What Is President Obama Doing to Improve Indian Health Care? (And Is It Enough?)

During the 2008 presidential campaign, then candidate Barack Obama promised that if elected he would work to “ensure quality, affordable, accessible health care for First Americans.” His campaign Web site stated that “perhaps more than any other group, American Indians understand that our health care system must be reformed and that disparities that affect American Indians—including significantly higher rates of diabetes and tuberculosis, and lower life expectancy— must be addressed and eliminated.” Specifically, the “Obama-Biden Plan to Improve First American Health Care” pledged to:

• Increase funding support for the Indian Health Service (IHS).
• Expand eligibility for Medicaid and the State Children’s Health Insurance Program (SCHIP) so that more American Indians can be covered.
• Require that federally supported Indian health care services utilize proven disease management programs.
• Tackle Indian health disparities by addressing differences in health coverage and promoting prevention and public health.

Flash forward to the present. As of September 2009, three-quarters of the way through President Obama’s first year in office, how many of those promises are actually being kept? How much has the Obama administration really done to improve health care for American Indians and Alaska Natives? Well, let’s look at the record so far:

• In March, the president’s economic recovery legislation, the American Recovery and Reinvestment Act of 2009, allocated $500 million to the Indian Health Service to help the agency construct and modernize health care facilities, increase its use of health information technology and make other much-needed improvements in care.
• That same month, President Obama appointed Yvette Roubideaux, MD, MPH, an assistant professor of family and community medicine at The University of Arizona College of Medicine, as the new director of IHS. Roubideaux, a member of the Rosebud Sioux tribe, has conducted extensive research on Indian health disparities and was co-director of the Coordinating Center for the Special Diabetes Program for Indians Competitive Demonstration Projects, a program that has implemented diabetes and cardiovascular disease prevention activities in 66 Native communities.
• In August, the Department of Justice awarded more than $6.7 million in Recovery Act funds to 17 tribes in eight states to fight violence against women, one of the most serious health disparities in Indian Country.
• The president’s FY 2010 budget, which took effect on October 1, calls for a 13% funding increase for the IHS—one of the largest increases in 20 years.

This may seem like a fairly decent start, considering everything else—including health reform legislation—that’s on the president’s plate this year. But is it enough? Some tribal leaders don’t think so, testifying before the Senate Committee on Indian Affairs that the 2010 IHS funding levels are nowhere near high enough. And according to an August 23 Gannett News Service article, “IHS officials say the $3.6 billion they received [in 2009] is a little more than half of what they need to fully fund the agency’s mission.”