Tahlequah Daily Press

Local News

July 30, 2012

Health care law won’t affect Indian services

TAHLEQUAH — Passage of the Patient Protection and Affordable Care Act and the U.S. Supreme Court ruling on its constitutionality provided permanent reauthorization of the Indian Health Care Improvement Act.

The IHCIA, enacted in 1976 to address declining health conditions in Indian Country, provides – without cost – health care to American Indians and Alaska Natives who are members of federally recognized tribes. The IHCIA and the Snyder Act of 1921 form the basis for delivery of care via Indian Health Services, an agency within the U.S. Department of Health and Human Services.

Dr. Charles Grimm, senior director of Cherokee Nation Health Services, said the provision of health care to American Indians and Alaska Natives has more to do with ethnicity than a legal precedent.

“American Indians and Alaska Natives consider themselves the first Americans who prepaid for their health care through the cessation of thousands of acres of lands, mineral rights and forced relocation from their ancestral homes,” said Grimm. “So, to Native Americans, this care is not free, but has been paid for many times over.”

He pointed out American Indians are also the only racial group with a government-to-government relationship with the federal government based on treaties, laws, Supreme Court decisions and executive orders over the years.

“So, the relationship with the federal government is not one based on ethnicity, but one based on political and legal foundations upheld over the years that give tribes status as both separate nations and part of the U.S.,” he said. “One of the many promises made by the federal government to Indian nations was the delivery of health care services.”

According to www.ihs.gov, Indian health care may be available to anyone “who is of Indian of Alaska Native descent as evidenced by one or more of the following factors: Is regarded by the community in which he lives as an Indian or Alaska Native; is a member, enrolled or otherwise, or an Indian or Alaska Native tribe or group under federal supervision; resides on tax-exempt land or owns restricted property; actively participates in tribal affairs; or any other reasonable factor indicative of Indian descent.”

Services may also be provided to a non-Indian woman who is pregnant with an eligible Indian’s child for the duration of her pregnancy and through post-partum, which is generally about six weeks.

To receive IHS health care benefits, a tribal member or citizen must sign up at the patient registration office of the local IHS facility in person and present proof of enrollment in a tribe.

Those seeking services in Tahlequah would register at Cherokee Nation W.W. Hastings Hospital, which provides care not just to Cherokees, but to anyone who can prove membership in a federally recognized tribe.

Membership requirements are established by individual tribes. The Cherokee Nation has no blood quantum rule, so even those with a tiny fraction of Cherokee blood may receive cost-free health care through CN. Many other tribes require a substantial degree of Indian blood for membership, and thus for health care. The United Keetoowah Band, for instance, requires its members to be at least a quarter Indian.

Many local American Indians have been concerned about how PPACA might affect their health care. Pamela Thurman, a Cherokee who receives IHS care, is among those.

“Are we the example that everyone will look to for success of failure in ‘socialized’ medicine and contract health? Will natives be absorbed into the general public for health care?” she asked.

Grimm said many different groups have studied IHS and tribal health programs over the years, and have been pleasantly surprised at what they found.

“[They] marveled at how much quality health care is delivered with a lesser per capita funding than almost any other health system in the U.S.,” said Grimm. “Many have worried that health reform would mean the Indian Health Service would go away, and everyone would have an insurance card. That was a myth and is wrong. The IHS is still here, and the passage of IHCIA, along with the health reform law, reaffirms that IHS is here to stay. The [PPACA] permanently reauthorizes the IHS, and it contains numerous provisions to modernize and update the IHS and tribal programs.”

He said tribal members – like all Americans – will now have more choices for their health care, rather than additional restrictions some claim PPACA will impose.

“They may choose to purchase the new, more affordable health insurances described in the PPACA, while many more should be covered for state Medicaid programs in the expansions of eligibility that may occur,” Grimm said.

Tribal citizens who opt to buy insurance or participate in employer-provided plans would no longer be limited to services at only IHS or tribal facilities. For many lower-income Indians, this has been the only option.

Cherokee citizen Lu McCraw said Indians with serious health conditions often find themselves out of luck.

“For instance, [IHS] can help detect or screen for breast cancer, but you’re out of luck getting treatment,” said McCraw. “There’s a priority list, and they serve or help those according to available funding.

McCraw is referring to contract health services, or those provided by facilities outside the IHS-designated pool.

“Indians may receive any type of health care that is delivered at their local facility – or at any [IHS] facility in the nation, for that matter,” said Grimm. “[McCraw] is referring to what is known as the contract health service program [when mentioning] priority lists. If a type of care [cannot] be provided within the walls of the local IHS or tribal health facility, then a person may be referred into the private sector for health care needs.”’

Grimm said a number of factors affect a tribe’s ability to refer patients to outside medical providers.

“The combination of medical inflation, particularly for providing services in rural and remote locations; an increasing eligible population; and limited competitive pricing and options, requires strict adherence to specific guidelines, medical priority and eligibility to ensure the most effective use of CHS resources,” said Grimm. “CHS programs negotiate contracts with providers to ensure that competitive pricing for the services are provided, in spite of the limited number of providers available in the many local rural communities. [McCraw’s] statement about denial of cancer treatment is not accurate. The denial rate of our CHS program with regard to cancer care is virtually zero, or near 100 percent treatment.”

Elissa Lyons, also a Cherokee citizen, is concerned about the fine that will be imposed on those who refuse to purchase health care, as set out in PPACA. The new law makes most Americans responsible for carrying some form of health insurance, and compliance will be enforced through the use of tax penalties via the Internal Revenue Service.

“The law exempts members of Indian tribes on the basis of the federal trust relationship,” said Grimm. “So, while Indian people will be able to access health insurance made more affordable and more available under the PPACA, they will not be penalized if they choose not to purchase insurance.”

Other key PPACA elements pertaining to American Indians include those set out under Titles I, II, IX and X. These affect cost-sharing requirements, the Medicare Part B “sunset” date, Medicare Part D on prescription medications, and tax exemption on tribally provided insurance.

The first of three provisions under Title I will protect Indians from cost-sharing requirements at or below 300 percent of the Federal Poverty Level, which DHS guidelines define as an annual income of $61,950 for a family of four. The second provision protects Indians from cost-sharing for services delivered through an IHS program; the third will allow Indians to enroll in insurance exchange programs on a monthly basis.

The PPACA also removes the Medicare Part B sunset date of Dec. 31, 2009, giving IHS programs permanent authority to receive disbursement of some Part B services. According to Grimm, the provision initially passed in the Medicare Modernization Act of 2003 limited the authority to five years.

“Also, effective Jan. 1 of 2011, the value of drugs provided by IHS programs will now count toward true out-of-pocket costs for Indian Medicare beneficiaries,” said Grimm. “This effectively removes the ‘doughnut hole’ for patients seen at IHS or tribal facilities.”

Finally, effective March 23, 2010, PPACA excludes from an individual tribal member’s gross income the value of health benefits, care or coverage provided by IHS programs, a tribe or tribal organization.

Grimm said he believes the permanency of IHCIA will improve services to tribes across the board.

“Under IHCIA, the Indian Health Services and tribes have new and expanded authorities to provide cancer screenings and dialysis, ensure our elders are cared for, recruit more qualified health professionals, modernize dated health facilities, and bring more funding to hospitals and clinics through third-party collections,” said Grimm

 “Even better still, IHCIA is permanent. It will remain in law, and tribes will never be forced to go through the reauthorization process again.”

Click here to get the entire Tahlequah Daily Press delivered everyday to your home or office. Code for E-EDITION TRIAL OR SUBSCRIBE Click here to get a free trial or to subscribe to the Tahlequah Daily Press electronic edition.

It's the ENTIRE newspaper (without the paper) for your computer, iPad or e-reader.

1
Text Only
Local News
  • sr-Sherman-Alexie.jpg Native wit

    Sherman Alexie Jr., self-professed “res” American Indian, dislikes casinos, mascots and Oklahoma for stealing his favorite basketball team.
    Northeastern State University welcomed the celebrated poet, writer and filmmaker to campus Wednesday, and the audience was treated to 90 minutes of witty and unblinking observation from the perspective of an American Indian all-too-familiar with life on a reservation.
    Alexie, named one of the 21st Century’s top 20 writers by The New Yorker, delivered what was essentially a standup monologue to a packed house in the auditorium of the W. Roger Webb Educational Technology Center. Some of Alexie’s best-known works are “The Lone Ranger and Tonto Fistfight in Heaven,” a book of short stories, and the film “Smoke Signals.”

    April 24, 2014 1 Photo

  • rock-jodi.jpg Woman serving time for burning baby seeks judicial review

    A Cherokee County mother sentenced to 17 years in prison for burning her 14-month-old baby with an iron is asking for a judicial review.
    Court records show Jodi Leann Rock, 21, requested a copy of her judgment and sentence, and this week filed an application for a judicial review. Copies of her request have been submitted to a judge and the District Attorney’s Office.

    April 24, 2014 1 Photo

  • SR-SchoolCharter.jpg Concerns expressed as SB 573 awaits House vote

    With an Oklahoma Senate bill now awaiting a vote on the floor of the House of Representatives, some parents are voicing concerns about the futures of rural K-8 schools in Cherokee County.
    Senate Bill 573 calls for a commission to establish charter schools throughout the state. A charter school receives taxpayer funding, but functions independently. They can be founded by an array of interests, including teachers, parents, universities and nonprofits. In Oklahoma, tribal entities can establish charter schools.

    April 24, 2014 1 Photo

  • Man gets suspended sentence for possession

    A 37-year-old Webbers Falls man has been given a suspended sentence on drug-possession charges.
    Dusty Kayl Skaggs was charged with endeavoring to manufacture methamphetamine earlier this year after he and 43-year-old Misty Hayes Paden, of Muskogee, were arrested during execution of a search warrant.

    April 24, 2014

  • sr-NSU-Earth-day.jpg NSU students observe Earth Day

    Students and members of the community converged on Northeastern State University’s Second Century Square on Tuesday to spend an afternoon celebrating Earth Day.
    The event featured tables sponsored by campus organizations, prizes and music by Chris Espinoza. NSU’s Earth Day theme was “Gather Here. Go Green,” and was organized by the Committee for Sustainability and the Northeastern Student Government Association (NSGA).

    April 23, 2014 1 Photo

  • ts-smallholders-courtesy.jpg Rural smallholders host annual show

    More and more, many people are showing growing interest in learning the sources of their food, including meat. As such, interest in farm-to-table living is increasing.
    Saturday, the Rural Smallholders Association held its annual spring show at the Cherokee County Fairgrounds, promoting the farming of sheep and goats, along with giving the general public a sample of their products.

    April 23, 2014 1 Photo

  • pitts-hurley.jpg Wanted man nabbed during traffic stop

    Cherokee County sheriff’s deputies arrested a wanted man this week after a traffic stop near South Muskogee and Willis Road.
    Hurley D. Pitts, 40, was being sought by authorities on a motion to revoke a previous sentence.
    Sheriff’s Deputy Jarrick Snyder said he stopped a car after it ran off the road a couple of times. A woman was behind the wheel, and Pitts was sitting in the passenger seat.

    April 23, 2014 1 Photo

  • SR-Wikafile.jpg Communiversity Band performs Sunday

    Musicians from on and off the Northeastern State University campus have made their final preparations for an upcoming performance of the NSU Communiversity Band.
    The ensemble performs Sunday, April 27, at 7 p.m., in the NSU Center for the Performing Arts. The conductor is Dr. Norman Wika, associate professor of music and band program director. Guest conductor is student Kameron Parmain. Admission is $5 for adults and $3 for students and seniors.
    “Everything has come together very well this semester,” Wika said.
    “We have about 40 musicians, and everyone who started the rehearsals has stuck with it. This could be the best Community Band concert yet.”

    April 23, 2014 1 Photo

  • Council concerned over reports of land contamination

    Negotiations involving the purchase of nearly 20 homes on 7 acres of land near Basin Avenue hit a snag Monday night when concerns surfaced over potential contamination of the area.
    Tahlequah Mayor Jason Nichols had proposed the city purchase the homes and duplexes as a large step in a greenbelt project, which would establish a solid park and trail system from the downtown area to the site of the city’s old solid waste transfer station.
    Until Monday, details of the negotiations had been mostly discussed behind closed doors, though Nichols confirmed the list price for the property to be $480,000.

    April 23, 2014

  • Council tables cell tower permit apps

    Tahlequah city councilors on Monday opted to hold off on approval of two special-use permit applications that would help AT&T install a couple of 150-foot cell towers within the city.
    Branch Communications is asking for the permits as it attempts to construct two monopole cell towers – one on Commercial Road near Green Country Funeral Home, and another at the Tahlequah Public Schools bus barn on Pendleton Street. Other towers are being built outside of the city limits.
    Members of the city’s planning and zoning board gave their OK for both permits last month.

    April 23, 2014

Poll

How confident are you that the immunizations for infants and children are reasonably safe?

Not at all confident.
Somewhat confident.
Relatively confident.
Extremely confident.
undecided.
     View Results
Tahlequah Daily Press Twitter
Follow us on twitter
AP Video
Raw: Obama Tours Gyeongbok Palace Swimmer Michael Phelps Back in Competition Raw: Obama Lays Korean War Memorial Wreath Obama Leads Naturalization Ceremony in Seoul Calif. School Bus Crash Hurts Driver, 11 Kids Country Club for Exotic Cars Little Science Behind 'Pollen Vortex' Prediction US Proposes Pay-for-priority Internet Standards Wife Mourns Chicago Doctor Killed in Afghanistan FDA Proposes Regulations on E-cigarettes Kerry Warns Russia of Expensive New Sanctions Mideast Peace Talks Stall on Hamas Deal Cody Walker Remembers His Late Brother Paul Grieving South Korea Puts Up Yellow Ribbons Raw: Kerry Brings His Dog to Work Raw: Girls Survive Car Crash Into Their Bedroom Three U.S. Doctors Killed by Afghan Security Yankees' Pineda Suspended 10 Games for Pine Tar Colleagues Mourn Death of Doctors in Afghanistan Ukraine Launches Operation Against Insurgents
Stocks