Though it has lurked on the sidelines in the national health care debate, Indian Health Services is one instructive example of a government-run health system that, for all its faults, serves as a fraying lifeline for impoverished communities devastated by just about everything from diabetes to teen suicide.
The native health crisis might get some long overdue relief from Congress. Both the proposed overhaul legislation and the pending Indian Health Care Improvement Act could significantly expand in funding for services as well as infrastructure for the network of IHS clinics and hospitals. But history suggests that those hard-fought improvements could come at a steep political price, as culture wars have a funny way of turning native women’s bodies into a battleground.
IHS generally represents the resource gaps that plague government health programs, exacerbated by the dysfunction in the private health insurance system. As the New York Times reports, many in Indian Country must rely on private insurers rather than IHS, a system that consistently fails to deliver a decent level of care. Beefing up the government’s role wouldn’t be a cure-all, but it’s a start:
Proposed legislation would not give Indians everything they want, but the overhaul does include grants for preventive care and research. And the Indian Health Care Improvement Act, which stands a good chance of being reauthorized by Congress for the first time since 2001, would enhance programs, physician recruitment and hospital construction. Although it approves no funding, advocates hope it will prompt additional money.
Legislation to revamp IHS is coming up for debate this week. Lawmakers will discuss the bill on Thursday as part of a broader examination of Indian health issues, with a key hearing held by the Indian Affairs Committee.
While native communities have a big stake in health care reform, they’re also prone to becoming a political football. Last year, a Senate bill to strengthen IHS foundered when Sen. David Vitter injected a poison pill amendment specifically aimed at restricting access to abortion for native women. Vitter’s amendment could be seen as symbolic in that it replicated the language of the Hyde Amendment’s broad restrictions on federal funding for abortion services. That longstanding anti-choice policy disproportionately impacts all poor women.
Still, since the proposed amendment would codify Hyde in the IHS statute—and because native women suffer from huge health disparities and barriers to care, advocates argued that Vitter’s move would subject native women to an especially discriminatory, more permanent and restrictive version of Hyde. Vitter figured that in attacking abortion rights, there was no better place to start than one of the most medically disenfranchised groups of women in America.
In an interview with In These Times last year, Kitty Marx, legislative director of the National Indian Health Board, said that native communities, who had worked hard to move forward the IHS reform bill, were being used as political cannon fodder.
“[This] is an Indian healthcare bill — written by Indians for Indians,” she says. “If Congress wants to have a national debate on abortion, then have it on a national bill.”
Today, with the Stupak amendment polarizing Congress and the body politic, conservatives finally have a chance to hijack a national bill with the abortion question. Vitter’s earlier effort to expand Hyde didn’t make the headlines when it only affected native women. How will the public respond now that the impending abortion restrictions could slash reproductive rights for women nationwide? Still reeling from the bipartisan assault on abortion rights, the reproductive rights movement is scrambling to stay ahead of the anti-choice steamroller on Capitol Hill.
The Indian health system, intended as a public safety net but handicapped by political neglect, is a microcosm of everything that could go right—or wrong—with health reform. And just as the abortion issue threatened to undermine reform efforts for Indian health care last year, anti-choice groups have stuck a poison pill in the bodies of poor women of color across the country.
So now, the price of watered-down reform might be the loss of abortion access, or alternately, preserving what’s left of abortion rights may come at the expense of the entire health system. Either way, we know who’ll be left hurting in the end, and for native communities, it’s a familiar sting.
Image: Indian Health Services