WASHINGTON—Tuolumne County’s Me Wuk tribe is receiving less than half the health care aid necessary to meet its needs -- and the level of funding hasn’t changed since 2001 when Congress allowed the Indian Health Care Improvement Act to expire.

  An effort to renew the law is under way. A bill reauthorizing the law unanimously has passed the first of three committees necessary to send it to the House floor.

“There are all sorts of improvements in terms of providing direction and oversight to the (Indian Health Service) in the health bill and there’s a real need to pass it this Congress, even if there’s no money,” said California Rural Indian Health Board Executive Director Jim Crouch. It’s laying the groundwork for better funding in the future, he said.

Although the original health care law has expired, money continued to flow through legislation passed in 1921, which acknowledged the nation’s obligation to support health care needs of tribes. Lawmakers have tried twice since 2001 to renew the Indian Health Care Improvement law, but both attempts failed.

 The health care program for American Indians differs from other health benefits because its funding is discretionary, compared with “entitlement” programs like Medicare, where the money is guaranteed by the government.

“One is on a whim of Congress, the other is on automatic pilot,” Crouch said.

While many in the American Indian community are excited by the attention the bill is receiving on Capitol Hill, the legislation faces criticism for the disparity in funding levels for different regions. In California, where there are no fully funded Indian Health Service hospitals, aid meant for specialist care gets used to pay for standard needs like blood tests and x-rays.

That gap comes primarily from the priority given to fund facilities in regions with dense American Indian populations. While there are more American Indians in California than in any other state, some states in the Southwest have 16 times the population density.

Despite the lack of well-financed facilities in California, the state’s tribes continue to receive half as much money for specialist care funding as those in states who already have access to Indian Health Service hospitals and clinics.

During the Natural Resources Committee consideration of the bill last Wednesday, Rep. Don Young, R-Alaska., responded to congressmen who questioned the priority in the reauthorization bill, and bluntly said “I do not apologize for the disparity.”

The California Rural Indian Health Board fears the gap in facility funding may sink the bill.

“If you can’t give us the facility money then at least give us more contract support dollars” for outside care, said Miwok Tribal member Nancy Ehlers, (who spells the tribal name differently than those in Tuolumne) chair of the MACT Health Board, which represents facilities that serve American Indians in the counties of Mariposa, Amador, Calaveras and Tuolumne.

Only 20 percent of the funding for the MACT facilities in those counties is paid by Indian Health Service.

The bill also ensures that any California tribes that remain unrecognized by Congress will not risk benefit cuts.

“The treaty rights are still there, we’re still entitled to the service,” Ehlers said. “We just want a fair chance to come to the bargaining table. I know we have to compete for the same small dollars, but make the playing field double.”

It’s hard to count on the aid money, Jim Crouch said, because Congress speaks with two mouths.  One Okays necessary funds through bills such as the health care reauthorization, but the other determines how much to make the check out for, through appropriation bills.

“Both pistons have to hit or this little two-cylinder-engine doesn’t go far,” he said.