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American Indian Health Policy: Where Weve Been and Where Were Going Families USA Health Action 2010 January 30, 2010 Donald Warne, MD, MPH Oglala Lakota.

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Presentation on theme: "American Indian Health Policy: Where Weve Been and Where Were Going Families USA Health Action 2010 January 30, 2010 Donald Warne, MD, MPH Oglala Lakota."— Presentation transcript:

1 American Indian Health Policy: Where Weve Been and Where Were Going Families USA Health Action 2010 January 30, 2010 Donald Warne, MD, MPH Oglala Lakota Executive Director Aberdeen Area Tribal Chairmens Health Board

2 PANELISTS Donald Warne, MD, MPH, (Oglala Lakota), Executive Director, AATCHB Donald Warne, MD, MPH, (Oglala Lakota), Executive Director, AATCHB Jennifer Cooper, JD, MPA (Seneca), Legislative Director, NIHB Jennifer Cooper, JD, MPA (Seneca), Legislative Director, NIHB Cara Thunder, MPA, (Menominee), Director of Health Programs, AICH Cara Thunder, MPA, (Menominee), Director of Health Programs, AICH

3 OBJECTIVES Overview of: Issues in Health Law & Policy Issues in Health Law & Policy AI Health & Resource Disparities AI Health & Resource Disparities Impact of Healthcare Reform on American Indians Impact of Healthcare Reform on American Indians Role of IHS, Tribes and Urban Indian Health Programs Role of IHS, Tribes and Urban Indian Health Programs

4 AMERICAN INDIAN HEALTH POLICY Health Policy Defined: Do people have a legal right to healthcare in the US? Do people have a legal right to healthcare in the US? Nearly $2.5 trillion spent annually on healthcare in the US Nearly $2.5 trillion spent annually on healthcare in the US Over 45 million uninsured people in the US Over 45 million uninsured people in the US

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6 IHS Areas Albuquerque PortlandBillings California Phoenix Oklahoma Nashville Navajo Tucson Alaska AberdeenBemidji

7 INDIAN HEALTH SERVICE The Indian Health Service (IHS) is the principal federal health care provider and health advocate for Indian people The Indian Health Service (IHS) is the principal federal health care provider and health advocate for Indian people Its goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people Its goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people

8 AI HEALTH POLICY ISSUES Complexity of Health Policy in US Complexity of Health Policy in US Political Relationships with Federal & State Governments Political Relationships with Federal & State Governments Trust Responsibility & Entitlement Trust Responsibility & Entitlement Contract Health Services (CHSDA System) Contract Health Services (CHSDA System) IHS-Medicaid and Medicare Interaction IHS-Medicaid and Medicare Interaction Sovereignty & Self-Determination (PL 93-638) Sovereignty & Self-Determination (PL 93-638)

9 Government to Government

10 Indian Health System 1955-1975 IHSFederal

11 Indian Health System 1975-1985 IHSFederal PL 93-638 Tribal

12 IHSFederal Tribal MedicaidState AIHealthcareConsumer Indian Health System Health Sector

13 AI Health Disparities Life Expectancy in Years: MenWomenTotal U.S. 74.1 79.5 76.9 AAIHS63.5 71.0 67.3 Disparity:10.6 8.5 9.6 Median age of death in SD (2007): 81 General Population 59 AI Population

14 AI Health Disparities Death rates from preventable diseases among AIs are significantly higher than among non- Indians: Diabetes 208% greater Diabetes 208% greater Alcoholism 526% greater Alcoholism 526% greater Accidents 150% greater Accidents 150% greater Suicide 60% greater Suicide 60% greater Indian Health Service. Regional Differences in Indian Health 2002-2003

15 Diabetes Death Rates (Rate/Per 100,000 Population)

16 Alcohol Related Death Rates (Rate/Per 100,000 Population)

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18 Medicaid BH Carveout

19 Leading Causes of Death Ages 1-4 Death Rates Per 100,000 Population

20 Leading Causes of Death Ages 5-14 Death Rates Per 100,000 Population

21 AI Demographics Over 2 million American Indian Only in 2000 CensusOver 2 million American Indian Only in 2000 Census Over 4 million AI and other in 2000 CensusOver 4 million AI and other in 2000 Census >60% of AI people live in urban areas>60% of AI people live in urban areas Over 560 federally recognized AI/AN tribesOver 560 federally recognized AI/AN tribes

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23 AI Resource Disparities Per capita medical expenditures in 2005 federal budget: Indian Health Service $2,130 Indian Health Service $2,130 Medicaid recipients $5,010 Medicaid recipients $5,010 VA beneficiaries $5,234 VA beneficiaries $5,234 Medicare $7,631 Medicare $7,631 Bureau of Prisons $ 3,985 Bureau of Prisons $ 3,985

24 AI Healthcare Resource Disparities Bureau of Prisons

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27 Donald Warne dwarne@aatchb.com

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