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Indian Health Service (IHS)


Historically, it is known that the native Indians have had to face many hardships ever since the

inception of the American territory by the invaders. At first, it was a war between the two

communities; the locals of the area and the well-equipped forces from the European continent

who barged in with all their might to establish a strong foothold in the area. This war was,

however, short lived. The Indians were always at a disadvantage because of their lack of skill

and their inability to compete with the forces of the occupants who had all the latest technology

of the world. The Europeans were more organized, proficient and prepared. They knew that they

had unearthed a part of the world which was going to provide them with all kinds of goods and

services that they needed. This was considered a no man’s land and the continent was brutally


Once the European forces completely took over the American land, the natives were left with no

leverage. They were men of lower status; most of whom were killed, and the rest went into

hiding. They knew that they were completely unwelcomed in the place that they once used to

call their homeland and the chances of recovering from that were very unlikely. Their whole

communities were destroyed, and they were referred to as “Indians”, instead of the “original

Americans”. The colonists were using America as their reservoir of riches and exploiting it to a

maximum degree to improve conditions further in the mother countries. During that time, it was

not possible for them to envision an independent American government with its own set of rules

and policies.

Initially, most of the people who were moved from the European countries to America were

either war criminals or those who were jailed for other reasons. This was done because the
colonists were not sure whether or not the weather and other conditions of the new continent

were going to be suitable for them to live in. Later on, more and more people were brought to

America by them which included the African Americans to set up the basis of slavery here.

These people were directly under the control of their European counterparts and they were made

to work tirelessly for the development of these nations. The feelings of resentment started to rise

in the hearts of the slaves and they began to sympathize with the natives of the area. As time

passed, these notions of discontentment increased as a result of which, Americans waged a war

of independence. This was undoubtedly a very long and hard struggle but eventually it proved to

be fruitful. For the first time in history, America started being known as a free and independent

continent; the center of which were the United States.

This was a victory that was a desire of the Americans for a very long time now. Although it was

a celebration call for most, the American Indians still had its own kind of reservations and

problems regarding it. This independence was only for the people who were moved to America

by their parent countries. It did not curtail any elaborate details of what the rights of the Indians

will be in this new country. Although the government of the United States claimed that it

represented all of the people residing in these states, the civil liberties of the Indians were never

discussed at length. The authorities, however, did realize that there was need to ensure that these

people were catered to in the new policies and legislations and proposed some ideas about how

the government will look after them so that they don’t cause any trouble. Although they were a

minority, they still felt like they became prey to the intrusion of the Europeans in their homeland

who were not the true masters of this area. The government of the United States was clever

enough to realize these feelings of resentment that might cause trouble in the territory and tried
to compensate the losses of the Indians by passing some laws that solely benefitted the

suppressed community.

The government of United States was under the obligation to provide the American Indians and

Alaska Natives with the best healthcare facilities in America. They tried to deliver that promise

by passing the act of Indian Health Service (IHS). This act embodied in its clauses the assurance

that the natives will be looked after just like others and they are not at a disadvantage in any

terms. However, passing this act was one thing and implementing it was a whole other story. The

underfunding of IHS came in the way and this organization could not perform as well as it was

hoped that it would. The lack of funding was not a problem of just the past; these problems are

still visible when looked into as shown by the following graph.

2009–2010 Indian health expenditures per capita compared with other federal health care

expenditures per capita.

(FEHB = Federal Employee Health Benefits; IHS = Indian Health Service.)

This fact was soon realized by the government and they felt that they needed to put in more

efforts to protect the interests on the American Indians. Thus, many acts were passed with the

common cause of improving health conditions for the natives. These acts included Snyder Act,

Transfer Act, Indian Self-Determination and Education Assistance Act, and the Indian Health
Care Improvement Act. These acts paved way in improving conditions that were previously very

bad. They are described here as follows:

Snyder Act:

This was one of the first legitimate acts by the Congress that helped in improving health

conditions for the Native Americans and solving the problem of underfunding to some degree. It

included the prospects of providing employment opportunities for physicians so that they can

help those who are suffering. This was proposed in a way that it was considered appropriate for

the Congress to allocate funds in this cause.

Transfer Act

In the Transfer Act, the Native Americans were given the liberty to authorize laws regarding

healthcare and the tribal community was given sovereignty. It was for the first time that the

natives had a margin of making policies and setting rules for themselves with proper deliberation

that catered to their interests and provided the best healthcare facilities in the areas that

concerned them. The authorities that were previously not controlled by the tribes were

transferred to the Secretary of health, education and welfare which is why the act came to be

known as the Transfer Act. Nowadays, these services are referred to as the Health and Human


Indian Self-Determination and Education Assistance Act

Indian Self-Determination and Education Assistance Act (ISDEAA) was promulgated in the year

1975. This was the most powerful act that had ever been passed regarding healthcare that

benefitted the American Indians. According to the law, the Secretary of Health was given free

rights to provide aids and grants to whatever tribes that he thought deserved enough and he

enjoyed free liberty of the allocation of these funds.

Indian Healthcare Improvement Act:

This was an act of 1976 and it was meant to further the interests of ISDEAA. The goal was also

the same; to improve health conditions of the American Indians. There was need to modify the

laws that had been passed previously and rewrite them to ensure that the best possible facilities

were being made available for the Indians. For that, it was necessary to redefine the whole

concept of modern healthcare with improved conditions and best amenities. In this act, a lot of

new programs were introduced that would help in the betterment of health conditions amongst

the Indians; the total number of which were 34. Apart from this, it also ensured that the 638

programs that were running were elevated to include medical care and medical aid in them. Ever

since then, repayments from the Medicare, Medicaid and Children’s Health Insurance program

have helped in providing best services to the American Indians.

In short, we can say that the health services for the Indians were not apt enough because of a lot

of scenarios. These included arguments with the laws for Indians, their policies for health and the

intergovernmental issues. Throughout history, the Indians have been subjected to conflicts and

troubles with the government, being forced to wage wars on the government’s behalf and having

to face terrible healthcare conditions due to the problems of underfunding. We can still see that

the health system for the natives is not free of errors and it needs to be supervised keenly to

avoid any major glitches and ensure that the tribes attain and provide excellent services which

are properly financed. The policies and laws that are needed to be made should not come in

conflict with the government and needless obstacles should be evaded.


The Indian Healthcare Improvement Act was passed in the year 1976 and it was given authority

to anew in 2000. That is when it was made permanent for the years to follow. As the name
indicates, the whole point and purpose of the act was to invest in the healthcare facilities of the

American Indians and Alaska Natives to support the cause of their medical care. The Affordable

Care Act makes sure that the authorities look over the act in a way that new techniques and

programs are promoted, innovation is appreciated, and constant efforts are made to ensure that

the demands of the quickly developing world are met. It includes many other incentives that are

discussed here in length.

The psychological and social health of people were given due weightage in the new policies. The

people were provided with home and extended healthcare amenities which supported community

lifestyle and improved the way of life. The problems that the patients faced were also taken into

account. They were provided with travel commodities and reduced the expenditure of treatment.

The best medical professionals were recruited and made available to those who were in need of

them to battle with their diseases.

Different programs were introduced that helped in meeting the needs of individuals. It was made

sure that the kidney patients could get free dialyses. Health was given a priority for all Indians

just like it was for others. The medical profession was expanded to a much larger scale than what

it was run on before that.

There was a reservation in the minds of many that the Indian Health Services Act would vanish

in the years to follow once the health reforms were implemented. The reason for this doubt lay in

the increased insurance coverage. However, it was seen that this was no more than a false doubt

in people’s imagination. The IHS was reinforced and made permanent with the authorization of

allowance of new and innovative technologies to help keep up with the increasing demand. This

legislation was the founding basis of the system in which all Americans were able to attain equal

These amends were such that they could not be implemented all at once. There had to be a

thorough study of when and how which program should be introduced for what tribe. These

programs were supposed to be made available to those in need and were hard to be executed all

at once. Therefore, the system that was setup in some areas was that representatives of those

areas were to forward the demands of their particular tribes and the facilities were to be provided

on need basis. In Michigan, for example, 12 different tribes were present, and the government

was trying to meet the needs of all in the best possible manner. President Barrack Obama

introduced Patient Protection and Affordable Care Act which automatically reauthorized the

previously existing Indian Health Care Improvement Act (IHCIA).

The goal of Indian Health Care Improvement Act (IHCIA) was that it would further the interests

of HIS. This sets up targets in the program in which it is made a destination to reach a whole

environment where premature illnesses lead to the death of patients because they are not looked

after in the best way. These programs intended to provide healthcare facilities to an estimated

number of 2 million Native Americans on reserved funds. New programs were introduced to

further the interests of best health possible for the first Americans.

With the targets set in mind, the American government works in the way of improving health

conditions in many new and innovative ways. Many methods have been introduced to provide

behavioral guidance to individuals and promote a healthy lifestyle in the societies of Native

Americans. They are allowed to enjoy equal share of health facilities like the rest of the people

and there is no discrimination on that basis. “Healthy People” is an organization which sets goals

in mind to better the conditions of health in the world and it looks over the conditions of

American Indians and Alaska Natives to ensure the success of IHCIA.

Apart from the common goals, the other diseases that are treated in these programs are diabetes.

Diabetic patients are looked after by the authorities in a way that long term care programs are

present. Cancer treatment and removal of tumors is also one important side of illnesses that are

dealt with. These health organizations are sponsored by the programs of reimbursement by

Medicare and Medicaid. This inflow of money is used to improve the conditions of these

facilities and camps. When the yearly reports of health appropriations for Indians is made, , the

Medicare and Medicaid programs are not evaluated.

IHCIA approves the following clauses:

 Designated Indian Health Service (IHS) programs

 Sets national policy for HIS

 Finalizes targets to eliminate avoidable diseases and untimely demises

The reauthorization for the First Americans:

 Increases platforms that pursue the health care workforce augmentation

 Upsurges facilities obtainable at services sponsored by IHS

 Intensifies programs that deliver mental health and exploitation treatment


Ever since the implementation of the law of 1976, the Medicare and Medicaid Centers have

become very important because they need to provide healthcare facilities for a large number of

people. There have been some problems in the way of successful implementation of these

policies though. The Indians still feel like CMS are an organization that is foreign, and they feel

threatened to share any kind of discreet information about their personal lives with them. The

truth, however, is that CMS are under direct control of the federal government, but the feelings

of resentment and disliking are still very common to be seen. They don’t trust these agencies
enough to share any sensitive information that can possibly prove to be harmful for them in any

way. The CMS is not underfunded like the IHS. They are backed by the federal government and

have huge reserves as compared to the latter. However, due to the cloud of mistrust, some states

have refused to acknowledge the authenticity of CMS and declined the expansion of Medicare.

The future of the healthcare system of American Indians and the Alaska Natives in these states

seems wobbling.

Policy Innovations and business:

While we see that a lot of the tribal communities are poor and deprived, there are still quite a few

that are stable economically. With the stability in a tribe’s monetary level, there come

opportunities to attain better and better medical facilities that the state has to offer. Newer setups

are being run in these areas and most of the residents are now insured. Apart from this, these

tribes also form linkages and partnerships with the private organizations running in the country

like hospitals, medical centers, pharmaceutical industries etc. This has improved the healthcare

conditions by aggravating newer concepts that provide best facilities for those who are able to

attain them.


It is the job of the American government to make sure that all of its citizens are provided with

the best medical facilities, be it the natives or others. The natives expect that they are eligible to

acquire these services in return of the land and resources that the conquerors have taken full

benefits of up until now. In return, Congress allocates money and resources for the Indian Health

Serves (IHS) every year. This, however, does not come under the control of the federal

government but on the will of the political leadership of the Congress. This is why the HIS is

prone to going bankrupt once the Congress decides to pull out of its agreements and not keep its
promises. Medicare and Medicaid programs are different though. These resources are allocated

directly by the government agencies and therefore, they are in a much better financial state than

the IHS. The financial condition of HIS has not been able to keep pace with the ever-increasing

population and the inflation. Due to this, the American Indians and Alaska Natives have had to

face very poor health conditions and the struggle has left many dead.

In conclusion, the study of health services shows that in monitoring the health setups in the

Indian and Native Alaska communities, the extent of unnecessary misery and losses of human

lives concerned with avoidable and curable illnesses make the financing of IHS a social cause

and a humanitarian problem. This matter needs to be given the due importance that it deserves,

and it should be prioritized by the advocates of health and welfare of mankind. The rights of

people demand that everyone receives the same care and facilities in the country. This is an area

where concentration is necessary and everyone needs to be put on the same pedestal when it

comes to health conditions, at the very least.