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Progress Towards Better Healthcare for American Indians and Alaska Natives

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Yvette Roubideaux, M.D., M.P.H., Senior Advisor to the Secretary for American Indians and Alaska Natives

As I prepare to leave HHS, I’m reflecting on the tremendous gains we’ve made for the healthcare of American Indians and Alaska Natives. I joined the Indian Health Service (IHS) knowing that there was much work to do and there were no quick fixes available. Tribes wanted the federal government to uphold the responsibility for health care and honor their treaties and agreements. Health services patients wanted to get the healthcare they need and deserve and disparities were a burden on Tribal communities. The job certainly had its challenges.

Now, six and a half years later, these problems are not solved, but the progress is unmistakable.

During the Obama Administration, we worked with Congress to increase the IHS budget by over a third greater than what it was in 2008. The part of the budget for referrals, formerly known as Contract Health Service and now known as Purchase/Referred Care, has increased by 58 percent.  But even with this large budget increase, over $700 million worth of patient referrals still have to be denied or deferred each year. The progress we made has been significant, but our work also helped us better understand the enormous remaining need.

A signature accomplishment of the Obama Administration was passage of the Affordable Care Act, and with that came the permanent reauthorization of the Indian Health Care Improvement Act. The Affordable Care Act has also meant that thousands of American Indians and Alaska Natives have been able to purchase affordable insurance, gain Medicaid coverage or still use the IHS if they are eligible.

Over the last few years, IHS has also expanded its patient centered medical home model from only 38 sites in 2009 to 172 sites in 2014. This model is the foundation of an initiative to improve patient care, which is reorganizing the way care is provided locally in clinics and hospitals. The goal is to ensure all patients can access quality healthcare by providing care centered on the patient’s needs. Patients at sites that have adopted this model tell us this is a welcome change to how IHS delivers services.

I am proud of the many IHS, Tribal and Urban Indian program staff who work hard each and every day to provide healthcare services to the patients IHS serves. And I appreciate all the Tribal leaders who helped make sure that we understood the great needs in their communities and who partnered with us to achieve progress. I am grateful for the opportunity to serve in the Obama Administration during a time where we were able to make significant progress, and I also know that, for those that continue to serve, there is much more work to be done. As difficult and challenging as this work is, we know how important it is to continue to change and improve the Indian Health Service. I am grateful that the Obama Administration will continue to work towards more progress.

Editor’s Note: IHS is currently seeking public input as it begins efforts to advance and promote the health needs of the American Indian/Alaska Native (AI/AN) Lesbian, Gay, Bisexual, and Transgender (LGBT) community. For more information, see IHS’ Notice of Request for Information.