The Sioux Nation has prepaid for our health care. In our treaties, our Indian nations ceded millions of acres of land; land that America now calls home. In exchange, we preserved our Indian reservations as permanent tribal homelands, under tribal self-government, and secured the United States’ pledge of health care, education and assistance to make our reservations livable homelands.

Yet, the United States has often broken its word and as a consequence, the Indian Health Service is drastically underfunded. While Medicare is funded at more than $7,000 per patient per year, Veterans Affairs is funded at about $6,500 per patient per year, and the Federal Bureau of Prisons is funded at about $5,800 per patient per year, IHS is only funded at a level of $3,400 per year. That leaves our people having to endure and suffer with painful conditions that require surgery classified by the government as “Priority 2” – illnesses and medical conditions that are serious but not immediately life threatening are put on hold, and if they are not taken care of in the first part of the year, money has run out and only Priority 1 conditions can be dealt with. In short, we are always in a triage situation.

We now have a window of opportunity. The Indian Health Care Improvement Act reauthorization has been included in the House Health Reform bill, H.R. 3962, together with a provision that covers American Indians under the health care mandate and provides a subsidy for low income tribal members, but exempts our people from the health care penalty provisions because we have already paid for our health care through our treaties. We urge our Great Plains congressional representatives to support the Health Reform bill because we have been seeking reauthorization of the Indian Health Care Improvement Act for more than 10 years. Now is the time to move it. At present, there is not yet a companion provision on the Indian Health Care Improvement Act in the Senate Health Care Reform proposal, so it is very important to keep it in the House bill and move the House bill.

Some tribal governments have been supplementing Indian health care with tribal health care or tribal health insurance. Recently, without statutory authorization, the IRS has undertaken a campaign to tax tribal government health care benefits and tribal health insurance. Recognizing that tribal governments are supplementing the federal health care responsibility, Sen. Kent Conrad, D-N.D., offered a measure to stop IRS taxation of tribal health care and tribal health insurance; that measure is in the House bill and the Senate bill. We applaud Sen. Conrad for his leadership in moving this issue forward.

For all of our people, health care is a critically important issue. As tribal leaders and tribal citizens, we have especially critical interests at stake because inadequate funding for IHS has left us for so many years at the lowest rung of health care, health status and life expectancy. This must change! The time is now.

We thank all of our congressional representatives for their diligence and leadership and ask them to again take a stand by voting for health care reform in the House and the Senate. All Americans, especially Native Americans, deserve good quality health care. The time for action is now.

Rodney Bordeaux is president of the Rosebud Sioux Tribe.