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Timothy M. Westmoreland, JD and Kathryn R. Watson, JD, MPH

Timothy M. Westmoreland is with the Georgetown University Law Center and the Georgetown University Public Policy Institute, Washington, DC. At the time of this research, Kathryn R. Watson was with the Georgetown University Law Center.

Correspondence: Requests for reprints should be sent to Timothy M. Westmoreland, JD, Health Policy Institute, Georgetown University, Box 571444, 3300 Whitehaven Street, NW, Suite 5000, Washington, DC 20057 (e-mail: westmort{at}law.georgetown.edu).

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.

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