Indian healthcare— a system in free fall
By Dave Baldridge
Indian healthcare is in trouble. That reality worsens with the potential loss of the Affordable
Care Act (ACA), which has at least partially begun to mitigate 50 years of not-so-benign
federal neglect. “More than a million American Indians and Alaska Natives are enrolled in
coverage through Medicaid and CHIP, and many more are eligible for coverage as a result of the
Affordable Care Act’s Medicaid expansion,” according to the U.S. Department of Health and Human
Services (HHS) 2016 Justification of Estimates for Appropriations Committees for the Indian
Health Service (goo.gl/bvvAYR).
Facing unprecedented damage pending passage (or partial adoption) of “Repeal and Replace” legislation
being advanced in Congress, many of the nation’s 5.2 million American Indians will suffer
even more than most other rural Americans, who will also suffer terribly if they lose their Medicaid
coverage. If current levels of Indian health funding continue to decrease, the teetering Indian Health
Care Delivery System—like Humpty Dumpty in free fall—may soon lie shattered, unrepairable by all
the King’s horses and all the King’s men—these, at present, being Republican legislators.
The Devil Is in the Budget Details
At its heart, healthcare for American Indians has been initiated and sustained by Congress as a nonnegotiable
right, in exchange for tribal lands and loss of sovereignty. The federal Indian Health
Service (IHS), an agency within HHS, has provided American Indians (AI) and Alaska Natives
(AN) healthcare since 1955, following implementation of the Transfer Act of 1954 (P.L. No. 83-568).
IHS provides primary and public healthcare, along with facility construction and maintenance
through a system of providers in 12 geographic service areas. American Indian clients can access
services in 49 hospitals and nearly 600 other medical facilities operated by the IHS, tribes, Alaska
Native corporations or purchased from private providers. Approximately 55 percent (1.8 million)
of AIANs rely on this delivery system for their healthcare, according to an article in Nativenewsonline.