How will Obamacare affect American Indians?

The question of the impact of Obamacare on Native Americans is rarely heard, but nonetheless very important. Photo: Indian Health Services

FLORIDA, June 21, 2013 — The Patient Protection and Affordable Care Act has hit more than a few snags as of late. 

From massively underfunded mandates to burdensome regulations for many business owners to certain doctor’s offices no longer accepting insurance programs, the PPACA is having serious difficulty living up to its name.


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For one demographic group, however, things seem to be especially perilous.

“[American] Indians have always been subjected to government-run health care,” pundit, composer, and academic David Yeagley explains. “It is all we have ever had.  And any Indian who has been involved or who has ‘partaken’ in Indian Health Services knows how extensive the complexity is, how frustrating the inefficiency, and how permeating a certain professional depression is among so many personnel who work in Indian clinics. 

“Indian Health Services has always been Obamacare on steroids.  IHS is the prototype of all bureaucratic nightmares.”

Yeagley is one of the most outspoken voices on American Indian-related issues today. A Doctor of Musical Arts by education, he is a direct descendant of Comanche dignitary Bad Eagle.


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“Interestingly,” he continues, “IHS is not part of the Bureau of Indian Affairs (BIA), but part of the Department of Health and Human Services.  (It includes American Indians and Alaskan Natives.  Why Alaskan Natives I don’t know.  They were never part of formative years of American history in which American Indians fought wars against the United States and won at least treaties, if we lost the wars.)   

“The annual budget for IHS  is $4.1 billion, for some 2.1 million American Indians. (The HHS budget for 2014 is well over $967 billion dollars, for the rest of Americans, including at least 30 million illegal immigrants, of course, or, some 316 million people living in America.)  The 2014 Bureau of Indian Affairs budget is $2.6 billion, as presented. 

“So, Indian health care (IHS) is on a separate budget, part of the Department of Health and Human Services, and it is nearly twice the budget of the BIA.  

“Obviously, this could forbode disaster for many Indians under IHS care.   Two recent AP reports have it that many people who have identified themselves as American Indians will not be identified as such under the new Obamacare….rules.  The AP May 13 report says thousands of Indians will no longer receive IHS care, unless they can demonstrate that they are “Indian enough” to qualify.  Otherwise, they will have to pay the IRS penalty of $695.

“In Oklahoma, says a May 15 AP story, the 39 federally recognized tribes comprise some 13% of the state’s population of 3.75 million.  That’s around 483,000 Indians.  But many of these self-identified Indians are not enrolled in any federally recognized tribe.  They will either have to enroll, or be cut from IHS.  They’ll have to buy their own insurance, even though they have been covered by IHS.

“Essentially, the numerous but small bands and tribes of Indians, nation-wide, that are not federally recognized (which number over a hundred) will be cut.  Many of them “popped up” in the last thirty years as casino tribes, and whose members have little if any Indian heritage at all.  But there are many groups recognized by states as Indians, and who have received benefits on that basis for decades.  Many people have taken advantage of the “Indian” identity through one means or another.  “Federal recognition” has become the key status at this point. 

“The fact that the IHS is not part of the BIA is a radical factor in the mix which no one mentions or seems concerned about.”

Despite government aid coming with more than a few strings attached, many individuals and communities are in dire need of it. 

American Indian reservations have long been subject to soaring rates of poverty and other socioeconomic ailments. It does seem that in spite of the PPACA’s plethora of problems, the legislation might stand to bring a great deal of American Indians some much-needed relief.

Is this actually the case?

“Right now….it doesn’t look like Obamacare….will bring any relief at all to Indian people,” Yeagley claims.  “The only effect will be the cutting off of resources to non-federally recognized tribes.  Remember, Indian Health Services is part of Health and Human Services, not part of the Bureau of Indian Affairs.   

“Will it mean that IHS then will have more money to work with?  Will they have more MDs to treat Indians?  Will services improve at all?

“I remember when Oklahoma Senator Tom Cole was here in Oklahoma City speaking on Indian health care.  He voted “Yes” on the Tribal Member Choice Program (S.B.1200), which allowed Indians to opt out of federal health care.  This was in February of 2008.  He spoke at Rose State College, and said there was more money absolutely wasted by Congress every year, and that even a portion of that wasted money could mean every Indian would have top level, private health care.  He well knew the inefficiently and poor quality of health care than came to Indians through the federal system.  

“Unfortunately, that bill was voted down, 28-67.  Democrat Senators representing states without Indian populations prevailed.  They wanted Indians on the federal program.   

“The massive bureaucracy of the IHS could only be further complicated by any connection to Obamacare.  There is no “Patient Protection” in IHS.  This operation is already controlled by the IHS “death panel.” If you’re lucky enough to have an actual M.D. as your caregiver in the Indian health system (rather than a Physicians Assistant.), that doctor is limited by the clinic system in which he works.  

“If there is a test that needs to be done, which his particular clinic does not provide, he can either order it to be done at another Indian clinic which happens to provide such a test, and which also may happen to be many hours away from where you live; or, he has to “refer” you to a specialist out in the real world—pending the permission of the IHS death panel in your particular region of the country.  

“These simple processes can take weeks, and months, and if you have a progressing disease or ailment, you are severely challenged.  If you have health problems other than diabetes or obesity, you may be in for a slow torture, Indian style. 

“How will Obamacare improve any of this?  I don’t see it as any sort of solution to anything pertaining to Indian health problems.  Enrolled tribal members of federally recognized tribes will still be under Indian Health Services, not Obamacare.  Obamacare will only affect those Indians who are of groups not federally recognized, or who never enrolled themselves in such tribes.  

“There are, in fact a good number of Eastern Oklahoma Indians, who are Cherokee, or Choctaw, for example, who are descendents of these tribes, but neither they nor their ancestors ever enrolled.  They never trust the United States government. 

“I don’t think, however, that Obamacare can be said to be “narrowing” the definition of what it means to be Indian; I think it simply means to reaffirm the “federally recognized” definition.  I support that entirely, corrupted as the pop-up casino tribes have made it.” 

While much can be — and indeed is — said about the PPACA, so little of it is ever heard from an American Indian perspective. Support the legislation or not, hopefully we can all agree that it is an extremely complex matter and ought to be regarded as such.

Platitudes and slogans simply shall not suffice.


Far-left? Far-right? Get realRead more from “The Conscience of a Realist” by Joseph F. Cotto 




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Joseph Cotto

Joseph F. Cotto is a social journalist by trade and student of history by lifestyle choice. He hails from central Florida, writing about political, economic, and social issues of the day. In the past, he was a contributor to Blogcritics Magazine, among other publications. He is currently at work on a book about American society.

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