Elder Care and Medicare
Abstract
For many American Indian elders who are poor, uninsured and underinsured, there is a limited range of options from which to choose when seeking medical care. For many decades, the Indian Health Service (IHS) was the primary care for Indians. That may no longer be the case. Because of budgetary restraints and cutbacks within the IHS system, medical care for the poor and elderly in American Indian communities has become severely restrictive. There was once a time when “just being an Indian” meant that entry into an Indian clinic was expected. Although never quite enough, congressional outlays provided funds to run Indian hospitals and clinics in order to meet the demand of those individuals in need of medical care. Then came the “on or near” ruling meant to restrict eligibility to those living within or adjacent to the county boundaries of reservations. One’s definition of eligibility then depended upon tribal status, place of residence, and blood quantum. Now, one more limitation faces those in need: medical provider acceptance. When Freida became an elder—when she was well into her sixties—she found herself being questioned endlessly at the local Alaskan Native clinic regarding her tribe (a California tribe), blood quantum (having a Norwegian last name brought questions), residence (moving from California to live with her son in Alaska), and ability to pay for medical care services. Diagnosed with cataracts, Freida struggled to survive from day to day on meager retirement funds. Having depended upon the IHS clinic to treat her diabetes and rapidly deteriorating eyesight, Freida was initially confident that she could also have her cataracts surgically removed with the support of the IHS. Her need for the surgery could not be contested; as it was, she greeted the morning through filmy gauze, which restricted her ability to see more than a few feet ahead. Although cataract surgery is available in Alaska, the ability to pay for such services is not readily available.