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Dorgan outlines health care benefits for tribes
30 March 2010

ADDRESSING TREATY AND TRUST OBLIGATIONS: North Dakota U. S. Senator Byron Dorgan met with North Dakota tribal leaders March 31 at United Tribes to outline the benefits for Native Americans contained in the nation’s health care reform legislation passed by Congress and signed by President Obama earlier this year. The new law “will begin to provide Indians with what was promised but never given,” said Dorgan. “First Americans cannot continue to have second-class health care.” Tribal leaders praised Dorgan for his leadership in getting the law enacted, from left: David M. Gipp, United Tribes Technical College president; Richard Marcellais, Turtle Mountain Band of Chippewa tribal chairman; Charles W. Murphy, Standing Rock tribal chairman; Myra Pearson, Spirit Lake tribal chairwoman; and Marcus D. Levings, Three Affiliated Tribes chairman. Also present was Councilman Delbert Hopkins of the Sisseton/Wahpeton Oyate.

How the Patient Protection and Affordable Care Act will help Native Americans
North Dakota U. S. Senator Byron L. Dorgan, Chairman of the Senate Committee on Indian Affairs, provided the following explanation for how national health care reform strengthens and improves health care for Native Americans.

Byron Dorgan

     The Federal Government has a treaty and trust responsibility to provide health care services to Native Americans. The Indian Health Care Improvement Act, which provides the key authorization for these services, has not been updated in over 17 years.
Native Americans suffer from health disparities significantly higher than the general U.S. population. For example, Native Americans die from diseases at rates much higher than the general population - tuberculosis (600 %), alcoholism (510%) and suicide (72%) - and the Native American infant mortality rate is 12 per 1,000 persons compared to 7 per 1,000 persons for the general population. In addition, Native Americans experience the highest rate of youth suicide and type II diabetes of any group in the U.S. Further, the Indian health system experiences high vacancy rates in health care providers: 26% for nurses, 24% for dentists, and 21% for physicians.
The Patient Protection and Affordable Care Act, includes the Indian Health Care Improvement Reauthorization and Extension Act, which permanently reauthorizes the Indian Health Care Improvement Act, and strengthens and improves health care for 1.9 million Native Americans across the country. The Act will also reauthorize Native Hawaiian health care programs through 2019.

     Following are examples of how the Patient Protection and Affordable Care Act (the Act) will improve health care for Native Americans:


Recruitment and Retention of Health Care Providers

  • The Act increases the ability of Native communities to recruit and retain health care professionals by updating the scholarship program.
  • The Act makes necessary updates to the Indian Health Service scholarship program.
  • The Act exempts health care professionals, employed by a tribally operated health program from state licensing requirements within the boundaries of the Reservation, so long as the professional is licensed within the United States. 

Health Care Facilities

  • The Act authorizes the transfer of funds, equipment, or other supplies from sources such as federal or state agencies, for use in construction or operation of Indian health facilities.
  • The Act establishes demonstration projects that provide incentives to use modern facility construction methods, such as modular component construction and mobile health stations, to save money and improve access to health care services.

Modernize the Indian Health System

  • The Act includes demonstration programs to promote new, innovative models of health care which are tribally driven and will improve access to health care for Native Americans.


Cancer Screening

  • The Act authorizes the IHS to provide cancer screenings beyond mammographies, as law currently limits.

Long-Term Care

  • The Act authorizes Indian health programs to provide long-term care, including home health care, assisted living, and community-based care.

Behavioral Health and Suicide Prevention

  • The Act will establish mental and behavioral health programs beyond alcohol and substance abuse, such as fetal alcohol spectrum disorders, child sexual abuse prevention, and domestic violence prevention programs. It will also expand the American Indians into Psychology program.
  • The Act authorizes comprehensive youth suicide prevention efforts, by streamlining the Substance Abuse and Mental Health Services Administration (SAMHSA) grants for Indian youth suicide prevention; authorizing tribal use of pre-doctoral psychology and psychiatry interns; creating an Indian youth tele-mental health demonstration project for Native American communities to use for technology efforts to enhance mental health and prevent youth suicides; and creating a demonstration project for a youth suicide prevention curriculum programs in schools serving Indian youth.


The Act also authorizes:

  • Expanded program authority for Urban Indian Health Programs by establishing behavioral health or mental health training, drug abuse prevention programs, and communicable disease prevention programs for urban Indian organizations;
  • Updates for tribal epidemiology centers, granting the centers more access to data in order to properly track the health status of Native Americans;
  • Expansions to chronic and infectious disease initiatives, by expanding the programs from only tuberculosis to all communicable and infectious diseases;
  • Enhances coordination between the IHS and Department of Veterans Affairs so as to improve the health care provided to Native American Veterans;
  • Allows certain Indian tribes and urban Indian organizations to purchase coverage for their employees from the Federal Employees Health Benefits Program, and also authorizes Indian tribes to use IHS dollars to purchase health benefits coverage for beneficiaries; and
  • Many other important expansions to improve the Indian health care system.


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