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.
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.
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...
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.
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.
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)...
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...
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."...
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...
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...
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...
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....
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...
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...
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...
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...
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...
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.
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.
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.
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.
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.
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).
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!
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."
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.
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.
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.
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.