American Spirit: Despite treaties and promises, US never allocated enough funds for Native American healthcare
Before the European settlers arrived in the 16th century, the lands that are now the United States were inhabited by an estimated 5M to 10M individuals, the first people or Native Americans. They were organized among hundreds of communities, each having a distinct language, culture, economy, government, and social institutions. According to 2013 data from the US Census Bureau, at present, at least 5.2M US residents identify as full or part American Indian or Alaskan Natives and another 527,077 as full or part Native Hawaiian. When computed together, Native Americans of the United States comprise only 2 percent fo the nation's total population. The Native American populations have been aging steadily resulting in a growing fraction of native elders. However, Native communities continue to face disparities with regard to healthcare.
The US government stated in the clauses of the treaty signed with Native American tribes that it would guarantee them healthcare in perpetuity in exchange for millions of acres of their land, during what is now known as the Indian removal. Yet, healthcare for Native Americans lags behind other ethnic and racial groups. They face a significant inequality in healthcare and health status in comparison to their White counterparts. Today, Native American individuals have a life expectancy that is significantly lower than the country's other populations. They also continue to die at higher rates than any other ethnic group in the countries due to many preventable ailments like chronic liver disease and cirrhosis, diabetes, and chronic lower respiratory diseases.
Despite a legal obligation towards Native Americans, the federal government has long failed to allocate sufficient funding to meet Native Americans' health needs. In 2016, Congress set the Indian Health Services (IHS) — an agency within the US Department of Health and Human Services — budget at $4.8B. Spread across the US Native population per capita, it wouldn't suffice.
The IHS is dedicated to providing healthcare services for members of 560 recognized tribes, but the Congress has chronically underfunded the agency, forcing administrators at the hospital to limit the services they could offer. Essentially, the reality of the health care services for Native Americans has stark differences with those offered to other US citizens. According to an analysis by the National Congress of American Indians, only if the funding for Native American healthcare were doubled would it match the level of care provided to prisoners incarcerated in federal prisons. It would have to be even higher to match the benefits that are guaranteed by programs like Medicaid.
An NPR report says that about a quarter of Native Americans have also reported experiencing discrimination when consulting a doctor or going to a health clinic. It also found that Native Americans in areas with a majority Native population reported experiencing higher levels of prejudices than in areas where they are considered to be a minority. In addition, the healthcare system outside of the IHS usually sees a small proportion of Native American patients, because it is very difficult for them to access care in private health institutions.
The main factors contributing to that are high poverty and uninsured rates among American Indians, who are accustomed to living in rural areas with few healthcare providers. The IHS isn't insurance, but it runs clinics and hospitals. Federal funding is also supposed to help Native American patients pay for care in private hospitals, that the IHS hospices cannot offer.
According to a report by the American Society on Aging, American Indian and Alaskan Natives are more likely to be uninsured than non-Hispanic Whites. This trouble has been incessant in healthcare and rates of service utilization, particularly for low-income Native people. Some 48 percent of low-income Native individuals are uninsured. The impact on the community is widespread and rampant, given that at least 55 percent of Native Americans have incomes below 200 percent of the federal poverty level, that is, $28,256 for a family of three (2001), in contrast to 25 percent of Whites. During the 2003 fiscal year, the IHS received $125B in federal grants for its services. The IHS Federal Disparity Index clarified the IHS would require an additional $1.8B to provide active IHS users with services at the same level as the benefits guaranteed by the Federal Employees Health Benefits programs. But despite the serious resource scarcity, the IHS has improved the health of Native Americans and continues to do so though it has a limited reach.
According to the American Bar Association (ABA), only 2.2M Native American individuals in the US receive care from the IHS. Some of those left out of the demographic could be ineligible because to access these services they have to be members of a federally recognized tribe. Many others are geographically distant from IHS hospices. When the IHS was instituted in 1955, a majority of the Native American tribes lived on or near reservations and the IHS facilities were in close proximity. However, now, a majority of Native Americans live in cities and the location of the IHS sites poses a real problem.
The health status of Native Americans can be better than it is today if they receive "adequate funding that supports evidence-based, outcome-based, and community-based approaches is essential," per the ABA. There is a need for quantifiable goals to be set that center entirely on chronic-illness reduction, while other measures need to be explicitly defined and closely monitored. The first step is a strong investment in public health, to help combat the severe chronic diseases impacting these populations that are being wiped out at an alarming rate because of illnesses. Access to specialty care, a greater consortium of health professionals to serve tribal communities as well as expansion in scholarship and loan repayment programs is the need of the hour. To reverse health inequities, the federal government needs to revise and adhere to its moral and legal responsibility. It needs to work with tribal leadership and acknowledge the health crisis in the Native America Community.
American Spirit is a campaign on the issues faced by the Native American Community in America. Over the next few days, this column will feature stories of determination, triumph, legacy and redemption.