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Posts published in “Day: January 29, 2013”

The Citadel, fleshed out

Remember that planned community - of sorts - that a group of survivalist gun enthusiasts have in mind to locate in rural Benewah County, Idaho?

More details are surfacing, including a sketch of the intended grounds.

Not that it stands a realistic chance of materializing, but it's ... quite a fantasy.

Austerity and Indian health

trahant MARK


The Indian Health Service faces, what IHS Director Yvette Roubideaux calls, a “new reality” requiring a business model to match this era.

For example the 2012 budget was $4.3 billion. But when third party collections and the Special Diabetes Program is added to that base, the funding totals $5.38 billion. Third party collections, mainly Medicaid, Medicare and insurance, are important because that money is “generated and kept” at each service unit.

And, better yet, that’s one line on the budget can continue to grow. Even as Congress threatens sequester or other budget cuts.

“We also must work on customer service – if more of our patients have insurance or other health coverage, we do not want them to go to other providers,” Dr. Roubideaux wrote on her blog. “Even though IHS is a ‘service,’ it is also a healthcare system, and we need to think like a business. We are encouraging every one of our employees to contribute towards ensuring that we provide the best quality of care and to maximize the resources we have to provide that care. No one in the IHS system can afford to ignore the bottom line. If our goal is to provide the best care possible, we need to ensure that we can survive in the changing health care marketplace in which our facilities must thrive.”

One key element in that third party collections is Medicaid. Medicaid is a state-federal partnership, an insurance program for low-income families. However the Affordable Care Act expands access to Medicaid, an idea that’s supposed to make sure that more people can afford basic health insurance. But the rules of Medicaid, because it’s a partnership are up to state governments. Moreover not every state is choosing to participate.

A recent study from the Harvard Law School says: “There is strong empirical evidence that ‘opting out’ of expansion will have many negative implications by any measure, not only for individual and public health outcomes, but also for state fiscal stability. In other words, expanding Medicaid to residents with income up to 133% federal poverty level is in every state’s interest. While political battles loom large in the coming months, states will benefit from analyzing the actual costs and benefits of the Medicaid expansion and making an informed decision that best serves states’ residents at large.”

American Indians and Alaska Natives are a big part of that equation, a benefit for state governments as well as a source of revenue for the Indian health system. (The Indian health system includes the IHS as well as tribal, nonprofit and urban Indian programs). (more…)