WINDOW ROCK, Navajo Nation ? If all goes well, the Navajo Nation Council will consider approving a plan by the Navajo Health Care System Corporation to take over two IHS Service units and a private Utah clinic when it meets in a special session tentatively scheduled for April 8 and 9.
The plan the council will consider is a scaled-back version of the tribally-owned non-profit corporation’s original $277 million proposal to contract for eight service units operated by Navajo Area Indian Health Service, the largest IHS operation in the country.
The council rejected NHCSC’s initial proposal on Jan. 30 after 11 hours of debate, but voted to reconsider a more limited “pilot program” that would encompass Tuba City hospital, Winslow health center and Utah Navajo Health Systems, a private clinic that receives some federal funding.
The council directed NHCSC to make revisions and submit a proposed plan for consideration at a special session set for March 15.
That date was postponed to April after it became apparent that the new plan could not clear the lengthy legislative process ? including three oversight committees ? that all resolutions must go through in time to be added to the council’s agenda.
“They asked us to revise the contract proposal with just those programs, so we went back to the negotiation table with IHS and we were able to finalize an agreement on March 6,” said Lydia Hubbard-Pourier, chief executive officer of NHCSC. “We have solid support from three communities that want to go forward with the contract and I believe we’ll have council support to achieve a successful outcome.”
Hubbard-Pourier said she is optimistic the plan will be approved because the initiative has been gaining support in recent weeks as an increasing number of community members learn more about the initiative and express support to their council delegates.
The council initially voted down the corporation’s plan to take over all Navajo IHS hospitals and clinics during its winter session, but a last-minute lobbying effort by Navajo President Kelsey Begaye and Speaker of the Council Edward T. Begay revived the initiative the following day.
The key factor in reviving the plan was their concern that $20 million available to pay for contract support costs would be lost after this fiscal year. CSC funds are what the government pays tribes for contract start-up expenses.
The Bush Administration has proposed only $2.5 million in next year’s IHS budget for new contracts, and President Begaye said it was imperative to secure as much of the $20 million currently available.
The Navajo Nation has been planning to contract for operation of its vast health care network under P.L. 93-638, the Indian Self-Determination Act, for about five years now. Navajo Area IHS is comprised of six hospitals, seven health centers and 15 health stations that served 224,969 patients in FY 2001.
The skyrocketing cost of health care, expected to double by 2011, and fast-growing Navajo population constantly stretch the capacity and funding of the system to keep up with Navajo people’s health care needs.
Dr. Taylor McKenzie, vice-president of the Navajo Nation, who was a practicing physician at the Shiprock hospital for many years, views the proposal as an important step in the Navajo Nation’s future.
“We would phase in the transition to a Navajo-administered and operated health care system that would enable us to do bigger and better things to enhance the health care of our Navajo people,” he said.
“The corporation is outside the line of authority of the federal government and the Navajo Nation government. It can be more responsive and flexible. The resources go directly to the corporation. This plan involves the local people by placing decision-making in their hands.”
Opponents of the plan vow to continue lobbying against it, citing last year’s election in which Navajo voters disapproved the idea by a four-to-one margin on a ballot marred by convoluted language in which voting “yes” actually meant “no.”
In recent weeks, signs have been posted near the council chambers and around Window Rock that read: “Want to get re-elected? Vote NO on 638.”
Larson Manuelito, who heads the Doo’Da (or No) Committee, said, “We continue to say ‘no.’ This is our health care, which is life and death for us. Listen to the people. Leave it alone.”
Local media coverage has reflected much of the widely expressed criticism heard around the Navajo Nation, but there has also been growing support for the proposal.
“I think the proposal will pass,” said Elmer Milford, a council delegate from Fort Defiance, Ariz. who was instrumental in securing funding for a new $132 million hospital and staff housing in his community that will be completed this spring.
“Other tribes around the country have done it and we can too. I think the Navajo people are ready to take control of their health care system.”
Milford cautions, however, that any plan to change such a large health care network must be carefully refined to ensure that there are no gaps in the delivery of patient care. He said that takes thorough planning.
Some Navajo health officials have expressed concern that while the plan has merit for controlling their own health care system, the current proposal lacks in-depth details on administrative and financial elements that are key to a smooth transition and to protect the integrity of patient care. They say a more refined plan must be developed over time.
Hubbard-Pourier admits that many Navajo people are afraid of change and have based their views on a number of widely circulated misconceptions, including the idea that the Navajo Nation Council will exercise control over the corporation.
“I think they feel that it’s such a big system that the Navajo people and professional health staff are not ready to operate our own system,” she said. “But we are.”
Many Navajos have said they do not trust the Council to be involved in running the health care system based on the Navajo government’s track record with past business enterprises.
They cite interference by council delegates in Navajo Agriculture Products Industries and Navajo Forest Products Industries as examples of how tribal politics can hurt a business or enterprise that must operate free of political string-pulling in order to be successful.
Hubbard-Pourier said those fears are allayed when people learn that federal funding will go directly to the corporation and not pass through the Council’s hands. She said the corporation would aggressively seek third-party reimbursements from Medicare, Medicaid and private insurance to supplement federal funding.
“We can take advantage of additional outside funding sources that IHS can’t access,” she said. “IHS can only use congressionally appropriated dollars to provide health care services. The corporations at the local level, like Utah Navajo Health Sytems, are able to access state, county and other funding sources to provide additional health services for our people.
“We view reimbursements as a real life-line for funding, ” she added. “It’s absolutely critical to future development, and even though IHS is doing a considerable amount of billing, we can make that process more efficient.”
Pourier-Hubbard and her staff have been conducting a series of public meetings to help educate people about the positive aspects of the proposed take-over as they prepare for the April council session.
To get Navajo approval, it may take more community involvement to change the minds of people like Ron Jones of Gallup, N.M. who wrote in an open letter to the council: “There’s a right way to 638, from the grass-root, capacity-building (level) with chapter support resolutions, not top-down under the mask of federal mandates being shoved down our throats.
“Where is our sovereignty? Let’s exercise it. Navajo Nation Council, vote no to 638. Our people and trust are worth more.”