Washington Report

An NIHB Publication

The Washington Report is an e-newsletter produced by the National Indian Health Board. Each issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis and action items.

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What you need to know about the Government shutdown and Indian Health

The U.S. government has officially shutdown as of 12a.m. on October 1 due to Congress’s failure to pass a continuing resolution, or “CR,” to fund the government. Late last night, the House of Representatives sent back a version of the CR to the Senate which delayed the individual mandate in the Affordable Care Act and eliminated health premium subsidies for members of Congress, their staff and the president, his cabinet and political appointees. However, the Senate immediately rejected this proposal. The House then voted to go into a “conference” with the Senate to work out a final CR. However, Senate Majority Leader Harry Reid refused noting, “We will not go to conference with a gun to our head." Both chambers are in session today, but a path forward is unclear.

What does this mean for Indian health?

The Department of Health and Human Services (HHS) has determined that the Indian Health Service (IHS) “continue to provide direct clinical health care services as well as referrals for contracted services that cannot be provided through IHS clinics” because these activities “involve the safety of human life.” It is also important to note that many IHS employees will not be reporting for work during the shutdown. IHS will be “unable to provide funding to Tribes and Urban Indian health programs, and would not perform national policy development and issuance, oversight, and other functions, except those necessary to meet the immediate needs of the patients, medical staff, and medical facilities.” You can reach HHS memo about how other services will operate under the shutdown CLICK HERE (PDF).

On a conference call with Tribal leaders and the White House yesterday, Indian Country learned that 638 compacting and contracting Tribes should also continue to operate, and can continue to pay employees if they use funds other than federal appropriated resources. Obviously, this is clearly an abrogation of the federal government’s trust responsibility to provide health care for American Indians and Alaska Natives (AI/ANs).

For both direct service Tribes and those operating their own programs, this means that there will be no additional funds to continue to provide health care until Congress passes a CR. If your Tribe is expecting to receive funding today, you will not be receiving additional funding until a CR is approved. For direct service Tribes, IHS facilities will continue to provide care, but much of the administrative and logistical support provided by IHS will not occur during the shutdown. For contracting or compacting Tribes, any funds you are depending on to operate your programs will not come in, therefore, until agreement is reached other Tribal revenues would need to be used to replace these delayed funds.

Many Tribes are currently planning their budgets for FY 2014, and without federal appropriations this is an impossible task. Unfortunately, due to the divisions in Congress, federal funds are on hold until a compromise can be reached and many Tribes’ budgets will remain in limbo.

The government shutdown underscores the necessity to achieve advance appropriations for the Indian Health Service, which would ensure that IHS funding is allocated by Congress one year before the year in which it is spent. NIHB is encouraging Tribes and Tribal organizations to send letters and resolutions to their Members of Congress supporting this effort. To read more about how advance appropriations will help Tribes CLICK HERE (PDF). To view a sample resolution and letter CLICK HERE (DOC).

On a related matter, the Affordable Care Act Exchanges (both state and federal) are officially open today and not affected by the government shutdown. Please stay tuned to the NIHB for more updates on this.

What is the immediate future of government funding for Indian Health?

After Congress is able to come to an agreement on the CR, they will then have two other major issues ahead. First, Congress must address the amount the federal government’s borrowing limit by October 17. This is likely to be another major fight in Congress as a faction of conservative House Republicans (about 40 to 45 representatives) is likely to block it in order to get other concessions on the Affordable Care Act or federal spending. Failure to raise the debt limit will result in a downgrading of the U.S. credit rating and could send the U.S. economy into a tailspin.

Congress must also pass a full budget for FY 2014. It is critical that Congress reverse the harmful sequestration cuts that have been felt across Indian Country, and especially when it comes to Indian health. Cutting these programs undermines the government’s treaty responsibilities and has a direct impact on the lives and health of American Indians and Alaska Natives. The federal government has a legal and moral obligation to ensure that Indian health is getting the funds necessary, yet the IHS is only funded at 56 percent of need. Even the smallest cut is felt immediately.

Currently, the House and Senate have budgets for FY 2014 that are $91 billion apart. While the House’s Interior, Environment and Related agencies Appropriations bill funds the IHS at level FY 2013 post-sequestration levels ($4.1 billion), the Senate’s draft bill contains $4.4 billion. If Congress fails to pass spending bills for FY 2014, automatic sequestration cuts will kick in again, likely in mid-January. Additional cuts will be devastating for Indian Country and will result in reduced care, sicker people and even loss of life.

What you can do to help

Tell Congress that it must fulfill its trust and treaty obligations to American Indians and Alaska Natives by ensuring the government is funded. Many Tribes who operate their own programs simply cannot continue to provide care without funds from the government.

Urge Congress to pass a FY 2014 Budget without any sequestration cuts or rescissions to Indian programs, and especially IHS. Congress simply cannot let fiscal crises overrun treaty obligations.

The Affordable Care Act is the law of the land and should be off the table during life and death budget negotiations.

You can find your Congressional delegation by going to www.house.gov or www.senate.gov or call (202) 224-3121.