A change in federal policy this year creates an opportunity to improve access to health care for Native Americans in Wisconsin. A new report urges state and tribal health officials to seize this chance to close “alarming disparities” in health care and health outcomes between Native Americans and whites in Wisconsin.
The new report, prepared by the Wisconsin Council on Children and Families (WCCF), reveals very large disparities in health indicators between whites and Native Americans in Wisconsin. For example, the report notes that Native Americans in Wisconsin live about 14 years less than whites. In 2014, the average age at death for Native Americans was just 63 years, compared to 77 years for white Wisconsinites.
Sashi Gregory, WCCF’s health care analyst, pointed to several additional indicators of large disparities that she said illustrate the need for remedial action. “The infant mortality rate for Native American children in Wisconsin was 69 percent higher than the rate for white children during the period 2012 to 2014,” Gregory said in a statement released by WCCF, “and the diabetes mortality for Native Americans was almost four times the rate for white Wisconsinites.”
The federal government has a longstanding commitment to fully fund health care for low-income Native Americans, which it does primarily by paying for clinics operated or funded by Indian Health Services (IHS). However, Gregory says “the clinics are chronically unfunded and there are large gaps in the types of health services that are provided.”
Communities of color often face greater health challenges that lead to larger health disparities between them and their white peers. This is especially true for the Native American community. Health indicators for Native Americans in Wisconsin are far worse than the health metrics for the state’s white residents. The alarming disparities are deep-rooted and will not be easy to solve, but it’s time to get serious about closing the huge gaps in health and life expectancy in Wisconsin.
Native Americans play an integral role in Wisconsin’s communities, culture, and economy. The state is home to 11 federally recognized tribes and has a Native American population of 86,000. Native Americans reside in urban areas, in rural communities, and on federally recognized Indian reservations throughout Wisconsin. Although many cities, lakes, and rivers in Wisconsin are named after Native Americans, they are often left behind in fights for equity in health care, education, and economic prosperity. Due to the lasting effects of colonization, forced assimilation, and the removal of resources, many native communities suffer from disproportionately high child poverty rates, roadblocks to economic success, and generally low health outcomes.
The report cited large disparities in health indicators for Native Americans. When it comes to health outcomes, the trend in disparities continues:
◆ From 2012-2014, infant mortality rates for native children in Wisconsin were 69% higher than those of white children.5
◆ The 2014 age-adjusted mortality rate was nearly 50% higher for Native Americans in Wisconsin than for whites (1036 vs. 702 deaths per 100,000 people).6
◆ The 2014 average age at death for Native Americans was 63 years compared to 77 years for whites.7
◆ The 2009-2013 average cancer age-adjusted mortality rate was 37% higher for Native Americans in Wisconsin than for whites.8
◆ The 2014 diabetes mortality rate was almost four times higher for Native Americans in Wisconsin than for whites.9
Native ANative_Health Graph_1mericans in Wisconsin also suffer high rates of suicide, especially for children under 18 who have the highest age-adjusted suicide rate (2.5 deaths per 100,000) across all races.10
This data is unsurprising, given the unacceptably low access to health care available to native people. In terms of health insurance, 29.6% of nonelderly native adults in Wisconsin and 15.6% of native children have no insurance, compared with 8.7% of white nonelderly adults and 4.1% of white children who are uninsured
Under the new policy announced in February, the federal government will pay the full cost of a broader range of Medicaid health care services for Native Americans. Up until this year, full federal funding was only available for services provided at IHS/tribal clinics, and not for care that the same patients have to go somewhere else to receive. The new policy will also pay the full Medicaid costs of other care provided to Native Americans, if it is delivered by providers under contract with an IHS/tribal clinic and that clinic refers the Medicaid patient and continues to oversee their care.
The policy change could yield significant savings in the Medicaid budgets of states with substantial Native American populations. In South Dakota, for example, officials are exploring the possibility of using the savings to pay for the state share of costs for an expansion of Medicaid eligibility.
Gregory said it is too soon to know if there will be significant savings in Wisconsin, and she added that the extent of those savings is not the key question. “The much more important issue,” Gregory said, “ is figuring out how best to take advantage of the new opportunity to fill gaps in health care services for Native Americans in Wisconsin, including things like mental health services and substance abuse treatment.”
Jerry Waukau, health administrator of the Menominee Indian Tribe of Wisconsin, said that tapping the full potential of the broader eligibility for 100 percent federal funding will not be a simple thing to accomplish because there are administrative challenges for tribal officials and the Wisconsin Department of Health Services to overcome.
“Despite those challenges, we’re optimistic that the policy change provides an avenue for removing some of the barriers to increasing access to care and improving health care outcomes for tribal members,” Waukau said. “The tribes look forward to working with the state to develop startup and ongoing funding mechanisms to assist tribes to implement these new agreements and work to design a Medicaid program to better address Native America health disparities in the state by increasing access to and coordination of care.”