On March 22, the Senate Finance Committee held a hearing on the Indian Health Care Improvement Act (IHCIA) (P.L. 94-437). The current authorization of the IHCIA expired on September 30, 2000.
“The current funding level for the Indian Health Service system is only 52 to 60 percent of the need. That means that in any given year, by the month of June, the only patients who can receive treatment in Indian Health Service hospitals are those with conditions that ‘threaten life or limb,’” said Chair Max Baucus (D-MT). He continued, “In Montana, two-thirds of child welfare cases are related to substance abuse primarily meth. The child welfare system is also languishing because of inadequate funding. And the system also suffers from a lack of culturally-appropriate approaches to help tribal children to find loving, permanent homes.” Sen. Baucus concluded his remarks: “We owe the first inhabitants of this great nation medical care consistent with the medical care found in mainstream hospitals and clinics. We also owe their children a child welfare system that works for them. We must do all we can to provide help.”
Ranking Member Charles Grassley (R-IA) said, “In 2003, the U.S. Commission on Civil Rights reported that ‘American Indian youths are twice as likely to commit suicide…are 630 percent more likely to die from alcoholism, 318 percent more likely to die from diabetes, and 204 percent more likely to suffer accidental death compared with other groups.’ Yet with IHS [Indian Health Service] and tribal health care delivery sites funded at less than 60 percent of the cost of providing health care to their patients, we aren’t doing enough to close the gap on the health disparities faced by Indians.” Sen. Grassley said that Congress must reauthorize the IHCIA. He also said he “recognize[d] the importance to tribes of being able to apply directly to the Department of Health and Human Services for foster care funds” and supported the idea of subsidized guardianships.
Connie R. Bear King, an enrolled member of the Standing Rock Sioux Tribe, testified on behalf of the National Indian Child Welfare Association. Ms. Bear King told the committee that “Native American children and families are disproportionately represented in the child welfare system, particularly the foster care system.” She attributed the overrepresentation to “known risk factors for child abuse and neglect, includ[ing] poverty, unemployment, alcohol and substance abuse, family structure, and domestic violence. In Native American communities the rates of these risk factors are very high and do contribute to Native American children being placed in out-of-home care in high numbers.” She discussed the historical removal of children from their homes, a common occurrence until 1978, “because of the lack of understanding and bias private and public agencies had regarding tribal families.” Ms. Bear King outlined the history of federal grants available to tribal governments and the current status of such funds: “What tribes do not have access to is a stable source of non-discretionary funding to support the vulnerable children that need foster care or adoption assistance services…Without this funding, tribes are forced either to place children in unsubsidized homes, which can lead to instability and failure of the placement, or turn them over to state agencies whenever possible, which burdens state governments and reduces the chance that tribal children and families will have access to services that are specifically geared to their needs.”
“Lawmakers need to revisit the sacrifices of aboriginal lands by Indians in exchange for the federal government’s commitment to provide healthcare,” said Carl E. Venne, chair of the Crow Tribe and the Montana-Wyoming Tribal Leaders Council. Mr. Venne discussed past federal budgets, saying that the funding received by the IHS and tribal governments has been insufficient. He urged the committee to designate IHS as the “primary payer” rather than the “payer of last resort” for Native Americans, saying that when a tribal person has a catastrophic illness, he or she often must seek payment through Medicaid or Medicare prior to IHS funding. The time delay involved in seeking alternate forms of payment “can exacerbate a life-threatening condition, and can, in some instances, impact a patient’s ability to be treated.” Mr. Venne asked that behavioral health services receive additional funding as substance abuse, depression, and homelessness are prevalent in native communities. He said that the IHCIA “will allow for programs to address behavioral and mental health issues that have been severely neglected under the current system. It will begin to address the horrifying and inexcusable disparities between the health levels of Native Americans and the general United States population.”
Also testifying were Linda Holt, Chairperson, Northwest Portland Area Indian Health Board and Suquamish Tribal Council Member; and Valerie Davidson, senior director at the Alaska Native Tribal Health Consortium.
