Role of Insurance in Indian Economy

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					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 –
    melissa-gower@cherokee.org
• J.T. Petherick
    jt-petherick@cherokee.org
•   Rachel McAlvain
    rachel-mcalvain@cherokee.org

				
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