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Access Issues Persist For Indians, Rural Americans, Immigrants

 Kaiser Daily Health Policy Report



[Jun 15, 2009]

Several reports today focus on inadequate health care for certain population groups within the United States. 

In a long feature story, the Associated Press reports that the Indian Health Service System, "which serves almost 2 million American Indians in 35 states," often provides "grossly substandard care." A 1787 agreement between tribes and the government gave the U.S. "an obligation... to provide American Indians with free health care on reservations. But that promise has not been kept. About one-third more is spent per capita on health care for felons in federal prison according to 2005 data from the health service." An "oft-quoted refrain" on reservations is 'don't get sick after June,' when the federal dollars run out." The health statistics in Indian country are "staggering. American Indians have an infant death rate that is 40 percent higher than the rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease." 

While residents of reservations qualify for Medicare and Medicaid coverage, "a report by the Government Accountability Office last year found that many American Indians have not applied for those programs because of lack of access to the sign-up process." And Indian health clinics are "ill-equipped to deal with such high rates of disease, and poor clinics do not have enough money to focus on preventative care." But, "the main problem is a lack of federal money. American Indian programs are not a priority for Congress, which provided the health service with $3.6 billion this budget year." Ron His Horse is Thunder, chairman of the Standing Rock tribe, "says his remote reservation on the border between North Dakota and South Dakota can't attract or maintain doctors who know what they are doing." He "often travels to Washing! ton to l obby for more money and attention," but says his tribe is "not one congruent voting bloc in any one state or we don't have the political clout." Sen. Byron Dorgan, D-N.D., has "led efforts in Congress to bring attention to the issue" and "has also probed waste at the agency." An American Indian health improvement bill passed in the Senate last year, but a similar bill "died in the House, though, after it became entangled in an abortion debate" (Jalonick, 6/14). 

Meanwhile, NPR reported yesterday that many people in rural areas struggle to obtain affordable health insurance. "Half of all jobs in rural places are tied to small businesses, a rate 13 percent higher than in cities and suburbs," and small business owners and employees are "twice as likely to be uninsured." People in rural America, therefore, disproportionately depend on individual plans, which often require costly premiums and deductibles. "One-third of farmers and ranchers depend on individual insurance," which is "four times the rate for everyone else." And while "some farmers and ranchers have off-farm jobs that provide insurance," the recession has made those jobs "harder to come by." So an even greater number of farmers and ranchers are turning to the individual market. 

Individual plans cost more both because "there isn't a large group to spread risk," and also because "the rural population trends older and sicker." "There is also less access to health care in rural places," and "farming and ranching are considered risky professions." Those extra costs mean that "farmers and ranchers dip into savings accounts and even take out loans to pay for health care," leaving less money to invest in business and lower overall retirement savings. The costs also leads to poorer health because, "people with no or costly insurance are less likely to get the preventative care that could help them stay healthy"! (Berkes , 6/14). 

NPR also on Saturday examined budget-strapped counties in Northern California and found they are "eliminating health benefits for thousands of undocumented immigrants." Yolo County, for example, "faces a $24 million shortfall, and the move will save the country more than a million dollars." Illegal immigrants "make up about half of the people on the county's program for the pool." In the past, "providers didn't check legal status, but starting in July they will." But "many providers in the region say these cuts are a short-sighted policy that could hurt everyone. They worry that if thousands of undocumented immigrants cut back on doctor's visits, they might go untreated for communicable diseases like tuberculosis, measles, gonorrhea or HIV" (Weiss, 6/13).

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