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New Mexico has the one of the largest populations of American Indians in the country. Nearly 50,000 call Albuquerque home, ranking it third in the nation among cities with the highest percentage of Indians. Given these facts, it seems New Mexico would serve as a model for the rest of the nation in its approach to the health care delivery system for Indians.

Sadly, Indians living in New Mexico struggle to access services in a health care delivery system riddled with broken processes and broken promises.

Despite its obligation to provide health care to Indian people, the federal government continues to abrogate its responsibility by underfunding programs and reducing services. Increasingly, Indian people find themselves reliant on federal entitlement programs such as Medicaid and Medicare or forced to declare themselves indigent to qualify for financial assistance at already overburdened local hospitals.

Indian people relinquished their tribal lands to the United States in exchange for a variety of services, including housing, education and health care. In essence, it was the first prepaid health insurance policy. Health care for Indians is not charity. It is a legal obligation based on a long history of Supreme Court decisions, treaties and legal precedence.

Federal relocation programs implemented in the 1960s dramatically changed the demographics of tribal communities, resulting in more than 70 percent of tribal members living off the reservation.

However, off-reservation communities do not enjoy a government-to-government relationship with state or federal agencies. They are dependent on the limited advocacy of tribal leaders struggling to provide services for tribal members on the reservation. The increasing marginalization of tribal members living in urban and rural communities, away from their home reservations, and their lack of representation has had catastrophic effects on off-reservation communities.

The recent experience faced by a member of our community paints a disturbing picture of how our local health care delivery system fails our people. In 2006, a member of the Lakota Sioux nation went to the Albuquerque Indian Health Center, and was told he needed cataract surgery.

Because of changes in available services, he was told, he would have to go outside the Indian Health Service system for care, and services would be paid only if he met strict eligibility requirements.

Although he is a member of a federally recognized tribe, he was not eligible for services, because he lives away from his home reservation. He was told to contact his home service unit, but when he telephoned, he learned that because he had been away for more than 180 days he was no longer eligible for services. Too young to qualify for Medicare and unable to declare himself indigent, he found himself in a no-man's land of a bureaucratic red tape.

Well-intended New Mexico lawmakers are sponsoring legislation meant to address these issues. HB 784, the Native American Health Care Improvement Act, would provide $10 million to expand health care services and develop plans to improve the delivery of and access to health care services for Indians in New Mexico.

The act would establish the Native American Health Council to develop improvement plans, as well as review and approve proposals for funding to expand and develop services. Yet the act does not adequately address the needs of the very community that needs it most - tribal members living off the reservation in urban and rural communities throughout New Mexico.

Despite the large number of Indian people living off the reservation in New Mexico and the critical health care needs faced by our community, the current language contained in HB 784 allows for only two off-reservation representatives on the council. Unlike tribal representatives, the off-reservation representatives must be selected by the governor of New Mexico, not by the communities they are expected to serve. Inadequate or ineffective representation will only serve to compound existing disparities. The council plays a key role in identifying priorities and allocating resources. Without sufficient representation, off-reservation communities will continue to languish.

The definitions and language in the provisions of the HB 784 do not adequately ensure it will equally benefit tribal and off-reservation communities. There are many instances in which benefits are specific to tribal communities. For example, the bill provides $400,000 for information systems and technology support for tribal health care delivery systems and $400,000 to complete assessments of unmet behavioral health needs in tribal communities.

In an interview with Indian Country Today on Feb. 28, Gov. Bill Richardson expressed his concern regarding the plight of our tribal members living off the reservation and deplored the lack of health care available to them. Recognizing the need to elevate the status of off-reservation communities, he stated he "would make it a government-to-government relationship."

Let's work together to make the governor's bold vision a reality right here in New Mexico, by crafting legislation that is truly inclusive of all Indian people and provides an equal voice for our off-reservation community members.

Today's bylines

Lewis, of Southwest Native Consultants Inc., and Franklin, president of the Albuquerque Metro Native American Coalition, wrote this article under the aegis of the Albuquerque Coalition of Native American Non-Profit Organizations.