Document Type



Purpose This Roundtable Conference focused on financial provisions contained in the Clinton Administration's national health care reform package. Discussions centered on how these provisions would impact approximately 1.3 million American Indians and Alaska Natives (AI/ANs) who currently receive health care from the Indian Health Service. Methods Two health care financial specialists from two prominent private sector investment firms exchanged ideas with Indian Health Service (IHS) policy makers and with representatives from the Warm Springs and Choctaw tribes. Topics explored included: 1) the Indian-specific provisions of proposed federal health care legislation; 2) the IHS, tribal, and urban Indian health care programs (ITUs) outlined in the legislation; 3) primary revenue sources for these programs; 4) ITU infrastructure needs; and 5) the private investment market as a source of capital for facility development. Results Discussions focused on selling debt in the private market. Types of bonds and requirements for obtaining financing were reviewed with special emphasis on the credit rating system. Discussion was also focused on the federal loan guarantee program proposed in the President's health care reform legislation. Conclusion Some recommendations are as follows: 1) consultation and collaboration between the Department of Health and Human Services and representatives of Indian tribes, tribal organizations and urban Indian organizations should begin immediately to design new financial strategies for Indian health care programs; 2) future strategies for financing Indian health care should depend more on reimbursement for services and less on appropriations; 3) IHS should assist tribes in exploring alternatives to federal appropriations by providing information and technical assistance; 4) ITUs should work to expand their patient base including networking with local non-Indian health plans as well as with Indian programs; 5) Tribes should work to increase their credit ratings and audits are essential; and 6) ITUs must develop strategies to compete in the capital investment market.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (RT-15).