"Role of Insurance in Indian Economy"
Lack of Health Insurance Coverage for American Indians Melissa Gower Group Leader for Health Services Cherokee Nation Defining “Insured” • The U.S. Census Bureau’s Current Population Survey (CPS) is the most commonly used data source for estimating the rates of health insurance coverage nationally and across states • According to the CPS, individuals who report Indian Health Services (IHS) and no other coverage are classified as uninsured. Why is an American Indian’s eligibility to access health care through the IHS, Tribal health facilities, and Urban Indian health facilities not considered insurance? Indian Health Service (IHS) • IHS is charged with the Federal Government's obligation to provide health services to American Indians and Alaska Natives (AI/AN) • Currently, the IHS provides health services to approximately 1.9 million AI/ANs belonging to over 557 federally recognized Tribes in 35 states • According to the 2000 U.S. Census, AI/AN alone or in combination with one or more other races population exceeds 4.1 million Why does the IHS provide services to less than ½ of the AI/AN population? • Inadequate funding - IHS funding is discretionary and competes with all other discretionary programs – national defense, emergency preparedness, etc. • The per capita personal health care expenditures for the IHS population are significantly less that the general population (In 2003, $1,914 compared to $5,085). The Oklahoma City Area receives only $976 per capita, which represents only 44% of the actual need according to the Federal Disparity Index • As a result, services are very basic and limited, extremely long waiting periods for appointments, reduced hours of operation, inadequate staffing, lack of facilities, overburdened facilities Why does the IHS provide services to less than ½ of the AI/AN population? • Geographic Limitations – Because of limited funding, facilities are typically located in areas with high AI/AN populations (in turn causing the facilities to be severely overburdened) • A substantial number of AI/ANs do not live in close proximity to I/T/U facilities and/or do not have adequate transportation to reach the facilities, therefore it is not a viable option A Quick Scenario • An American Indian adult resides in Norman without private insurance and not eligible for Medicare, Medicaid • Closest primary care facility – over 26 miles • Closest hospital – over 70 miles A Quick Scenario • An American Indian adult resides in Enid without private insurance and not eligible for Medicare, Medicaid • Closest primary care facility – over 65 miles • Closest hospital – over 180 miles A Quick Scenario • An American Indian adult resides in Bristow without private insurance and not eligible for Medicare, Medicaid • Closest primary care facility – over 22 miles • Closest hospital – over 30 miles A Quick Scenario • An American Indian adult resides in Tahlequah without private insurance and not eligible for Medicare, Medicaid • Closest primary care facility and hospital – within city limits • However….. Proximity ≠ Available Services • Due to the lack of funding, services are limited • Specialty care is not readily available and funding is severely limited to seek specialty care through IHS contract health services (CHS) Cherokee Nation averages 316 CHS denials per month at an average of $431,000 Claremore Indian Hospital denied CHS 1,752 referrals in FY 2005 at an estimated cost of $6.6 million. South Dakota Perspective • Health Insurance Coverage in South Dakota: Final Report of the State Planning Grant (SPG) Program From a consumers’ perspective, the burden that American Indians face in attempting to secure needed health coverage and medical services (both on- and off-reservation) undermines public efforts to improve the health status of all South Dakotans in measurable ways Coverage and service problems identified through the SPG project’s focus groups and interviews include: • cumbersome process to establish eligibility for IHS Services; • provider shortages, limited facilities, and limited service capabilities in many areas; • consumer dissatisfaction with IHS health service quality and scope in many areas; • consumer and provider dissatisfaction with IHS contract health services requirements, typically necessitating long travel and waiting/access delays; • federal resources that are grossly insufficient to meet populations health care needs; • cumbersome intersection among IHS, Medicare, and other payers’ policies and regulations that inhibit timely delivery of care and payment for care received. • Zaniya Project Task Force Report Although American Indians are able to access care through the Indian Health Service, focus group participants were most critical of the extended wait times to access care and the substandard quality of care Minnesota Perspective • Minnesota Department of Health Fact Sheet Eliminating Disparities in the Health Status of American Indians in Minnesota Because of higher rates of poverty and economic insecurity, American Indians are less likely to have continuous health insurance, and as a result, less access to health care resources. 21.5 percent of American Indians lack health insurance, compared with 8.8 percent of the white population Health Service Access, Use, and Insurance Coverage Among AI/ANs and Whites: What Role Does the IHS Play? • AI/ANs lack insurance coverage at much higher rates than Whites, and efforts are needed to reduce these disparities in coverage • The IHS provides a valuable source of basic health care for some AI/ANs who lack coverage, but there are clearly gaps in preventive care that need to be addressed • IHS coverage varies widely among Indian health programs and should not be assumed to be equivalent to defined benefits packages of private insurance Source: Zuckerman et al., American Journal of Public Health, Volume 94, Number 1, January 2004 Health Insurance Coverage and Access to Care Among American Indians and Alaska Natives • The Indian Health Service is an appropriated agency and not an entitled benefit for all AI/ANs • In 1997 only 20% of AI/ANs reported having access to IHS • Just under half of AI/ANs have job-based health coverage compared to 72% of whites • The combination of lack of employment opportunities and low incomes, even in a growing economy, has limited AI/ANs ability to obtain health insurance • Uninsured AI/ANs, and even those with access to the IHS, are less likely to periodically see a physician than those with coverage Source: Henry J. Kaiser Family Foundation Issue Brief, February 2004 Questions/Comments? • Melissa Gower – firstname.lastname@example.org • J.T. Petherick email@example.com • Rachel McAlvain firstname.lastname@example.org