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Native American Health Care Reform

April 8, 2010 - by Eric Naing

The passage of the Affordable Care Act (H.R.3590) was a very big deal to more than just Vice President Biden – it also represents the successful culmination of years of work on behalf of Native Americans and their allies in both parties. Peppered throughout the bill are numerous provisions that permanently reauthorize and extend a landmark health care law governing American Indians and Native Alaskans that expired in 2001.

Even today, the disparity in health between Native Americans and other races in this country is startling. The Indian Health Service, a government agency that provides health care services to nearly 2 million Native Americans, reports that American Indians and Alaska Natives die at a 500 percent high rate than other races from tuberculosis, 195 percent higher from diabetes, 519 percent high from alcoholism and 79 percent higher from suicide.

To address this disparity, Congress passed the Indian Health Care Improvement Act in 1976. The law serves as a cornerstone for the government’s legal obligation to provide Native Americans with health care.

Since 1976, the law has been reauthorized four times by Congress, with the latest time being in 1992. But in 2001, Congress failed to act and the law expired. Since then, politicians from both parties have been working with various Native American groups to not only reauthorize, but also modernize the law.

Medical philosophy and technology has changed a great deal since 1992. For example, there’s been a greater focus on prevention and a more comprehensive approach to dealing with mental health issues. Attempts to reauthorize the IHCIA have therefore focused in large part on similarly updating methods of care for Native Americans.

The Department of Health and Human services lists several other features of the bill:

  • Enhancement of the authorities of the IHS Director, including the responsibility to facilitate advocacy and promote consultation on matters relating to Indian health within the Department of Health and Human Services.
  • Provides authorization for hospice, assisted living, long-term, and home- and community-based care.

  • Extends the ability to recover costs from third parties to tribally operated facilities.

  • Updates current law regarding collection of reimbursements from Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) by Indian health facilities.

  • Allows tribes and tribal organizations to purchase health benefits coverage for IHS beneficiaries.

  • Authorizes IHS to enter into arrangements with the Departments of Veterans Affairs and Defense to share medical facilities and services.

  • Allows a tribe or tribal organization carrying out a program under the Indian Self-Determination and Education Assistance Act and an urban Indian organization carrying out a program under Title V of IHCIA to purchase coverage for its employees from the Federal Employees Health Benefits Program.

  • Authorizes the establishment of a Community Health Representative program for urban Indian organizations to train and employ Indians to provide health care services.

  • Directs the IHS to establish comprehensive behavioral health, prevention, and treatment programs for Indians.

The law also permanently reauthorizes the Indian Health Service and increases the agency’s budget by 13 percent.

Multiple Congresses have worked on reauthorization bills since 2001. A bill reauthorizing the IHCIA was derailed in 2008 thanks to an amendment from Sen. David Vitter [R, LA] relating to the federal funding of abortions. Two reauthorization bills from the current Congress are Sen. Byron Dorgan’s [D, ND] S.1790 and Rep. Frank Pallone’s [D, NJ-6] H.R.2708. To avoid this kind of controversy, many of the provisions from these bills were inserted into the Affordable Care Act and became law alongside that bill.

Despite bipartisan support for the IHCIA reauthorization – the very conservative former Rep. J.D. Hayworth, now a primary challenger to Sen. John McCain [R, AZ], was at one point a supporter – some conservatives have attacked parts of the measure.

Conservative activist and author Jason Mattera recently criticized outspoken liberal Rep. Alan Grayson [D, FL-8] for voting for a bill “that allocates money to fund the rehabilitation of Native American child molesters.” Mattera is referring to Section 713 of the House health care bill (H.R.3962) which funds treatment programs for Native American victims and perpetrators of child sexual abuse. This provision is not in the Senate health care bill, which ultimately became law.

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