Lack of Health Insurance Coverage for American Indians

1
Lack of Health Insurance Coverage for American
Indians

• Melissa Gower
• Group Leader for Health Services
• Cherokee Nation

2
Defining Insured

• The U.S. Census Bureaus 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.

3
Why is an American Indians eligibility to access
health care through the IHS, Tribal health
facilities, and Urban Indian health facilities
not considered insurance?
4
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

5
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

6
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

7
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

8
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

9
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

10
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..

11
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.

12
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 projects 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

13
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

14
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

15
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

16
Questions/Comments?

• Melissa Gower
• melissa-gower_at_cherokee.org
• J.T. Petherick
• jt-petherick_at_cherokee.org
• Rachel McAlvain
• rachel-mcalvain_at_cherokee.org