Category Archives: Native American Health

Worlds Apart: Vast disparities in treatment separate Americans with HIV

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Loren Jones, 63, lives in a government-subsidized studio apartment in downtown Berkeley. (Heidi de Marco/KHN)

Loren Jones, 63, lives in a government-subsidized studio apartment in downtown Berkeley. (Heidi de Marco/KHN)

By Barbara Feder Ostrov

A major insurer said recently it would offer life insurance to HIV-positive people because of their rising life expectancies, prompting cheers from AIDS activists.

But on the very same day,  the nation’s top disease control official described an America falling far short in its fight against AIDS.

Compared to white men, African American men were more than seven times and Latino men were almost twice as likely to die from HIV-related complications.

It might seem a jarring disconnect — but it reflects very different realities dividing the estimated 1.2 million Americans living with the human immunodeficiency virus that causes AIDS.

While life expectancies are approaching the national norm among white, affluent gay men, about 66 percent of the 1.2 million people living with HIV/AIDS in the United States are not in treatment, imperiling their health and putting them at risk for infecting others.

African-Americans, mostly gay or bisexual men, account for nearly half of the approximately 45,000 Americans infected with HIV each year.

Both African-Americans and Latinos are less likely to remain in treatment than whites.

Compared to white men, African American men were more than seven times and Latino men were almost twice as likely to die from HIV-related complications.

HIV/AIDS activists and physicians say that despite the significant medical advances in treating the disease, many patients are being left behind because of their life circumstances.

Groups that once held angry demonstrations against government agencies and pharmaceutical companies to speed access to affordable, life-saving HIV medications now emphasize the socioeconomic barriers that keep some people living with HIV from consistently obtaining and using those drugs to remain healthy.

“There is an extreme disparity when it comes to treating HIV and AIDS,” said Anthony Hayes, managing director of public affairs and policy for GMHC, formerly Gay Men’s Health Crisis. Continue reading

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Diversity in medical research is a long way off, study shows | University of California – San Francisco

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Photo courtesy of Sanja Gjenero

Despite Congressional mandates aimed at diversifying clinical research, little has changed in the last 30 years in both the numbers of studies that include minorities and the diversity of scientists being funded, according to a new analysis by researchers at UC San Francisco.

That lack of diversity could have a serious impact on our ability to care for the nearly 40 percent of the current U.S. population whose heritage includes non-European races, the authors said, and will increase in urgency as the proportion of minority residents exceeds 50 percent in 2044.

The commentary, which was published Dec. 15, 2015, in the Policy Forum of online scientific journal PLoS Medicine, compiled 30 years of raw data on funding for research by non-White scientists, as well as two decades of analyses from the National Institutes of Health (NIH) and others regarding the percentage of clinical studies that include racial and ethnic minorities.

They found that since the 1993 NIH Revitalization Act, which required all federally funded clinical research to prioritize the inclusion of women and minorities, less than 2 percent of the 10,000-plus cancer studies have included enough minorities to be relevant, and less than 5 percent of respiratory studies have.

Photo courtesy of Sanja Gjenero

Source: Diversity in medical research is a long way off, study shows | EurekAlert! Science News

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States look for help with bilingual mental health

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From a string of public suicides in Alaska to assimilation anxiety among young Hispanics in Cleveland, states are faced with the need for more bilingual and culturally sensitive mental health care professionals

Illustration of the skull and brainBy Tim Henderson
Stateline

The U.S. is grappling with a severe shortage of mental health professionals. But the situation is particularly dire for some minority communities, where barriers of language and culture can make it hard to seek and get help.

Most good mental health care requires subtle, intimate conversation with patients. But too often, mental health experts say, professionals lack the language skills needed to serve those who struggle with English.

The greatest mental health needs are often in remote, rural areas with scattered populations.

“It’s difficult to trust that translation will capture nuances in the soul-baring process of mental health treatment,” said Sita Diehl, director of state policy at the National Alliance on Mental Illness (NAMI).

The greatest mental health needs are often in remote, rural areas with scattered populations. Continue reading

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US awards $21 million to support tribal domestic violence programs

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From the US Department of Health and Human Services and the Indian Health Service

indian-health-services-seal-200pxThe U.S. Department of Health and Human Services Administration for Children and Families (ACF) and Indian Health Service (IHS) announced Thursday the award of nearly $21 million to support tribal domestic violence victims and organizations in American Indian and Alaska Native communities across the nation.

ACF funding announced today is being awarded under the Family Violence Prevention and Services Act (FVPSA), which is the primary federal funding source dedicated to providing immediate shelter and supportive services for victims of family violence, domestic violence, or dating violence and their dependents.

Grants will be awarded to 136 tribes and tribal organizations serving 274 tribes.

These funds will help to strengthen tribal responses to domestic violence and emphasize public awareness, advocacy, and policy, training, and technical assistance. Continue reading

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Longevity and health in later life vary greatly by community in L.A.

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3-D Perspective image of the Los Angeles Basin from the Landsat satellite using NASA's Shuttle Radar Topography Mission (SRTM) for topography information. The vertical scale is exaggerated one and half times.

3-D Perspective image of the Los Angeles Basin from the Landsat satellite using NASA’s Shuttle Radar Topography Mission (SRTM) for topography information. The vertical scale is exaggerated one and half times.

By Anna Gorman
KHN

report on aging in Los Angeles County, the nation’s largest county and one of its most diverse, shows wide disparities in life expectancy among different ethnic groups and neighborhoods.

Overall, the life expectancy for Los Angeles County residents was about 82 years in 2011, up from nearly 76 in 1991, according to the report by University of Southern California’s Roybal Institute on Aging. Much of that can be attributed to drops in coronary heart disease, strokes and lung cancer, the report noted.

But African Americans can expect to live to an average of about 76 years whereas the average for Asians and Pacific Islanders approaches 86 years, the report said.

And residents who have reached the age of 50 in the more affluent western part of the county are expected to live about five years longer than those in largely poor South Los Angeles.

Similarly, researchers found stark differences among ethnic groups when it comes to chronic disease. Latinos in L.A. County aged 50 or older have nearly double the rate of diabetes as whites, and older African Americans have a much higher rate of hypertension than other ethnic groups. Continue reading

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Tried to sign up but couldn’t finish by the deadline?

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Washington Healthplanfinder outlines steps you need to take to qualify for special enrollment

From Washington Healthplanfinder:

Coverage is hereWith the deadline to enroll in a Qualified Health Plan through wahealthplanfinder.org now passed, Washington Healthplanfinder is reaching out to residents who couldn’t complete their application by March 31 with important guidance to qualify for a special enrollment.

Washingtonians who were prevented from submitting their application by the deadline should complete these steps as soon as possible to qualify for coverage that begins May 1, 2014. Continue reading

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How states are tackling ‘health disparities’

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Question Q&ABy Michael Ollove
Stateline Staff Writer

African-Americans are more likely to suffer heart disease and diabetes than whites. The cancer death rate for men is a good deal higher than it is for women.

American Indians and Alaska Natives are more likely to smoke tobacco than Hispanics, blacks or whites.

And Native Hawaiian adults are less likely to exercise than other ethnic groups.

These differences are called “health disparities,” and in the last two decades, the federal government and the states have focused on eliminating them. Continue reading

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Does Indian Health Service coverage meet the requirements of the individual mandate?

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indian-health-services-seal-200pxBy Michelle Andrews

Q. If our son is able to get healthcare from the local Indian Health Clinic, is he still required to get Obamacare insurance?

A. He may not be. Starting in January, most people have to have health insurance that qualifies as “minimum essential coverage” under the law or face a penalty.

Job-based health insurance, Medicare Part A, Medicaid and Tricare, the health program for members of the military and their families, all meet the standards for minimum essential coverage under the health law.

About 2 million American Indian and Alaskan Native tribe members receive health care at 600 Indian Health Service facilities around the country. But IHS services aren’t health insurance, nor do they meet the standards for minimum essential coverage.

However, members of federally recognized tribes are one of several groups exempt from the penalty for not having insurance. Others include people who can’t afford coverage or are experiencing a hardship, or those who have a short gap in coverage of less than three months.

In 2014, the penalty for not having insurance will be $95 or 1 percent of family income, whichever is greater. That amount will increase to $695, or 2.5 percent of income in 2016.

Members of Indian tribes who qualify can complete a form to apply for an exemption from the requirement to have insurance. The form is currently under development, according to an IHS spokesperson.

Please send comments or ideas for future topics for the Insuring Your Health column toquestions@kaiserhealthnews.org. We regret that we can’t respond to individual requests for health insurance advice or information. Please visit healthcare.gov to locate a health insurance expert in your area.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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ACA – A hard sell for Native Americans

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indian-health-services-seal-200pxBy Christine Vestal
Stateline Staff Writer

For most uninsured Americans, the motivation for checking out the health insurance exchanges is simple – they could face stiff penalties if they don’t sign up. For Native Americans, the decision is more complicated.

Longstanding treaties with the federal government guarantee all Native Americans free health care. As a result, the Affordable Care Act exempts them from paying a penalty if they choose not to purchase insurance.

More than 2 million Native Americans receive free health care at federally supported Indian health facilities. Many others receive care from tribal facilities and urban Indian organizations.

So why would an American Indian or Alaska Native sign up for reduced-rate insurance on the exchanges?

Indian health advocates said the benefits are many. “It’s an unprecedented opportunity,” said Roxane Spruce Bly, who is working with New Mexico’s health insurance exchange to provide outreach to Native Americans. “It’s the biggest thing to happen in Indian health in my lifetime. It solves so many problems for Indian people.”

Although tribal members are entitled to free health care, most Indian health facilities do not offer a full array of services. When patients need major surgery or cancer treatments, for example, they are referred to specialists outside of Indian lands.

At least two-thirds of those referral claims are rejected, Bly said. That puts Indians at risk of either paying major medical bills themselves or doing without needed treatments. In addition, about half of Native Americans live in urban areas that are great distances from tribal health facilities.

As a group, the nation’s 5.2 million Native Americans have poorer health and less access to health care than the rest of the U.S. population. Their uninsured rate is nearly 30 percent, compared to 15 percent for the country as a whole.

And nearly half of all Indians have incomes low enough to qualify for Medicaid in states that have chosen to expand coverage, according to the Center on Budget and Policy Priorities. More than 1 million Native Americans are already enrolled in Medicaid.

Still, Bly and others said the idea of purchasing health insurance, even if deeply discounted, is a foreign concept for most tribal members. Even optimistic advocates for Indian enrollment in the exchanges said convincing tribal leaders and individuals to sign up could take years. Bly’s goal is to sign up 10 percent of New Mexico’s eligible Native Americans by the end of 2014.

20 States with Most Native Americans
  • California 739,964
  • Oklahoma 415,371
  • Arizona 366,954
  • New Mexico 215,605
  • New York 194,714
  • Washington 188,071
  • Michigan 128,335
  • Alaska 126,999
  • Oregon 104,143
  • Colorado 102,451
  • Minnesota 95,130
  • Wisconsin 82,335
  • South Dakota 76,205
  • Montana 74,399
  • Nevada 60,283
  • Utah 53,679
  • Massachusetts 45,653
  • North Dakota 40,740
  • Idaho 36,464
  • Wyoming 18,692
Source: Census Bureau

Special Advantages

The ACA includes provisions for American Indians and Native Alaskans that make purchasing insurance on the exchange an even better proposition than it is for everyone else.

They can sign up at any time – there are no open enrollment deadlines. Tribal members with incomes below 300 percent of the federal poverty level ($34,470 for an individual) are exempt from paying deductibles and copays, so they can purchase the cheapest plans without worrying about out-of-pocket expenses.

All tribal members, no matter what income level, are exempt from out-of-pocket payments if they receive services from Indian health facilities. And unlike employers, tribes can pay exchange premiums for their members without paying taxes.

In addition, a separate law that has governed Native American health care for decades – the Indian Health Care Improvement Act – was amended when the ACA was signed.

New provisions make it easier for Indian health facilities to accept payments from other insurers, including Medicaid, Medicare and private insurance.

The new law also expands the types of services the facilities can offer and requires inclusion of behavioral health and substance abuse treatments.

For Indians enrolled in Medicaid, Indian health providers receive a fee-for-service that is much higher than other providers receive. In addition, they can collect fees from private insurers if Native Americans take advantage of the exchanges.

The new income sources are expected to help Indian health facilities expand and improve their services. Some, for example, do not now include dentistry or deliver babies.

Few offer preventive services. According to a 2011 Centers for Medicare and Medicaid (CMS) report, the Indian Health Service budget—$4.2 billion in 2010—“is only sufficient to provide about half the necessary health services required.”

Ed Fox, a member of a tribal advisory group to the CMS, estimates the ACA could result in as much as $4 billion in additional revenue for Indian health services. But that’s only if tribal leaders take advantage of it, he said.

A tribal member himself, Fox conducts outreach meetings with tribal leaders in Washington state. He said so far the leaders he’s talked with plan to wait and see what other tribes do about the health insurance exchanges before they make a decision.

“They haven’t had the greatest experience with government programs in the past,” Fox said. If he walks into a meeting and says, “I’m with the federal government and I’m here to help you,” most tribal leaders simply laugh.

Medicaid Expansion

In states that expand Medicaid in January, enrolling newly eligible Native Americans will be less of a challenge than selling the exchange concept. But it will still take substantial state and federal outreach and education, an effort that is required by the ACA.

According to a report from the Government Accountability Office, Native American enrollment in Medicaid could double under the expansion.

But the GAO said the CMS and the Indian Health Service are not doing enough to spread the word about health insurance exchanges and new Medicaid coverage. States are also responsible for getting the word out.

In New Mexico, Medicaid director Julie Weinberg said members of her staff have been crisscrossing the sparsely populated state since August and have visited more than 200 tribal locations.

The agency has also purchased radio, print and television ads. “It ends up being fairly costly,” Weinberg said. “We’re digging way down deep into our administrative budget to do the outreach.”

Montana and California have received a federal Medicaid waiver to directly reimburse tribal leaders for Medicaid expansion outreach efforts.  Alaska and Washington have pending waiver requests, and three other states are interested, according to the GAO report.

In general, the federal government will pay 100 percent of all costs for newly eligible Medicaid enrollees for the first three years. After that the federal share tapers to 90 percent. Traditionally, however, the federal government has paid 100 percent of all Medicaid costs for Native Americans.

“The most important thing for state administrators,” said Carolyn Ingram of the Center for Health Care Strategies, “is to talk to tribes early and often.” She and others agree that most individual Native Americans are not likely to take full advantage of the health law without the support of their tribal elders.
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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Abortion laws force closure of women’s health clinics serving the poor

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Abortion Knoxville-march-for-life-2013-3

Photo: Brian Stansberry / Creative Commons

By Jake Grovum, Staff Writer
Stateline

New state restrictions on clinics that provide abortions could leave millions of women—many of them poor and uninsured—without easy access to cancer screenings and other basic health care services.

In recent years, abortion opponents have tried to limit abortions by barring them after a certain number of weeks and by requiring women who want to end their pregnancies to have ultrasounds. Those strategies target abortion directly.

Now abortion opponents in some states are pushing for new standards for clinics, such as requiring doctors to have admitting privileges at a nearby hospital, that may be difficult or impossible for them to meet.

Abortion rights supporters fear the new rules could force many clinics to close—a result that would make it more difficult for women to get a broad array of health care services, not just abortions.

“Every time a clinic closes, the women who would be using those clinics, it’s not as if those women stop existing,” said Kimberly Inez McGuire of the National Latina Institute for Reproductive Health, an advocacy group. “It will affect whether women can get cancer screenings, whether women can get to a provider to get their blood pressure checked.”

“Clinics that serve women who may not have insurance are literally a lifeline,” McGuire said.

Fifteen states now require clinic doctors to have hospital admitting privileges, according to the Guttmacher Institute, which supports abortion rights.

In addition, 26 states require abortion-providing clinics to meet surgical facility standards, which stipulate everything from the size of certain rooms, the types of light switches used and the width of hallways.

Supporters say such requirements are common-sense public health measures. They cite high-profile examples of poor oversight and gruesome malpractice cases, most notably the Kermit Gosnell case in Philadelphia.

“What is so wrong about having high health standards in place?” asked Alabama Rep. Mary Sue McClurkin, who sponsored legislation which includes clinic regulations and requirements for doctors that has been blocked by a federal judge. “If they would just do what was in the best interest of the patient, it would not be a problem.”

Opponents of such laws say they might close a vital health care entryway for women. In many states, the clinics offer services ranging from sexually transmitted disease testing and treatment to mammograms, Pap tests and cancer screenings.

They also offer family planning counseling and birth control services—in many cases at reduced fees for the uninsured.

In 2011 and 2012, the Guttmacher Institute conducted a survey of women receiving services at family planning centers located in communities in which there were other health care options.

About four in 10 women said they used a clinic as their exclusive health care provider in the past year. Among other reasons, the women said they preferred going to a clinic because staff there knew more about women’s health and it was easier to talk to them about sex.

The connection between the clinics, public health care programs and women’s health was further underscored by a Kaiser Family Foundation study.

The report noted that in many states, there are few providers willing to accept Medicaid or other subsidized insurance programs. In those places, the clinics are a vital, and sometimes the only, option for low-income people.

For example, in 2011 Texas blocked Planned Parenthood-affiliated health centers from receiving funds from the state’s Medicaid Women’s Health Program.

Prior to the funding cut-off, those centers were caring for nearly 50,000 patients. The program served 63 percent fewer women the year after the cuts, state data showed.

The American Congress of Obstetricians and Gynecologists has also argued that clinic closings could damage women’s health. The group blasted Texas’ new abortion law and measures under consideration in North Carolina.

Those who back the laws argue the regulations would make the clinics safer.

So far, courts haven’t bought that argument, seeing laws that could shutter clinics as potentially unconstitutionally restrictive of abortion.

Courts already have blocked physician requirements in Mississippi and Alabama. Last week, Wisconsin’s law was temporarily blocked by a federal judge and advocates are preparing to fight Texas’ law as well.

“The courts have seen right through the arguments that this is somehow supposed to protect women’s health,” said Julie Rikelman of the Center for Reproductive Rights, which is involved in the legal fights.  “These laws really hurt women’s health, not help them.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Despite challenges, community health centers win high satisfaction rates

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Doctor at deskBy Valerie DeBenedette
HBNS Contributing Writer

Low-income Americans are more likely to be satisfied with the care they receive at federally qualified health centers (FQHC) than at mainstream health care providers, reveals a new study in the Journal of Health Care for the Poor and Underserved.

The level of satisfaction shown by people who use the health centers was surprising, said lead author Leiyu Shi, DrPH, MBA, MPA, professor at the Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, M.D.

Because the centers treat a more vulnerable population, they often have a more difficult time addressing their patients’ needs, he noted. Yet, the study shows that health centers appear to be reducing gaps in both quality of service and accessibility, he said.

Federally funded health centers are usually located in medically underserved communities, making them more likely to be either in inner city or rural areas, explained Shi.

Patients using these centers are more racially and ethnically diverse than the national population and more likely to be uninsured (39 percent compared to 17 percent) or to receive Medicare or Medicaid (54 percent compared to 27 percent) and to be in fair to poor health than the general population.

But patients at FQHCs also reported better access to primary care and were more likely to be satisfied with the care they received (97.7 percent) than low-income Americans getting health care elsewhere (87.2 percent).

Patients at FQHCs also reported better access to primary care and were more likely to be satisfied with the care they received (97.7 percent) than low-income Americans getting health care elsewhere.

“This study tells us a lot about the role of a safety net system,” said Georges C. Benjamin, M.D., executive director of the American Public Health Association in Washington, D.C.

Federally qualified health centers have become like other health providers, but are more focused on primary care and preventive medicine, he noted.

They are based in the community, with one federal requirement being that 51 percent of the members of their board of directors be from the community. They can bill private health insurance, Medicare and Medicaid, he said.

“They have a range of ways for the completely uninsured to pay, usually on sliding fee scale,” he added. “They are much more sensitive to the individual who does not have any money or the ability to pay it back.”

Study authors suggest that there should be broader adoption of the FQHC model of care, which includes comprehensive and preventive primary care, a focus on vulnerable populations such as minorities and the uninsured, consumer participation, and cultural and linguistic sensitivity, among other features.

Reference: 

Shi L, LeBrun-Harris LA, Daly CA, et al.: Reducing disparities in access to primary care and patient satisfaction with care: The role of health centers. J Health Care Poor Underserved. 24 (2013): 56–66

Reach CFAH’s Health Behavior News Service at (202) 387-2829 or hbns-editor@cfah.org

<strong><em><a title=”HBNS” href=”http://www.cfah.org/hbns/index.cfm” target=”_blank”>Health Behavior News Service</a> is part of the </em></strong><strong><em><a title=”Center for Advancing Health” href=”http://www.cfah.org/index.cfm” target=”_blank”>Center for Advancing Health</a></em></strong></p>

<strong>The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.</strong>

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