Healthcare for Indian tribes in need of increase in funding

If there is one issue almost everyone in Washington agrees on, it’s the need to improve healthcare in Indian country. A few years ago, the former top Democrat in the Senate, Tom Daschle (D-S.D.), proposed an amendment to more than double the Indian Health Service (IHS) budget. President Bush has proposed steady increases in recent budget requests. And last year, conservative Republican Sen. Tom Coburn (R-Okla.), known for his strong opposition to wasteful federal spending, said, “The disease in the IHS is that we are not funding it adequately enough.”

Bipartisan support for more spending is not surprising to those who know the facts. American Indians live sicker and die younger than most Americans. Yet, per capita spending for the IHS is about $1,914 per year while spending for federal prisoners is roughly $3,803. In other words, the federal government spends twice as much on convicted criminals as it does on Indians. And, as in other areas, you get what you pay for. Compared to the rest of the population, Indians have seven times the rate of tuberculosis, more than six times the rate of alcoholism, nearly three times the rate of diabetes and a 62 percent higher rate of suicide.

The reason this issue is so important is that it affects all of Indian country. Some in the media would like to turn this into a battle of the haves versus the have-nots. But it’s simply not the case. I can’t help but laugh when I read articles that refer to my tribe of 10,000 enrolled members as “wealthy” and “casino-rich.” It is true that our tribal businesses, including our two casinos, generate significant revenue, but that is spent before it even gets in the door on government programs and services, such as education, transportation, law enforcement and, yes, healthcare. I wish the media would keep in mind that not everyone who lives in New York City is rich just because the city’s budget is $53 billion.

The Mississippi Choctaw tribal government has spent an ever-increasing amount of its economic-development revenue on healthcare. Before the tribe began gaming, it did not have any extra income for healthcare. In 1995, a year after the first casino opened, we allocated $407,000 to pay for health services. Last year, we spent more than $7.7 million. That is significantly more than we received from Medicare and Medicaid combined. It allowed us to make many improvements in healthcare delivery, including provision of dental services and elective surgeries, as well as the purchase of important medical equipment and devices, including a mammogram machine.

We are fortunate that we have been able to do this. We know that many tribes do not have similar resources. The fact remains, however, that even tribes such as ours fall far short of the “level of need” standard established by the federal government. Choctaw is one of 56 tribes that receive 60 to 80 percent of need. There are 161 tribes that are not even receiving 60 percent.

These numbers illuminate only the disparities in funding for personal medical care. Funding for tribal health facilities, as well as public health and sanitation programs, also lags. Less than a year ago, the House Appropriations Committee concluded that, at current spending levels, proposed tribal hospitals that were already on the priority waiting list would not be built for 60 years.

Like other tribes, we have a hospital and clinic more than 40 years old that need to be replaced immediately. But if the House committee is right, since we are still waiting to get on the waiting list, we likely won’t receive money for a new hospital during my youngest grandchild’s lifetime.

All Americans should call on Congress and the president to double IHS funding over the next three years. Congress can take the first step in the upcoming appropriations process by making sure that every tribe has funding sufficient to fulfill 80 percent of its healthcare needs. In other words, all tribes should have “80 by ’08.”

“80 by ’08” is necessary because we must start to close the indefensible healthcare gap. “80 by ’08” is realistic because it would require an investment just shy of $1 billion, a significant sum, but less than past proposals and miniscule as a percentage of overall spending. Finally, “80 by ’08” is the right thing because it asks only that the federal government ensure that all tribes receive 20 percent less than their real level of need.

The situation is critical. Fortunately, the opportunity is here. There is bipartisan support. What Indian country needs to do is to work together, set realistic goals, and hold our elected representatives responsible for meeting those goals. I propose that Indian country as a whole call for a doubling of IHS funding over three years.

Martin is the tribal chief of the Mississippi Band of Choctaw Indians.