One of the Largest Issues Facing American Indian's Today

One of the largest issues facing American Indian's today

Kevin Turnage

Western International University

ETH 123 - Cultural Diversity

Carol Agurs

December 16, 2005

One of the largest issues facing American Indian's today

One of the largest issues facing the American Indian's today is that health care. As tribes and urban Indian health centers struggle along with the rest of the country to address the growing numbers of Elders in their communities. There are key issues and special considerations that must be addressed to ensure American Indian Elders are not forgotten in any proposed reform or redesign proposals that the newly formed Medicaid Commission or Congress put forth. By 2030, it is estimated there will be 430,000 American Indian and Alaska Native Elders, constituting 12.2% of the American Indian population (Day, 1993). While the federal government has a legal trust responsibility to all federally-recognized Tribes, the Indian health care system has broad discretion in how it fulfills that responsibility as stated Lincoln v. Vigil (91-1833), 508 U.S. 182 (1993) (Supreme Court of the United States, 1993) . Unlike Medicare and Medicaid, the services provided by the Indian Health Service are not considered entitlements to those that receive them. The Indian Health Service operates as part of the Public Health Service and does not offer insurance or have an established benefits package. Instead, it relies on yearly Congressional appropriations and third party reimbursements from Medicare, Medicaid, and private insurance to provide direct, contracted, or compacted services to American Indians and Alaska Natives ("About Indian Health Services," 2005.)

The National Indian Council on Aging in July of 2002 stated:

Despite our nation's prosperity, times are still very hard for Indian elders. Their health status ranks among the poorest of any minority in the nation. They are disabled at rates 50% higher than other American elderly. Nearly three out of five of them live below 200% of poverty. Only 66 percent of eligible Indians are accessing Social Security, a rate far lower than the national average of 88 percent. As the diabetes epidemic continues in Indian Country, elders are affected by the disease and its complications more severely than any other age group. More than two of every five Native elders have diabetes and in some communities, more than half of our elders are afflicted. As they live longer, elders are also living with the complications and disabilities caused by the disease. We need more help from you in educating them about how to prevent the disease . . . or how to live with it. Nowhere are the disparities in minority health care so great . . . nowhere is the mandate to the federal government so compelling as with the well-being of Indian elders (Baldridge, 2002).

Graph 1

Data Compiled from Baldridge and the United States Census Bureau

Congress dedicated its commitment to urban Indians in the Indian Health Care Improvement Act where it provided:

...that it is the policy of this Nation, in fulfillment of its special responsibility and legal obligation to the American Indian people, to meet the national goal of providing the highest possible health status to Indians and urban Indians and to provide all resources necessary to effect that policy ("25 U.S.C. 18 § 1602," 2005)

In so doing, Congress has expressed a policy encompassing a broad spectrum of "American Indian people." Similarly, in the Snyder Act, which for many years was the principal legislation authorizing health care services for American Indians, Congress broadly stated its commitment by providing that funds shall be expended

"...for the benefit, care, and assistance of the Indians throughout the United States for the following purposes: . . . For relief of distress and conservation of health." ("25 U.S.C. 1 § 13," 2005). As noted above, in Acts of Congress, as well as in both Senate and House reports, there has been an acknowledgment of a Federal responsibility for urban Indians.

The United States has entered into hundreds of treaties with tribes from 1787 to 1871. In almost all of these treaties, the Indians gave up land in exchange for promises. These promises included a guarantee that the United States would create a permanent reservation for Indian tribes and would protect the safety and well-being of tribal members (Oklahoma State University Library, 2005). Chief Justice Marshall of the Supreme Court held that such promises created a trust relationship between the United States and Indians resembling that of a ward to a guardian ("CHEROKEE NATION v. STATE OF GA.,