Health Archives » Native Voice One

Pandemic

March 16, 2020 By Bob Petersen

There is nothing more important now than good science — and that means washing your hands often, staying at home and avoiding people.

This is Trahant Reports.

Our ancestors have faced smallpox, influenza, and war. Now our generation is looking at a pandemic that is disrupting our daily lives.

Things that we take for granted are on hold. Visiting friends, even family. Going to work. Or watching our favorite team or musicians.

The coronavirus spreads by contact, so when you meet someone who has the virus, they are likely to spread it. The math says that everyone who carries the disease will likely pass it along to at least two others. That’s a lot of people. And what makes this even more nasty is that you can spread this disease before you’re sick. So the idea of … if you are sick, stay home … is less relevant. We also know that coronavirus spreads more easily than the flu. Think of it as an infectious pneumonia.

Then the COVID-19 pandemic is new in so many ways, one that’s particularly dangerous for elderly people or those with chronic health conditions such as diabetes.

But the biggest concern is human behavior. Can we all adjust, quickly, so that we don’t spread it on? Can we stay home? Away from people? And this is the big one: Can we wait in line for medical help?

So we have been trained to go to the doctor when we are sick. We want to get fixed up as soon as possible. That’s normal.

Perhaps we even had contact with someone who tested positive.

Yet we should wait.

If we get sick, go to bed. Most people get fever and cough, sometimes fatigue or shortness of breath, and then recover in about two weeks. About 15 percent of the cases develop into pneumonia. The symptoms usually start slowly and often worsen as the illness goes on.

So if you are running a fever, experts say, assume that you have coronavirus. Stay home. Yes there will be a growing number of tests available but those should be reserved for patients who are high risk. Most of us should just go to bed and stay there until it passes.

The alternative is the entire medical system will be overrun and none of us will get the care we need.

This is not in our nature. We want to get healed. Now. But this is different. We should call the doctor — and even seek help if we can’t breathe.

This pandemic is different because we can control the outcome. We can shut down life — for a bit — and then limit the damage from this disease.

I am Mark Trahant.

Feeling the traveling bug? How COVID is affecting travel.

March 9, 2020 By Bob Petersen

The virus now known as COVID-19 wasted no time finding its way to Indian Country. And tribes, casinos, and other institutions are all coming with plans for the “what’s next?”

This is Trahant Reports.

Last week the Congress appropriated emergency dollars — some $8.3 billion — to fund the federal government’s response. The legislation includes funding for tribes and urban Indian organizations, “to carry out surveillance” and other control measures.

In the meantime, one of the first questions raised by a lot of tribal communities is about travel.

The Umatilla Tribe’s Wildhorse Resort and Casino reopened last week two days after it closed for deep cleaning after an employee tested positive for the virus. The deep cleaning took place at the casino, a movie theater, hotel, conference center, restaurants and children’s entertainment center.

This whole chapter is remarkable. The tribe’s management of this incident was brilliant. The government took immediate steps and closed down its operation. And when it reopened the process included an inspection and a certification from the tribal government.

This was sovereignty in action.

Of course every tribal government and organization is coming up with its own plans.

The National Indian Gaming Association for example said its annual convention and trade show will go on as scheduled, March 24-27, in San Diego. “We are following the suggestions of the U.S. and state public health guidelines as they are developing with regards to the COVID-19 virus,” the association said. It said it is taking a number of steps to protect attendees, ranging from additional hand sanitation stations to medical support onsite.

Other tribes are significantly cutting back on travel. The San Manuel Band of Mission Indians announced its Yawa Award Lunch was being postponed. And the Navajo Nation has decided to limit travel for employees.

On the other hand, a National Tribal Health Summit is still scheduled to begin March 17 in Omaha and it will kick off with a pre-summit listening session. That session is scheduled for 4 pm.

The Denver March Powwow in Colorado is still “moving forward” with their plans to celebrate their 46th annual powwow. They said they are not considering cancelling their event at this time.

The thing is … there is no right answer here. The fact is that virus has probably been out in the world for some time and it’s only now we are only now learning about its impact.

I am Mark Trahant.

Diabetes

July 1, 2019 By Bob Petersen

Delegates listen to a report on the progress of diabetes programs at the National Congress of American Indians midyear meeting in Sparks, Nevada. (Photo by Tsanavi Spoonhunter)

This is Trahant Reports.

Dr. Yvette Roubideaux took a quick poll last week from the podium at the National Congress of American Indians mid-year meeting in Sparks, Nevada.

“How many of you think we’ve made great progress with American Indians and Alaska Natives with diabetes? Raise your hand.”

A few hands went up. “How many think we still have more to do?”

Far more hands in the air, followed by, “how many of you think that diabetes is still a significant crisis in our communities?”

Nearly every hand went up.

For the record Roubideaux agreed with all three premises.

But the takeaway is this: Indian Country has made extraordinary progress on the diabetes front … even though there remains a long way to go before the disease is under control.

Indian Country still shows the highest rate of diabetes; Native Americans are twice as likely to get diabetes as other population groups.

But as Roubideaux said last week: The big picture is that we’ve seen amazing outcomes in the prevention and treatment of diabetes over the past 20 years. She credits the Special Diabetes Program for Indians as a key element.

The proportion of people with diabetes who are American Indians and Alaska Natives has not increased since 2011. This Roubideaux called “amazing results.”

She said there is a decline in diabetes-related mortality and the most exciting news is that complications are decreasing, specifically a 54 percent drop in kidney failure, according to the Centers for Disease Control and Prevention.

More than 300 tribes are engaged in diabetes education, exercise programs, or nutrition initiatives.

An issue brief by the U.S. Health and Human Services Office of the Assistant Secretary for Planning and Evaluation translated the data into “cost savings” for taxpayers through Medicare. Permanent kidney failure, also known as end-stage renal disease, is covered by Medicare.

“Under our relatively conservative assumption,” the agency observed, the overall reduction in kidney-related issues estimated an accumulated Medicare savings between 2006 and 2015 of $435.9 million.

At the NCAI conference, Dr. Roubideaux made that point that best practices do lead to better outcomes in diabetes prevention.

Not that many years ago Alaska Natives had the highest rate of juvenile carries disease — an epidemic of tooth decay — yet now because of prevention, education, and community engagement many communities are cavity free. Now imagine that same sort of outcome for diabetes. No doubt we have a long way to go … but it’s possible that the diabetes epidemic can be defeated, too.

I am Mark Trahant.

What Qualifies a Leader? The Nominee Director for IHS with Nominal Experience

January 8, 2018 By Bob Petersen

IHS Director Nominee, Robert Weaver

What qualifications are needed to manage (and possibly reform?) the Indian health Service?

This is Trahant Reports.

The Indian Health Service is Indian Country’s largest employer with more than 15,000 people on the payroll and many, many more people who work in health care for tribes, non-profits and other related agencies. The IHS budget is $6.1 billion. Yet it’s also the least funded national health care delivery system.

The Wall Street Journal published a story last week about the controversial nomination of Robert Weaver, the Trump Administration’s pick to head the Indian Health Service. The Journal raised questions about Weaver’s role at St. John’s Regional Medical Center in Joplin, Mo.

Weaver is a member of the Quapaw Tribe of Oklahoma.

These are the facts. Weaver will be the least educated director of the Indian Health Service ever. If confirmed, Weaver will the tenth permanent director. All but one prior to Weaver have been physicians, most with multiple degrees in public health, science, and health administration. Weaver is not a college graduate. His background is insurance. In a September 2016 profile in Native Oklahoma magazine he said his business saved the Quapaw Tribe more than $5 million a year.

The problem here is one of scale. He was owns a business where he can hire and fire at will. But at the Indian Health Service most of the key personnel decisions are made by folks in the chain of command. Sometimes even as a favor to a United States Senator. And firing? Just one such action could take up more time than the three years left in this administration.

And that’s the easy stuff. The agency’s operations are complicated by Congress, law, regulation, tribal relations, the Veterans Administration, Medicare, Medicaid, and private insurance.

To his credit, Weaver has been outspoken about the underfunding of the Indian health system. (My question: Will he say so again in his confirmation testimony?)

Perhaps the Indian Health Service should be led by someone with an insurance background. It would surely help if the agency could come up with a better funding model, including a mix of insurance funds. But it’s a complex organization and he would be managing jobs that he himself could not be qualified to run, such as a hospital administrator.

Just what are the qualifications necessary to run the Indian health system? I have a bias. I met some of the great physicians who ran the agency. I remember Emery Johnson’s passion and thoughtfulness about what IHS could be. So the standard for me, at least, is high.

Then the Trump administration likes the idea of shaking up government. And, appointing someone to run the IHS with a very different background, does just that.

We would do well to remember a phrase that medical doctors learn early in their training, First, do no harm.

I am Mark Trahant.

Children’s Health Insurance Program

November 27, 2017 By Bob Petersen

The Children’s Health Insurance Program expired Sept. 30. This federal program insures young people and pregnant women who make just enough money not to qualify for Medicaid (but can’t afford private insurance). The idea is to make sure that every child has the resources to see a doctor when they are ill. But unless Congress acts soon, some 9 million children will lose their insurance.

Congress has yet to reenact the Children’s Health Insurance Program and states will soon run out of funds to prop up the program. That will mean that thousands of American Indian and Alaska Native children will lose their health insurance. And, the result is the Indian Health Service will have to stretch its already thin dollars to try and cover a growing budget hole.

This is Trahant Reports.

The Children’s Health Insurance Program expired on Sept. 30. This federal program insures young people and pregnant women who make just enough money not to qualify for Medicaid (but yet who can’t afford private insurance). The idea is to make sure that every child has the resources to see a doctor when they are ill.

It’s hard to break down precise numbers because agencies lump funds from the Children’s Health Insurance Program or CHIP into overall Medicaid data. But we do know that the law worked really well.

We also know there are more than 216,000 Native children that have health insurance because of Medicaid and CHIP. Indeed, Native American children rely on Medicaid and CHIP at much higher percentages than other population groups. A study by Georgetown reported that 54 percent of American Indian and Alaska Native children were enrolled in Medicaid or CHIP as compared to 39 percent of all children. “Even though much progress has been made in extending Medicaid coverage to American Indians and Alaska Natives, the uninsured rate for American Indian and Alaska Native children and families remain unacceptably high,” the report said.

This is a big deal and here’s why: The Indian Health Service is a health care delivery operation that works best when insurance (third-party billing in government-speak) pays for the medical costs. Medicaid, CHIP, Medicare, and other third-party billing now accounts for 22 percent of the IHS’ $6.15 billion budget.

But if Children’s health is no longer funded (because Congress did not reauthorize the legislation) then the Indian Health Service will have to make up the difference. That means taking money away from other patients and programs. It will be a critical problem for clinics because by law dollars from third-party billing (or Medicaid and CHIP) remain local.
Alaska is the state most impacted by Congress’ failure to act because two-thirds of the children in the Native health system are covered by Medicaid or CHIP. Other states that will be hit: Montana, North Dakota, South Dakota, Washington, New Mexico, Oklahoma, North Carolina, and California.

Across the country, some nine million low- and middle-income children rely on CHIP for health coverage.

I am Mark Trahant.

Full funding for Indian Health under Sanders’ plan

September 19, 2017 By Bob Petersen

Last week Bernie Sanders introduced his version of health care reform, a plan he calls “Medicare for all.”

This is Trahant Reports.

Medicare for All is “where the country has got to go,” Sanders told The Washington Post. “Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way.”

Sanders’ bill has no chance in a Republican Congress.

Yet the Vermont Independent (who caucuses with the Democrats) is adding to the richness of the debate. He is showing a clear alternative to the many Republican plans, including the latest by Sens. Lindsey Graham of South Carolina, and Bill Cassidy, of Louisiana.

Indian Country should take note.

Sanders bill would fully-fund the Indian health system.

Let’s do the math. The current budget for the Indian Health Service is $6.091 billion dollars. And of that, roughly $1.2 billion will come from Medicaid, Medicare and other insurance. This serves about 2.2 million American Indians and Alaska Natives in 39 states.

So if Sanders’ proposal for universal care were enacted, every one of those 2.2 million patients would have funding from insurance. The national average for a Medicare beneficiary is $10,986. That total: $24.191 billion. A four-fold increase (and this does not even include appropriations, just insurance dollars). So if you include both, the total is roughly $30 billion.
This sound like an awful lot of money, right?

Yet that big number reflects what other health systems already spend. So actually it’s the ideal demonstration of just how underfunded the Indian Health Service is under current law. This is what a fully-funded Treaty Right looks like.

Of course some of this can be done now, even without Sanders’ bill. Many people in tribal communities are posting on Facebook exactly how to sign up for Medicaid (the government insurance program that so many in Indian Country already qualify for.) They are doing this as an act of defiance, because the Trump administration has recently quit advertising the program and is not actively promoting sign-ups.

So, again, let’s do the math. If every American Indian and Alaska Native was eligible for Medicaid that would net the Indian health system about $7.211 billion.
Either way, Medicare or Medicaid: This is what full funding looks like. And a Treaty Right fulfilled. I am Mark Trahant.