‘Health Care Reform’ on the Flathead Indian Reservation

By Beacon Staff

ST. IGNATIUS – The Tribal Health and Human Services Clinic under construction in downtown Polson represents more than bricks and mortar – it is a visible example of the Confederated Salish and Kootenai Tribe’s objective to at once provide adequate primary health care to tribal members and show their commitment to Indian health care providers.

“It’s as much about building the social fabric and infrastructure as it is in providing health care,” CSKT Health and Human Services Director Kevin Howlett said during an interview at his office here. “This clinic reflects our commitment to health professions as much as it does to the providing of care.”

A change in federal law in the late 1980s created a self-governance compact, which gives tribes the flexibility to consolidate and redesign programs and services to meet their needs. Clinics in Arlee, Elmo and Ronan, are examples of a change in the way the CSKT sees its responsibility.

“This reservation has been almost totally dependent on the private sector to provide care and that served us adequately for a number of years,” Howlett said. “As health care costs rose and the population grew and the dollars appropriated by Congress to pay for that care did not keep pace with growth and with inflation, we began to experience some serious problems with the ability to just get primary care.”

The three-story, 23,000 square-foot building that’s scheduled to open in March in Polson replaces an 1,100 square-foot structure that the tribe had outgrown long ago, but reached crisis level over the last couple of years (often leaving patients lined up outside).

“We’ve long understood in the community of Polson that the services were inadequate. We’ve had those discussions since the early ‘70s,” he said. “It became real obvious with the advent of self governance that the Tribes could begin to look at creating a mechanism to provide health care to its people.”

Make no mistake, however, the Tribes understand the financial ramifications.

“A lot of this will depend on our ability to make collections from people who have third-party, because that kind of drives the business model,” said Howlett. “This is a business and it has to be done in that context as well as providing a service that people might have just viewed as free. There’s nothing free about this. It all costs.”

While there are 3,700 CSKT enrollees, there are 11,000 reservation residents eligible for services. Visits to area Tribal Health facilities numbered 90,000 last year. Howlett estimated 30 percent of those eligible for services choose Indian facilities.

“We expect that to increase substantially with the advent of Polson,” said Howlett.

Eligible Tribal members are not mandated to use Tribal Health facilities, which strictly provide primary outpatient services.

“We understand that we have to make it a place where people want to come, where they feel comfortable, where they have confidence in the care they’re getting that it is as good of care as they can acquire anywhere else and we intend to do that,” he said.

Howlett said he’s worked extensively with local medical facilities to address their concerns.

“We were mindful that it would have an impact on the local medical community,” he said. “I can’t tell you that there wasn’t some ambivalence.”

Construction of the state-of-the-art, $3 million-health center was financed by Tribal resources, mainly from the third-party collections received for services from such programs as Medicare and Medicaid.

Indian Health Service earmarked some $400,000 for equipment, which could eventually cost $1 million. A staff of 35 will operate the facility, with some moving from other clinics, while others will be hired at an estimated increased payroll of $1 million.

The facility will include eight exam rooms, seven dental labs, two full-time pharmacies, two medical providers, physical therapy, digital X-ray, an eye clinic and eyewear facilities, a behavioral health component and spaces for a visiting mobile MRI machine and mammography facilities, in addition to conference space that will be available to the community.

“We understand the issues of health care,” Howlett said. “We were looking at health care reform long before it became a national issue.”

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