Sick of It
Confusion and infighting addles the Native American health care system. But some groups are ready for change.
Navida Johnson's not sure how her $650 hospital bill ended up in collections. On Veteran's Day in November of last year, she had to take her ill 14-year-old son to the hospital. Indian Health Services (IHS) wasn't open so she went to UNM Hospital. To get the bill taken care of by IHS, Johnson says she knew she had to give IHS notification of her hospital visit within the following 48 hours. "Which I did," says Johnson. "I was following everything they told me."
A month went by. Johnson applied for Medicaid and was denied. She left IHS three more voicemail messages. So she went to the offices, she says. They told her she needed to apply for health coverage through UNMH. She did and again was denied, her income barely exceeding the limit. A month ago, she says she was told by IHS, "We have proof you've been denied. We're going to take care of it.” Last week she got a call from UNMH notifying her that the bill had gone to collections.
People that might have a heart condition get disgusted with the system and just don't go, because they feel they're not going to get good services or it's too hard to get services.
Sonny Weahkee, executive director of the Sage Council
Not knowing how the billing is going to work or even where one is supposed to go for health care are problems that are turning Albuquerque-dwelling Native Americans from medical help altogether, says Sonny Weahkee, executive director of the Sage Council, a nonprofit advocacy group. "People that might have a heart condition get disgusted with the system and just don't go, because they feel they're not going to get good services or it's too hard to get services," Weahkee says. "Their health condition just piles up on them. A lot of people that should be seeing doctors on a regular basis don't."
The Sage Council has spent plenty of time knocking on doors and calling Native Americans every year for elections since 2002. A survey by the council found, by far, the No. 1 issue for the community in Albuquerque is health care, he says.
That's why Weahkee helped lobby for a bill that would create a commission representing urban Native Americans on the health care issue. It's the first bill Rep. Mimi Stewart passed unanimously in the House and in the Senate, he says.
Johnson wound up getting some health care coverage through her job, though she still has a bill from UNMH in collections. But, she says, there are many urban Native Americans who can't afford health care or whose jobs don't offer insurance options.
Two deals, one with the federal government and one with UNMH, should provide Native Americans health care, says Roxane Spruce Bly, coordinator for the Native Health Care Council of New Mexico. In exchange for land, the federal government obligated itself to provide health care, among other things, to Native Americans. "That never changed," says Bly. "In exchange for those lands, those services must be provided."
The second contract with UNMH allows the hospital to use the tribal lands it's on. Steve McKernan, CEO for UNMH, responded to Alibi questions regarding specific provisions of the contract, which requires 100 beds for Native Americans and an outpatient department.
"Because of the lease, UNMH has a special relationship with our Native Americans and consistently works with Native American leaders to meet the changing needs of the people of the nations, tribes and pueblos who rely on UNMH for health care," McKernan wrote in an e-mail. "The recent expansion at UNMH has helped to increase the hospital's capacity; however, we still face challenges as the needs also grow."
More People, Less Cash
Linda Stone is the executive director of the First Nations Community Health Source in Albuquerque, serving urban Native Americans since 1972. Stone says the number of Native Americans migrating to the city is increasing, but health care funding isn't. Though her clinic sees about 650 patients a month, including 10 walk-ins a day, it isn't enough, she says. "There's a shortage in terms of the services that are offered."
Bly says despite the land-for-services deal, the Indian Health Budget is discretionary, not an entitlement program like Medicaid or the Veteran's Administration. "It's funded at the discretion of Congress, and it's always been really tight," she says. "But with the current administration and a lack of resources directed toward domestic programs, the shortfalls are huge." Indian Health Services (IHS), from which Stone's clinic gets some of its funding, only receives about 54 percent of the money it needs, according to Bly.
The federal government spent $3,242 on health care for each federal prisoner in 2006, according to a report compiled by advocacy groups in Albuquerque using data from the U.S. Department of Health and Human Services, IHS and other sources. In contrast, $2,130 per person is spent on health services for on-reservation Native Americans, and about $310 per person is spent on "Urban Indian Health Programs."
Fighting Over a Small Chunk
Keith Franklin, president of the Albuquerque Metro Native American Coalition, says there's a lot of fighting among the tribes and urban Native Americans over the small chunk of change the federal government doles out. Sometimes, he says, urban-dwellers with certain conditions are referred from IHS to tribal clinics. But since they haven't lived on the reservation for years, the tribal clinics don't want to treat them either. "Then you're in a Catch-22," he says. "You can't go anywhere."
Norman Ration, executive director of the National Indian Youth Council, agrees. "The concern the reservation has is if we [urban Native Americans] get funded, the reservation loses funding." Tribal governments are concerned with caring for the people of their tribe, Ration says. He and Franklin are trying to get money for all Native Americans, regardless of where they live, he says. Instead of fighting over a trifling sum, why doesn't everyone get together and try to get more? he asks. "We haven't been smart enough to say, OK, let's sit down and bury the hatchet. So what if you don't like me and I don't like you? We've got people to take care of."
Go to alibi.com to see Part I of this two-part Native American health care series.