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Health
Senate committee to examine contract health services


The leader of the Senate Indian Affairs Committee is asking tribes for input on an upcoming hearing that will address the contract health services program.

The Indian Health Service uses the program to pay outside providers for care that it cannot provide at its facilities. But tribal people have discovered that the money runs out quickly, leading to the now common refrain -- "Don't get sick after June."

As a result, some Indian patients are forced to pay the cost of the services themselves and if they can't, their credit becomes ruined. In some cases, they go without the critical treatment they need.

Sen. Byron Dorgan (D-North Dakota), the chairman of the committee, says it's clear the contract health services program is "not working." During debate on the Indian Health Care Improvement Act and a measure to add $1 billion to the IHS budget, he described the case of Ardel Hale Baker, a North Dakota woman who felt first-hand the impacts of the funding shortage.

"So Ardel Hale Baker is having a heart attack, and she is wheeled into an emergency room with a piece of paper taped to her thigh that says: Oh, by the way, hospital, admit this woman, and you may not be paid," Dorgan said on March 12.

For fiscal year 2009, the Bush administration is seeking $588 million for contract health services, or $9 million above current levels. That represents an increase of just 1.5 percent, far below the rate of inflation.

Contract health services is part of the clinical services budget at IHS. Dorgan's $1 billion amendment, which was approved by the Senate on March 13 by a 69-30 vote, would go directly to increasing the amount of money available for the program.

"What do they say on Indian reservations? Do not get sick after June, because there is no contract health money," Dorgan said. "If you are going to get sick, it has got to be before June."

During his confirmation hearing, Bob McSwain, the acting director of the IHS, said the budget includes additional funds that will extend the life of the contract health services program. He also said he hopes to fill vacancies that will enable the agency to provide care instead of referring patients outside the system.

"We're looking at possibly getting the CHS funds to go all the way through August now," McSwain, a member of the North Fork Rancheria of Mono Indians of California, told the committee.

"Well, that's good, but that gets you through August," responded Sen. Lisa Murkowski (R-Alaska), the vice chair of the committee.

"We're moving the ball," said McSwain, whose confirmation is still pending before the committee.

"I think we celebrate the success when we're able to provide for the level of health care services year-round," said Murkowski.

Relevant Documents:
Sen. Dorgan Letter | HHS Budget in Brief

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