A new law that would “modernize” tribal health care by allowing tribes to pay for programs such as in-home care, diabetes prevention and drug awareness is expected to go before the U.S. Senate on Tuesday.

The law, called the Indian Healthcare Improvement Act, would bring the first major changes to tribal health care in 15 years.

The change would not bring more funding to tribes, but it will allow tribes to use federal dollars that would ultimately save money, said Jacqueline Johnson, executive director of the National Congress of American Indians, a Washington, D.C.-based group that lobbies for the nation’s more than 500 federally recognized tribes.

“The act will allow more flexibility,” Johnson said. “For example, they’ll be able to have in-home care for elders, and pay for contract care services.”

In 1993, the Tulalip Tribes negotiated a self-governance grant of $3.8 million per year with Indian Health Services. That grant was meant to serve 1,600 people, but the dollar amount hasn’t increased since then.

Health services for American Indians are severely underfunded, but if the Senate approves the act, it could be a sign of a changing federal attitude toward tribes, Johnson said.

Changes to the act are long overdue, said Sen. Patty Murray, one of the act’s sponsors, in an e-mailed statement.

“I’ve visited and talked with tribes in Washington state,” she said in the statement. “I know how important these services are, and I’ll keep fighting until this bill is passed.”

Passage of the act would be just one small step toward fulfilling an obligation that has long been ignored, Tulalip Tribes Chairman Mel Sheldon said.

“Health care is a treaty right,” he said, referring to the 1855 Treaty of Point Elliott, in which the federal government promised to provide a doctor, at the government’s expense, who would live on the reservation and provide health care for tribal members.

What tribes need most is more cash for health care programs, Sheldon said. The Indian Healthcare Improvement Act will help, but it won’t stop tribal leaders from petitioning lawmakers in Olympia and Washington, D.C., for more help, he said.

“We are examining the opportunities we have to either go back to D.C. and speak about the areas where we want help,” he said.

The Tulalip Tribes have offered health services to local Indians, including members of other tribes, since 1979. In 2003, the tribal government opened a new 26,000-square-foot building, which drew many more patients. Now, the clinic serves about 6,000 patients, clinic manager Karen Fryberg told The Herald last year.

Methamphetamine addiction, suicide and other addiction and health issues are much bigger problems now in Indian Country than they were 15 years ago, she said. The act would allow tribes to target those problems with federal dollars and put their own money toward other concerns, she said.

Reporter Krista J. Kapralos: 425-339-3422 or kkapralos@heraldnet.com.