COVID-19 highlights the U.S. government’s failure to meet health care obligations to Indian Country

The current coronavirus pandemic has laid bare the many failings and disparities in the U.S. heathcare system.

Dr. Mary Owen, President-Elect of the Association of American Indian Physicians, recently wrote a column for Indian Country Today where she highlights the fact that Native Americans are the only population with a “legal right to health care,” and how the system is failing them.

“Despite the guaranteed provision of health care that is in part, payment for millions of acres of land, the Indian Health Service is chronically underfunded,” said Dr. Owen, an Assistant Professor of Medicine at the University of Minnesota Medical School-Duluth and the Director of the Center of American Indian and Minority Health.

Dr. Mary Owen. (Image: University of Minnesota-Duluth)

Dr. Owen’s piece: “COVID-19, ‘It’s not as if we haven’t been through this before,’ includes the starting fact that American Indians have lived through 90 separate epidemics since European arrival. Citing Charles Wilkinson, she said those included “smallpox, measles, tuberculosis, scarlet fever, influenza, bubonic plague, diphtheria, typhus, cholera, and gonorrhea.”

American Indians lacked immunity to these diseases, but that’s only part of the story, Dr. Owen said. It’s also about how American Indians were living under constant stress — including war, disrupted trade routes, forced removal, malnutrition, and starvation — all weakening their ability to fight off disease.

American Indians continue to live under a lot of stress today, including poverty, homelessness, and inadequate housing, making them more susceptible to diseases such as COVID-19, she said.

The federal government has a legal and moral responsibility to provide Native Nations with adequate health care.

The National Center for Biotechnology Information says “the original basis for the federal–tribe relationship” is Article I, Section 8 of the U.S. Constitution, which states that Congress has the power: “To regulate Commerce with foreign Nations, and among the several states, and with the Indian Tribes.” It further explains that while there is no single legal source stating the federal government’s obligation to provide Native American Nations health care, “there is an extensive history of treaties, laws, and judicial decisions that collectively form the legal basis of this obligation.” It continues:

Native American tribes have a legal relationship with the federal government that can be traced back to the 18th century, which has shaped the conditions that impact the health of this population. According to a report transmitted by the , the special relationship between the federal government and Native Americans, referred to as a “trust” relationship, requires the government to protect tribal lands, assets, resources, treaty rights, and health care, in addition to other responsibilities.

Dr. Owen wrote that chronic underfunding of the Indian Health Service means that providers have to triage, “with infrastructure second to patient care.” Native Nations, the Indian Health Service and Urban Indian clinics and hospitals “suffer from a healthcare provider vacancy rate of 25%.

Indian Health Service staffing includes members of the National Health Corps, a federal program that provides scholarships and loan repayments to health care workers who agree to serve in “high-need areas.” Members also get called out for national emergencies, including COVID 19. Dr. Owens said 200 corps members were “recently deployed away from” the Indian Health Service to respond to the pandemic elsewhere.

Click here to read Dr. Owen’s full opinion piece.

In related news:

The Navajo Nation reported 97 new cases of COVID-19 and a total of 59 deaths as of Saturday. The total number of positive COVID-19 cases for the Navajo Nation has reached 1,637. (It has a total enrollment of 332,129.)

Yahoo News reported that the Navajo Nation “has a per capita infection rate 10 times higher than that of neighboring Arizona and the third-highest infection rate in the country behind those of New York and New Jersey.”

Counterpunch reported that “Governor Michelle Lujan Grisham of New Mexico warned President Trump nearly a month ago that coronavirus ‘could wipe out tribal nations.’ Governor Lujan Grisham cited ‘incredible spikes on the Navajo Nation,’ to which Trump responded, ‘Boy, that’s too bad for the Navajo Nation – I’ve been hearing that.’”

The Guardian reported Friday that many states aren’t tracking the coronavirus’ impact on Native people. It said:

Native Americans are being left out of demographic data on the impact of the coronavirus across the US, raising fears of hidden health emergencies in one of the country’s most vulnerable populations.

A Guardian analysis found that about 80% of state health departments have released some racial demographic data, which has already revealed stark disparities in the impact of Covid-19 in black and Latinx communities. But of those states, almost half did not explicitly include Native Americans in their breakdowns and instead categorized them under the label “other”.

In March, the “Coronavirus Preparedness and Response Supplemental Appropriations Act” provided $8.3 billion in emergency funding to respond to the pandemic. Of this funding, no less than $40 million will get allocated “to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes.” (If Indigenous nations and organizations get the $40 million minimum, it would be 0.5 percent of the total allocation, less than their population would suggest. Native Americans are roughly 1 percent of the population.)

The U.S. government needs to meets its obligations to provide health care to Indigenous nations and peoples, especially in this time of greatest need.

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