By James Monteleone
Triplicate Washington Bureau
WASHINGTON The Yurok tribe is receiving roughly 40 percent of the aid it needs, but the level of funding hasn't changed since 2001 when Congress allowed the Indian Health Care Improvement Act to expire.
Last week, a bill reauthorizing the law unanimously passed the first of three committees necessary to send it to the House floor. The legislation must also receive Senate approval and President Bush's signature. Lawmakers have tried twice since 2001 to renew the Indian Health Care Improvement law, but both attempts failed.
Democrats are optimistic the bill will move forward this time, said Rep. Mike Thompson's aide, Anne Desmond Warden, but she declined to predict the final outcome. Thompson is a co-signer of the bill.
Although the legislation expired six years ago, Congress has continued to fund the health programs at the same level. But the new bill does not change what critics call an unfair provision: States with large concentrations of American Indians receive more money than those that have greater overall numbers.
"There are all sorts of improvements in terms of providing direction and oversight to the (Indian Health Service) in the health bill and there's a real need to pass it this Congress," said Jim Crouch, executive director of the California Rural Indian Health Board.
Even if this legislation does not result in increased money for tribal health, Crouch said, it is important that Congress reauthorize the measure to lay the groundwork for better funding in the future.
The disparity in allocation of federal money has left California without any fully funded Indian Health Service hospitals. Consequently, aid money goes for routine treatment like blood tests and X-rays, rather than the specialized care that is intended.
While there are more American Indians in California than in any other state, some states in the Southwest have 16 times the population density.
"We have a bigger gap to make up," said Jerome Simone, CEO of United Indian Health Services Inc., which runs clinics in Del Norte and Humboldt counties, including a facility in Crescent City. "We've always had to be very aggressive to maximize every dollar we get."
Unlike federally funded facilities, United Indian Health Services looks to private sources to foot the bill, including the tribes themselves. "We go to other federally operated places and they just take what they get for granted," Simone said.
In addition to the lack of well-financed facilities in California, the state's tribes receive only half the amount of money for specialized care as those in states with Indian Health Service hospitals and clinics.
"We don't have the hospitals with the labs and X-ray equipment, etc.," Simone said. "So not only do we get less money but then we have to use it not just for critical cases, but for hospitalization, X-rays and lab work."
The health care program for American Indians, begun by Congress in 1921, differs from other health benefits because its funding is discretionary, compared with "entitlement" programs like Medicare, where government funds are guaranteed.
"One is on a whim of Congress, the other is on automatic pilot," Crouch said.
During the Natural Resources Committee consideration of the bill last week, Rep. Don Young, R-Alaska, brushed off criticism by fellow lawmakers of the formula for apportioning funds.
"I do not apologize for the disparity," Young said bluntly.
The California Rural Indian Health Board, which favors reauthorization, is concerned that arguments over the formula for distributing funds could sink the bill, Crouch said.
But congressional reauthorization is not the final step; appropriating funds is a separate process.
"Both pistons have to hit or this little two-cylinder-engine doesn't go far," he said.