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Reducing Health Inequality

September 18, 2012 By Sasha Hulsey, Policy Associate

Since the Supreme Court upheld the constitutionality of the Patient Protection Affordable Care Act (known as ACA), debate in the presidential race has continued to rage about whether or not this act will be repealed.

In the meantime, many federal programs continue to struggle with budget cuts, especially the continually underfunded Indian Health System (IHS). The Affordable Care Act authorizes the Indian Health Services to continue its current services, and grants more authority to IHS to expand upon these, however, the ACA does not grant more money for these provisions. 

Lack of funds, however, is only one small piece of the overall problem with the Indian Health System. Complicated insurance systems, transportation issues and remote clinic locations, understaffed clinics and hospitals, and lack of specialty services must all be addresses to provide better health services to Native Americans.

Created in 1955, Indian Health Services is run through the U.S. Department of Health and Human Services and serves 1.9 million members of the American Indian and Alaskan Native communities. Although IHS has helped to decrease the great divide in health status between American Indians and the rest of the US population, there remain health disparities between populations.

Many health problems, including diabetes, chemical dependency, cancer, and tobacco use have a greater prevalence among the American Indian population compared to the general population. Diabetes mortality rates in Minnesota are higher for American Indians than any other ethnic group: American Indians, 87.9 per 100,000, followed by 51.0 per 100,000 for African Americans, 30.4 per 100,000 for Hispanics, 21.0 for Caucasians, and 19.0 for Asian Americans. 

Prenatal care for the American Indian women is inadequate compared to the care received by white women, and infant mortality remains high at 9.3 deaths per 1,000 births (versus 4.4 per 1,000 for general population.) Due to the lack of funding for the clinics and hospitals through Indian Health Services, many communities have created their own programs to educate women about prevalent conditions like Fetal Alcohol Syndrome (FAS) and HIV/AIDS. However, with scarce resources, and poverty levels on reservations being some of the highest of any place in the country, it is difficult for these communities to fund their own programs without federal assistance.

The Minnesota Department of Health surveyed members of the White Earth Nation and other American Indians in the Twin Cities about their health concerns. The main issues were with lack of health insurance, difficulty keeping a primary care doctor, issues with culturally appropriate health centers, lack of accessible transportation, and lack of access to specialty care. 

New funding should be spent on creating more comprehensive health care and ensuring that there is a transportation infrastructure in place to get people to these centers. Health care centers should focus on having preventative care, nutrition and substance abuse counseling, prenatal care, and chronic illness care in a culturally sensitive environment. Creating larger transportation funds for those living on reservation lands to have access to these clinics, and improving the access to specialty care would improve health care for American Indians, as well. Educating the American Indian population about health insurance eligibility, and what services are provided under it will help people to understand what they can use in the health care system.

The IHS has been chronically underfunded for years. Funding steadily decreased between 1993-2007 to a cumulative loss of $2.55 billion. In 2009, President Obama invested $590 million in the Indian Health Services through the American Recovery and Reinvestment Act however, there are many challenges that remain before health inequality between American Indians and the rest of the population dissolves.

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