After weeks of secret negotiations, Republicans in the Senate finally released their "Better Care" health reform bill. But where does Indian Country fit in?

The New York Times asked readers for their views on the controversial proposal and Dina Gilio-Whitaker, a citizen of the Colville Tribes, points out that the bill doesn't mention the Indian Health Care Improvement Act at all. She told the paper: "[I]t is like a big black hole for American Indians, and that can’t be good."

In May, Republicans in the House passed H.R.1628, the American Health Care Act. The bill repeals key portions of the Affordable Care Act, otherwise known as Obamacare, but it does not affect the Indian Health Care Improvement Act.

Both the Senate and House versions, though, make significant changes to the Medicaid program in a way that would reduce revenues for the Indian Health Service, which is already severely underfunded. Gilio-Whitaker notes that the the federal government spends more money per capita on prisoners than for the first Americans.

Gilio-Whitaker's full remarks in the paper's editorial follow:

As an American Indian, I have access to an amazing health plan that has a zero deductible, no maximum and zero co-pays. It’s reasonably affordable, although the cost has escalated over the few years I’ve had it.

American Indians have a right to receive medical care under the treaties our ancestors made in exchange for land. Asking American Indians to purchase an insurance plan, however good it is, is asking them to pay the government to live up to its treaty obligations. Plus, the Indian Health Service has never been adequately funded, so the standard of care is less than that for federal prisoners.

The plan for American Indians and Alaska Natives was made possible by the permanent reauthorization of the Indian Healthcare Improvement Act under the A.C.A. Nowhere in the new bill is the I.H.I.A. mentioned, so it is like a big black hole for American Indians, and that can’t be good. I’ve gone most of my life without health insurance as a self-employed artist and writer. My insurance under the A.C.A. has allowed me to attend to lingering but minor health issues I’ve had for years. The A.C.A. saved my sister’s life in December after she suffered a brain aneurysm, providing access to excellent medical help. At 59, I’m at the age where even though I’m in excellent health now, anything can happen.

Read More on the Story:
Editorial: If We Lose Our Health Care ... A Black Hole for American Indians (The New York Times 6/24)

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