“If you knew the conditions and circumstances…you would do all you could to remedy them.” These were the words written by Dr. Susan La Flesche Picotte—the first Native American woman to earn a medical degree—in 1907. Her letter appealed to the federal government to act to address a lack of health-care resources for her Omaha tribe, to send more medical professionals to her people, and to stem the spread of disease among local children.
Her clarion call reflected a broader outcry from Native Americans across the U.S. But these pleas would go almost entirely unanswered. The necessary remedies failed to arrive. The conditions and circumstances continued to deteriorate.
Too often in the century since Dr. Picotte’s letter, our government’s response to the struggles of Native Americans has still come up short, and its actions have not done enough to alleviate issues of health care or poverty.
Yet today, the situation is starting to change for the better. Under Democratic leadership, we are no longer turning a blind eye to the conditions and circumstances in Indian country. We are working to remedy them: by improving health care for Native American families and by fighting to protect Native American women from violence and abuse.
More than two years ago, we enacted the Affordable Care Act to put consumers in charge of their own health future—with greater accountability for insurance companies, lower costs for patients, and more access to quality care for every family.
In one of the most critical reforms for Native American communities, the Affordable Care Act permanently reauthorized the Indian Health Care Improvement Act—to help build hospitals, train nurses, and ensure healthy moms and babies in tribal communities.
The law will mean expanded Indian Health Service (IHS) services, including mental and behavioral health treatment and prevention. It will mean more clinicians serving Native Americans and rural areas. It will mean that tribes and tribal organizations will be able to purchase federal insurance coverage for their employees.
Already, millions of Americans, including Native Americans, are enjoying the benefits of new patient protections at the center of the Affordable Care Act.
As we are witnessing in communities across the country, Native American seniors are seeing the “doughnut hole” close and their prescription drug costs drop, while receiving access to critical preventive services free of charge. Native American children can no longer be denied coverage due to pre-existing conditions; young adults can stay on their parents’ health plans until age 26; and small-business owners are getting tax credits to help provide insurance to their employees.
As the law fully takes effect, Native American families will have new health-care choices in state-based insurance exchanges, and lower-income households will no longer face co-pays at the doctor’s office. Medicaid will expand and help extend the reach of Native American health initiatives. Stronger reimbursements from Medicare, Medicaid, insurers, and others will help the Indian Health Service fund needed services across the board.
Health reform is central to our effort to improve the quality of life for Native Americans. But it’s not the only step we can, and must, take. Right now, too many Native American women face domestic violence and abuse in silence, in the shadows. Yet today, with the fight to reauthorize the landmark Violence Against Women Act (VAWA), we have an opportunity to remedy these conditions once and for all.
The U.S. Senate took the first step, when they passed a bipartisan reauthorization of VAWA that would enable Native American women to hold abusive partners accountable for violence. It gives tribes and law enforcement the tools to address these crimes at the local level, and seeks to stop abuse in Native American households in the early stages, before it leads to severe physical injury or death.
These provisions of the bipartisan Senate-passed VAWA bill are essential to the health and safety of Native American women; yet the House Republican version of the bill left them out. This is simply wrong and unacceptable, and Democrats will not let this stand. We will fight for passage of a law that gets the job done. We will fight to ensure that Native American women get the same protections as all American women.
In closing her letter to the Commissioner of Indian Affairs, Dr. Picotte noted that “the financial outlay for…these…requests is but small compared to the amount of good it will bring forth to my people.”
She was right then, and her appeal rings true today. We must keep working to remedy the conditions and circumstances of Indian country in our own time. Together, we must uphold our moral obligations to the health, safety and prosperity of all Native Americans.
Nancy Pelosi, the first woman Speaker of the House, is the current House Democratic Leader.