The Meaning of "Universal"
Among those cheering the passage of the Affordable Health Care for America Act (H.R. 3962), on November 7, were American Indians. Included in the sweeping legislative overhaul of the American health care system is the permanent reauthorization of the Indian Health Care Improvement Act (H.R. 1328). Originally enacted in 1976 due to deplorable health conditions in Indian Country, this bill guarantees the federal delivery of health services and funding of tribal and urban Indian health programs. IHCIA was last reauthorized in 1996 and expired in 2000. As a result, Indian health care has been chronically underfunded over the last decade.
In addition to expanding coverage for American Indians under Medicaid, Medicare and SCHIP, the reauthorized bill aims to recruit and retain professionals to work on isolated reservations. Despite efforts to eliminate disparities in the quality of health care, the life expectancy for Indians is still six years less than the national average. This fact alone raises the urgency for health care reform and yet it appears IHCIA is about to meet another obstacle to reauthorization.
The existence of a public option and stipulations regarding federally-funded abortions are not the only disparities between the health care bills in the House in the Senate; the Patient Protection and Affordable Care Act, introduced by Sen. Harry Reid (D-NV) on November 18, has no provision for the permanent reauthorization of IHCIA. More surprising, however, is the divided response of the American Indian community to this obvious omission. Former Republican Sen. Ben Nighthorse Campbell, a citizen of the Northern Cheyenne Tribe, believes it is a mistake to attach Indian health legislation to the reform bill. He fears that the failure to pass universal health care reform legislation will stifle any extant momentum to pass IHCIA as a standalone bill. On the other side, Tom Rodgers, a tribal affairs lobbyist with Carlyle Consulting and a member of the Blackfoot Tribe, believes few will have an appetite to go the distance on a standalone bill after putting so much on the line for the big health care reform package.
There is no question that the American Indian community must have expanded and improved access to health care. In an article about Indian poverty in the United States, Mr. Rodgers notes that health care is just one example of how this community is consistently denied the services they so desperately need. He refers to a study by the U.S. Commission on Civil Rights, which found that, per capita, American Indians receive disproportionately lower funding than the general population for federally administered services and programs.
The fear expressed by some that health care reform will fail and American Indians will once again be left in the lurch is not unfounded. Still, we must not lose sight of the ultimate goal of our current struggle: universal health care reform. If we begin to knit pick legislation to find constituencies that are best served by an omnibus versus a standalone bill, we will undermine our principle objective. When the Senate and House bills make it to conference, it is imperative that the IHCIA be included. Anything less would not be universal.