American Indians Spared in Medicaid Cuts
May. 29, 2003
WARM SPRINGS, Ore. (AP) _ Lucy Gadberry cradled her broken arm in a sling, waiting for a doctor's appointment in the Warm Springs Health and Wellness Center.
For Wasco tribe members like Gadberry, medical care is a birthright, like their claim to the high desert land east of Mount Hood on the Warm Springs Reservation.
Medical insurance for Gadberry is guaranteed for the tribe by an 1855 treaty with the federal government. Tribal chiefs ceded 10 million acres, and in return were promised the 647,000-acre reservation and access to a government-paid doctor.
That treaty is why Warm Springs Indians say it's fair that they get separate _ and better _ medical treatment as Oregon slashes care for the poor.
Gov. Ted Kulongoski signed a bill Thursday creating the distinct standards for Indians under Oregon's state-subsidized health insurance for low-income residents. The law guarantees dental, vision, mental health and drug treatment for Indians, although 118,000 non-Indians lost those services March 1 because of cuts.
Tribes across the West struggling with a shortage of health care funds hope the Oregon measure sets a trend.
``There are some people who think the Native Americans are handed money, but it's not true,'' Gadberry said, sitting on an examination table in the clinic. ``If you to add up all the acres that we lost, we still weren't paid enough.''
Dealing with the worst fiscal crisis since World War II, many states are shedding Medicaid patients or restricting services, which is affecting Indian hospitals and clinics in 35 states, mostly west of the Mississippi.
It's making a dent in Indian health.
Some Indians have had access to free prescription drugs through Indian clinics. Now, some clinics have a residency requirement; those who live off the reservation or outside a certain area are turned away. And officials are trying to switch patients to cheaper generic drugs.
Waiting times have also become longer for appointments. At the Chemawa Indian clinic in Salem, nobody is turned away, but new patients can wait up to a year for a dental appointment. Russ Alger, director of the Warm Springs clinic, said addiction treatment centers are saving money by offering fewer services.
Medicaid, the nation's largest public health program for the poor, covers 25 percent of Indian health needs nationally, according to Elmer Brewster, a senior policy analyst with Indian Health Service in Washington. The IHS pays the rest.
It's unclear how much states' Medicaid-slashing policies are costing Indians, but the loss could reach many millions of dollars, Brewster said.
Medicaid for Indians doesn't cost states because the federal government reimburses them 100 percent for Indians and Alaska Natives. But under the 1965 Medicaid Act, state governments set the eligibility standards for all Medicaid recipients.
The Oregon bill protects 2,800 American Indians from cuts in Medicaid.
The Affiliated Tribes of Northwest Indians, an intertribal group, has endorsed Oregon's bill and is calling on other states to also create separate Medicaid standards for American Indians.
Washington state has a similar measure in the Legislature.
The Oregon bill hits a key issue in Indian health, because the federal government has increasingly relied on Medicaid as the instrument for upholding treaty health care promises.
Congress raises the Indian Health Service budget a few percentage points a year _ not enough to match 13 percent annual medical inflation, Alger said. Indian health clinics bill Medicaid for the difference, he said.
``The tribes feel there's a vast shortage of funds to meet their needs,'' he said.
The Warm Springs Health and Wellness Center is a source of pride for the tribe, Alger said. The brick building, decorated with ceremonial masks and photos of Wasco, Wala Wala and Paiute Indians dancing in traditional beaded buckskin, is furnished with modern equipment, he said. Its bay windows overlook rolling, grassy hills peppered with manufactured homes and horse pastures sweeping down to U.S. 26.
Ed Fox, director of the Northwest Indian Health Board, said tribal members see the Medicaid cuts as the government backing out of its promise.
``American Indians believe that the government has an obligation,'' said Fox. ``It's really a big issue for tribes.''
``By the way,'' he added, ``we'd be happy to take the land back if they want to drop the health care promises.''
On the Net:
Warm Springs Reservation: http://www.wstribes.org
Oregon Legislature: http://www.leg.state.or.us