In February, the Senate Committee on Indian Affairs held a three-hour hearing and listening session on health care provided in Indian Country by the Indian Health Service (IHS). Members of the committee from both sides of the aisle spoke of the disturbing reports they’ve had from their own Native American constituents.
In February, the Senate Committee on Indian Affairs held a three-hour hearing and listening session on health care provided in Indian Country by the Indian Health Service (IHS). The hearing focused on three hospitals in the Great Plains region – the Oklahoma-Winnebago, Rosebud, and Pine Ridge hospitals – because the U.S. Center on Medicaid and Medicare Services had withdrawn Medicare certification from the Oklahoma-Winnebago hospital and had put the other two hospitals on notice that their certification was also threatened. Indian Country Today published an excellent story summarizing the hearing, and video and written testimony from the hearing are available on the Committee’s website.
Former chair of the Committee, Senator Byron Dorgan was invited to testify and comment on a similar hearing that the Committee held in late 2010, resulting in a report with the alarming name, “In Critical Condition: The Urgent Need to Reform the Indian Health Service’s Aberdeen Area.” (The Aberdeen area is now known as “Great Plains.”) Emphasizing the number of skilled and dedicated medical and administrative staff in IHS, Dorgan also recounted a culture of cronyism and corruption that he and his staff saw in 2010, and which still stands in the way of accountability for high quality standards.
Members of the committee from both sides of the aisle – and Senator Rounds of South Dakota, who is not on the committee – spoke of the disturbing reports they’ve had from their own Native American constituents, including closed emergency clinics, missed diagnoses, and dirty facilities. They pressed the urgency of the problem, and expressed their commitment to see it solved.
All senators and several witnesses acknowledged three challenges: the remote location of the hospitals and clinics, the inability of IHS to recruit and retain qualified medical personnel, and the severe health challenges faced by many Native Americans. Although Committee members asked repeatedly about assurances of accountability and quality control, witnesses from IHS and the Department of Health and Human Services (HHS) indicated that there were measures in place to ensure quality care.
Senators also pointed to inadequate funding as a core issue in maintaining quality care. Senator Heitkamp noted that, compared to federal spending on health care in other situations, per patient spending in IHS is the lowest. Medicare spends $12,000 per year per patient, the Veterans’ Administration - $7,000, Medicaid - $5,600. IHS per patient spending is barely $3,000 per year. Senator Dorgan, in his testimony, and Senator Tester both focused on overall funding. Even though IHS has received additional funds in the last several years, it still receives less than half of what is needed to assure consistently high quality health care. Underfunding leads almost inevitably to understaffing (37 percent vacancies in the Great Plains region) and to rationing of care.
New appointments to the top leadership in HHS and IHS will take on the challenge of turning the health care system around. Dorothy Dupree brings quality assurance experience from her IHS and HHS service in Arizona, and Mary Smith brings a management background and a deep knowledge of health care. The hearing was full of determination, frustration, and a certain amount of blaming, but nearly every senator spoke of the paramount importance of the federal responsibility to provide high quality healthcare, and to “get this right.”
