6 MAY 1, 2003
Smoke Signals
Feds To Decide A Health Care Fix For Oregon Tribes
One-third of Oregon Indians and poorest Tribes stand to suffer most.
By Ron Karten
On April 8, the bill was poised to
sail through the Oregon legislature.
Following a mere twenty minutes
of testimony led off by Confeder
ated Tribes of Grand Ronde Chair
woman Cheryle Kennedy, other
Oregon Tribal leaders and Oregon
Medical Assistance Program
(OMAP) manager Joan Kapowich,
the Senate Health Policy Commit
tee sent SB 878 to the floor of the
Senate with a unanimous "Do Pass"
recommendation. A week later, it
sailed through the Senate, 29-0.
The bill fixes a mistake the Legis
lature made last year when it cut
health benefits for Indians along
with the general population of Or
egon,' thinking that it was saving as
much money by reducing benefits for
poor Indians as it saved by reducing
benefits for the rest of the state's poor.
The issue came into sharp relief
in February when OMAP com
pleted a Legislative directive to de
velop a second and lower level of
care for as
tion, routine vision services, ser
vices related to hearing aids, den
tal services, medical equipment and
supplies and outpatient mental
health and chemical dependency
services.
"It's hardly an insurance plan at
all," said Edward Fox, Director of
the Northwest Portland Area In
dian Health Board, one of the SB
878's prime movers.
In order to make SB 878 happen,
the federal government has to ap
prove two waivers already submit
ted by OMAP. One will allow
OMAP applications to be effective
from the date of the application.
Without the waiver, patients have
to wait for the application to be ap
proved, which can take two months
and all bills accruing in those two
months become the patient's re
sponsibility, or in the case of most
Oregon Indians, the responsibility
of the Tribes that provide the care.
"If there's a motorcycle accident,"
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Tribal Council Chairwoman Cheryle Kennedy testifed before the Senate Health
Policy Committee. Kennedy said that the Confederate Tribes of Grand Ronde
supports this legislation because it "would indeed raise the health care status
of Native Americans."
many as
100,000 the
state's poor,
including
about 2,400
Indians.
About 5,000
Indians con
tinue to be covered by the state's
"Plus" program, which provides the
best coverage that state health
plans have to offer.
The "Standard" program requires
higher co-payments and does not
provide non-emergency transporta-
said Fox, "it could cost the Tribe
$200,000. One hospital stay has
already cost the Coquille Tribe
$40,000," he said.
In Grand Ronde, the cost to the
Health & Wellness Center to the
Confederated Tribes of Grand
Ronde has not yet been determined.
"We're still trying to figure it out,"
said Michael Watkins, Health Ad
ministrative Of
ficer. "When they
come in here,
they're not identi
fied as Plus or
Standard."
And for each
Tribe, the costs
could be different
because federal reimbursement
rates vary depending on whether
the Health Center is reimbursed at
a federal or Indian Health Service
rate.
The second waiver allows the
Tribes to be exempted from prin-
ciples applying to the rest of Orego
nians. The issue here is whether
Indians are considered a minority,
in which case Indians have to be
treated like everybody else, and the
waiver is not likely to be approved,
or whether Tribes are considered
separate, independent govern
ments, and in that case, the waiver
seems more likely to be approved.
Although the fix could cost the
federal government millions a year,
Mary Kahn, Public Affairs staffer
for the federal Centers for Medicare
and Medicaid Services said that cost
does not enter into the decision. As
Smoke Signals went to press, how
ever, she reported that "both re
quests are still under review."
Health & Wellness Center Facing Hard Times But Also Rolling Out Prevention Efforts
The goal is to develop a model program.
By Ron Karten
In the three months since he came out
of retirement to serve as the Health and
Wellness Center interim executive direc
tor, Steve Bowles has seen a turnaround
in morale.
"I have seen a group of people who were
afraid of their future change to a group
that is excited about their future," he said.
"Employees were criticized. All they heard
were complaints. We started telling them
that they're doing great work. And they
are."
Like health care providers across the
state, the Wellness Center is finding it
harder to offer services that are no longer
reimbursed by the Oregon Health Plan to
the more than 30-percent of the client load
that is non-Native.
Tribal members who use the Wellness
Clinic will continue to receive services cut
by the Oregon Health Plan, including drug
and alcohol treatments, but Tribal members living
in Portland or Salem who rely on the Oregon Health
Plan will have a hard time getting health care, ac
cording to Bowles.
"The cuts are almost ruthless," said Bowles.
"People count on a service being there and suddenly
it's cut off."
In the short term, the Clinic is looking at con
tract health dollars and Tribal dollars to get mem
bers through this period of medical under funding,
but in the longer term, according to Michael Watkins,
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Health Administrative officer, efforts to get the state
to exempt Indians from health care cuts have made
progress. (See related story above).
"The Tribes were not consulted (about statewide
healthcare policy)," said Watkins. "We're just get
ting the effects." The argument for exempting Indi
ans from state health care cuts is that the state
does not contribute to Indian health care programs.
It is 100-percent paid through federal budgets.
The financial pressure on the Wellness Center in
times like this is easily seen from the results of a
study which showed that people pay their
housing bills first, their cable bills sec
ond, but their medical bills 35th!
As a result of these financial pressures,
massages are now only offered when pre
scribed by a physician, said Bowles.
"With massage as a stand alone practice,
it is hard to be efficient on a cash basis,"
he said. "You can't get reimbursed for it
by an insurance company."
By contrast, physical therapy is "clini
cally driven" and reimbursed by insur
ance companies.
While managed care has attempted to
limit the unnecessary costs and costly
incentives built into the health care sys
tem, "what it hasn't done," said Bowles,
"is promote good health. That's why it's
so exciting to me to see the Tribes focus
on wellness. (Unfortunately), we still
don't have anyone, including the federal
government, willing to pay for preventive care. We're
spending huge amounts on health care and we're
not a healthier society."
The Wellness Center, however, is making a re
newed effort to place the emphasis on prevention. It
comes as part of an overall planning process that
includes bike and walking paths on the Tribal cam
pus. The new gym, the exercise and weight room
are other examples of the Tribal effort to promote
good health. "The goal," said Bowles, "is to develop
a model system."