Native Americans say they are expecting President-elect Donald Trump to fulfill a promise made to their community in a provision of the Affordable Care Act.
The Obama administration did not establish an office dedicated to addressing disparities plaguing Native American men.
In response to a question raised during an appearance Monday at the National Press Club, HHS Secretary Sylvia Mathews Burwell said that office would not be opened before the current administration ends. She did not say why, only noting that the ACA through its coverage provisions had improved care for all of the native population.
“Prevention of rising statistics as they relate to Native American and Alaskan men should be a priority,” said Bobbi Webster, a spokeswoman for the Oneida Nation based in Wisconsin, referring to the specific issues affecting the community.
Burwell's announcement was made the same day the Government Accountability Office reported that several Indian Health Service facilities were providing limited and inconsistent quality reports and failed to report many adverse events. The government auditors also documented the massive leadership turnover at many facilities and said many are delivering poor-quality care to the nation's Native American population.
A Modern Healthcare special report last month documented a series of deaths and adverse incidents at a small IHS hospital in Winnebago, Neb., that had its Medicare and Medicaid funding cut. The facility has had 10 CEOs in the past five years.
The Indian men's office was supposed to complement an existing Office of Indian Women's Health. The health disparities affecting Native American men are well documented. Males on some reservations have the lowest life expectancy of any group of Americans of any race, according to an October 2016 op-ed.
The piece, co-authored by a longtime IHS staffer, said Native American men experience rates two to five times greater than women within the community for suicide, HIV/AIDS, homicide, diabetes, firearm injury and alcohol-related deaths. They are also 10% to 50% more likely than Native American women to have cancer, heart disease and liver disease.
When the ACA provision was first announced, Rep Tim Murphy (R-Pa.) said he thought the office allowed men's health to take “its rightful place in our federal government's healthcare priorities.”
But seven years after the health reform law was passed, the office has yet to open. An HHS spokesman did not respond to a request for comment on the matter.
Ed Fox, a member of a group that advises the CMS on tribal issues, said he doesn't recall the HHS mentioning the office since the ACA passed.
Fox, who is health director for the Skokomish tribe in Washington state, agrees the ACA Medicaid expansion and subsidized health plans “more than compensates” for the lack of an office.
Trump hasn't publicly taken up the issue of Native American healthcare. But in recent years, the nominee for HHS Secretary, Rep. Tom Price (R-Ga.), visited the Oneida reservation twice to get a sense of the community's needs, Webster said.
“He has seen the healthcare needs of those who live in Indian Country firsthand,” Webster said.
Trump opening the men's office “would be a solid signal that he takes seriously the urgent need to address the appalling healthcare-related inequities experienced by Native Americans,” said Francys Crevier, director of policy and regulatory affairs for the National Council of Urban Indian Health.
The GAO report also said the IHS is seeking a new quality chief to implement remediation programs at agency facilities.