Health Archives - Page 57 of 90

Serving patients while raising awareness Quarterly diabetes day at the Tulalip Health Clinic

By Andrew Gobin, Tulalip News

The Tulalip Karen I. Fryberg Health Clinic held their quarterly Diabetes Day Tuesday, May 13. Diabetes Day is held once every three months, and for four hours the clinic makes all the services readily available to patients.

“With diabetes, it’s just convenient to have everybody right there and then to see me,” said Veronica Leahy, diabetes educator for the clinic. “People can come in and do their labs. Some people have had to fast, so we have healthy snacks available for afterwards.”

While Diabetes Day is intended to provide convenient all inclusive same-day service to patients, there is also an effort to bring awareness to people on how to prevent the disease. Clinic nurses used diagrams and models to show the effects of unhealthy lifestyles and how they can lead to or magnify diabetes.

Burleigh Snyder is a patient of the clinic and an advocate for diabetes awareness. He participates in most of the diabetes events, and contributes the gardens at the clinic and at the Hibulb Cultural Center.

He said, “I should be six feet under. My highest number (highest blood sugar level) was 1873. I was found in a coma, I died three times at the hospital. I advocate for diabetes awareness so that maybe what happened to me will help someone else prevent diabetes in their life.”

Rob Taylor, who volunteers at the clinic’s garden, said, “We are showing people how to eat better. Diet is so closely tied to diabetes and obesity. Healthy eating to reduce weight is very beneficial to diabetes. We would like to expand the garden, maybe include an orchard, but that’s a ways out.”

The next Diabetes Days are August 12 and November 18. Stop in at the Tulalip Health Clinic from 9:00 a.m. to 1:00 p.m. on those days to learn more.

Andrew Gobin is a reporter with the See-Yaht-Sub, a publication of the Tulalip Tribes Communications Department.
Email: agobin@tulalipnews.com
Phone: (360) 716.4188

Tulalip Bay Fire conducts an airlift drill

By Andrew Gobin, Tulalip News

The Tulalip Bay Fire Department is updating emergency plans, which includes finding landing zones for patients needing helicopter transport. On Wednesday, May 7, TBFD coordinated an airlift drill with Airlift Northwest, a Med-Evac company that operates in Snohomish County. In addition to finding suitable landing zones accessible to various housing developments, TBFD firefighters reviewed airlift protocols and safety procedures.

At approximately 8:30 p.m. the Airlift Northwest Med-Evac helicopter landed in the field next to the Tulalip health clinic, the old Boom City site. Firefighters set up the landing zone prior to the arrival of the Med-Evac. When the helicopter had landed, the emergency response team from Airlift Northwest reviewed some landing procedures, highlighting what TBFD did well, and what to keep in mind for emergency situations. Airlift Northwest also discussed how landing procedures might vary depending on time of day, weather conditions, the patient condition, and status of a landing zone. They then demonstrated how to properly load a patient into the helicopter.

TBFD has selected and defined five landing zones around the reservation, near neighborhoods and areas with higher population densities. In addition to identifying landing zones, they have developed a protocol for contingent landing zones. For example, the baseball field at the tribal center is a landing zone, but it could be occupied for a game or other event at any time. Therefor the contingent landing zone is the old Boom City site, where the drill was executed. They have also developed a protocol for securing on-scene landing zones, where a Med-Evac chopper could land in a suitable location other than one of the designated landing zones.

The commotion inevitably drew some attention from vehicles passing by, with many stopping to observe what was going on.

Tulalip Firefighter Nikolay Litvinchuk being loaded into a Med-Evac chopper Photo: Andrew Gobin/Tulalip News

Andrew Gobin is a reporter with the See-Yaht-Sub, a publication of the Tulalip Tribes Communications Department.
Email: agobin@tulaliptribes-nsn.gov
Phone: (360) 716.4188

Why Should Tulalip Tribal Members Care About the Affordable Care Act?

By Kyle Taylor Lucas

The Affordable Care Act (ACA), signed into law in 2010, became effective January 2014. Many questions continue to roil in the minds of American Indians about just what the new health care law means to them.

The law helps make health insurance coverage more affordable and accessible for millions of Americans, including American Indians. Importantly, the law addresses inequities, increases access to affordable health coverage and prevention medicine for tribal members. The ACA is important to American Indians because it provides greater access to care and coverage unmet by the Indian Health Service (IHS).

The ACA requires all Americans to have health care insurance coverage. However, American Indians and Alaska Natives have the option to file a lifetime exemption. They are encouraged by the state Health Care Exchange to file the exemption regardless of their current insurance status in case their insurance should ever lapse.

There are numerous state and federal agencies working to implement and manage ACA health care delivery. Tulalip members can most directly obtain enrollment process advice from clinic staff members who have received specialized training as Tribal Assisters. They can help members through the enrollment process and refer you to a broker who is licensed to provide information and advice on qualified health insurance plans and policies. Tulalip Resource Advocate, Rose Iukes, has received intensive training on the ACA. She and Brent Case can answer questions and help enroll members. Fortunately, for Tulalip members, the Board of Directors contracted with a licensed broker, Jerry Lyons, to assist members in understanding and selecting the best-qualified health insurance plan for themselves.

Contact Information:

Tribal Assisters:

Rose Iukes, Resource Advocate – (360) 716-5632 / RoseIukes@tulaliptribes-nsn.gov

Brent Case, Resource Specialist – (360) 716-5722 / BCase@tulaliptribes-nsn.gov

Broker:

Jerry Lions, American Senior Resources – (206) 999-0317

Asked about the greatest impediment to enrolling tribal members, Rose Iukes said many tribal members assume IHS coverage is sufficient, so have been disinterested in the ACA. Even so, she noted, “We had almost 800 people apply. We got probably about 250 on qualified health plans and about 150-180 on Apple.” She said efforts were hampered by the state system “going down,” which required many tribal enrollments to be done in-person. “There were so many flaws that we started having people do paper applications here at the clinic. Now, we need to have them do follow-up. We didn’t get to do a test-run on the site. We thought we could go in and enroll them, but there were additional security questions. So, now we’re asking members who completed paper applications to come in and complete their application processes.”

Even with the challenges, Washington State fared better with its overall ACA rollout than other states, leading the nation in early enrollment numbers.

Rose Iukes noted significant confusion due to the state’s failure to provide clarifying information on special tribal provisions and exemptions on its websites and call centers. She said, “I’m hoping these call centers get educated on the tribal provisions and exemptions.” She could not say why there is little detail about income, age and other special provisions posted on state websites. Publicizing details of special federal poverty level provisions and exemptions for tribal members may be confusing to the general public. The result is that the rollout for American Indians, especially urban Indians without easy access or even referral to a Tribal Assister, has been challenging. However, despite the state’s system inadequacies, Iukes praised the American Indian Health Care Commission staff and Sheryl Lowe at the Washington Health Care Exchange whose support she felt was invaluable.

“The bottom line for tribal members, if they have ACA health care they can be taken care of. And they can get the help they need. That’s what drives me and why I advocate the way, I do. I don’t want somebody to go through the heartache,” said Iukes.

Tribal members often inquire about alcohol and chemical dependency treatment options, especially as many have a history of unsuccessful treatment attempts. Iukes said that beyond the Tribe’s one treatment option, “With qualified health plans, there is unlimited treatment, but we need to find a way to help them pay their premium. For example, a young man was ready to go to treatment, but his premium was $4. It must be paid with a debit card, but he didn’t have one. Ultimately, he didn’t go to treatment. I’ve asked the Board about setting up a way for the premium to come out of per capita, then we can issue them a card to use” to pay their premiums.

Broker, Jerry Lyons, is licensed with eighty (80) different insurance companies said, “In my brief time working with Tulalip, we feel confident in our efforts. We are being successful as we have been instrumental in assisting members with questions and we have enrolled more Native Americans into the ACA than any other tribe.” He added that never in his career has he been involved in a more “disorganized” insurance roll-out, but emphasized it was not due to the tribal efforts, but rather the bureaucracy. “Even so, we have helped about 250 people obtain insurance in one way or another.” Asked if he is available to all members many of whom reside off-reservation, Lyons replied, “We assist all members. There are also many special plans that most tribes are unaware of. Just have them call me.”

Several state, public/private, federal, and non-profit organizations are supporting tribal ACA implementation and enrollment. They are the Washington Health Benefit Exchange, the Health Care Authority, the Centers for Medicare and Medicaid Services (CMS) Region 10 office in Seattle, and the American Indian Health Commission.

Washington Health Benefit Exchange (HBE)

The Washington Health Benefit Exchange was created in 2011 state law as a “public-private partnership” separate and distinct from the state. The Exchange is responsible for the creation of Washington Healthplanfinder–the online marketplace to assist Washingtonians to find, compare, and enroll in qualified health insurance plans.

Many tribal members who rely upon IHS for their health care needs question the need to apply for ACA coverage. They also question the need to go outside treaty guaranteed health care services. Unfortunately, as most trust responsibilities, health care for American Indians/Alaska Natives has been historically and woefully underfunded and continues to be so today.

When asked why the ACA is important to tribal members, Sheryl Lowe, tribal liaison with the Washington Health Benefit Exchange, said, “Individual coverage offers tribal members more access to specialty care and even if the member uses their own tribal clinic, the tribe can then bill the health insurance company rather than the Indian Health Service. She emphasized that the basic tribal contract dollars can then be utilized for other urgent and uncovered care.

Lowe said the ACA benefits both individuals and tribes. “For most tribes, IHS only provides direct care and tribes have to pay Contract Health Care. And the IHS continues to be funded at less than fifty percent of need, so the ACA is another way for individuals and tribes to access health care. Also, most tribal clinics are Priority One clinics offering basic care and provide referrals only for life and limb.”

After working out many of the bugs and training, there are 93 Tribal Assisters, at least one in each of the federally recognized tribes in Washington, the state and the Tribal Assisters are now able to focus upon a more comprehensive effort to enroll tribal members. Lowe praised the Tribal Assisters who she credits with outstanding efforts to learn a complicated enrollment process to become certified as Tribal Assisters. She said Tulalip has four Tribal Assisters and she exclaimed, “Rose Iukes is so dedicated!” The HBE shared the following statewide training statistics:

– HBE-Certified Tribal Assisters: 93

– Tribal Staff in the process of becoming Certified: 34

– 66 Active Tribal Assisters helped 10,000 people enroll through the HPF (through 2/15/14)

– Tribal Assisters represented 25 Tribes, 2 Urban Indian Organizations, and SPIPA

The Health Benefit Exchange reports that statewide, of the 26,378 who answered “yes” to “Are you an American Indian/Alaska Native [AI/AN]?” on the ACA enrollment site, 21,201 of “enrolled tribal members” have enrolled in the Healthplanfinder. Significantly, 17,350 enrolled in Washington Apple Health (expanded Medicaid). Unfortunately, of the 3,885 AI/ANs eligible for Qualified Health Plans, only 1,110 actually enrolled even though many would likely have zero to low premiums and no cost shares.

Lowe said she couldn’t emphasize enough the importance of tribal members considering enrollment because those whose income falls in 138 – 300 percent of federal poverty level have no cost-sharing which means no co-pay or deductibles, “which is a huge benefit.” She added, “Depending upon household size and other factors, some may even have a premium that is zero. They can take the tax credit to lower their monthly premium or take it at the end of the year. Those in the 138 – 400% of poverty level are eligible for premium tax credits. Depending upon income or household size you can get tax credits which will reduce your overall costs.” She pointed out that some plans have deductibles for $5000 for a family before they’ll pay anything, so the cost-sharing benefit is one of the biggest things for tribal members.” It is clearly worthwhile for tribal members to speak to a tribal assister and/or broker.

Those whose income is below 100 – 138 percent of federal poverty level qualify for expanded Medicaid or Apple Health as it is now called. However, children are eligible for Apple Health in households whose income is up to 300% of the federal poverty level. Therefore, although the adults may not qualify for Apple Health, it is important to consider that children may.

Unlike Apple Health, the Qualified Health Plans do not provide dental. Yet, the ACA does require that all children be covered by dental insurance. The HBE indicates there are two low-cost children’s plans available. Sheryl Lowe indicates there is also discussion about the potential of adult dental plans to be introduced in 2016. Broker, Jerry Lyons, encourages tribal members to ask him about low-cost and special plans that most tribes are unaware.

Washington Health Care Authority (HCA)

The HCA oversees Washington expanded Medicaid or Apple Health plan for low-income residents. Washington is one of 27 states implementing expanded Medicaid. Of the many benefits for American Indians from the new health care law, expanded Medicaid seems most significant. Eligibility for Apple Health (expanded Medicaid) is the same for tribal members and the general public–that is household income below 100 – 138 percent of the federal poverty level. Tribal members in the Apple Health Program would not be eligible for tax credit that is offered tribal members in the Qualified Health Plans. However, one important benefit is that effective January; dental coverage for adults was restored.

Through expanded Medicaid in Washington, countless low-income American Indians and Alaska Natives can now receive specialty care. As of March 25, 2014, of all who identified as AI/ANs at enrollment, 17,350 have enrolled in Washington Apple Health (or expanded Medicaid). Staff at the Tulalip Tribes health clinic is working to update Tulalip enrollment numbers. Rose Iukes reported it is difficult because many are in process of updating enrollment after the glitches in the state system caused the Tribe to revert to paper applications.

Tribal members can enroll monthly by the 23rd, and then the plan starts the first of next month.

Big changes in Medicaid/Apple Health became effective January 2014. Because of the ACA, more people are able to get preventive care, like check-ups and cancer screenings, treatment for diabetes and high blood pressure, and many other health care services they need to stay healthy.

Apple Health (Medicaid) Benefit Changes Effective January 2014

Dental Services for Adults: Dental health benefits were restored for individuals 21 years of age and older in January. Ensure that your dentist is enrolled as a Medicaid provider.

Mental Health Services Unlimited Number of Visits: Beginning in 2014, there are no limits on the number of visits for mental health services in a calendar year.

Expanded Pool of Licensed Providers: Previously, psychiatrists were the sole mental health provider approved for adults, but effective January 2014, mental health services can be sought from a variety of providers. Coverage is expanded to services by Licensed Advanced Social Workers, Licensed Independent Social Workers, Licensed Mental Health Counselors, Licensed Marriage and Family Therapists and Psychologists. Just ensure your provider is enrolled with Medicaid.

Preventative Care Shingles Vaccine: Beginning January 2014, Apple Health shall will cover the shingles vaccination for clients 60 years of age and older. Age 60 or older is considered the most effective time to receive the vaccine.

Oral Contraception: Effective 2014: Apple Health now allows eligible clients the option to fill birth control prescriptions for a 12-month period.

Early Intervention Screening for Substance Abuse: Apple Health will cover services provided by trained, certified medical providers who conduct screening, brief intervention, and referral for treatment for individuals who may present as facing challenges with substance abuse, including alcohol, drugs and tobacco.

Screening of Children for Autism: Funding has been approved so that Apple Health’s enrolled primary care physicians can screen your child, if they are under three years of age to assess for autism.

Licensed Naturopathic Physicians serving as Primary Care Doctors: Beginning in 2014, licensed naturopathic physicians are able to provide primary care services. Given there are a limited number of primary care physicians, individuals possessing a Washington Department of Health Naturopathic Physician license shall be able to provide care in the scope of care outlined by Department of Health, including diagnosing, administering vaccines and immunizations, provide referrals to specialists, conduct minor office procedures, and write limited Food and Drug Administration-approved prescriptions.

Vendors that Provide Wheelchairs and Accessories: In 2014, Apple Health will provide coverage of wheelchairs and accessories from vendors Medicare certified to provide Complex Rehabilitation Technology items.

Centers for Medicare and Medicaid Services (CMS) & Indian Health Care (IHS)

The federal CMS has a Region 10 office to assist tribes with questions about expanded Medicaid and Medicare services. They were unable to be reached for comment. Per the CMS website statement, “Within the vast reforms in PPACA, AI/AN populations will be affected not only by the general provisions, but through specific, explicit provisions, including the permanent reauthorization of the Indian Health Care Improvement Act.”

A question unanswered by both CMS and IHS is how the federal trust responsibility intersects with tribal elders no longer qualifying for expanded Medicaid or Apple Health once they reach age 65. The Washington Health Benefit Exchange is attempting to secure answers to the inquiry. Ideally, those elders would be covered by treaty guaranteed programs created through IHS in their federal trust responsibility and expanded Medicaid that continues beyond age 65.

Though the IHS did not respond to questions about its continuing federal trust responsibility for tribal health care, according to its website, IHS states “it will continue to provide quality, culturally appropriate services to eligible American Indians and Alaska Natives.” Both the CMS and IHS websites also point to the ACA as benefiting Indian elders with strengthened Medicare, affordable prescriptions, and free preventive services regardless of their provider.

The IHS website notes that if tribal members buy private insurance in the Health Insurance Marketplace, they will not have to pay out-of-pocket costs like deductibles, copayments, and coinsurance if their “income is up to around $70,650 for a family of 4.” The IHS assures members of federally recognized they are eligible to continue receiving services from the Indian Health Service, tribal health programs, or urban Indian health programs even if they have obtained insurance in the marketplace.

The Native American Contact (NAC) for CMS Region 10 is Deborah Sosa. Deb is the agency’s main contact for questions or clarification on:

health policies related to the Medicare, Medicaid, and CHIP programs
policies and programs under the Affordable Care Act, such as the new health insurance exchanges/marketplaces, and
emerging health policies and issues that arise in your community.

She can be reached directly at Deborah.Sosa@cms.hhs.gov or by telephone at (206) 615-2267.

Basic ACA Details for Tribal Members

Exemption

American Indian and Alaska Native consumers who are members of federally recognized tribes have access to a Tribal Membership Exemption from the shared responsibility requirement payment. The exemption applies to American Indian and Alaska Natives who are members of federally recognized tribes and are unable to maintain minimum essential coverage for any time during the year.
To receive an exemption, members may apply through the Marketplace, through their tax return submitted to the Internal Revenue Service by April 2015, or members can receive assistance from either Rose Iukes or Brent Case whose contact information is provided earlier in this story. Alternatively, members can access the form at the following website: http://marketplace.cms.gov/getofficialresources/publications-and-articles/tribal-exemption.pdf

If you have health insurance coverage from your employer or if you have other health care coverage (through Medicare, Medicaid, CHIP, VA Health Benefits, or TRICARE), you are covered and don’t need to worry about paying the shared responsibility payment or enrolling for health coverage available through the Health Insurance Marketplace. However, tribal members are encouraged to complete the tribal lifetime exemption regardless of current coverage.

Enrollment

A frequent question arises about enrollment periods. There is no enrollment period or deadline for members of federally recognized tribes and Alaska Native shareholders who can enroll in Marketplace coverage any time of year. Plans can be changed as often as once per month. Be sure to apply no later than the 23rd of the month for benefits to become effective on the first of the following month. Again, see Rose Iukes at the clinic for assistance. Otherwise, information can also be found at the Health Benefit Exchange – Health Plan Finder website: https://www.wahealthplanfinder.org

Insurance Premiums

Premium payment is due by the 23rd of each month for coverage beginning the following month. Payment can be made by echeck or debit card. Recurring payments can only be setup by echeck. Autopay requires an email address. Rose Iukes can assist you with this during enrollment.

Urban Tulalip Tribal Members

The Health Care Authority tribal liaison, Karol Dixon, recommends that enrolled Tulalip tribal members who reside off-reservation, but within Washington state, can access enrollment assistance by telephoning the Tribal Assister at their tribal clinic (Rose Iukes), but if it is more convenient–they can enroll through the HCA website. In fact, all tribal members can enroll there if they choose. At the website, they can locate a Navigator or Broker who can assist them with the process and in selecting a plan. Select the question mark in the top right of the web page to see links to Navigator or Broker at: https://www.wahealthplanfinder.org

Unfortunately, Tulalip members residing outside of Washington are not eligible to enroll through the Washington Healthcare Exchange. They will need to enroll in the state in which they reside. This is disappointing for any members who may be residing in one of the 24 states that have not expanded Medicaid.

Summary

Many American Indians/Alaska Natives are taking advantage of expanded Medicaid as demonstrated by enrollment data reported by the Health Care Exchange. However, enrollment in the Qualified Health Plans, which offer tribal members many tax credits and cost-share exemptions, could be improved. Moreover, the ACA offers American Indians many advantages expanded access and coverage in both Apple Health and the Qualified Health Plans.

Some political and policy questions remain unanswered such as the federal trust responsibility and how that extends to care for tribal elders 65 and over who have no Medicare coverage. One would hope that the ACA’s permanent reauthorization of the Indian Health Care Improvement Act, extending and authorizing new programs and services within the IHS will find a means to address that void in care for our dear elders.

Early enrollment reports from the Health Care Exchange indicate American Indians/Alaska Natives have taken advantage of expanded Medicaid in Washington State. Many of those tribal members were urban Indians who formerly had little access to any health care, so the ACA is proving itself critical to the health services of urban Indians. Those same individuals can also now receive what for many is urgent dental care.

From early indications, the ACA is fulfilling some of its promise in that it is reducing the number of uninsured Americans with more than 8 million Americans enrolling to date. And the number (17,350) of AI/AN enrolled in Washington’s Apple Health (Medicaid) plan as of March 25 seems to indicate the ACA is fulfilling some of its promise to low-income AI/AN and children. Increased tribal enrollment in the marketplace and in expanded Medicaid will free IHS tribal contract dollars for the tribe to utilize for other urgent care needs.

Many political and policy questions remain unanswered relative to trust responsibility and treaty guaranteed expectations. The possibilities of tribal sponsorship have not yet been fully explored. However, in Washington, and at Tulalip, there is a determined effort by many dedicated individuals and organizations to right some of the historic federal oversights in Indian health care.

Kyle Taylor Lucas is a freelance journalist and speaker. She is a member of The Tulalip Tribes and can be reached at KyleTaylorLucas@msn.com / Linkedin: http://www.linkedin.com/in/kyletaylorlucas

Make Mother’s Day Extraordinary: Huckleberry Muffins

Flickr Creative Commons/Meaghan O'Malley http://tinyurl.com/mn9pofcHuckleberry muffins with huckleberry jelly — Flickr Creative Commons/Meaghan O’Malley http://tinyurl.com/mn9pofc
Huckleberry muffins with huckleberry jelly

Darla Antoine, Indian Country Today

Happy Mother’s Day, Mom! I don’t think I’ve ever told you how much it meant to me when you’d wake up early to make us muffins in the winter. It’s one of my favorite childhood memories. Thank you and I love you.

Huckleberries are an important and much loved berry of the Pacific Northwest. They’re “in season” for only one or two weeks of the late summer and they don’t grow just anywhere. In fact, part of their appeal is that they refuse to be domesticated. Scientists/botanists have tried to domestic the plant to no avail. Thus, if you want to enjoy the ruddy purple berry you have little choice but to pack a picnic, pack the kids, and head to the mountains to find a good patch.

In the late summers my own family would spend an afternoon picking in our own carefully scouted secret patch. Mom would pack a picnic of peanut butter and jelly sandwiches while dad clumsily lathered his three daughters in sunscreen. Then we headed up Vulcan Mountain in search of treasure. The car carefully wound up the dusty dirt road as we climbed out of the Curlew Valley to over 5,000 feet above sea level. We’d eat at least as many berries as we picked but somehow we’d still manage to come home with two or three gallons of huckleberries. Some of the berries were used immediately as topping for shortcake or ice cream. The rest were placed in the freezer to be made into jam or to be carefully rationed out over the winter.

Because, you see, winter in the Northwest kind of sucks. And huckleberries were my mother’s secret winter-morning weapon.

Six-thirty in the morning never comes easily when daylight is still an hour away and at a time of year when daylight doesn’t guarantee sunlight—for days. Toss in a school morning and you have a recipe for three little girls who will fight to stay in bed under the warm covers. Mom usually had to threaten us out of bed on such mornings, but on the occasional Northwest winter morning—we never had advanced warning—my sisters and I would wake up to the smell of something glorious baking.

Something extraordinary to start an ordinary, cold, dark, and harsh winter morning.

And in the place of threats, negotiations, mumbles and grumbles, in the place of cold cereal or oatmeal, the cold and dark morning would become punctuated with the sound of three sets of excited little feet racing to the kitchen, shouting: “Get up! Get up! Mom’s making muffins!”

And there was never any doubt as to what kind of muffins they’d be, for there was only one kind: Huckleberry.

And 6:30 a.m. would become easy. Treasured. Magical. Nothing could go wrong, the weather be too cold, the morning too dark, on huckleberry muffin mornings.

To me, early morning batches of huckleberry muffins are still an ultimate expression of love, devotion, and solidarity in that, hey, sometimes it’s hard to get out of bed. And they’re one of my most treasured childhood memories. So if I happen to get up extra early, no matter the season, and if I happen to offer you a cup of my precious winter stash of huckleberries in a batch of muffins, then you should know that I love you. Dearly.

And I want your day to be extraordinary.

Bonnie’s Huckleberry Muffins

Make these for your mom as the perfect breakfast-in-bed treat! Makes 12 muffins

Preheat oven to 400 degrees
1 c. oatmeal
1 c. milk
1 egg
¼ c. oil
1 c. flour
1/3 c. sugar
2 t. baking powder
¼ t. salt
1 c. huckleberries (or blueberries/raspberries/strawberries)

Combine oatmeal, milk, egg, and oil. Set aside for 15 minutes.

Combine flour, sugar, baking powder and salt. Make a well in the center of dry ingredients. Add oat/milk mix until moist, mix will be lumpy.

Bake 18-20 minutes.

Darla Antoine is an enrolled member of the Okanagan Indian Band in British Columbia and grew up in Eastern Washington State. For three years, she worked as a newspaper reporter in the Midwest, reporting on issues relevant to the Native and Hispanic communities, and most recently served as a producer for Native America Calling. In 2011, she moved to Costa Rica, where she currently lives with her husband and their infant son. She lives on an organic and sustainable farm in the “cloud forest”—the highlands of Costa Rica, 9,000 feet above sea level. Due to the high elevation, the conditions for farming and gardening are similar to that of the Pacific Northwest—cold and rainy for most of the year with a short growing season. Antoine has an herb garden, green house, a bee hive, cows, a goat, and two trout ponds stocked with hundreds of rainbow trout.

Walking for a cause: local women join the Warriors in Pink

Tawyna Cortez and Trisha Montero-Higginbotham of Kindred Spirits will walk the Seattle Komen 3-day event on September 19-21. Photo/ Brandi N. Montreuil, Tulalip News — Tawyna Cortez and Trisha Montero-Higginbotham of Kindred Spirits will walk the Seattle Komen 3-day event on September 19-21.
Photo/ Brandi N. Montreuil, Tulalip News

By Brandi N. Montreuil, Tulalip News

TULALIP – Donning pink with a purpose! Tulalip citizen Tawyna Cortez, and teammate Trisha Montero-Higginbotham, will participate in the Susan G. Komen 3-Day event, Walk for a Cure.

On September 19-21 they will tackle 60 miles in 3 days. Their walk begins at the Seattle Center, finishing at the Memorial Stadium at Seattle Center. Their motivation? Women close to their heart.

“I joined this adventure for two women that touched my life,” said Cortez, who is currently fundraising for the three-day walk. “My high school friend was diagnosed [with breast cancer] right after graduation. She didn’t survive her battle. The other is my grandmother who is a survivor of 17 years. She is an amazing woman to me. These two women are the reason I walk and hope to find a cure. Because no child should have to be raised without a mother, grandmother, aunt, friend, or family member that has been taken by this horrible disease. So I walk for those that are not with us or unable to walk.”

Montero-Higginbotham, whose family history includes cancer in a variety of forms, is walking in support of her aunts.

“In January I decided I would take this journey in memory of my Auntie Sylvia Montero. She was an advocate, patient educator and role model for Alaska Natives and Native Americans living with cancer. She lost her battle with the disease in October 2003. In February of this year I found out my Auntie Pat Antioquia, who has been a survivor, has had her cancer return. There isn’t a reason I shouldn’t walk this walk, so I signed up,” explains Montero-Higginbotham in her Susan G. Komen fundraising page.

Cortez and Montero-Higginbotham, are joined by Montero-Higginbotham’s husband Rob, are each trying to raise $2,300 for a total of $6,900, for the Kindred Spirits team they will be walking with. So far they are halfway there, but are still in need of donations. The money raised will go to support breast cancer research, training, and education outreach.

Last year $3.3 million was raised at the Seattle Komen 3-day walk. According to BreastCancer.org in 2013, an estimated 232,340 new cases of invasive breast cancer were expected to be diagnosed in women in the U.S., along with 64,640 new cases of non-invasive (in situ) breast cancer.

So far Kindred Spirits have put in 70 miles of training with an average of 6.5 to 8.5 miles walked a day. By the time of the 3-day walk the team will have walked an approximate 580 training miles.

You can donate to Cortez and Montero-Higginbotham by going to their individual pages at www.the3day.org. To find their pages, click on the “Donate Today” tab and search Tawnya Cortez or Trisha Montero-Higginbotham.

Brandi N. Montreuil: 360-913-5402; bmontreuil@tulaliptribes-nsn.gov

Tribes and federal government begin settling decades-long contract disputes

Norma Thomas, a resident of Owyhee on the Duck Valley Indian Reservation, talks with David Simons, a doctor at the Shoshone-Paiute Tribes Owyhee Community Health Facility in Nevada on Nov. 25, 2013. (Darin Oswald for The Washington Post)

By Kimberly Kindy

The Washington Post May 1, 2014

After decades of underfunding hundreds of contracts with Native Americans, the federal government over the past several months has reached settlement agreements on 146 claims, totalling $275 million, government records show.

The settlements for health and social service contracts represent about 10 percent of all outstanding tribal claims with the federal Indian Health Service. The unpaid contract expenses were the subject of two U.S. Supreme Court rulings, the latest in June 2012, in which both IHS and the Bureau of Indian Affairs (BIA) were ordered to pay outstanding claims on the self-determination contracts.

The disputed contracts have their origins in the 1975 Indian Self-Determination Act, which gives tribes the option of receiving federal funding to run their own education, public safety and health-care programs. Those services — which were promised in perpetuity in tribal treaties — historically were delivered by the IHS and BIA.

The unpaid claims are for “contract support costs,” which include travel expenses, legal and accounting fees, insurance costs and workers’ compensation fees. Such costs typically account for between 10 to 20 percent of the value of a contract.

“The federal government has a trust responsibility to provide health care for this nation’s First Peoples and it’s about time it steps up to pay legal and contractual obligations to those tribes that choose to take over this responsibility through self-governance contracts and compacts,” Sen. Mark Begich (D-Alaska) said in a prepared statement.

Through letters and public hearings, Begich and several other members of Congress have pressured IHS and BIA to resolve past unpaid claims since the last Supreme Court ruling nearly two years ago.

IHS is working through thousands of disputed claims in more than 200 lawsuits filed by tribes, which are being individually negotiated. BIA is dealing with a single class-action lawsuit, which includes unpaid claims for hundreds of tribes, which has not yet been resolved.

The largest IHS settlement of $96 million went to Southcentral Foundation in Anchorage. The organization operates several health-care facilities, including a portion of the Alaska Native Medical Center, and serves more than 60,000 Alaska Natives and American Indians.

Llloyd Miller, an attorney in the Supreme Court cases, who is also representing 55 tribes in the settlement talks, said progress is being made, but at the current pace it would take IHS another three years to resolve all outstanding claims.

“It’s an enormous breakthrough because, over the past two years, little in the way of settlements have been achieved,” Miller said. “The challenge for the agency is to resolve the remaining 90 percent in a coherent time frame.”

In February, both agencies committed for the first time in decades to fully fund the self-determination contracts in their 2014 revised budgets. The revisions followed a Washington Post article in December that detailed the administration’s plans to impose spending caps on the contracts, despite two U.S. Supreme Court rulings ordering the government to fully compensate the tribes.

Federal contractors have carefully monitored the case because they worried that if federal agencies were able to not pay contract support costs for tribes, it could set a dangerous precedent for non-tribal service contracts with federal agencies.

In a friend-of-the-court brief to the Supreme Court in 2012, the U.S. Chamber of Commerce said: “The government’s position would have the effect of making contracts illusory by giving it a broad right to refuse payment at the stated price for services rendered.”

Advocates vow to revive Navajo junk-food tax

By Felicia Fonseca, Associated Press

FLAGSTAFF, Ariz. (AP) – Facing a high prevalence of diabetes, many American Indian tribes are returning to their roots with community and home gardens, cooking classes that incorporate traditional foods, and running programs to encourage healthy lifestyles.

The latest effort on the Navajo Nation, the country’s largest reservation, is to use the tax system to spur people to ditch junk food.

A proposed 2 percent sales tax on chips, cookies and sodas failed Tuesday in a Tribal Council vote. But the measure still has widespread support, and advocates plan to revive it, with the hope of making the tribe one of the first governments to enact a junk-food tax.

Elected officials across the U.S. have taken aim at sugary drinks with proposed bans, size limits, tax hikes and warning labels, though their efforts have not gained widespread traction. In Mexico, lawmakers approved a junk food tax and a tax on soft drinks last year as part of that government’s campaign to fight obesity.

Navajo President Ben Shelly earlier this year vetoed measures to establish a junk-food tax and eliminate the tax on fresh fruit and vegetables. At Tuesday’s meeting, tribal lawmakers overturned the veto on the tax cut, but a vote to secure the junk-food tax fell short. Lawmakers voted 13-7 in favor of it, but the tax needed 16 votes to pass.

The Dine Community Advocacy Alliance, which led the effort, said it plans to revise the proposal and bring it before lawmakers again during the summer legislative session.

“We’re going to keep moving on it,’’ group member Gloria Begay said. “It’s not so much the tax money – it’s the message. The message being, ‘Let’s look at our health and make healthier choices.’ We have to go out and do more education awareness.’’

Shelly said he supports the proposal’s intent but questioned how the higher tax on snacks high in fat, sugar and salt would be enacted and regulated. Supporters say the tax is another tool in their fight for the health of the people.

“If we can encourage our people to make healthier choices and work on the prevention side, we increase the life span of our children, we improve their quality of life,’’ said professional golfer Notah Begay III, who is among supporters.

American Indians and Alaska Natives as a whole have the highest age-adjusted prevalence of diabetes among U.S. racial and ethnic groups, according to the American Diabetes Association. They are more than twice as likely as non-Hispanic whites to have the disease that was the fourth leading cause of death in the Navajo area from 2003 to 2005, according to the Indian Health Service.

Native children ages 10 to 19 are nine times as likely to be diagnosed with Type 2 diabetes, the IHS said.

The proposed Navajo Nation tax wouldn’t have added significantly to the price of junk food, but buying food on the reservation presents obstacles that don’t exist in most of urban America. The reservation is a vast 27,000 square miles with few grocery stores and a population with an unemployment rate of around 50 percent. Thousands of people live without electricity and have no way of storing perishable food items for too long.

“They have a tendency to purchase what’s available, and it’s not always the best food,’’ said Leslie Wheelock, director of tribal relations for the U.S. Department of Agriculture.

Wheelock said the diabetes issue in tribal communities is one that has been overlooked in the past or not taken as seriously as it could be. It has roots in the federal government taking over American Indian lands and introducing food that tribal members weren’t used to, she said.

To help remedy that, the USDA runs a program that distributes nutritional food to 276 tribes. Grants from the agency have gone toward gardening lessons for children within the Seneca Nation of Indians in New York, culturally relevant exercise programs for the Spirit Lake Tribe in North Dakota and food demonstrations using fresh fruit and vegetables on the Zuni reservations in New Mexico.

The Dine Community Advocacy Alliance estimated a junk-food tax would result in at least $1 million a year in revenue that could go toward wellness centers, community parks, walking trails and picnic grounds in Navajo communities in Utah, New Mexico and Arizona. It would have expired at the end of 2018.

No other sales tax on the Navajo Nation specifically targets the spending habits of consumers. Alcohol is sold in a few places on the reservation but isn’t taxed. Retailers and distributors pay a tobacco tax.

Opponents of the junk food tax argued it would burden customers and drive revenue off the reservation. Mike Gardner, executive director of the Arizona Beverage Association, said the lack of specifics in the legislation as to what exactly would be taxed could mean fruit juice and nutritional shakes could be lumped in the same category as sodas.

“I don’t think they mean that, but that’s what will happen,’’ Gardner said. “It’s a little loose, a little vague. It’s going to create problems for retailers and … it doesn’t solve the problem.’’

F.D.A. Will Propose New Regulations for E-Cigarettes

The multibillion-dollar e-cigarette industry is not regulated, but the Food and Drug Administration is seeking to change that. Credit Frank Franklin II/Associated Press

By SABRINA TAVERNISE, New York Times News Service

WASHINGTON — The Food and Drug Administration will propose sweeping new rules on Thursday that for the first time would extend its regulatory authority from cigarettes to electronic cigarettes, popular nicotine delivery devices that have grown into a multibillion-dollar business with virtually no federal oversight or protections for American consumers.

The regulatory blueprint, with broad implications for public health, the tobacco industry and the nation’s 42 million smokers, would also cover pipe tobacco and cigars, tobacco products that have long slid under the regulatory radar and whose use has risen sharply in recent years. The new regulations would ban the sale of e-cigarettes, cigars and pipe tobacco to Americans under 18, and would require that people buying them show photo identification to prove their age, measures already mandated in a number of states.

Once finalized, the regulations will establish oversight of what has been a market free-for-all of products, including vials of liquid nicotine of varying quality and unknown provenance. It has taken the agency four years since Congress passed a major tobacco-control law in 2009 to get to this stage, and federal officials and advocates say it will take at least another year for the rules to take effect — and possibly significantly longer if affected companies sue to block them.

“If it takes more than a year to finalize this rule, the F.D.A. isn’t doing its job,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group.

Thursday’s release of the blueprint — which is hundreds of pages long — is sure to set off a frantic lobbying effort in Washington as affected industries try to head off the costliest, most restrictive regulations.

Members of the Smoke Free Alternatives Trade Association, one of the e-cigarette industry trade groups, descended on Washington in November, and reported holding nearly 50 meetings with congressional officials to help them “learn more about the negative impact inappropriate regulation could have on this nascent industry,” the group said in a statement.

The industry has several trade associations, and a number of them have met with Obama administration officials about the regulations over the past several months, according to public records and industry group statements.

F.D.A. officials gave journalists an outline of the new rules on Wednesday, but required that they not talk to industry or public health groups until after Thursday’s formal release of the document.

The agency said the 2009 law gave it the power to prohibit sales to minors of all tobacco products that it has authority over, which now will include e-cigarettes and cigars. A spokeswoman said the move did not reflect a finding about the safety of these products.

Perhaps the biggest proposed change would require producers of cigars and e-cigarettes to register with the F.D.A., provide the agency with a detailed accounting of their products’ ingredients and disclose their manufacturing processes and scientific data. Producers would also be subject to F.D.A. inspections.

“You won’t be able to mix nicotine in your bathtub and sell it anymore,” said David B. Abrams, executive director of the Schroeder National Institute for Tobacco Research and Policy Studies at the Legacy Foundation, an antismoking research group.

But the new blueprint was also notable for what it did not contain: any proposal to ban flavors in e-cigarettes and cigars, like bubble gum and grape, that public health experts say lure children to use the products, or any move to restrict the marketing of e-cigarettes, as is done for traditional cigarettes, which are banned from television, for example.

F.D.A. officials said the new regulations were the first major step toward asserting the agency’s authority and eventually being able to regulate flavors and marketing. But doing so will require further federal rulemaking, they said.

For example, to restrict the use of flavors, the agency would have to establish a factual record that they pose a health risk for young people. The same goes for marketing, an area that has been vulnerable to litigation from industry. The agency tried to impose graphic warning labels on cigarette packaging, for example, only to have tobacco companies fight the measure in court and win on grounds that it violated their First Amendment right to free speech.

“You can’t get to the flavors until you have regulatory authority over them,” said Mitchell Zeller, director of the Center for Tobacco Products at the F.D.A. He called the blueprint “foundational.”

The regulations establish federal authority over tobacco products that were not named in the 2009 tobacco control law, including certain dissolvable tobacco products, water pipe tobacco and nicotine gels. E-cigarettes are considered a tobacco product because their main ingredient, nicotine, is derived from tobacco.

One exception is sure to worry antismoking activists: Mr. Zeller said the agency was asking for public comment on whether premium cigars — hand-rolled with a tobacco leaf as a wrapper — should be placed in a special separate category not subject to F.D.A. authority. The cigar industry has lobbied Congress furiously for exemption to the rules, garnering some support from both Democrats and Republicans.

The new regulatory proposal is open to public comment for 75 days, and then the agency will make final changes, a process that will take months.

Under the new rules, companies would no longer be able to offer free samples, and e-cigarettes would have to come with warning labels saying that they contain nicotine, which is addictive. Companies would also not be able to assert that e-cigarettes were less harmful than real cigarettes unless they got approval from the F.D.A. to do so by submitting scientific information.

In the proposed restrictions on sales to minors, vending machines in public places where minors are allowed would no longer be able to carry them. A ban on Internet sales to minors, already in place for cigarettes, would extend to e-cigarettes and cigars.

E-cigarette consumption is rising fast, and in the absence of federal regulations, many states have already passed laws that ban e-cigarettes from public places, regulate their sale, and in some cases tax them. More than half of states already enforce bans on their sale to minors.

Under the new rules, companies would have to apply for F.D.A. approval for their products, but would have two years after the new rules are finalized to do so. Companies can keep their products on the market in the meantime. Eventually, the companies would have to adhere to F.D.A. standards for manufacturing their products, not unlike how drug companies and food companies do now, but the agency has yet to write those rules.

Some experts have cautioned that too high a regulatory bar could stifle smaller e-cigarette producers and help deep-pocketed tobacco companies, which have also gotten into the e-cigarette business. Innovation to make e-cigarettes better would also slow if regulations were too burdensome, they say. Meeting such requirements includes the expenses of application costs, user fees that industry pays the agency, and assembling a scientific case to show that a product should be approved.

Bonnie Herzog, an analyst at Wells Fargo Securities in New York, said the proposal would probably lead to consolidation in the fragmented e-cigarette industry, where there are now around 200 manufacturers.

“It benefits the entrenched players,” she said, referring to the three big tobacco companies that produce e-cigarettes, Lorillard, R.J. Reynolds and Altria, the parent company of Philip Morris U.S.A., as well as larger e-cigarette producers, like Njoy and Logic.

Health experts disagree over the role of e-cigarettes, with some arguing that they offer the first real alternative to the deadly risks of smoking and could save millions of lives. Others are more cautious, saying their gadgetry and flavors tempt children, and that people are using them to enable smoking habits, not to quit.

Antismoking activists say the agency must strike a balance.

“In the urgency not to stifle innovation, we shouldn’t eliminate the need for scientific evidence,” Mr. Myers said. “You can’t let them be fly-by-night operations.”

New Study: Mercury Found In Sport Fish In Remote Northwest Lakes

New research from the U.S. Geological Survey shows some fish in the West's pristine, alpine lakes like Lake Solitude in Grand Teton National Park (pictured here) have high mercury levels. | credit: U.S. Geological Survey/John Pritz | rollover image for more — New research from the U.S. Geological Survey shows some fish in the West’s pristine, alpine lakes like Lake Solitude in Grand Teton National Park (pictured here) have high mercury levels. | credit: U.S. Geological Survey/John Pritz | rollover image for more

Ashley Ahearn, KUOW, April 21, 2014

SEATTLE — Some bad news for backcountry in the West: Some of the fish in the region’s wild alpine lakes contain unsafe levels of mercury, according to a new study by the U.S. Geological Survey.

In the broadest study of its kind to date, the USGS tested various kinds of trout and other fish at 86 sites in national parks in 10 western states from 2008 to 2012. The average concentration of mercury in sport fish from two sites in Alaskan parks exceeded federal health standards, as did individual fish caught in California, Colorado, Washington and Wyoming.

But perhaps more importantly, mercury was detected in all of the fish sampled, even from the more pristine areas of the parks.

The study, conducted jointly by the National Park Service and the USGS, found that mercury levels varied greatly from park to park and even among sites within each park. Overall, 96 percent of the sport fish sampled were within safe levels of mercury for human consumption.

“It’s good news that across this entire study area most of the fish were low,” said Collin Eagles-Smith, a research ecologist with USGS and the lead author of the study. “The concern is that there were some areas, and some fish, that did have concentrations that might pose a threat to either wildlife or humans.”

Spatial distribution of the 21 national parks sampled in this
study. Size of circle represents percentage of total dataset.
Credit: USGS.

Two percent of the fish sampled in Mount Rainier National Park exceeded the Environmental Protection Agency’s guidelines for safe human consumption. Fish sampled in Olympic National Park had a higher average mercury concentration than some other parks in the region, but none of the samples were above safe human consumption levels.

“Mercury concentrations in those fish in the Pacific Northwest were quite variable,” Eagles-Smith said. “Crater Lake had quite low concentrations in comparison to other parks, whereas Olympic National Park had some of the highest concentrations in comparison to other parks.”

The researchers were surprised to find some of the highest levels of mercury in a small fish called the speckled dace, which were sampled in Capitol Reef and Zion national parks in Utah.

“The concentrations in those fish were comparable to the highest concentrations we saw in the largest, longlived fish in Alaska,” Eagles-Smith said. He added that more research is needed to better understand how mercury is deposited from the atmosphere into the environment and then concentrated at varying levels in different species.

Speckled dace

There was some bad news in the study for birds: In more than half the sites tested, fish had mercury levels that exceeded the most sensitive health benchmark for fish-eating birds, Eagles-Smith said.

“People can regulate their intake of fish and wild fish-eating birds can’t. So, they’re going to take in more fish and more mercury as a result, and it can impact their behavior, ability to reproduce and ability to find food.”

Mercury can come from natural sources, like volcanoes. However, since the industrial revolution atmospheric mercury levels have increased three-fold because of the burning of fossil fuels. Recent studies have shown that particulate pollution from China, which could result from the burning of coal among other sources, can and does make its way across the Pacific Ocean to North America.

The Centers for Disease Control and Prevention warns that exposure to high levels of mercury in humans may cause damage to the brain, kidneys and the developing fetus. Pregnant women and young children are particularly sensitive to the effects of mercury.

Walk MS raises $90K in Snohomish County

From left, Team 4 Dave members Dennis, Chris and Sarah Coerber round the corner of the final stretch of the Walk MS in Tulalip on April 12.— image credit: Kirk Boxleitner — From left, Team 4 Dave members Dennis, Chris and Sarah Coerber round the corner of the final stretch of the Walk MS in Tulalip on April 12.
— image credit: Kirk Boxleitner

by KIRK BOXLEITNER, Marysville Globe

TULALIP — Nearly 600 walkers started and ended their course at the Tulalip Amphitheatre for this year’s Walk MS in Tulalip on Saturday, April 12, and while this represented a slightly smaller turnout than last year’s local event, event organizers still considered it a healthy show of support given the other worthy causes close to home that are calling for people’s time and commitment.

“We understand the community is splitting its attention, with the recent tragedy in Oso,” said Sarah Chromy, communications manager for the National Multiple Sclerosis Society’s Greater Northwest Chapter. “It’s still an impressive number for Snohomish County.”

As of Tuesday, April 15, Chromy estimated that the Walk MS in Tulalip had generated nearly $90,000 for the National MS Society in Snohomish County, out of the $1.6 million in funds raised through this year’s Walk MS events throughout the Greater Northwest Chapter. These numbers are actually up from last year’s.

“The Lumpy Bruisers, with team captain Mitzi Ahles, did an amazing job of recruiting and fundraising this year,” Chromy said. “The Snohomish Goat Farmers, with team captain Ray Emery, led the way as our highest local fundraising team, with more than $16,000. Plus, they always bring out at least two goats to Walk MS, which is a sure crowd-pleaser for the children.”

The Mel Walkers team, with joint captains Bruce and Melissa Groenewegen, ranked second in fundraising, with more than $15,000, while Elaine’s Power Walkers, with team captain Jeff Ponton, came in third with more than $4,000.

“Elaine’s Power Walkers also brought tons of team spirit and balloons,” Chromy said. “The face painter was a big hit as well, painting everything from birds to tigers, and everything in between.”

Chromy explained that more than 77 cents of every dollar raised through Walk MS goes directly to improve the lives of people living with MS. Through its donors and fundraisers, the National MS Society is able to:

Fund cutting-edge research to stop MS, restore lost functions and end MS forever.
Drive change through advocacy.
Facilitate professional education.
Collaborate with MS organizations around the world.
Provide programs and services that help people with MS and their families move forward with their lives.

“Last year, it was pouring rain out here, so everyone was happy to hang around after this year’s Walk MS to catch up with one another, have some lunch and soak up some sunshine,” Chromy said. “Walk MS connects those in our local communities to one another, as we rally together to raise funds and celebrate hope for a future free of multiple sclerosis. It’s an opportunity for everyone affected by MS to meet others who may be going through similar life experiences, and to take action to end MS forever. There’s an incredible network of support, information and resources available, and Walk MS is the rallying point that makes it all possible.”

For more information, log onto www.nationalmssociety.org/Chapters/WAS.