title: Redeeming hollow promises: the case for mandatory spending on health care for American Indians and Alaska Natives.
abstract: The reliance on discretionary spending for American Indian/ Alaska Native health care has produced a system that is insufficient and unreliable and is associated with ongoing health disparities. Moreover, the gap between mandatory spending on a Medicare beneficiary and discretionary spending on an American Indian/Alaska Native beneficiary has grown dramatically, thus compounding the problem. The budget classification for American Indian/Alaska Native health services should be changed, and health care delivery to this population should be designated as mandatory spending. If a correct structure is in place, mandatory spending is more likely to provide adequate funding that keeps pace with changes in costs and need.
authors.affiliation: Health Policy Institute, Georgetown University, Box 571444, 3300 Whitehaven Street, NW, Suite 5000, Washington, DC 20057, USA. westmort@law.georgetown.edu
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Westmoreland
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Watson
mesh_terms: D002017:Budgets / Q000331:legislation & jurisprudence; D003695:Delivery of Health Care / Q000191:economics*; D005380:Financing, Government / Q000458:organization & administration*; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007198:Indians, North American; D004930:Inuit; D014481:United States; D016549:United States Indian Health Service / Q000191:economics* / Q000458:organization & administration