that this committee give every consideration to reassess the contents of this bill and to do what is necessary to restructure it to meet the needs of and provide the quality of benefits that Indian people are entitled to receive,” said Mickey Peercy, executive director for Health Services for the Choctaw Nation of Oklahoma.

Honorable Ron His Horse Is Thunder, chairman of the Aberdeen Area Tribal Chairmen’s Health Board and chairman of the Standing Rock Sioux Tribe, called the bill a “great framework,” but said that there are areas of concern to him in the legislation.

One area was in regards to determining tribal eligibility. An IHCIA bill that is moved forward in Congress should not allow states to determine who qualifies for tribal membership, but this should be determined by tribes, he explained. “Tribes themselves should be the ones who determine our members,” he told the committee.

Committee Chairman Sen. Byron Dorgan, D-ND, said that tribes have not been able to determine thus far what standards should be used in determining membership. The question of eligibility is important in determining who and how many people qualify for healthcare services in a health bill, he said.

Ron His Horse Is Thunder said that they want the matter to be determined by tribes and not states. “It is a very complex issue and the only thing we ask is to allow tribes to determine for themselves who the tribal members are,” he said.

Ron His Horse Is Thunder also asked that tribal leaders be consulted about any amendments made to the IHCIA bill. “We understand that there are many health organizations out there and they have done a great job in adding input to the content of this bill. However, as tribal leaders, we have to look at not only the healthcare issues, but how healthcare issues affect all of the tribes,” he said.

In response to the concerns voiced from the organizations about updating the IHCIA legislation, Sen. Dorgan said that the committee would re-evaluate the IHCIA legislation. “I think it makes sense to evaluate what should be the new approach of this legislation, obviously continuing much of the same structure but different approaches as well,” he said.

Contract Health Services Funding

Funding for the IHS budget was also addressed by the organizations at the hearing. In her written testimony, Rachel Joseph said more funding must be budgeted for contract health services (CHS). When care is otherwise not available at IHS and tribal facilities, medical care services are purchased from outside the IHS system through the CHS program. The CHS program only covers those services provided to patients who meet certain requirements and only when funds are available. When CHS funding is depleted, CHS payments are not authorized.

“Due to the severe underfunding for the CHS program, the IHS and tribal programs must ration healthcare,” Joseph said in a written statement. “Unless the individual’s medical care is a priority 1 level, request for services that otherwise meet medical priorities are ‘deferred’ until funding is available. Unfortunately, funding does not always become available and the services are never received. For example, in fiscal yer 2007, the IHS reported 161,750 cases of deferred services. In that same year, the IHS denied 35,155 requests for services that were not deemed to be within medical priorities.”

Sen. Dorgan told those who were testifying that Congress must address the lack of funding for contract health services. “If we are saying to people that money is only available for life and limb, we are signing a whole lot of folks to a life of pain and suffering,” he said.