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June 19, 1996

First Americans Face Their Latest Challenge: Indian Health Care Meets State Medicaid Reform

JAMA. 1996;275(23):1786-1788. doi:10.1001/jama.1996.03530470014004

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AMERICAN INDIANS know a lot about "reform." If some people had had their way, Native American tribes would have been reformed out of existence a century ago. So it's not surprising that members of some 500 federally recognized tribes that remain are wary when talk in their locality turns to "health care reform."

Gerald Hill, MD, a past president of the Association of American Indian Physicians, spoke about "The Indian Health Care System and State Health Care Reform" at the annual meeting of the National Rural Health Association last month in Minneapolis, Minn. He contrasted the Indians' aims—respect for and preservation of tribal sovereignty, continued delivery of culturally appropriate health care services, and maintenance and improvement of the Indian health care system funding base—with the states' desire to reduce Medicaid spending and improve the access of tribal members to other types of health insurance as well as to health services.