has remained a focus area of many government programs. The government has created programs to assist with costs for those unable to provide adequate healthcare coverage for themselves, whether through poverty, age, or disability.
How does the U.S. government fund programs for special populations? Medicare is funded through payroll taxes paid by employers and employees, general federal income tax revenue, income taxes paid on Social Security benefits, premiums paid by Medicare beneficiaries, interest earned on trust funds, Hospital Insurance (HI) and Supplementary Medical Insurance (SMI), and investments (Medicare.gov, n.d.). Medicaid is jointly funded through the federal government and individual states (Medicaid.gov, n.d.). This chapter will describe special populations in which the U.S. healthcare system provides healthcare benefits. Through a brief review, it will additionally highlight the federal and state programs which provide support to specific special groups. This chapter includes discussion of Native American and Alaska Natives, military veterans, children and adults with disabilities, elderly, and incarcerated individuals.
American Indians and Alaska Natives (AIAN) currently number 6.79 million or 2.09% of the U.S. population (World Population Review, 2020). This vulnerable population is disproportionately affected by many health conditions and have a higher rate of death than other Americans with these same conditions. Common conditions include diabetes, chronic lower respiratory diseases, chronic liver disease and cirrhosis, and mental health disorders that lead to intentional self-harm and suicide (Indian Health Services [IHS], 2019). In addition, American Indians and Alaska Natives suffer more unintentional injuries and assault/ homicides. In 2017, the leading causes of death for AIAN were heart disease, cancer, and unintentional injuries (Centers for Disease Control and Prevention [CDC], 2020a). Sadly, this group of vulnerable citizens also has a life expectancy of 73 years of age, 5.5 years less than other Americans from any race (78.5 years of age) (IHS, 2019) (Figure 7.1).
The U.S. government and Indian tribes developed a “trust” relationship as far back as the eighteenth century, a relationship that has had an impact on and shaped the focus of health for the AIAN community (National Academy of Science, 2017). Indian Health Services (IHS), an agency within the Department of Health and Human Services (HHS), is the leading health provider for this vulnerable group of citizens. IHS has been federally recognized since 1954 with a transfer of health services from the Bureau of Indian Affairs to the Public Health Service. In addition, as a result of the 1975 Indian Self-Determination and Education Assistance Act (ISDEAA), tribes are able to have control and management of healthcare services. Over 60% of the IHS budget is appropriated and managed by tribes.
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