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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Legislative

Located on Capitol Hill, the National Indian Health Board is a dedicated advocate in Congress on behalf of all Tribal Governments and American Indians/Alaska Natives. We maintain a presence in the halls of Congress, working with representatives from across the country to achieve quality, lasting health care for tribal members.

In our efforts to secure quality health care we track legislation and regulations, lead discussions on health care reform, provide recommendations and analysis of the Indian Health Service budget and assist tribes in securing federal funding.

2017 Legislative and Policy Agenda (PDF)

Congressional Talking Points for Indian Health (PDF)


What's New?

Posted: July 28, 2017

Senate Votes Down "Skinny Repeal": Congress to Move On, ACA to Stay in Place For Now
Your Action Made the Difference!

In a dramatic and unexpected vote early this morning, the United States Senate rejected the so-called "skinny repeal" legislation, which was seen as Senate Republicans' last chance to pass healthcare reform. The bill became public at 10:00 PM yesterday, and voting began at midnight. After a Democratic motion to recommit the bill to committee failed, the final vote failed 49-51 at 2:00 AM...

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Posted: July 27, 2017

Senate Continues Debate on Health Reform: Amendments to Help Tribes Introduced
Your Action Needed!

As we've been reporting, the Senate has several failed attempts at passing healthcare reform legislation this week. However, debate continues today and the process is moving quickly toward another vote on legislation that would change the U.S. health insurance system and greatly impact the Indian health system...

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Posted: July 26, 2017

Senate Continues Debate on Health Reform: 2015 Repeal Bill Fails, Vote-A-Rama Coming Soon

Yesterday, the Senate voted to proceed on healthcare reform with Vice President Pence casting the tie breaking vote. This vote signified the beginning of 20 legislative hours of debate - a time in which Senators can also introduce a limitless number of amendments. The Senate has since held a vote on their version of Affordable Care Act (ACA) repeal - the Better Care Reconciliation Act (BCRA). The vote failed 43-57 late last night....

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Posted: July 26, 2017

Senate Votes to Advance Debate on Health Reform

This afternoon, Senate Republicans pulled off a 51-50 procedural vote needed to advance the debate on healthcare reform efforts. Vice President Mike Pence cast the tie-breaking ballot that will lead to further negotiations on reforming the U.S. health insurance system.....

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Posted: July 13, 2017

Revised BCRA Released!
Vote Now Expected Next Week

This afternoon, Senate Majority Leader Mitch McConnell released a revised Better Care Reconciliation Act (BCRA). You can read a summary of changes from the original BCRA discussion draft here. Though the bill would provide additional funds to help cover out-of-pocket costs and fight opioid addiction, the revised bill would substantially cut Medicaid and end cost-sharing reductions as well as critical public health funding. Due to the role Medicaid plays in providing much-needed revenue for the Indian health system, BCRA's changes to the Medicaid program and additional funding reductions still raise serious concerns for Indian Country...

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Posted: July 13, 2017

House and Senate Appropriations Committees Consider IHS Spending for FY 2018: Strong Support for Indian Health Programs

WASHINGTON, DC - On Wednesday, June 12, the Senate Appropriations Subcommittee on Interior, Environment and Related Agencies held a hearing on the FY 2018 Budget for the Indian Health Service (IHS).

During the hearing senators from both sides of the aisle voiced significant concerns on the proposed cuts in the President's budget to the IHS. Subcommittee Chairwoman Lisa Murkowski (R-AK) noted that, "I am very, very concerned that the budget request does not adequately meet the needs for health care in Indian Country. We recognize the disparities between health outcomes for American Indians and Alaska Natives (AI/ANs) compared to the population at large are staggering."

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Posted: June 28, 2017

Senate Vote on ACA Repeal Coming Soon
Use These Resources to Call Your Senators

This week, Senate Republican leadership expressed confidence in their ability to pass the "Better Care Reconciliation Act" (BCRA), a bill which repeals large parts of the Patient Protection and Affordable Care Act (ACA) and cuts Medicaid spending. Due to the Medicaid provisions, the National Indian Health Board cannot support the legislation as it is currently written. NIHB and other national level Tribal organizations expressed Tribal concerns in a letter to Senate Republican leadership...

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Posted: June 27, 2017

Healthcare Reform Update: Opposition to BCRA Pushes Vote to after July 4 Recess

The Senate's Better Care Reconciliation Act (BCRA) was released last week. Five Senators in the Republican caucus announced their opposition to the bill as it is currently written: Senators Ted Cruz (Texas), Mike Lee (Utah), Rand Paul (Kentucky), Ron Johnson (Wisconsin), Susan Collins (Maine), and Dean Heller (Nevada).

  Because Senate Republicans can only afford two "No" votes from their own caucus to pass the legislation, Senate leadership announced Tuesday that they would not hold a vote before the Senate left Washington for the July 4 recess... 

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Posted: June 27, 2017

HNIHB Testifies on IHS Reform Legislation 

The House of Representatives Committee on Natural Resources' Subcommittee on Indian, Insular, and Alaska Native Affairs held a hearing on June 21, 2017 regarding H.R. 2662, also known as the "Restoring Accountability in the Indian Health Service Act of 2017". Identical legislation has been introduced in the US Senate (S.1250). Victoria Kitcheyan, Great Plains Area Representative to NIHB from the Winnebago Tribe of Nebraska, testified on behalf of the National Indian Health Board. 

The legislation would reform the hiring and firing process for IHS, streamline volunteer credentialing, and expand incentives for providers to work in under-served areas, among other changes. Click here to read more about the hearing and NIHB's testimony.

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Posted: June 27, 2017

Possible Legislative Vehicle for SDPI Receives Hearing 

On Friday June 23, 2017 U.S. House of Representatives Energy and Commerce Committee held a hearing on the future outlook for the Children's Health Insurance Program (CHIP). In addition to the health coverage this program provides for many American Indian and Alaska Native children and women, the FY 2018 reauthorization of CHIP is of special interest to Indian Country because it is a potential legislative vehicle for the Special Diabetes Program for Indians (SDPI) reauthorization that is needed before September 2017.

The hearing focused on considering the length and costs of extending CHIP beyond its current authorization period. The general sense of the lawmakers present was to support an extension of the program, however, the length and amount were not decided upon. There will be continued conversations in Congress about the reauthorization of CHIP and, hopefully, the SDPI. NIHB will consider to monitor this movement and that of the Special Diabetes Program for Indian Reauthorization Act of 2017 (S. 747/H.R. 2545). Please visit www.nihb.org/sdpi for more information.

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Posted: June 22, 2017

Senate Republicans Release ACA Repeal Bill
Vote Expected Next Week--Call Your Senators!

On June 22, Senate Republican leadership released a discussion draft of the "Better Care Reconciliation Act" (BCRA) a bill which repeals large parts of the Patient Protection and Affordable Care Act (ACA) and reforms Medicaid.

Under the proposed legislation, starting in 2020, Medicaid would be put under a per capita spending limit. States would have the option of switching the program to a solely state-run block grant. Providing states with decision making authority fundamentally shifts the trust responsibility to Tribes from the federal government to the states and means that services under the state-operated Medicaid will likely be cut. However, the bill does retain 100% federal matching under Medicaid for Indian Country which is critical...

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Posted: June 20, 2017

Senate Committee on Indian Affairs Holds Hearing on the Restoring Accountability in the IHS Act

On Tuesday, June 13, the Senate Committee on Indian Affairs held a hearing on S. 1250 the "Restoring Accountability in the Indian Health Service Act."  The legislation was introduced with the goal of improving the quality of care at the Indian Health Service.  NIHB Great Plains Area Representative Victoria Kitcheyan, who serves as the Tribal Council Treasurer for the Winnebago Tribe, told members of the committee on behalf of her Tribe the problems still facing the Great Plains, "The services are weakened, the reputation is poor, and the [Purchased/Referred Care] are minimal. Many of the services are not available at the service unit aren't available, so they're referred out. Well, if you're only referred out life or limb, many of the people are sick and have chronic conditions that are not life or limb and continue to suffer."

Senator John Barrasso (R-WY), the bill's lead sponsor, said, "As both a doctor and a Senator, I find the level of dysfunction completely unacceptable. Not only does the United States government have the trust responsibility that they must fulfill, but failures of the Indian Health Service should never result in the loss of life. And yet stories of unnecessary patient deaths have dominated Indian Health Service oversight hearings for years."

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Posted: June 20, 2017

AHCA Update: Senate Democrats Slow Bill Progress, Vote Still Possible Next Week

Senate Majority Leader Mitch McConnell has stated his desire to hold a vote in the Senate on its version of healthcare reform before the July 4th recess. The bill, still being drafted by a select group of Senate Republicans, will not receive committee hearings before the Senate votes. A CBO score is expected to be released concurrently with the legislation, shortly before the vote. It remains to be seen how different the Senate's bill will be from the American Health Care Act, which the House passed in May and which the CBO estimates would increase the number of uninsured Americans by 23 million.

Senate Democrats, balking at the Majority Leader's decision to bypass the committee process, threatened on Monday to use procedural moves in the Senate to slow the body down. This could impede the Senate's ability to hold committee meetings, consider legislation for debate, and other routine functions. Running out the clock before the Senate recess runs the risk of killing other noncontroversial legislation. Senators have historically only used these tactics as a last resort to stop legislation. 

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Posted: June 12, 2017

Senate Indian Affairs Committee to Hold Hearing on IHS Reform Legislation TOMORROW

On Tuesday, June 13, the Senate Committee on Indian Affairs will hold a hearing on S. 1250, the Restoring Accountability in the Indian Health Service Act of 2017, introduced by Senator John Barrasso (R-WY). Similar legislation received a committee hearing last year, which you can watch here.

  The committee will hear testimony from several witnesses, including NIHB Board member and Great Plains Area Representative Victoria Kitcheyan, Winnebago Tribe. 

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Posted: June 7, 2017

NIHB -NCAI Letter on Senate Healthcare Reform Legislation

Read Letter Here



Posted: May 24, 2017

President Trump’s First Budget Released | Major Cuts to Health Spending Including IHS

On May 23, 2017 the Trump Administration released its FY 2018 budget request to Congress. The budget calls for cutting funding for all federal departments besides the Departments of Defense, Veterans Affairs, and Homeland Security. It would decrease non-defense spending by $57 billion in FY 2018. This budget is a proposal of what the Administration thinks that funding priorities should be for next fiscal year. The final funding decisions will be made by Congress, and key leaders in Congress have made public statements emphasizing that.

For the Indian Health Service (IHS), the Administration proposes that IHS spending would be $4.7 billion in FY 2018. This is a shocking $300 million less than the FY 2017 Consolidated Appropriations Act (P.L. 115-31) which was enacted earlier this month. While full details of the budget are not yet available at the time of this writing, the budget achieves most of its cuts through major reductions to the facilities funding at IHS. You can read more details about the IHS budget proposal below…

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Posted: May 9, 2017

Congress Releases FY 2017 Spending Plan- Increase for Indian Health Service and Other Tribal Health Priorities

On Sunday, April 30, 2017, Congressional leaders unveiled the final FY 2017 Omnibus appropriations measure (H.R. 244). The current continuing resolution keeping the federal government open expires on Friday, May 5, 2017. Overall, the legislation does not make dramatic cuts in the federal discretionary budget as proposed by President Donald Trump. Instead, the legislation represents a compromise between Republicans and Democrats and funds the federal government through September 30, 2017. The legislation is expected to be enacted by the end of the week.

This legislation contains annual discretionary appropriations for the Indian Health Service (IHS), Bureau of Indian Affairs (BIA) and the Bureau of Indian Education (BIE) and other federal programs at the Department of Health and Human Services (HHS) for Indian Health. Many of the health-related programs are unfortunately flat-funded or have nominal increases for FY 2017...

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Posted: May 7, 2017

House of Representatives Passes the American Health Care Act, NIHB Remains Engaged

Today, the House of Representatives passed H.R. 1628, the American Health Care Act (AHCA), by a vote of 217-213. The legislation had been previously considered in March 2017. The bill, with amendments from Congressmen Tom MacArthur (R-NJ) and Fred Upton (R-MI), repeals portions of the Patient Protection and Affordable Care Act (ACA) and reforms the nation's healthcare insurance system. It will now head to the U.S. Senate for further consideration before it can become law.

Tribes are pleased that the bill leaves the Indian Health Care Improvement Act (IHCIA) intact. IHCIA has led to important gains in Tribal healthcare and public health systems. Additionally, the AHCA's effective repeal of the employer mandate alleviates what had become a significant economic burden on Tribal employers...

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Posted: March 26, 2017

House Leadership Pulls Modified American Health Care Act

Today, Congressional Republican leadership pulled the American Health Care Act (AHCA), meaning the legislation will not receive a vote. Leadership had struggled over the past few days to get the required majority from their own caucus, as all Democrats were opposed. Some Republicans opposing AHCA were frustrated that the bill did not more thoroughly repeal the ACA, while others were concerned that the bill would lead to loss of coverage and higher premiums.

The bill would have greatly impacted the Indian healthcare delivery system as a whole, and NIHB had outlined our concerns with the AHCA in a letter to Speaker Ryan.

The President said last night that if the House were to reject the AHCA, his preferred alternative would be to leave the ACA in place and move on to other legislative priorities. It is unclear at this time how much political will exists to revisit reforms to the ACA. NIHB will continue to advocate for healthcare improvements in Indian Country and for the federal government to uphold the trust responsibility for healthcare to our people.



Posted: March 7, 2017

Indian Health Care Improvement Act Not Targeted in House Health Reform Plan

On Monday night, House Republican leadership of two key committees, Energy & Commerce and Ways & Means, each released legislation to reform the nation's healthcare systems and change many aspects of the Affordable Care Act.

Crucially, neither committee's draft legislation included repeal of the Indian Healthcare Improvement Act (IHCIA), which was passed in 2010 as part of the ACA but remains unrelated to the main structure of the law's healthcare reforms. Other Indian-specific pieces of the ACA are also left intact...

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Posted: February 8, 2017

NIHB Heads to Capitol Hill to Advocate for SDPI

NIHB led a group of diabetes prevention and treatment advocates to Capitol Hill on February 7 to educate lawmakers and their staff about the Special Diabetes Program for Indians (SDPI). A vital public health program, SDPI has helped cut the rate of End-Stage Renal Disease among American Indians and Alaska Natives by 54% since 1996. Even going without a funding increase since 2004, the program has helped over 300 Tribes and Urban Indian programs develop public health programs to combat diabetes. The SDPI Day Outreach teams met with 18 Congressional and committee offices to stress the importance of the program and the success stories it has caused.

The authorization for SDPI will expire on September 30th of this year, so Congress must pass legislation renewing the program or the progress made in combating diabetes in Indian Country will be at risk. You can learn more about the program here.



Posted: February 2, 2017

NIHB Board Heads to Capitol Hill to Advocate for Tribal Health

After their First Quarter Board Meeting, National Indian Health Board (NIHB) Members Chief Beverly Cook, Lisa Elgin, Andy Joseph, Jr., Sam Moose, Tori Kitcheyan, and Lester Secatero spent the day on Capitol Hill.The board advocated for the Indian Healthcare Improvement Act to be preserved as Congress considers healthcare reform; increased appropriations for the Indian Health Service; an exemption for IHS from the federal hiring freeze; long-term renewal of the Special Diabetes Program for Indians; and improvements to quality of care at IHS.

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Posted: October 19, 2016

NIHB Applauds the Enactment of the Native Children's Commission Bill

On Friday, October 14, 2016, President Obama singed the Alyce Spotted Bear and Walter Soboleff Commission on Native Children Act into law. The Act authorizes the Alyce Spotted Bear and Walter Soboleff Commission over a three-year period to evaluate and make recommendations regarding ways to improve Tribal, state, and federal programs serving Native children. The original bill was introduced by Senator Heidi Heitkamp (D-ND) and Senator Lisa Murkowski (R-AK)...

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Posted: May 5, 2016

OUTREACH NEEDED: Congressional Sign-on Letter for Zika Funding to Tribal Communities

Dear Tribal Leaders, Tribal members and Advocates:

We encourage you to contact your Representatives to urge them to sign onto a letter requesting that Tribes be included in any supplemental funding for Zika virus mitigation. The closing date for the letter is Wednesday, May 11, 2016.

The incidence of the Zika virus is reaching high levels in certain areas close to the United States. The Zika virus is spread by the Aedes mosquito and has been found recently in areas of Central America, the Caribbean, and South America. Zika in pregnant women is thought to be associated with microcephaly in infants which is a sign that the baby is born with a smaller brain which can result in medical programs and impaired development. The Centers for Disease Control and Prevention (CDC) estimates that Zika inflected mosquitos could reach the lower part of the United States in 2016, and there are efforts underway to ensure that communities in the United States can accurately respond to the disease...

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Posted: March 30, 2016

Disease Prevention and Control Highlighted in CDC Hearing

Last week, the Director of the Centers for Disease Control and Prevention (CDC), Dr. Thomas Frieden, appeared before the House Appropriations Subcommittee on Labor, Health and Human Services (HHS), Education, and Related Agencies. This subcommittee provides annual funding for most HHS agencies (besides the Indian Health Service).

During the hearing, Subcommittee Chairman Tom Cole (R-OK), asked Dr. Frieden what the CDC is doing to support issues on a wide range of public health issues in Indian Country such as suicide, motor vehicle accidents, cancer, HIV and others. Dr. Frieden noted that CDC is proposing in its FY 2017 budget to strengthen capacity through the Tribal Epidemiology Centers and hopes to build on traditional practices that are healthy. He also discussed ways that CDC can support families and communities. In response, Chairman Cole said that CDC often works "directly with state and local health departments, and quite often Tribes do seem left out of that equation by states. So having federal involvement to make sure there is some equity in those communities ... I think is very important."...

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Posted: March 22, 2016

NIHB testifies before House Interior Appropriations Subcommittee

On Thursday, March 17, National Indian Health Board Secretary Lisa Elgin presented testimony to the House Appropriations Subcommittee on Interior, Environment and Related Agencies on the FY 2017 Indian Health Service Budget (IHS). The testimony was delivered as part of the subcommittee's American Indian and Alaska Native public witness hearings which heard testimony from over 70 representatives from across Indian Country.

Ms. Elgin delivered the recommendations of the Tribal Budget Formulation Workgroup for full funding of IHS at $30 billion, with a FY 2017 recommendation of $6.2 billion. She reiterated the Workgroup's top priorities of Purchased/Referred Care; Hospitals & Clinics; Alcohol & Substance Abuse Services; Mental Health; and Dental Services...

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Posted: March 10, 2016

NIHB Sponsors Native Youth to Provide Remarks on Children's Mental Health in Indian Country

WASHINGTON, DC - On Tuesday, March 8, 2016, the National Indian Health Board (NIHB) was pleased to sponsor the participation of Wiyaka Little Spotted Horse in a Congressional Briefing on Native Children's Mental Health. The briefing was hosted by the American Academy of Pediatrics and co-hosted by NIHB, the American Academy of Child and Adolescent Psychiatry; the Center for Native American Youth; and the School-Based Health Alliance...

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Posted: February 10, 2016

President Releases FY 2017 Budget Request to Congress - Proposes $5.2 billion for IHS

On February 9, 2016, the President Released his FY 2017 Budget Request to Congress. This yearly process kicks off the annual budget process in Congress. Republican leaders in Congress have noted that this proposal will be considered "dead on arrival," as they consider many of the proposals contained in the budget to be too progressive. However, funding for Tribal programs, and especially Tribal health, continue to garner bipartisan support in Congress and the National Indian Health Board (NIHB) will advocate that many of the important policy and funding proposals that are specifically targeted to benefit Indian Country will remain in the final FY 2017 enacted budget...

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Posted: February 5, 2016

NIHB Participates in Senate Committee on Indian Affairs Hearing and Listening Session

Committee Chairman Calls Unacceptable Indian Health Care in the Great Plains "Malpractice"

The Senate Committee on Indian Affairs (SCIA) held an oversight hearing yesterday on "Re-examining the Substandard Quality of Indian Health Care in the Great Plains." Immediately following the oversight hearing, SCIA held a listening session on "Putting Patients First: Addressing Indian Country's Critical Concerns Regarding the Indian Health Service (IHS)." During the oversight hearing, there were ten U.S. Senators in attendance. The oversight hearing consisted of three panels before the SCIA designed to address all of the issues that plague the Indian health care system.

NIHB attended this hearing and participated in the listening session, calling IHS to account, but also calling on Congress to enact solutions that will ensure meaningful changes for Indian health. You can read the whole statement of NIHB's Board of Directors Member, Charles Headdress here....

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Posted: January 26, 2016

Washington State Senator John McCoy calls for Washington State to adopt legislation allowing Tribes to hire dental therapists.

John McCoy - The Seattle Times

THE year I started legislative efforts to bring basic dental-care services to native communities, more than 1,800 Indian children were born in Washington state.

That was 2006. Ten years later, the data show us that at least 75 percent of these children already will have experienced tooth decay and many more have experienced pain or had infections.

Generations of native children before have faced the same barriers to oral health care. For too many, their introduction to oral hygiene was waiting in line to have teeth pulled if a dentist happened to be visiting the reservation...

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Posted: January 25, 2016

RESCHEDULED: Senate Hearing on Quality of Care issues in the Great Plains - Input Requested

The Senate Committee on Indian Affairs will hold a hearing titled: "Reexamining the Substandard Quality of Indian Health Care in the Great Plains." Due to blizzard conditions in Washington, DC the hearing has been postponed to Wednesday, February 3, 2016 at 2:15PM EST...

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Posted: January 11, 2016

How Obamacare Will Cost Native American Tribes Millions of Dollars

The Daily Signal

Native American tribes are pushing back against a provision of Obamacare mandating that tribal governments provide health insurance to their employees. Tribal leaders say it’s a "misinterpretation" of the law that will cost millions of dollars.

When Congress passed the Affordable Care Act in 2009, lawmakers exempted Native Americans from the individual mandate, shielding them from having to pay a fine for not having insurance. Native Americans could, however, purchase health insurance on the federal exchange, HealthCare.gov, and have access to substantial tax credits, driving down the cost of their plans...

Read full article at dailysignal.com



Posted: January 4, 2016

Must read: This story about a grassroots movement to improve access to dental & why the American Dental Association is fighting it.

Dental health for the poor is a big problem in Washington state. Some see dental therapists — licensed professionals who can perform simple procedures — as a route to less expensive care. But the powerful state dentists association has thwarted efforts to allow the therapists...

Read more at seattletimes.com



Posted: November 20, 2015

Cherokee Nation Public Health Director Highlights Public Health Needs of Indian Country on Capitol Hill

WASHINGTON, DC - On November 18, 2015, the Congressional Public Health Caucus and the Coalition for Health Funding organized a briefing entitled "Public Health 101- Opportunity Lost: Struggles to Meet Health Demands in an Era of Austerity." The National Indian Health Board (NIHB) was also a co-host of this event. During the briefing, panelists discussed how federal funding cuts have impacted health outcomes across the country. Among the panelists was Lisa Pivec, Senior Director of Public Health at the Cherokee Nation, who highlighted public health needs in Indian Country. NIHB was pleased to sponsor her participation in this event. Other panelists included Sandy Eskin, Pew Charitable Trusts; Jessica Hayes, Illinois Alcohol and Other Drug Abuse Professional Certification Association; Dr. Clarence Lam, The Johns Hopkins Bloomberg School of Public Health; and Dr. Benjamin Margolis, University of Michigan Medical School...

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Posted: November 17, 2015

NIHB and Other Tribal Organizations Send Letter to the American Dental Association Supporting DHATs

On Friday, November 12, the National Indian Health Board, Northwest Portland Area Health Board, Affiliated Tribes of Northwest Indians and the National Congress of American Indians sent a letter to the American Dental Association (ADA) in response to a recent blog post by the Washington State Dental Association (WSDA). A few weeks ago, WSDA added a post to their website that that took aim at the Swinomish Dental Health Aide Therapist (DHAT) project and generally at Indian Country's ability to act as sovereign nations with respect to providers on Tribal lands.

The WSDA post claimed that Tribes do not know how to access the dental industry and assumed that dental care provided by a DHAT is not of a highest standard. The Tribal organization letter disputed these claims by noting that, "Tribes will not accept anything less than a single, high standard of care for our citizens." The letter also emphasized the strong track record of DHATs in the United States and elsewhere around the world. You can view the whole letter and the original blog post here.



Posted: November 13, 2015

Public Health 101 Congressional Briefing to Feature Cherokee Nation

On November 18, 2015, Congressional Public Health Caucus will sponsor a Congressional Briefing entitled "Public Health 101: Opportunity Lost: Struggles to Meet Health Demands in an Era of Austerity." The National Indian Health Board is a Co-Host of the briefing, along with other partner organizations including the Coalition for Health Funding.

The event will feature five panelists including Lisa Pivec the, Senior Director of Public Health at the Cherokee Nation. Ms. Pivec will discuss the role of public health in Indian Country and unique challenges that Tribes experience as they navigate jurisdictional competition and strive to find resources for public health programs.

When: November 18, 2015, 12:00PM- 1:30PM EST
Where: 2168 Rayburn House Office Building
RSVP: [email protected]
(Lunch will be provided)

For more information on the briefing click here.



Posted: November 5, 2015

Mental Health Reform Legislation Moving Forward in the House

This week, the House Energy and Commerce Committee's Subcommittee on Health will consider H.R. 2646 - the Helping Families in Mental Health Crisis Act - which seeks to reform mental health systems in the United States. According to the bill's primary sponsors, Congressman Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX), the legislation "breaks down federal barriers to care, clarifies privacy standards for families and caregivers, reforms outdated programs, expands parity accountability, and invests in services for the most difficult to treat cases while driving evidence-based care."

The legislation would replace the Substance Abuse and Mental Health Services Administration (SAMHSA) with the Office of the Assistant Secretary for Mental Health and Substance Use Treatment and transfers all authority to the Assistant Secretary. The legislation would also promote evidence-based practices and share certain patient information with primary caregivers. It would also reauthorize the Garrett Lee Smith Suicide Prevention Programs and allow Medicaid to bill mental health services and primary care services at the same location, on the same day, to a patient. To view a full summary of the legislation, click here.

NIHB has carefully reviewed the legislation and is working to ensure that Tribes are treated fairly under this legislation especially when it comes to access to federal funds, traditional and cultural healing practices, and with Tribal consultation.



Posted: November 5, 2015

Bipartisan Budget Act Passes Congress, Work Moves to Appropriations Committee

On Monday, November 2, President Obama signed the Bipartisan Budget Act of 2015 into law. As NIHB reported last week, the deal would add an extra $80 billion to the federal discretionary budget in FYs 2016-2017. In FY 2016, non-defense discretionary spending (the funding that Congress appropriates every year) will see a $25 million increase beyond what is originally established.

Work now moves to the House and Senate Appropriations Committees to craft a final appropriation for FY 2016. Congress must pass FY 2016 by December 11 when the current continuing resolution funding the government expires. IHS currently has $4.8 billion in both House and Senate draft Appropriations bills. Also contained in the draft appropriations bills is important language for Tribal behavioral health, Tribal Epidemiology Centers and Definition of Indian in the Affordable Care Act.

If you have any questions on the Bipartisan Budget Act or FY 2016 appropriations, please contact NIHB's Director of Congressional Relations, Caitrin Shuy, at [email protected] or (202) 507-4085.



Posted: October 5, 2015

Congress Likely to Pass Short-term Funding Extension for FY 2016

With the surprise resignation of House Speaker John Boehner (R-OH) last week, it is expected that Congress will pass a short-term funding measure, known as a "continuing resolution" or "CR," to keep the federal government funded until December 11, 2015. Many conservative Members of Congress have argued for the stopgap measure to exclude funding for Planned Parenthood after a series of videos was released that allegedly show the organization illegally profiting from the sale of tissue from aborted fetuses. However, as of the time of this writing, it looks like efforts to derail the funding measure over the issue will not be successful. Congress is expected to clear the CR sometime on Wednesday, September 30, just hours before the end of the fiscal year.

If Congress does pass the CR, Congress must finalize the rest of FY 2016 appropriations by December 11. Many in Congress, on both sides of the aisle, are calling for a compromise that can raise the "caps" on spending set forth in the Budget Control Act of 2011. Without an agreement on higher spending levels, there could be the risk of devastating across-the-board sequestration cuts. Legislation has been introduced in both the House and the Senate to exempt Tribes from sequestration. You can click here to learn more about these bills.



Posted - July 30, 2015

Legislation introduced in the House of Representatives to exempt Tribal programs from Sequestration

On July 14, 2015, Congressman Don Young (R-AK) introduced legislation called the Honoring Our Trust Relationships Act (H.R. 3063). The bill would exempt Tribal programs, including the Indian Health Service (IHS) and all programs administered for Native Americans of the Department of Health and Human Services, from across the board sequestration as outlined in the Budget Control Act (BCA) of 2011. Similar legislation has been introduced in the U.S. Senate (S. 1497) by Senator John Tester (D-MT).

As you may recall, the BCA calls for annual across-the-board budget cuts through FY 2021 unless Congress can make a deal to stay below certain spending limits. In FY 2013, IHS lost $220 million due to sequestration forcing IHS, Tribal and Urban health facilities to scramble to keep their doors open. Many cut service hours and delayed or deferred care. With no clear deal in sight for FY 2016 appropriations, it is critical that Congress specifically exempt the Tribes from sequestration.

If you would like to send a letter of support to your Senator or Representative, please Click here (DOC).



Posted - February 10, 2015

Tribal Leaders Visit Capitol Hill in Support of SDPI

Tribal leaders took to Capitol Hill on February 3, 2015 to provide outreach and education to Congress on the Special Diabetes Program for Indians (SDPI). Over 15 individuals participated in visits to 9 Congressional offices. The group met with members of both the House of Representatives and the Senate and included representatives from Cowlitz Indian Tribe; Cow Creek Band of Umpqua Tribe of Indians; Navajo Nation; Sault Ste Marie Tribe of Chippewa Indians; Pueblo of Zuni; Astariwi Band of Pit River Indians; the Santa Ynez Band of Chumash Indians; and the Tohono O'Odham Nation.

SDPI will expire on September 30, 2015, unless Congress acts. The legislation that typically serves as the legislative vehicle for SDPI, the Sustainable Growth Rate Fix (aka the "Doc Fix"), which governs the rates physicians are paid by Medicare, expires on March 31 2015. It is still unclear if Congress will find a way to pay for the overall bill which is estimated to cost over $150 billion. If there needs to be another short-term patch for the Doc Fix Tribes are asking that SDPI be included in that reauthorization.

Please visit www.nihb.org/sdpi for more information on how you can be involved in SDPI renewal for 2015!



Posted - January 29, 2015

"Our People continue to live sicker and die younger than other Americans," said the National Indian Health Board before Senate Committee on Indian Affairs January 28th Hearing - highlighting Native American priorities for the 114th Congress

WASHINGTON, D.C. - On Wednesday, January 28, the Senate Committee on Indian Affairs held its first hearing during the 114th Congress to gain an overview of American Indian and Alaska Native priority issues. National Indian Health Board (NIHB) Executive Director Stacy A. Bohlen (Sault Ste. Marie Chippewa) testified before the Senate Committee on Indian Affairs in an oversight hearing to explore "Indian Country Priorities for the 114th Congress."

Read Full Media Release



Posted - January 28, 2015

Congress Begins Early Consideration of Legislative Vehicle for SDPI

Last week, the House Energy and Commerce Committee began considering changes for the Medicare's physician payment formula -- also known as the "Doc Fix" -- as the current "patch" blocking cuts to Medicare doctors expires on March 31, 2015. During the meeting, the path forward on how to pay for this major legislation remained unclear.

The Doc Fix is typically the legislative vehicle that contains renewal for the Special Diabetes Program for Indians (SDPI) as part of what are known as the "Medicare Extenders." In recent years, SDPI has only received one-year renewals because the Doc Fix bill has only received short-term patches.

NIHB and other SDPI Advocates from across Indian Country will be meeting with their Members of Congress in the coming months to support long-term SDPI renewal as part of the "Doc Fix" by March 31. Please visit www.nihb.org/sdpi for more information in SDPI including fact sheets on the program, or contact Caitrin Shuy, NIHB's Director of Congressional Relations, if you would like to become more involved in SDPI advocacy efforts at [email protected] or 202-507-4085.



Posted - January 20, 2015

Legislation Introduced to provide for Advance Appropriations for the Indian Health Service

On Wednesday, January 14, Congressman Don Young (R-AK) introduced H.R. 395 which would provide for Advance Appropriations for the Indian Health Service (IHS). Tribes and Tribal organizations have been supporting this change in the way IHS is funded in order to achieve better stability in how our health care is funded.

Advanced appropriations would mean Tribal and IHS facilities would know their funding levels one year in advance, but the funds would not be drawn down until the year in which it was spent. Congress uses a similar funding procedure for the Veterans' Health Administration. Advance appropriations would allow Indian health programs to effectively and efficiently manage budgets, coordinate care, and improve health quality outcomes for American Indians and Alaska Natives.

But in order to see this legislation enacted, we will need help from you! NIHB and its partners are encouraging Tribes to pass resolutions and send letters to Congress in support of this important issue in order to demonstrate widespread support in Indian Country. We are also encouraging you to share your story on how funding delays have impacted health care delivery at your Tribe. Click here to learn more.



Posted - January 13, 2015

House of Representatives Passes two bills aimed at employers under Obamacare

Last week, the U.S. House of Representatives passed two measures that would affect employers under the Affordable Care Act (ACA). The first bill, the "Hire more Heroes Act," would tweak the law so that veterans who are hired by businesses would not count toward the company's total number of employees under the ACA. (Under the law, employers, including Tribal governments, with more than 50 employees must provide health insurance to their workers or face fines.) This change would be premised mainly on the basis of Veterans already having health insurance coverage options through the Department of Defense or the Veterans' Administration. This legislation passed with a wide majority and is expected to head to the Senate, but it is unclear if President Obama would sign the legislation into law.

The second piece of legislation that passed the House is H.R. 30, which passed the House last Thursday by a vote of 252-172. It would adjust the ACA so that a "full-time" employee would be established at 40 hours per week, instead of 30 hours per week. The law currently requires that employees who work more than 30 hours weekly to be considered full-time when employers are determining their size for coverage purposes - including the mandate requiring them to provide coverage. Many small employers have argued that this threshold of 30 hours per week for full-time employees will discourage hiring and force them to cut hours. Supporters of the law argue that the bill will do significant harm to workers across the country by limiting coverage options. The President has indicated he would veto this legislation if it reaches his desk.

You can read more about these two bills here.



Posted - January 7, 2015

New Congress Convenes Today, Faces Many Challenges

Yesterday marked the start of the 114th Congress. It is the first time since 2006 where both chambers will be controlled by the Republican Party, but divisions remain within the party that might make passing legislation difficult. The Senate will have 13 new members while the House will have 60 new Members of Congress.

As we head into 2015, there are many deadlines and challenges that Congress must deal with and several of these will be important to Tribal communities. Appropriations for FY 2016 will continue to be a sticking point in the new Congress. The Budget Control Act of 2011 will provide for sequestration in FY 2016 unless a deal can be reached to ensure that federal spending remains below the statutory caps in the law. Republican leadership will have to decide if they will make an attempt to replace the cuts in part or in whole or write bills to the lower level. There is pressure to do both. NIHB will be educating the Congress in the coming weeks and months on Tribal health priorities for FY 2016. Tribes may also submit testimony to the House and Senate Appropriations Committees detailing your priorities. For your information, NIHB will send updates when information on submitting testimony is available.

On March 31, 2015, the current patch for the "Sustainable Growth Rate" or "Doc Fix" will expire. This is the legislation that governs the rates that physicians are paid by Medicare. It is also typically the legislative vehicle for the renewal for the Special Diabetes Program for Indians (SDPI). SDPI will expire on September 30, 2015 unless Congress acts. NIHB will be working tirelessly to educate Congress on the success of the SDPI program. Tribes across Indian Country have called for multi-year renewal to further sustainability of their programs. As in past years, that will largely depend on the ability of Congress to agree on a long-term "Doc Fix." Please visit www.nihb.org/sdpi for more information.

NIHB will also continue to educate Congress on key legislative priorities for Tribes in the new Congress. These include advance appropriations for the Indian Health Service, achieving a Medicare Like Rate for non-hospital Purchased/Referred Care at the Indian Health Service, and a legislative fix for the Definition of Indian in the Affordable Care Act.

For a general article on some of the upcoming challenges facing the new Congress please click here.





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Legislative Inquiries:

Caitrin Shuy
Director, Congressional Relations

910 Pennsylvania Ave, SE
Washington, DC 20003
Phone: 202-507-4085
Email: [email protected]