Smoke Signals 5
JUNE 152011
hhs
By Ron Karten
Smoke Signal staff writer
The primary concern of North
west Tribes at the June 7 U.S.
Department of Health and Human
Services Region 10 Tribal Consulta
tion was the federal government's
failure to consult meaningfully, in
a timely manner and, under some
circumstances, a failure to consult
at all about concerns going back
30 years.
"Everything is not rosy," said
Tribal Chairwoman Cheryle A.
Kennedy during a break in the
proceedings.
She points to Oregon HB 3650,
Oregon Healthcare Transforma
tion, a bill that would revamp
health care in the state by pooling
federal and state Medicaid funds
for distribution to local "commu
nity care organizations" (CCOs)
that would deliver preventive care
in the community. Savings, under
the plan, go back to health care
providers as an incentive to keep
costs down.
The problem for the Grand Ronde
Tribe, and likely others, is that the
bill puts eligibility requirements in
the hands of the CCOs and takes it
away from the Tribes.
"We should be able to determine
eligibility," said Kennedy.
"We're asking you to consult with
the Tribes before decisions become
law," said another Tribal represen
tative, "so we can be up there fight
' ing for the language we need."
The date for this sparsely attend
ed Tribal Consultation, held this
year at Spirit Mountain Casino,
had been changed at least twice.
Though comments during the
meeting showed that many Tribes
fault federal agencies for working
with the states and through the
states on Tribes' behalf, Tribal and
federal staffers alike point to the
state as the problem.
"There's a long way to go," said
Jay Angoff, Senior Adviser to
Health & Human Services Secre
tary Kathleen Sebelius. "Dealing
with the states is difficult for the
Tribes and it is for us, too."
The feds have leverage, however,
to withhold approval for waiver
requests from states that do not
consult meaningfully with Tribes.
Take the Health Care Trans
formation bill that, if passed in
the state Legislature, will require
federal waivers.
Oregon state advocates at the
Oregon Health Plan are pushing
to have the bill approved by the
Legislature's close, likely later this
month, but consultation with the
Grand Ronde Tribe is not scheduled
until July.
"What do you do when states ig
nore Tribal needs?" asked Angoff.
"If you've got a solution, let me
Photo by Michelle Alaimo
Tribal Chairwoman Cheryl A. Kennedy gives the Tribal welcome at the
beginning of the U.S. Department of Health & Human Services Region 1 0
Tribal Consultation held at Spirit Mountain Casino on Tuesday, June 7.
know."
Kennedy, who serves on the fed
eral department's Tribal Advisory
Committee, "put this issue on the
table" a few weeks ago in a meeting
with the Sebelius.
Sebelius assured Kennedy that
without state cooperation with
the Tribe, "the waiver will not go
through," Kennedy said.
Kennedy also has been active at
the state level.
"There is a meeting being set up
(with Dr. Bruce Goldberg, director
of the Oregon Health Authority),"
she said. "We will get an audi
ence." Because much federal funding
for Tribes goes through the states,
Tribes are often left trying to nail
down two moving targets to bring
the dollars the last mile out to the
reservation.
In many instances, Congress ap
propriates money for Tribes but it
never arrives. In Washington state,
of $24 million allocated for imple
menting health care reform, Tribes
received $30,000, noted a Cowlitz
Tribal member.
The long trail of broken promises
is not lost on the federal agency,
either.
"It's almost like 'Groundhog
Day,'" said Gene Frogge, Deputy
Regional administrator for Region
10 of the Centers for Medicare and
Medicaid Services, referring to the
movie where a weatherman wakes
up every morning to the same
Groundhog Day. "We're hearing
the same issues over and over. That
big push (to deal with these issues)
never seems to get there."
Frogge was among at least three
top Health & Human Services
officials who said they now are
taking seriously the federal com
mitment to consult meaningfully
with Tribes, and promised better
in the future.
Region 10 Director Susan John
son said that in the last year, the
department had started tracking
progress on the issues raised in
previous consultations.
Tribal representatives also called
on the department to ease expen
sive and time-consuming bureau
cratic requirements.
The effort to move clinics to elec
tronic health reporting is a case in
point. Many Tribes face technical
hurdles, like incompatible soft
ware, in collecting and maintaining
this data.
"All the administrative costs are
killing our people," said one Tribal
representative.
Many said that Tribes ought to be
exempted from anticipated budget
cuts from the department. Even
without cuts, they noted, federal
inmates have twice the health bud
get of Tribal peoples. In addition, 35
percent to 40 percent of Indians are
without health care insurance, more
than twice the national average.
Tribes are continually seeking
updates unsuccessfully, a Tribal
staffer said on what health care
reform will mean on the reserva
tions. Johnson said she took 20 pages of
notes during the meeting.
"I'd like to see a model of what it
would take to bring Tribal health
up to the level of the rest of the
country," said Kennedy. "It's time
we address that. Just saying that
the care should be 'culturally ap
propriate' doesn't mean much.
"I believe the task of consultation
is to remove barriers," she said.
The 10-hour Consultation in
cluded discussions and updates of
the 2010 federal Patient Care and
Affordable Care Act, the Centers of
Medicare and Medicaid Services,
Child and Family Well-Being, El
der Weil-Being and Indian Health
Services.
Tribal Council member Wink
Soderberg gave the invocation,
and Tribal Executive Officer and
Tribal member Chris Leno ended
the session. B
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