Senate to act on Indian Health Service funding

Washington -- The Senate is poised to vote on new funding for the Indian Health Service that includes plans to combat a doctor shortage. But President Bush says he would veto it over cost and Medicaid documentation concerns.

The Indian Health Care Improvement Act of 2007 would authorize $35 billion from 2008 through 2017 for the IHS. The bill would establish doctor retention and recruitment bonuses of up to $25,000 and fund demonstration programs to recruit new physicians to the IHS. The agency's physician vacancy rate is currently 13%. The measure also would:

• Allocate $1 billion to build new health care facilities and $1 billion for new sanitation facilities.
• Establish a new program on domestic violence and sexual abuse in the American Indian community.
• Require the agency to offer cancer screenings beyond mammograms and eliminate the minimum age requirement of 35 on IHS-provided mammograms.
• Enroll more American Indians in Medicare, Medicaid and the State Children's Health Insurance Program.

Bill sponsor Sen. Byron Dorgan (D, N.D.) has made the improvement of Indian health care a major political goal. "I have in the past couple of weeks done some listening tours on Indian reservations, particularly in North Dakota, and we heard and saw many examples of deplorable conditions in Indian health care," said Dorgan in a Jan. 22 Senate speech. "It is true that some health care providers in the Indian Health Service are making very strong efforts to do the best they can, but they are overburdened, understaffed and underfunded."

Infant mortality rates are higher for American Indians than for other U.S. populations, reported the IHS in 2001, and the rate of diabetes increased 160% from 1990 to 2004 for American Indians ages 25 to 34.

The IHS needs the modernizations in the bill, said Heather Dawn Thompson, director of governmental affairs for the National Congress of American Indians. The legislation calls for more funding of preventive and mental health services. The IHS wouldn't have to outsource the services, she added. The bill also would allocate funding so that the agency could provide in-home health care.

IHS funding is too low and runs out three-quarters of the way into the year, said Craig Caldwell, MD, a general practice physician for the Bay Mills Indian Community in Brimley, Mich., which operates its own tribal medical facility. Specialists are in short supply because the population is so remote, forcing him to step outside of his practice comfort zone.

"I used to practice in a county of 250,000 people, and we had every type of specialty available," he explains. "I didn't used to do ICU patients. I have to here." The nearest urologist is 90 miles away, while the nearest pediatrician is 70 miles away, he added.

The tribe often must ration health care, said Laurel Keenan, director of Health and Human Services for the Bay Mills Indian Community Tribal Health Program. "When we have to resort to that when funds get low, we tie our doctors' hands," she said.

The bill has bipartisan support, said Dorgan spokesman Barry Piatt, and a good chance of passing. But Bush expressed numerous objections to the measure in a Jan. 22 Statement of Administration Policy. Among the president's concerns: the bill would require the federal government to pay local labor rates for construction performed under the act. The president also opposes provisions in the bill that would accept tribal documents for Medicaid qualification because of concerns they could weaken the documentation requirements for the program and open up services to those who do not qualify for them.

But the bill is in flux, and most of the administration's concerns have been addressed, said a spokesperson for bill co-sponsor Sen. Lisa Murkowski (R, Alaska).

At press time in early February, the Senate was likely to vote on the bill during the week of Feb. 11. The House has not begun to debate its IHS measure.

There are ongoing discussions to resolve the president's remaining concerns over the Senate bill, the Murkowski spokesperson confirmed.