While Congress and the nation focus their attention on health-care reform, there's another segment of the population faced with inadequate funding and services for its health care. However, this segment is different than others the federal government has a trust responsibility to provide them health care.
It is the American Indian population, which includes about 30,000 people in North Dakota or about 5 percent of the North Dakota population.
"We can't forget American Indians as the country moves forward in health-care reform," said Dr. Monica Mayer, of New Town.
Mayer, an enrolled member of the Three Affiliated Tribes, is an independent contractor working with VISTA Staffing Solutions out of Salt Lake City, which contracts with Indian Health Service facilities for emergency room coverage. She works 12-hour shifts for two-week periods at the Indian Health Service hospital in Belcourt, then has two weeks off.
American Indians make up 2.5 million of the U.S. population and 1.9 million of them use Indian Health Service, Mayer said.
Indian Health Service is the federal health program for American Indians and Alaska Natives, through the U.S. Department of Health and Human Services.
American Indians are in a whole different section in the health-care process than the 47 million people who are not insured, Mayer said. She said the federal government has trust responsibilities to American Indian people.
"We know more money doesn't take care of everything but at least if we can get more than 50 percent," she said. She said tribes across the United States have typically received 40 to 50 percent of their total budget to care for American Indian patients.
Earlier this month Mayer took part in a national meeting held in Washington, D.C., on the future of Primary Care Workforce in rural and urban America. The meeting was sponsored by the U.S. Department of Health and Human Services, Health Resources and Services Administration. Mayer was invited to participate by Dr. Mary Wakefield, a native of Devils Lake, who President Obama named as the administrator of the Health Resources and Services Administration.
Concept paper
Last month, Sen. Byron Dorgan, D-N.D., who is chairman of the Senate Indian Affairs Committee, released a concept paper on Indian health-care reform which was sent to tribal leaders across the country.
The concept paper contains a number of proposed solutions to improve and reform the Indian health-care delivery system based on an examination of health-care problems on reservations and comments from tribal leaders.
Dorgan said Friday that the concept paper was developed with input from the National Congress of American Indians, tribal governments and others.
He said he expects a hearing will be held in September and that an Indian health bill will be introduced by mid- to late September.
Health-care services to American Indians are provided by three methods:
Indian Health Service-direct health-care services.
Tribally operated health-care services.
Urban Indian health-care centers.
But it is widely believed on reservations that health-care funding is not adequate for the needs of Indian people.
Jim Foote, of Parshall, has worked in the health field for more than 20 years as a federal employee with Indian Health Service and the Three Affiliated Tribes Health. Since 2005, he has been the project manager of the Elbowoods Memorial Health Center, which will be built on the north side of New Town on the Fort Berthold Reservation. He is an enrolled member of the Three Affiliated Tribes.
"We only get about half (of the funds) what we should get," Foote said. "When the money runs out, you can't get sick." He said it's about June when there's no more money available for contract health care.
He said direct care care at an Indian Health Center facility is available as long as the person is a member of a federally recognized tribe,
But he said when the money runs out for contract health care or patients needing to be referred to other facilities, many tribal members will go on their own to that facility. But if they can't pay their bill, then there are problems, he said.
Health reform for tribal population
Delvin Cree, of Dunseith, said health reform is important for the tribal population in North Dakota.
Cree is a member of the Turtle Mountain Treaty Council, founding member of the Pembina Land Commission and steering committee member of the Dunseith Horizons project, a poverty reduction project for the Dunseith area.
"We have many health disparities in our communities much higher than the national average statistics. Indian people live a much shorter life span than most people in America," he said. "It is important for our tribal communities to be part of health reform for the benefit of possibly receiving more monies for Indian health care."
Cree said the federal government does have an obligation to help Indian tribal members.
"It is questionable if we really are in a different category when receiving health benefits," he said. "For example, I had to fend for myself when I first moved to Minneapolis over 25 years ago for health coverage."
He said that at the time he was receiving a county government check and had to receive his health care from the county. "My tribal reservation couldn't help me in any way. It is like that today still. The only assistance I could receive from my reservation was for burial services when and if I passed away while living in Minneapolis. It is a known fact that you have to reside on or near the reservation to receive any benefits."
Cree reiterated what other tribal members have said, that health care for the tribal community has been inadequate.
"Will it change? I think if Congress heard more from the tribal population regarding our health issues, they would be more responsive to help us," Cree said.
"There are many stories out there among our tribal members who have to make life or death decisions because there is a lack of health funding," Cree said. "I witnessed a collection of monies from people who had attended our powwow recently for the purpose of helping an Indian family because they had to have transportation to send their son/brother out of state for a kidney transplant. The young man who needed to continue kidney dialysis in the past few months had given up on his life simply because he didn't have the money to go to his treatments. His sister is donating one of her kidneys to him so he can continue to live."
Cree also reiterated that money for health care runs out quickly. He specifically referred to his reservation Turtle Mountain Reservation.
"Our money runs out quickly due to the fact that we have not had in-patient services for our tribal people," he said.
Cree said he recently attended a health listening session with staff from Dorgan's office, the Turtle Mountain Band of Chippewa tribal council and a few other community members when the issue of not having enough health dollars was discussed.
"Though the hospital is planning to have in-patient services as soon as September, our health dollars do dry up very quickly," he said.
"Yes, we do not receive enough funding for services, but on our end we need to take some course of action to better stretch our health-care dollars," Cree said.
Indian health care is in a crisis, just like the rest of the nation, Mayer said. She said people are working with very low budgets for Indian health care and there's high professional vacancy rates, while Indian people have a high rate of heart disease, diabetes and cancer among them.
"It's not about politics but about taking care of people," Mayer said of improving health care for American Indian people. "I think there's still hope."
Dorgan's entire concept paper on reforming the Indian health-care system is available online at the Senate Committee on Indian Affairs Web site.