AP INTERVIEW: Sebelius to boost Indian health care

Health and Human Services Secretary Kathleen Sebelius acknowledged on Tuesday that government health care for American Indians has been a "historic failure" for more than a century and pledged to launch an extended effort to improve it.

Sebelius told The Associated Press that she will begin a multiyear effort to better the troubled Indian Health Service and will challenge Congress to make the back-burner issue a priority. Part of that strategy would be to recruit more providers for reservations and to focus more on preventive care, which is often neglected at Indian health clinics as dollars run out.

"(We need to) begin to lay the groundwork with Congress right now to say 'here's where we need to be,'" she said. "I think often the tribal issues just fade away."

She said her department is also increasing the size of the U.S. Public Health Service Commissioned Corps, which dispatches doctors to reservations as part of its mission.

The U.S. has an obligation, based on a 1787 agreement between tribes and the government, to provide American Indians with free health care on reservations. However, as The Associated Press reported this week, the troubled Indian Health Service only has about half of the money it needs, leaving poor tribes in remote areas with severely underfunded facilities and substandard care.

Wealthier tribes are often able to supplement the federal budget with their own dollars, The AP reported, but on poorer reservations the saying is "don't get sick after June," when the federal dollars run out.

Sebelius said that is "a pretty accurate mantra."

"Some of the Indian health facilities are in great shape, some are really in terrible shape," she said.

President Barack Obama campaigned on Indian reservations during his Democratic primary last year and promised better health care there. His budget for 2010 includes an increase of $454 million, or about 13 percent, and the stimulus bill he signed earlier this year provided for construction and improvements to clinics.

Sebelius said that generous increase would still be far from what the agency needs.

"One of my challenges to the new head of the Indian Health Service is that we need a multiyear strategy, we need an end goal," she said.

North Dakota Sen. Byron Dorgan, the Democratic chairman of the Senate Indian Affairs Committee, said the attention from Obama and Sebelius is long overdue.

The Senate passed a Dorgan bill last year that would have provided about $35 billion for Indian health programs over 10 years, but similar legislation died in the House after becoming entangled in an abortion dispute. Dorgan said he will try again this Congress.

"President Obama's and Secretary Sebelius' attention to this, early in the Administration's term, is very welcome news," he said. "We're drafting legislation in the Senate Indian Affairs Committee to bring about exactly this kind of reform."

American Indians have higher rates of diabetes, infant death, stroke, high blood pressure, heart disease, suicide, unintentional injuries and a spate of other conditions and diseases than do whites.

Sebelius said such severe health disparities between minority groups and whites are "unconscionable."

"The most severe disparity between quality care and what goes on with health outcomes is in the Native American population," she said.