On June 16, 2015, the Governor of Montana, Steve Bullock (D) announced that he had signed an Executive Order to create an Office of American Indian Health within the Montana Department of Health and Human Services. This office, according to Bullock, will “focus on identifying specific factors contributing to health disparities,” between Native Americans and other residents of the state. The Governor’s office noted that the average life span for American Indians in Montana is 20 years shorter than for non-Indian Montanans.
The perhaps shocking statistic on Montanan American Indians’ lifespans cited by the Governor’s office was one of the results uncovered by a 2013 state health department report, which stated that Native Americans were more likely to suffer from certain diseases and chronic illnesses, including cardiovascular disease, cancer, and respiratory illness. Moreover, the report noted that these groups also tended to have less access to health care in the state. The Bismarck Tribune summarized the relevant data this way, with reference to the expanded eligibility for Medicaid due to implementation of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) in the state: “Although Native Americans comprise less than 10 percent of Montana’s population, it’s estimated that they account for 20,000—nearly 30 percent—of the 70,000 Montanans who will be newly eligible for Medicaid under the state law enacted this spring to cover very low-income citizens.”
The new role
Although the new office will only consist of one full-time employee, the role will allow for improved collaboration with other state agencies, tribal leaders, and federal Indian health centers in order to “ensure that the state’s native and non-native residents have the same access to essential health services,” according to Montana Public Radio. In Bullock’s words, the new employee will be tasked with identifying the reasons behind the disparities, coordinating the development of strategies, and overseeing an action plan to attack the disparities and improve access for Montanan American Indians. The Governor’s order also outlines other duties of the newly-created position, including: (1) coordinating efforts within the health department to address the disparities; (2) establishing continuous consultations with local leaders and experts, including federal government agency representatives; (3) coordinating efforts with other state agencies; (4) identifying and developing a list of state programs that may be useful in addressing the disparities; and (5) providing updates on the progress of actions taken in this area. The details, including the projected costs of the creation of this office and the date the office will be filled, remain unknown.
Medicaid and the ACA in Montana
The implementation of the ACA not only highlights the identified disparities but also could play a large role in the strategies adopted by the new office to address these disparities. Earlier this year, the Montana legislature voted to expand Medicaid in the state. This expansion still awaits federal approval but Governor Bullock has begun to prepare the state for the transition to expansion.
A report released by the Montana Budget and Policy Center explained that Medicaid expansion in Montana would result in coverage for 70,000 residents. Moreover, the report warned that the failure to adopt expanded Medicaid in the past has resulted in the state losing “as much as 1.96 million of federal funds every day.”
The benefits that the ACA may bring to the Native American population in the country in general have been highlighted in a report issued by Kaiser Health News (KHN). In addition to noting the benefits of the expansion of Medicaid, (which the report noted could make a huge impact on the Native American community since nearly half of the population is eligible for Medicaid services) KHN also explained that the ACA implemented new provisions, through the amendment of the Indian Health Care Improvement Act, that provided for easier ways for Indian health centers to accept payment from different types of payers and expanded the types of services these facilities may offer.
With the effect that ACA could have on Native American residents in Montana as it is further embraced by the state, the newly-created Office of American Indian Health will have plenty of avenues to explore.