WASHINGTON — The Senate is expected to begin its 2008 session this week with work on legislation to modernize Indian health care, and Sen. Tom Coburn said he plans to make it a battle. Some lawmakers and Indian tribes have been pushing for years to pass a bill renewing the Indian Health Care Improvement Act, but have run into numerous obstacles. Sen. Byron Dorgan, D-N.D., chairman of the Indian Affairs Committee, said last week, "it's long past the time this (bill) should have been done.” Coburn, R-Muskogee, a physician, has been critical of the overall quality of service provided by the Indian Health Service and is among the senators who have blocked consideration of the legislation. But he has pledged not to hold it up this week. Senate Majority Leader Harry Reid promised Dorgan, the author, that it would be the first legislation scheduled when the Senate returns to work on Tuesday. Coburn said in an interview last week he plans to offer several amendments aimed at improving the bill but he hasn't had a chance to finalize them. "We're going to have a pretty good battle on Indian health care,” he said, adding, "I'll lose.” Regarding the circumstances of the Indian Health Service, Coburn said, "I see inefficiency, I see poor outcomes, I see less than the standard of care. "If we're promising health care to Native Americans, we should deliver it.”
Care called ‘second-rate'The Indian Health Service is responsible for providing care to 1.8 million American Indians and Alaska natives in 35 states. The agency is divided into 12 area offices; the largest is the Oklahoma City area office, which has responsibility for about 280,000 American Indians in Oklahoma and parts of Kansas and Texas. The Oklahoma City region includes seven Indian hospitals and 40 outpatient health centers. Some are run by the agency, while others are run by tribes with IHS funding. Last year, the health service opened a new center in Clinton and completed work on a major addition to the Indian hospital in Lawton. Coburn said the care in Oklahoma is probably better than in other, more remote areas where it is difficult to attract trained doctors and nurses. But he said competition needs to be introduced where feasible so Indians can choose where they want to get their care. He said he didn't want Congress to pass a bill that continues providing "second-rate” health care while lawmakers claim they are helping. Dorgan on Friday said he had talked to Coburn numerous times about the need to reform the Indian Health Service. Dorgan said he agrees that's necessary and that he would support Coburn's efforts. But he said the first step is renewing the law under which health care is provided to American Indians. He took issue with Coburn's position that the bill continues the status quo, saying it would expand services like cancer treatment and diabetes prevention, authorize hospice care and launch efforts to make clinics more accessible to Indians. "This is one step,” he said. "The other step is to fix what's wrong with the Indian Health Service” and secure adequate funding for Indian health care. He said it has been "like pulling teeth” to get Indian Health Service officials to say how much money is needed to provide the level of health care that is promised under the law. He said Dr. Charles W. Grim, the Oklahoman who ran the health service from 2003 until late last year, told him only about 60 percent of the health care needs are being met. "What that says is there's full-scale health care rationing for American Indians,” Dorgan said. "It is an outrage.” The bill does not authorize major increases in money for the Indian Health Service, which many say is chronically underfunded. However, it does call for a national commission to study how best to provide and finance Indian health care. Congress approved a 2008 budget of $3.3 billion for the Indian Health Service, which includes $374 million to build or improve facilities. That is an increase of about $200 million over last year's agency budget. Coburn said the agency was "resource poor and overcommitted.” Coburn said he wasn't advocating abolishing the agency but that it needs to be part of a comprehensive overhaul of the entire U.S. health care system. The legislation has drawn some objections from the Bush administration, including a Justice Department concern that a program for "Urban Indians” could lead to constitutional questions if they're not members of a recognized tribe. The Justice Department has also raised concerns about liability if the care didn't conform to standard medical practices. But H. Sally Smith, chairman of the National Indian Health Board, and Joe A. Garcia, president of the National Congress of American Indians, said it was time to pass the bill. "For nearly a decade, tribal leaders have been working to reauthorize the bill that serves as the underlying authority for the federal government's responsibility to provide health care to American Indians and Alaska natives,” the two said in a joint statement. "We have worked on this bill for years. It has been negotiated, amended, revised, wordsmithed and compromised. It is now in the hands of Senate leadership and we want them to move the bill.”
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