Dr. Yvette Roubideaux, U.S. Director of Indian Health Services (AP Images)

IHS Advocates Optimism Despite Uncertainty About Affordable Care Act

Carol Berry
10/18/12

The Indian Health Service (IHS) and its clients face some uncertainty with the advent of the Affordable Care Act (ACA) and federal belt-tightening, but continuation of services—even their expansion—is part of the IHS’ anticipated future, said Yvette Roubideaux, IHS director, a member of the Rosebud Sioux Tribe.

IHS’ fate is “important, because children and youth depend on us to make the right decisions, to do the right things and to fight the fights we need to fight,” she told attendees of the 29th Annual Consumer Conference of the National Indian Health Board (NIHB) in Denver, September 24-27. Yet, “what can we control in the face of all this uncertainty?” she asked.

Across-the-board budget cuts January 2, 2013 could leave the IHS vulnerable to a major reduction of 8.2 percent under a government-wide measure in which “everyone is at risk,” although “the administration is willing to work with Congress to make sure this doesn’t happen,” she said.

Further cutbacks would curtail a budget that “is not enough to meet the need,” despite a 29 percent growth in funding over the last four years, Roubideaux said.

The president’s 2013 budget request for IHS is $4.422 billion, an increase of $115.9 over the 2012 enacted level, including funding to support activities identified by tribes as priorities: increases in contract health services, funding contract support costs shortfall, and addressing health information technology and facility maintenance, according to material submitted to appropriations committees.

There are “many strengths in Indian country,” Roubideaux said, and IHS is making tribal partnership a priority through regular meetings, better coordination, and meetings with tribes. Although the “federal government doesn’t have a good history in Indian communities,” it’s making changes in a stronger government-to-government relationship, she said.

“Self-governance is the future of the Indian Health Service,” she said, because “tribes know best what they should do for their communities.” Self-governance could include some tribes’ decision to operate their own health systems, but it could also mean that tribes ask the government to run its programs under direct service “as long as tribes make that choice.”

The future may also witness greater recognition of community impacts, depending on how we think about health care, Roubideaux said, citing the example of a patient discharged after hospitalization to a family “that might not be a well family,” possibly with substance abuse or mental health problems. Serious diseases like cancer or diabetes could have poorer outcomes in families “that have their own issues.” She said that IHS will seek ideas and solutions from communities themselves.

The IHS is “not ever going to be perfect,” she said, but internal reforms are underway, including a reduction in long waiting times and making it possible for patients to see the same doctor each time they come in for care. Other measures include the use of “secret shoppers” to check on the quality of patient care, enhanced customer service, better business practices, improved hiring processes, and increased supervisory training.

Improvements include the Special Diabetes Program for Indians’ rate of diabetes control, which recognizes that “some of the things we were doing 100 years ago were right,” especially a healthy diet and physical activity, she said.

Roubideaux listed other program accomplishments, including increased mammographies, depression testing and suicide prevention.

The IHS is “here to stay,” she concluded.

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