Decision on Obamacare bodes well for Indian Country

By Cindy Yurth
Special to the Times

WASHINGTON, D.C., July 5, 2012

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T he Obama Administration weren't the only folks celebrating the U.S. Supreme Court's recent decision to uphold "Obamacare."

In a 10th-floor office on First Street within sight of the capitol, a handful of Navajo Nation staffers were breathing a sigh of relief.

"If the (Affordable) Health Care Act had been thrown out, it would have meant starting over after 13 or 14 years of work," said Clara Pratte, executive director of the Navajo Nation Washington Office.

The reason, Pratte explained, is that the legislation included the long-awaited reauthorization of Indian Health Care Improvement Act, an overhaul of the Indian Health Service that authorizes programs addressing health professional shortages, dialysis services, urban Indian health, Indian veterans and behavioral health, among other things.

"We all thought at least parts of the act would be shot down, and the best we could hope for would be that the parts concerning the IHS would be preserved," Pratte said. "Much to everyone's surprise, they upheld the whole act."

President Ben Shelly and Vice President Rex Lee Jim joined a chorus of Native American leaders praising the court decision, with Shelly calling it "a victory for Indian Country."

And, when it comes to health care, there was more good news, Pratte reported in an interview with the Times on Monday.

The IHS has awarded funds for a feasibility study on whether the Navajo Nation can establish its own Medicaid program on a par with those of the states.

If the study turns out positive, the nation could start to assemble a program to fund health care for its neediest citizens. Currently, Pratte said, the nation is reliant on the three states it straddles, adding a layer of bureaucracy between poor Navajos and their medical care.

"It's just the start of a long process, but this is really good news," she noted.

In a similar vein, the IHS and the U.S. Department of Veterans Affairs have begun consultation on a possible memorandum of understanding that would allow the VA to reimburse the IHS for health care provided to Native American veterans who seek care at a facility on a different tribe's reservation.

"The way it is now," Pratte explained, "if you're a Navajo veteran living on the Pine Ridge reservation, and you go to the Pine Ridge IHS, you have a hard time getting the VA to pay the Pine Ridge IHS for your care. They would probably tell you to go to Albuquerque or some place."

But "We live in a modern age, where a lot of people are intermarrying and moving to their spouse's reservation," Pratte said. "Both the VA and IHS are funded with federal money, so it doesn't make sense to restrict where Native American veterans can go for their health care."

On the Navajo Nation, with VA clinics few and far between, veterans will often choose to go to the IHS instead - and are sometimes referred to the VA facilities Albuquerque or Prescott, Ariz., to make sure the VA foots the bill.

If the negotiations go well, it's possible even non-Native veterans living close to an IHS facility could use its services rather than seek out the nearest VA clinic.

The catch would be that IHS facilities contracted to a certain tribe for health care - for instance, the Tsehootsooi Medical Center in Fort Defiance - could elect to opt out of the MOU.

Health care is a bright spot in an otherwise frustrating legislative session for Native American lobbyists (see accompanying story).