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 Archive

Posted - December 16, 2014

Congress Passes FY 2015 Omnibus Appropriations Bill

On Saturday, December 13, the U.S. Senate cleared an omnibus appropriations package that will keep the majority of the federal government (including the Indian Health Service) funded through September 30, 2015. The final vote on the legislation was 56-40. In the Senate, 31 Democrats and 24 Republicans, majorities for both parties, supported it.

Specifically, the provisions for Indian Health Service Include:
  • $4.6 billion in FY 2015. This is $208 million above the FY 2014 level.
  • $4.2 billion is provided for services
  • $460.2 million for facilities
  • $914 million for Purchased/ Referred Care (formerly known as Contract Health Services) This is a $35 million increase from FY 2014.
  • $663 million for Contract Support Costs (CSC). This amount includes increased CSC for FY 2015 but also funds to repay other budget line items which were reprogrammed to cover the FY 2014 CSC shortfall.

Please stay tuned to NIHB in the coming days for specific details on the FY 2015 Indian Health Service budget.



Posted - December 16, 2014

Congress Repeals Section 910 of the Violence Against Women Act

On December 11, Congress passed S. 1474 which repeals Section 910 of the Violence Against Women Act (VAWA). This provision prohibited Alaska Tribes from exercising Special Domestic Violence Jurisdiction over non-Indian domestic violence offenders. This action is a major victory for Alaska Native Tribes.

Last year, the Indian Law and Order Commission, a bipartisan advisory board, called the Alaska exemption "unconscionable".



Posted - July 24, 2014

Tax Break Eyed to Help Indian Health Service Boost Staffing

By Kerry Young, CQ HealthBeat Associate Editor

While serving a population that tends to be poorer and sicker than average, the Indian Health Service has struggled to staff positions in its network of far-flung and sometimes remote sites.

As of February, the service had 1,500 vacancies for health professionals, including doctors, dentists, and nurses, according to a budget document. Openings included those for psychiatric nurse practitioners in Montana, pharmacists in South Dakota and physical therapists in New Mexico...

Read Full Article (PDF)



Posted - July 22, 2014

Licensing ‘dental therapists’ could give more Americans the care they need

The Washington Post

In 2009, 830,000 visits to emergency rooms around the country could have been prevented if the patients had seen a dentist earlier. In 2011, more than half of children on Medicaid went without dental care. These facts lie behind the story of Deamonte Driver, a Prince George’s County seventh-grader who died of a preventable infection that spread from his mouth to his brain in 2007. Maryland pushed through some reforms following Deamonte’s death, but the situation across the country has not dramatically improved...

Read Full Article



Posted - June 30, 2014

American Journal of Public Health reports on American Indian Health Policy and under-funding of IHS:

The United States has a trust responsibility to provide services to American Indians and Alaska Native (AI/AN) persons. However, a long-standing history of underfunding of the Indian Health Service (IHS) has led to significant challenges in providing services

http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2013.301682



Posted - April 7, 2014

American Indians Look to Veterans’ Model for Stable Health Budgets

By Kerry Young, CQ HealthBeat Associate Editor

Groups representing American Indians are looking to adapt a strategy used by veterans’ associations to secure more stable funding for tribal health needs and relieve the strain on a system that faces some of the nation’s most serious medical crises.

The National Indian Health Board, National Congress of American Indians and the National Council on Urban Indian Health and the Maniilaq Association are backing a pair of bills (S 1570,HR 3229) that would allow the Indian Health Service to receive advance appropriations, meaning that Congress would settle on more than one year’s budget at a time. Congress began doing this for the Veterans Health Administration for fiscal 2010 with the goal of giving the agency more flexibility to do longer-term planning...

Read Full Article (PDF)



Posted - April 2, 2014

Native American Leaders Promote Affordable Care Act in National Indian Health Board Video

BILLINGS, Mont.--April 3, 2014--During its full day of free Affordable Care Act training for Tribes, today in Billings, MT, the National Indian Health Board (NIHB) launched a media campaign featuring American Indian elders. The launch was marked by the national debut of a public service announcement (PSA) for American Indian and Alaska Native elders highlighting how the Affordable Care Act (ACA) improves the health care for Native elders.

Read Full Article




Posted - April 2, 2014

NIHB Tribal Public Health Summit Focuses on Building Capacity and Partnerships on First Day

BILLINGS, Mont.--April 1, 2014--The National Indian Health Board (NIHB) opened its 5th Annual National Tribal Public Health Summit in Billings, Mont. with a powerful, passionate keynote address from one of Indian Country's most renowned physician and a leading resource on Indian health.

Dr. Donald Warne, Director of the Master of Public Health Program at North Dakota State University, impressed upon nearly 400 Summit attendees that to build effective public health capacity in Indian Country the investments, resources and mind-sets need to change...

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Posted - December 16, 2013

SDPI Renewal Clears First Legislative Hurdle

On Thursday, December 12, the Senate Finance Committee passed its “Doc Fix” reform bill which will reform the payments made to doctors under Medicare. Importantly, the legislation that was advanced also contained provisions known as “Medicare Extenders.” The renewal of the Special Diabetes Program for Indians (SDPI) was part of that package. The bill would renew the program for 5 years at $150 million per year. The legislation passed out of committee without any opposition. Thank you to everyone who called in to support this important legislation!

The House Ways and Means Committee also passed a “Doc Fix” bill last Thursday. The version does not contain the extender package. However, it has been reported that Chairman Dave Camp (R-MI) also plans to “address” the Medicare extenders before this bill reaches the full House of Representatives for consideration. NIHB encourages you to continue to contact House of Representatives members to support this in the Medicare Extender package when it is considered in 2014.

These measures will likely be considered by the full chambers next year as Members of Congress search for ways to offset the additional spending in the proposals. This week, Congress is expected to pass a 3 month patch for “Doc Fix” until they can complete a full reform which will likely occur in early 2014.

If you have any questions about SDPI, or would like information on how you can become involved in NIHB’s renewal campaign, please contact Caitrin Shuy, NIHB Manager of Congressional Relations at [email protected] or (202) 507-4085.



Posted - October 7, 2013

Advance Appropriations

The National Indian Health Board, along with the National Congress of American Indians, the National Council on Urban Indian Health and the Maniilaq Association are working with Congress to achieve advance appropriations for the Indian Health Service. On October 1, 2013, Congressman Don Young (R-AK), Chairman of the House Natural Resources Subcommittee for Indian and Alaska Native Affairs, along with Rep. Ben Ray Lujan (D-NM), introduced the “Indian Health Service Advance Appropriations Act of 2013” (H.R. 3229). This legislation would allow for the Indian Health Service (IHS) to receive advance appropriations. An advance appropriation is funding that becomes available one year or more after the year of the appropriations act in which it is contained. For example, if the FY 2015 advance appropriations for the IHS were included in the FY 2014 appropriations bills, those advance appropriations would not be counted against the FY 2014 funding allocation but rather, against the FY 2015 allocation. If IHS had received advance appropriations, it would not be subject to the government shutdown or automatic sequestration cuts as its FY 2014 funding would already have been in place...

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Posted - October 4, 2013

Indian Health Among Tribal Programs That Could Re-Open Under Mini Continuing Resolution

Yesterday (October 3, 2013), the House of Representatives approved for House Floor consideration several measures which would end the government shutdown for select agencies. Among these was a resolution offered by Chairman of the Interior Appropriations Subcommittee Mike Simpson (R-ID) to continue funding for several programs critical to Indian Country. The “American Indian and Alaska Native, Health, Education, and Safety Act” (H.J.Res.80), would fund the Indian Health Service (IHS), The Bureau of Indian Affairs (BIA), and the Bureau of Indian Education (BIE) until December 15, 2013. This bill would provide funding for these programs at FY 2013 funding levels, and still maintain sequestration cuts. In addition to this bill there were also measures approved for consideration that would fund nutrition assistance for low-income women and children (H.J.Res.75) Impact Aid, (H.J.Res.83) and Head Start (H.J.Res.84)...

Read More (PDF)



Posted - October 4, 2013

Government shutdown's hit magnified for tribes; 300 in Crow Tribe furloughed

Billing's Gazette

CROW AGENCY — American Indian tribes have more than access to national parks on the line with the government shutdown, as federal funding has been cut off for crucial services including foster care payments, nutrition programs and financial assistance for the needy.

For the 13,000 members of southeast Montana's Crow Tribe, the budget impasse had immediate and far-reaching effects: Tribal leaders furloughed more than 300 workers Wednesday, citing the shutdown and earlier federal budget cuts...

Read full article:
http://billingsgazette.com/news/local/government-shutdown-s-hit-magnified-for-tribes-in-crow-tribe/article_28d79f72-667c-5eb7-b01d-3bd6d59610d5.html#ixzz2gn2JbT5N



Posted - October 1, 2013

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?...

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Posted - July 31, 2013

House Appropriations Committee Considers FY 2014 Interior Appropriations Bill

Amendment on IHS Sequestration Exemption Offered

Today the House Appropriations Committee began consideration of the Interior, Environment and Related Agencies Appropriations bill. As you may recall from last week, spending in this bill was cut by 14 percent from FY 2013 post-sequestration levels. While the Indian Health Service (IHS) received funding equal to that of the FY 2013 post-sequestration level, many other programs in the bill were eliminated or drastically slashed causing Ranking Member of the Interior Subcommittee Jim Moran (D-VA) to call the bill a "disgrace" and "an embarrassment." ...

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April 9, 2013

Senate and House Pass FY 2014 Budget Resolutions

In the early morning hours of March 23rd, the U.S. Senate passed a Fiscal Year (FY) 2014 Budget Resolution, the first time in nearly four years that the Senate has produced a budget. The proposal, which Democratic drafters say will reduce the federal deficit by $1.85 trillion between spending cuts and tax increases, passed narrowly 50-49 on a largely partisan vote after thirteen continuous hours of voting. A handful of Democrats, all up for reelection next year and representing conservative states, voted against the measure: Sens. Kay Hagan (D-NC), Mark Pryor (D-AR), Max Baucus (D-MT), and Mark Begich (D-AK). Sen. Frank Lautenberg (D-NJ) was absent.

On March 22, Senator Lisa Murkowski (R-AK) introduced an amendment to the Senate Budget Resolution that sought to provide advance appropriations to IHS. While passage of this amendment was unsuccessful, the amendment would have created a deficit-neutral reserve fund to allow for advance appropriations to IHS. Healthcare services directly administered by the federal government, such as those delivered through the Department of Veterans Affairs, are funded by advance appropriations to minimize the impact of late, and at times, inadequate budgets, forcing the federal government to reduce demand (i.e. ration care). This amendment would have provided some predictability for funding to administer IHS medical services and ensure passage of a sufficient, timely and predictable budget at least a year in advance. NIHB led a national outreach campaign asking Indian Country to contact their Senator and support advance appropriations for IHS. NIHB also worked for the inclusion of an amendment to protect IHS from all future sequesters. That effort was not successful.

On March 21, the House of Representatives passed Rep. Paul Ryan’s (R-WI) FY 2014 Budget Resolution on a mostly party-line vote of 221-207. The House spending plan aims to bring the federal deficit into balance in ten years by repealing the Affordable Care Act, overhauling Medicare and pairing back government spending.



April 9, 2013

Congress Approves Stopgap Spending Bill to Avert Government Shutdown

On March 21, the U.S. House of Representatives approved H.R. 933 - the Consolidated and Further Continuing Appropriations Act - which provides funding for government agencies the remainder of Fiscal Year (FY) 2013 (March 27-September 30) in the wake of automatic cuts ordered under sequestration and averts any threat of a government shutdown in March. Final passage of H.R. 933 came on a 318-109 vote in the House, as top Republicans opted to embrace significant changes approved by the Senate on March 20 rather than risk further delay.

H.R. 933 does not reverse the automatic budget cuts of Indian programs under the sequester. The bill added $53 million in funding to the Indian Health Service budget for staffing of new health care facilities and $3.9 billion in funding for the Indian Health Service, which is a slight increase from the FY 2012 enacted level of $3,866,000. The bill has been sent to the White House where President Obama is expected to sign the bill into law soon.



April 8, 2013

NIHB Releases the 2013 Legislative and Policy Agenda

The NIHB Board of Directors has set forth the American Indian and Alaska Native health care priorities that the NIHB will pursue at the national level through its legislative and regulatory work in 2013.

To view a copy of the NIHB 2013 Legislative and Policy Agenda, CLICK HERE (PDF).



March 4, 2013

Office of Management and Budget (OMB) Releases Report to Congress on the Joint Committee Sequestration for Fiscal Year 2013

On March 1, the Office of Management and Budget (OMB) released its Report to the Congress on the Sequestration for Fiscal Year (FY) 2013. The Report provides calculations of the amounts and percentages by which various federal agency budgetary resources are required to be reduced over the seven months remaining in the fiscal year and a listing of the reductions required for each non-exempt budget account.

As a result of the Congress’s failure to enact legislation to stop the sequester, President Obama was required by law to issue a sequestration order on March 1 canceling $85 billion in budgetary resources across the federal government for FY 2013. As noted in the Report, the Indian Health Service (IHS) discretionary lines – IHS services and facilities – are subject to a 5% cut, which translates into a cut of $195 million for services and a $22 million reduction for facilities in FY 2013. The IHS mandatory account for the Special Diabetes Program for Indians (SDPI) is subject to a 2% cut of $3 million.

For a copy of the OMB March 1 Report, CLICK HERE



March 4, 2013

House of Representatives Votes to Renew the Violence Against Women Act (VAWA)

On February 28, the House of Representatives voted in support of S. 47, a renewal of the Violence Against Women Act (VAWA). The legislation passed on a vote of 286 to 138, with 199 Democrats joining 87 Republicans in support of the reauthorization of the landmark 1994 law, which assists victims of domestic and sexual violence. The successful measure passed the Senate last month with 78 votes — including those of every woman, all Democrats and just over half of Republicans. The approved VAWA measure includes a key provision that will allow Tribal courts to prosecute non-Native perpetrators accused of assaulting Indian women on Tribal lands. The measure is now on its way to the desk of President Obama to be signed into law.

The alternative unveiled by the House last week immediately came under sharp criticism from Democrats and women’s and human rights groups for failing to include protections in the Senate bill for gay, bisexual or transgender victims of domestic abuse. The House bill eliminated “sexual orientation” and “gender identity” from a list of “populations” that face barriers to receiving victim services — and also stripped certain provisions regarding American Indian women on reservations. With House Republicans divided, House leadership agreed that it would allow a vote on the Senate bill if the House version could not attract sufficient votes. It failed on a vote of 257 to 166. Sixty Republicans joined 197 Democrats in opposition; 164 Republicans and 2 Democrats voted for it.



February 26, 2013

House Republicans Unveil Violence Against Women Act (VAWA) Proposal

This week, House Republicans will bring to the House floor a five-year reauthorization of the Violence Against Women Act (VAWA), but the legislation is considerably narrower than the bipartisan VAWA bill passed by the Senate earlier this month. The House VAWA proposal includes narrow language that would give Tribal courts the authority to prosecute non-Indian perpetrators, but only if those courts are certified by the U.S. Department of Justice.

Two House Republicans – Reps. Tom Cole (R-OK), a member of the Chickasaw Nation, and Darrell Issa (R-CA) – plan to offer an amendment that would allow Tribal courts to prosecute non-Indian perpetrators accused of domestic violence offenses against Indian victims. The amendment would also allow non-Indian defendants being tried by a Tribal court the right to request their trial be moved to a U.S. district court if they believed their constitutional rights were being violated.

On February 12, the U.S. Senate, by a robust bipartisan majority of 78-22, passed S. 47- Violence Against Women Act Reauthorization Act of 2013 - legislation would allow Tribal courts to prosecute non-Native perpetrators accused of assaulting Native women on Tribal lands. The Violence Against Women Act, which provides federal grants for legal assistance, transitional housing, law enforcement training and domestic violence hotlines, expired in 2011. Both the House and Senate passed renewal bills last year, but were unable to come to an agreement before the end of the Congressional session.



February 26, 2013

107 House Democratic Caucus Members Sign Letter to White House Opposing Entitlement Cuts

Concerned that a potential deal to defuse the looming sequestration cuts will include cuts to social safety-net programs, 107 House Democrats sent a letter to President Obama on February 15 calling on him to oppose any entitlement benefit reductions, including switching to the so-called “Chained CPI.” The Chained CPI is a measure of inflation that factors rises in the cost-of-living into, among other things, social security benefits. Chained CPI does not rise as quickly as the measure of inflation that the government uses currently. If the federal government switched to the Chained CPI to calculate social security benefits, these benefits would increase slowly over time. The chained CPI would change the way the federal government calculates inflation and could lead to reduced benefits to seniors.

Republicans are demanding entitlement reform as part of a deal to avert the sequester, the planned across-the-board spending cuts that will go into effect on March 1 unless Congress acts to pass legislation to avoid the sequester. President Obama nor Senate Democrats have endorsed any cuts to the social safety-net programs, including Medicare, Medicaid and Social Security benefits while the White House has specifically ruled out raising the Medicare eligibility age.



February 20, 2013

NIHB Urges Congress to Oppose Budget Cuts to Tribal Programs Through Deficit Reduction

Last week, the National Indian Health Board (NIHB) stood with Indian Country and urged Congress to uphold the Federal government’s trust responsibility and oppose any cuts to Indian program funding as Congress looks for ways to reduce the country’s deficit. The recently passed American Taxpayer Relief Act reduced the level of the sequester for non-defense discretionary programs, including the Indian Health Service (IHS), from 8.2% to 5.1%, which would result in a reduction of the IHS budget by $219 million. This cut would translate into lost funding for primary health care and disease prevention services for American Indians and Alaska Natives (AI/ANs), which is certain to produce tremendous negative health impacts.

Due to the delay in implementing the sequester, these cuts would be achieved over only seven months instead of 12, making the effective percentage of reductions approximately 9% for non-discretionary programs like IHS. Recently, the White House projected that sequestration would slow efforts to improve the delivery of health care to AI/ANs through the IHS and would result in 3,000 fewer inpatient admissions and 804,000 fewer outpatient visits. In addition, the billions in cuts to funding for other key health agencies such as the Centers for Disease Control & Prevention and the Substance Abuse and Mental Health Services Administration, will further the devastating blow to the Indian Health Care system. NIHB continues to monitor the situation and will provide updates as they develop.



February 20, 2013

Senate Democrats Reach Deal on the Sequester

On February 14, Senate Democrats agreed to move forward with a roughly $110 billion budget package – evenly divided between new tax revenues and spending cuts – to forestall the across-the-board sequester cuts due to take effect on March 1. Senate Majority Leader Harry Reid (D-NV) indicated that he hopes to bring the bill to the Senate floor the week of February 25 when the Senate returns from the President’s Day recess.

That leaves little time before the billions in across-the-board cuts take effect and Senate Democrats face an uphill climb finding Republican supporters of the legislation. The goal of the bill is to forestall sequestration and buy 10 months in which Congress and the White House could potentially implement a larger budget deal to put the rest of the continued threat of the deep budget cuts threatening the Pentagon and domestic appropriations every year. Nonetheless, the Senate Democratic bill is the first sign of legislative movement after weeks of finger-pointing in Congress. House Speaker John Boehner (R-OH) stated that if Senators “are willing to pass a bill, the House will find some way to work with them to address this problem.”



February 20, 2013

President Obama Delivers Annual State of the Union Address to a Joint Session of the 113th Congress

On February 12, President Obama delivered his first State of the Union address of his second term to a joint session of the 113th Congress. President Obama urged a deeply-divided Congress to embrace his plans to use federal funding to create jobs and strengthen the nation’s middle class and insisted that lawmakers pay down the federal deficit through a combination of targeted spending cuts and tax increases.

President Obama will continue to work with a Congress that remains nearly as divided as it was during the final years of his first term, when Congress lurched from one from one crisis to another. Republicans are ardently opposed to President Obama’s calls for legislating more tax revenue to reduce the nation’s deficit and offset the broad automatic spending cuts – known as the sequester – that are to take effect on March 1. During the Address, the President broke little new ground on two agenda items he has pushed vigorously since winning re-election: overhauling the nation’s fractured immigration laws and enacting tougher gun control measures in the wake of the horrific shootings around the nation. Yet with unemployment persistently high and consumer confidence falling, the economy remains a vulnerability for the President and could disrupt his plans for pursuing a broader agenda.



February 20, 2013

Senate Approves Legislation Reauthorizing the Violence Against Women Act (VAWA)

On February 12, the U.S. Senate, by a robust bipartisan majority of 78-22, passed S. 47- Violence Against Women Act Reauthorization Act of 2013 - legislation that contains a key Tribal provision that would allow Tribal courts to prosecute non-Native perpetrators accused of assaulting Native women on Tribal lands.

President Barack Obama, in a statement, praised the Senate for working across party lines to pass the bill and said: “The bill passed by the Senate will help reduce homicides that occur from domestic violence, improve the criminal justice response to rape and sexual assault, address the high rates of dating violence experienced by young women, and provide justice to the most vulnerable among us. The Tribal court jurisdiction over non-Native perpetrators issue is expected to be a hurdle as lawmakers try to reconcile the Senate bill with the eventual House bill. Two House Republicans – Reps. Tom Cole (R-OK), a member of the Chickasaw Nation, and Darrell Issa (R-CA) – have been pushing a legislative compromise that would give defendants the right to request that their trail be moved to a federal court if they felt they were not getting a fair trial.

Last year, both the Republican-led House and the Democratic-controlled Senate passed VAWA renewal bills, but were unable to reach a final compromise. The original 1994 VAWA was negotiated by Vice President Joe Biden, then a Senator from Delaware, and expired in 2011.



February 19, 2013

NIHB Urges Congress to Oppose Budget Cuts to Tribal Programs Through Deficit Reduction

Last week, the National Indian Health Board (NIHB) stood with Indian Country and urged Congress to uphold the Federal government’s trust responsibility and oppose any cuts to Indian program funding as Congress looks for ways to reduce the country’s deficit. The recently passed American Taxpayer Relief Act reduced the level of the sequester for non-defense discretionary programs, including the Indian Health Service (IHS), from 8.2% to 5.1%, which would result in a reduction of the IHS budget by $219 million. This cut would translate into lost funding for primary health care and disease prevention services for American Indians and Alaska Natives (AI/ANs), which is certain to produce tremendous negative health impacts.

Due to the delay in implementing the sequester, these cuts would be achieved over only seven months instead of 12, making the effective percentage of reductions approximately 9% for non-discretionary programs like IHS. Recently, the White House projected that sequestration would slow efforts to improve the delivery of health care to AI/ANs through the IHS and would result in 3,000 fewer inpatient admissions and 804,000 fewer outpatient visits. In addition, the billions in cuts to funding for other key health agencies such as the Centers for Disease Control & Prevention and the Substance Abuse and Mental Health Services Administration, will further the devastating blow to the Indian Health Care system. NIHB continues to monitor the situation and will provide updates as they develop.

Indian Health Service Sequestration Amendment (PDF)

NIHB IHS Budget Factsheet (PDF)



February 13, 2013

President Obama Nominates REI Chief Executive Sally Jewell for Department of the Interior Secretary

On February 6, President Obama announced the nomination of Sally Jewell, president and CEO of the outdoor and recreational retailer, Recreational Equipment Inc. (REI), to replace Ken Salazar as the Department of the Interior Secretary. Last month, Secretary Salazar announced that he will step down by the end of March.

At a 15-minute White House rollout with the President, Jewell said she was "humbled" and "energized" by the appointment. President Obama called Jewell a "strong, capable leader and an expert on the energy and climate issues that are going to shape our future." Jewell’s selection drew immediate support from conservation advocates as well as from some oil and gas industry supporters who have criticized the Administration’s policies on energy production. Jewell has advised Republican and Democratic Administrations alike on how to enlist more Americans in outdoor activities, most recently helping to chart a plan for the U.S. National Park Service’s future while she served on the National Park Second Century Commission.



February 13, 2013

House of Representatives Votes in Support of Balanced-Budget Plan

On February 6, the House of Representatives passed H.R. 444 – Require A PLAN Act - legislation that would require President Obama to submit a supplemental budget describing when a balanced budget would be reached if the President’s Fiscal Year 2013 Budget proposal does not eliminate the federal deficit.

The House passed the measure by a vote of 253-167, with 26 Democrats breaking from their party to vote in favor of the bill, which is not expected to be taken up by the Democratically-controlled Senate. In support of H.R. 444, House Republicans criticized President Obama for missing the February 4 deadline for sending his budget request to Congress, arguing it’s the fourth time in five years that the deadline has not been met by President Obama. Before passing the measure, the House adopted by voice vote three Republican amendments, including a proposal that would require the supplemental budget to include an estimated cost per taxpayer for each year that a deficit is projected. By a vote of 75-348, the House also rejected an amendment that would have added language stating the balanced budget recommendations of the 2010 Simpson-Bowles commission should from the basis for meeting the requirements of the bill.



January 24, 2013

Senators Introduce Bipartisan Bill to Improve Mental Health Services & Prevent Youth Suicide

On January 23, in an effort to improve mental health services for young people and prevent youth suicides, U.S. Senators Jack Reed (D-RI) and Lisa Murkowski (R-AK) introduced the Garrett Lee Smith Memorial Act Reauthorization bill. The Reauthorization will help improve access to counseling for at-risk teens and promote the development of statewide suicide early intervention and prevention strategies. It will also increase federal funding for competitive grants to help States, colleges, universities, and Tribes improve mental and behavioral health counseling services...

Read More (PDF)



January 24, 2013

Violence Against Women Act Bills Re-introduced in Congress

On January 22, U.S. Senate Judiciary Committee Chairman Patrick Leahy (D-VT) and Sen. Michael Crapo (R-ID) introduced S. 47, a bipartisan bill that would reauthorize the landmark Violence Against Women Act (VAWA) in the new 113th Congress. On the same day, Rep. Gwen Moore (D-WI) and Rep. John Conyers (D-MI) introduced H.R. 11, a House companion bill identical to the bipartisan Senate bill S. 47...

Read Full Article (PDF)



January 24, 2013

House Passes Legislation to Suspend the Debt Limit

On January 23, the House of Representatives passed debt legislation that would suspend the country’s debt limit through May 18. House Members voted 285-144 to pass H.R. 335, with 86 Democrats supporting the measure and 33 Republicans opposing it.

H.R. 335 automatically increases the current $16.4 trillion ceiling to accommodate additional debt accumulated before May 18. Without action, the federal government would reach its borrowing ceiling as early as mid-February. H.R. 335 would also tie Congressional pay to passage of a budget plan by suspending salaries of House or Senate Members if either chamber does not adopt a budget resolution by April 15.

Senate Majority Leader Harry Reid (D-NV) said that the Senate will pass H.R. 335 and the White House has indicated that it will not block the measure. The timing of the Senate vote to pass the measure has not been determined. Stay tuned to www.nihb.org for updates as they develop.



November 27, 2012

NIHB Announces Indian Country Campaign to Stop Sequestration

The National Indian Health Board (NIHB) recently launched the Stop Sequestration Now campaign in Indian Country. The purpose of the campaign is to engage Tribes, Tribal organizations and supporters of American Indian and Alaska Native (AI/AN) programs to communicate to Congress now about protecting the funding for Indian programs from sequestration.

Under the recently released Office of Management and Budget (OMB) Report to Congress, the entire Indian Health Service (IHS) budget is subject to an 8.2% cut. This across-the-board cut to the IHS budget would result in a loss of $356 million in funding for Indian Health programs. This cut translates into lost funding for primary health care and disease prevention services for AI/ANs. If sequestration occurs, the automatic cuts to federal funding for Indian health programs will have devastating consequences for Indian Country and adversely impact tribal efforts to address health challenges that affect AI/ANs. Sequestration will be triggered on January 2, 2013, if Congress does not enact legislation to stop sequestration.

NIHB has provided a sequestration fact sheet and a sample engagement letter that Tribes can modify and use as they contact their Congressional Members and urge them to take action to stop sequestration. NIHB continues to monitor the situation and will report new information as it develops.

NIHB Sequestration Fact Sheet (PDF)

Sequestration Call To Action Sample Letter



November 19, 2012

Presidential and Congressional Elections Results and Implications

On November 6, 2012, Barack Obama was reelected the 44th President of the United States. President Obama received 332 electoral votes (62 more than the 270 required to win the Presidency) and 51% of the popular vote. Several key "swing states" were crucial to President Obama winning reelection, including: Wisconsin, Colorado, Nevada, Ohio, Florida, Pennsylvania, and Virginia. President Obama will be sworn in for his second term on January 21, 2013.

The National Indian Health Board (NIHB) expects President Obama and his Administration to continue to be dedicated to a strong and progressive Tribal agenda in the second term. During his first term, President Obama signed into law several important pieces of Indian legislation including the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA). This landmark piece of legislation was passed as part of the larger Patient Protection and Affordable Care Act (ACA). With the reelection of President Obama, implementation of IHCIA and ACA is guaranteed to continue. NIHB will work diligently to ensure that the Obama Administration continues this commitment to assisting Indian Country with the implementation of ACA and IHCIA. (For more information about the election and ACA implementation, please see NIHB paper State Election Recap: Deadline for Health Insurance Exchange Decision Looms over the State.)...

Read More (PDF)



November 8, 2012

NIHB Announces National Call-In Day Event in Support of SDPI

Read Full Legislative Action Alert (PDF)

Throughout the past year, the National Indian Health Board (NIHB) has stressed the importance of reauthorization of the Special Diabetes Program for Indians (SDPI). Next week, we need you to take action and speak up in support of SDPI.

On Wednesday, November 14th - World Diabetes Day - please join NIHB and Tribal communities from across the country in asking your Senators and Representatives to support renewal of SDPI this year! Congress will be back in session and we need to make sure that they renew SDPI!

As Tribal leaders in the diabetes community, we are notifying you in advance to help us spread the word about this critical call-to-action. NIHB will send out an Action Alert asking you to call your Members of Congress encouraging their support of SDPI. The Action Alert will provide information how you can contact Congress in this important call-to-action.

Should you have any additional questions or comments, please contact Jeremy Marshall, NIHB Senior Legislative Associate, at (202) 507-4078 or via email at [email protected].



NIHB Submits Statement on the Special Diabetes Program for Indians

August 24, 2012

On August 22, the National Indian Health Board submitted an official statement to the Senate Finance Committee in response to the August 8 Field Hearing at Crow Agency, MT, titled: Healing in Indian Country: Ensuring Access to Quality Health Care. The hearing was held at the All-Purpose Building in Crow Agency, MT.

The purpose of the Field Hearing was to address accessing quality health care in Indian Country. In addition to the tribal testimony provided at the Field Hearing, the statement highlights two additional recommendations: Special Diabetes Program for Indians (SDPI) reauthorization and protection of the Indian Health Service budget through any cuts enacted through the sequestration process next January.

The Field Hearing also examined the hurdles in providing and maintaining high-quality health care in Indian Country. Long-term underfunding, workforce shortfalls and technical concerns with facilities and equipment can cause conditions to deteriorate in hospitals. Tribal communities face challenges in meeting health needs as Indian Country explores what could be done to ensure better access to quality care.

The SDPI statement will be posted on the Senate Finance Committee website in the coming months as it becomes a part of the official record.

NIHB Field Hearing Statement on SDPI 8.22.12 (PDF)



NIHB Submits Comments on IHS-VA Draft Agreement Summary

On April 4, the National Indian Health Board (NIHB) submitted comments to the Indian Health Service (IHS) and the Department of Veterans Affairs (VA) regarding the agencies’ draft agreement for reimbursement for direct health care services.

Click here to read the comments



NIHB Executive Director Testifies at House Interior Appropriations Hearing on FY 2013 Budget

On March 27th, NIHB Executive Director, Stacy Bohlen, served as a witness at the House Appropriations Committee Subcommittee on Interior, Environment, and Related Agencies hearing on Native American Programs. Ms. Bohlen testified before Chairman Mike Simpson (R-ID), Ranking Member Jim Moran (D-VA), Rep. Tom Cole (R-OK), Rep. Betty McCollum (D-MN), and Rep. Cynthia Lummis (R-WY) on the President’s Fiscal Year (FY) 2013 Budget Request for the Indian Health Service (IHS). The President requested a $116 million or 3% increase to IHS, with targeted increases to Contract Health Services, Contract Support Costs, and staffing. NIHB requested that Congressional appropriators find additional, much-needed increases for IHS, ensuring that the final amount appropriated for FY 2013 is closer to the levels requested by the National Tribal Budget Formulation Workgroup.

To read Ms. Bohlen’s testimony, click here.




TRIBAL INTEREST IN SUPREME COURT HEALTH REFORM CASE
NIHB, and Tribes, Make the Case to Protect Indian-Specific Provisions

With 449 Tribes and Tribal organizations from across the nation, the National Indian Health Board (NIHB) filed an amicus brief to protect the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA) and other Indian-specific provisions included in the ACA in the Affordable Care Act (ACA) case in the United States Supreme Court.

The Indian-specific provisions of the ACA are critical to the delivery of health care services to Indian tribes and their members. The IHCIA, originally enacted in 1976, forms the statutory basis for the delivery of health care to American Indians and Alaska Natives and plays a key role in addressing chronic health disparities in Indian Country. Tribal Leaders and advocates worked tirelessly for over a decade seeking the reauthorization of the IHCIA to update and modernize the Indian health care delivery system with much needed services such as expanded cancer screenings and long-term care for the elderly and disabled. Today, the Indian Health Service and Tribes have begun implementing many of these new IHCIA authorities and the other Indian-specific provisions in the ACA.

The brief argues that the Indian-specific provisions are separate from other provisions in the ACA and should stand on their own (i.e., are severable) even if the individual mandate provision is held to be unconstitutional. The brief describes Congress’s long-standing policy of enacting separate and unique legislation to govern Indian health care services and it provides a detailed analysis of the separate genesis of the IHCIA amendments and other Indian-specific provisions included in the ACA.

A determination by the Supreme Court that the entire ACA is unconstitutional would be a significant blow to Indian Country, requiring a new legislative effort to pass the reforms, and delaying the implementation of the vital programs and services that the ACA provisions authorized. Cathy Abramson, Chairperson of the NIHB Board of Directors, states, "NIHB and numerous Tribes and Tribal organizations decided to file the brief to demonstrate that Indian Country is firmly united to protect and preserve the IHCIA and other Indian-specific provisions in the ACA."

On March 26th – 28th, the Supreme Court will hear ACA oral arguments, and on March 28th, the Court will hear arguments on the "severability" issue – whether the rest of the ACA, including the IHCIA and other Indian specific provisions, should remain intact if the individual mandate provision is struck down.

View AMICUS BRIEF (PDF)



NIHB Celebrates the 2nd Anniversary of Health Care Reform

Click Here for more information (PDF)



HHS Announces Vacancies on Secretary’s Tribal Advisory Committee

In 2010, the Department of Health and Human Services (HHS) created a Secretary’s Tribal Advisory Committee (STAC), which has successfully been meeting for a little over a year. The STAC was one of the first Cabinet Level Tribal Advisory Committees to any Secretary in the Administration and HHS is grateful to the Tribal Leaders who are current members for their dedication and partnership. To date five meetings of the STAC have occurred. Secretary Sebelius, Tribal STAC members, and senior leadership from HHS, together, have been working to focus collective efforts to improve how HHS works with Tribes, delivers services and reduces barriers to access of HHS programs and services. The STAC signals a new level of attention to Government-to-Government relationship between HHS and Indian Tribal Governments. HHS currently has three vacancies on the STAC and is requesting nominations for these vacancies.

Primary Delegate Nominations:
  • 1-National At Large Delegate
  • California Area
Alternate Delegate Nominations:
  • Oklahoma Area

HHS encourages Tribal leaders to submit nomination letters no later than Friday April 13, 2012. If you have further questions or concerns, please feel free to contact Stacey Ecoffey at [email protected]. You may either fax your nomination to 202-205-2727 or email it to [email protected].

At-Large Delegate "Dear Tribal Leader" Letter (DTLL) (PDF)

California Area Primary Delegate DTLL (PDF)

Oklahoma Area Alternate Delegate DTLL (PDF)

STAC Charter (PDF)

STAC Rules of Order (PDF)


HRSA Seeks Comment on Draft Consultation Policy

The Health Resources and Services Administration (HRSA) has distributed a pre-decisional, draft Tribal Consultation Policy for comment. HRSA will be accepting comments through March 16, 2012 at [email protected]

Click here to read the “Dear Tribal Leader Letter” (PDF)

Click here to read the draft Tribal Consultation Policy (.DOC)


NIHB Board Member Rex Lee Jim Testifies at House Subcommittee Oversight Hearing

On March 6th, NIHB At-Large Member and Navajo Area Representative, Vice President Rex Lee Jim of the Navajo Nation, testified before the House Committee on Natural Resources Subcommittee on Indian and Alaska Native Affairs during its oversight hearing on the, “Fiscal Year 2013 Budget Request of the Indian Health Service (IHS) and of the Office of the Special Trustee for American Indians." NIHB’s testimony focused on the differences between the President’s FY 2013 budget request for IHS and the recommendations developed by the IHS Budget Formulation Workgroup. Other witnesses included IHS Director, Dr. Yvette Roubideaux, and Michael F. Singer, Acting Principal Deputy Special Trustee in the U.S. Department of the Interior on a federal panel. In addition to President Jim, the Tribal panel featured Jefferson Keel, President of the National Congress of American Indians (NCAI); Chairman Michael Finley of the Confederated Tribes of the Colville Reservation; Carolyn Crowder, Health Director for Aleutian/Pribilof Islands Association Inc.; Jerry Isaac, President and CEO of Tanana Chiefs Conference; and Robert McGhee, Councilman of the Poarch Band of Creek Indians.

To read Vice President Jim’s testimony, click here.

To view a video of the hearing and other panelist testimony, click here


Ask Congress: Sign onto a Support Letter for the Special Diabetes Program for Indians (SDPI)

Background:
Congress established the Special Diabetes Program for Indians (SDPI) in 1997 for the prevention and treatment of diabetes in American Indian and Alaska Natives (AI/ANs). AI/ANs have the highest rates of type 2 diabetes in the United States, 2.8 times higher than the U.S. general population. The SDPI is currently funded at $150 million per year through Fiscal Year (FY) 2013. The program will expire in 2013 unless it is reauthorized. To ensure uninterrupted funding for SDPI, it is crucial that Congress pass a reauthorization this year. SDPI proves that federal investment in community-driven, culturally-appropriate prevention programs has immensely positive results:

  • Average blood sugar levels among the AI/AN population decreased a full percentage point (from 9.0 percent to 8.0 percent) between 1996 and 2011.
  • Average LDL (bad) cholesterol declined over 20 percent between 1998 and 2011.
  • Between 1995 and 2006, the incidence rate of End State Renal Disease (ESRD) in AI/AN individuals with diabetes fell by 27.7 percent, which translates into millions of dollars in savings for Medicare, the Indian Health Service, and other third party payers.

Action:
Call your Senators and Representative, and ask them to add their name to an SDPI support letter because:

  • SDPI is a life-saving program that provides real returns on federal investment.
  • SDPI must be reauthorized in order to continue to make progress on the devastatingly high incidence of diabetes in Indian Country.

House of Representatives:
To determine your Representative and receive specific contact information for them, click here. The House SDPI support letter is being distributed by Reps. Diana DeGette (D-CO) and Ed Whitfield (R-KY)

Senate:
To determine your Senators and receive specific contact information for them, click here. The Senate SDPI support letter is being distributed by Sens. Susan Collins (R-ME) and Jeanne Shaheen (D-NH).

To be connected to a Representative or Senator via phone, call the Congressional switchboard at: 202-224-3121

Links

VA/IHS Consultation Scheduled

The Department of Veterans Affairs (VA) and the Department of Health and Human Services (HHS)/Indian Health Service (IHS) are initiating consultation to facilitate VA reimbursement for services provided by IHS and Tribal health facilities to Eligible American Indian and Alaska Native Veterans. Comments are due in 30 days from the date of the letter and an in person session will be held at the IHS Tribal Consultation Summit scheduled for March 13-14, 2012.

Click here to read the “Dear Tribal Leader Letter”

Click here to read a draft agreement between the IHS and the VA.


INDIAN HEALTH SERVICE (IHS) CONSULTATION SUMMIT
March 13-14, 2012
DC Metropolitan Area

Click here for Save the Date Flyer (PDF)


Tribal Health Reform: National Training for Indian Country on the Affordable Care Act and Indian Health Care Improvement Act

April 18-19, 2012
Mystic Lake Casino. Prior Lake, MN

Please call 952-445-9000 or 1-800-262-779 to reserve your room today! To receive group rate of $77 plus taxes, please reserve by April 4, 2012 and ask for the NIHOE rate.

Registration is free, but required by April 13, 2012.
Click Here to Register

Click Here for the Save The Date Flyer (PDF)

Click Here for the Agenda (PDF)

Hosted by the National Indian Health Board and the National Congress of American Indians


HHS Releases 2012 Tribal Budget and Regional Tribal Consultation Dates

On January 11th, the Department of Health and Human Services released a “Dear Tribal Leader Letter” inviting Tribes to the 14th Annual U.S. Department of Health and Human Services (HHS) Tribal Budget Consultation (ATBC) which will take place from March 7- 9, 2012, in the Great Hall of the Hubert H. Humphrey Building at 200 Independence Avenue, SW, Washington, DC as well as to its 2012 Annual Regional Tribal Consultations held across the country.

In an effort to continuously improve the consultation process and in order to facilitate better communication and consultation with Tribes, HHS will develop an improved agenda format for the 2012 ATBC based on feedback from Tribal and Federal participants. The Department understands the importance of hearing from Tribes on national crosscutting issues, regional perspectives, as well as Tribal-specific concerns and has developed a format that will allow for all.

Dear Tribal Leader Letter and Other Information (PDF)


NIHB Submits Comments on FACA to IHS

The National Indian Health Board has submitted comments to the Indian Health Service (IHS) in response to a November 9th “Dear Tribal Leader Letter” regarding the Federal Advisory Committee Act (FACA) and IHS Advisory Groups.

Click here to read NIHB’s comments.

Click here to read the “Dear Tribal Leader Letter”


OPM Releases Dear Tribal Leader Letter on FEHB

In a “Dear Tribal Leader Letter” dated December 21st, the Office of Personnel Management (OPM) provided an update on Tribal access to the Federal Employees Health Benefits (FEHB) Program. Under the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), Tribes and Tribal organizations operating programs under the Indian Self-Determination and Education Assistance Act are eligible to purchase health insurance for their employees under the FEHB Program.

Tribal employers may begin to enroll employees starting on March 22, 2012 with an effective coverage date of May 1, 2012. All Tribes, Tribal organizations, and Urban Indian organizations wishing to participate in the FEHB program must notify OPM by February 1, 2012 via email at: [email protected] or via phone at: 202-606-2530.

2012 Premiums FFS (PDF)

2012 Premiums HMO (PDF)

Dear Tribal Leader Letter OPM FEHB Dec 2011 (PDF)

FEHB FastFacts for Tribal Employees (PDF)

FEHB Guide for Tribal Employees (PDF)

Timeline for Purchasing FEHB (PDF)


December 20, 2011 - This weekend, Congress approved a $1 trillion omnibus appropriations package containing a 6% increase in funding to the Indian Health Service (IHS).

Please click here for details.


Update on Fiscal Year (FY) 2012 Appropriations

Although Fiscal Year (FY) 2012 officially began on October 1st, Congress has yet to pass nine of the twelve appropriations bills for this year. This includes the Interior, Environment, and Related Agencies Appropriations bill, which contains funding for the Indian Health Service (IHS)...

Read More (PDF)


On December 2, 2011, the White House will host its third annual Tribal Nations Conference. NIHB has created fact sheets on current issues in Indian Health for the use of Tribal Leaders and others at this event.

The Indian Health Services Budget and Sequestration (PDF)

Affordable Care Act and Indian Health Care improvement Act Implementation (PDF)

The Special Diabetes Program for Indians (PDF)

Suicide and Substance Abuse Prevention (PDF)


Supercommittee Fails

On November 21st, the Joint Select Committee on Deficit Reduction aka Supercommittee officially admitted defeat in the quest to find $1.2 trillion in federal deficit reduction over the next 10 years.

Click here for more information on what this means for federal spending and the Indian Health Service.


IHS Initiates Consultation on FACA

A recent “Dear Tribal Leader Letter” from Indian Health Service (IHS) Director, Dr. Yvette Roubideaux, has initiated a formal consultation with Tribes on the Federal Advisory Committee Act (FACA). In particular, input and advice is needed to help ensure that all IHS advisory groups remain compliant with FACA. The comment period will be open for 60 days, beginning on November 9th. Comments may be emailed to [email protected]

To view the “Dear Tribal Leader Letter,” click here.


CMS Releases Final Tribal Consultation Policy

On November 17th, the Centers for Medicare & Medicaid Services (CMS) released the final version of its Tribal Consultation Policy. The final policy is the result of comments to CMS by its Tribal Technical Advisory group and other Tribal leaders. To discuss the policy further, CMS has scheduled an All Tribes conference call:

Date: December 9, 2011
Time: 1:00-3:00 pm EST
Call-in: 1-888-637-7740
Passcode: 538239

Dear Tribal Leader Letter (PDF)

Final Consultation Policy


Supreme Court to hear Health Reform Cases

On November 14th, the Supreme Court announced announced that it will hear arguments regarding the constitutionality of various provisions of the Patient Protection and Affordable Care Act (ACA), including the controversial individual mandate, this March.

Click here for an NIHB update.


NIHB Submits Written Comments in Support of Prevention and Public Health Fund

On October 25th, the National Indian Health Board submitted written comments for the record of a Senate Health, Education, Labor, and Pensions hearing entitled, “The State of Chronic Disease Prevention.” In the comments, NIHB discusses the health disparities faced by Indian Country, the wisdom and cost-effectiveness of investing in prevention, and the great potential that the Prevention and Public Health Fund poses for reducing disparities for Native people. Click here to read the comments.

At the October 12th hearing, much of the testimony focused on the question of whether the Joint Select Committee on Deficit Reduction should spare the Prevention and Public Health Fund from cuts to funding in its final report. The Obama Administration has recommended that it be reduced by $3.5 billion. As Chairman Tom Harkin (D-IA) said in his opening statement, “…The Prevention and Public Health Fund is so fundamental to addressing the gap that exists between what is and what can be done to address chronic disease. The Prevention Fund supports evidence-based health promotion programs; however, this fund is only a small down payment in comparison to the size of the problem.”

Ultimately, the Committee asked for hard data from HHS and the disease prevention organizations to use in a letter to the Joint Select Committee on Deficit Reduction on its priorities for funding to show that the Prevention and Public Health Fund is making cost-effective progress.

To view a video recording of the hearing in its entirety and to read witness testimony, please click here.



HHS Secretary's Tribal Advisory Committee: Current Vacancies, Nomination Request

In 2010, the Department of Health and Human Services (HHS) created a Secretary’s Tribal Advisory Committee (STAC) and has successfully been meeting for nearly a year. The STAC was one of the first Cabinet Level Tribal Advisory Committee to any Secretary in the Administration.

To date four meetings of the STAC have occurred. Secretary Kathleen Sebelius, Tribal STAC members, and senior leadership from HHS, together, have been working to focus collective efforts to improve how HHS works with Tribes, delivers services and reduces barriers to access of HHS programs and services. The STAC signals a new level of attention to Government-to-Government relationship between HHS and Indian Tribal Governments.

The Secretary has released a “Dear Tribal Leader Letter” to announce vacancies for the 2 primary delegates and for 2 alternate delegates. Listed below are the areas from which HHS seeking nominations.

Primary Delegate Nominations:
  • Aberdeen Area
    Click here for the “Dear Tribal Leader Letter”
  • Albuquerque Area
    Click here for the “Dear Tribal Leader Letter”
Alternate Delegate Nominations:
  • Bemidji Area
    Click here for the “Dear Tribal Leader Letter”
  • Portland Area
    Click here for the “Dear Tribal Leader Letter”

Click here to read the STAC Charter

Click here for the current STAC Membership List

Nomination letters should be submitted no later than Thursday December 1, 2011. If you have further questions or concerns, please feel free to Stacey Ecoffey at: [email protected]



U.S. Government Accountability Office (GAO) Releases Report on IHS and Forensic Data Collection in Sexual Assault, Domestic Violence Cases

On October 26th, 2011, the United States Government Accountability Office (GAO) released a report entitled, "Indian Health Service: Continued Efforts Needed to Help Strengthen Response to Sexual Assaults and Domestic Violence."

Summary
In response to a Tribal Law and Order Act of 2010 mandate, GAO examined (1) the ability of Indian Health Service (IHS) and tribally operated hospitals to collect and preserve medical forensic evidence involving cases of sexual assault and domestic violence, as needed for criminal prosecution; (2) what challenges, if any, these hospitals face in collecting and preserving such evidence; and (3) what factors besides medical forensic evidence contribute to a decision to prosecute such cases. GAO surveyed all 45 IHS and tribally operated hospitals and interviewed IHS and law enforcement officials and prosecutors.

Results
GAO's survey of IHS and tribally operated hospitals showed that the ability of these hospitals to collect and preserve medical forensic evidence in cases of sexual assault and domestic violence--that is, to offer medical forensic services--varies from hospital to hospital. GAO found that the utility of medical forensic evidence in any subsequent criminal prosecution depends on hospital staff's properly preserving an evidentiary chain of custody, which depends largely on coordinating with law enforcement agencies.

Recommendations
GAO is making five recommendations aimed at improving IHS's response to sexual assault and domestic violence, including to develop an implementation and monitoring plan for its new sexual assault policy and to modify sections of the policy regarding required training and subpoenas or requests to testify.

For more information and to read the report, please visit: http://www.gao.gov/products/GAO-12-29?source=ra


NIHB Board Member Sally Smith Testifies at Senate Committee on Indian Affairs Field Hearing

On October 22, 2011, NIHB Board Member and Alaska Area Representative, H. Sally Smith, testified at a Senate Committee on Indian Affairs Oversight Field Hearing at the Dena’ina Civic and Convention Center in Anchorage, Alaska. Entitled, “H.O.P.E. for the Future: Helping Our People Engage to Protect Our Youth,” the hearing centered on root causes of the youth suicide epidemic currently plaguing Indian Country and featured witnesses from the federal government, as well as Alaska Native witnesses. Ms. Smith’s testimony on behalf of NIHB focused on adverse childhood experiences (ACEs) as a major cause of suicide and called for greater funding for the Indian Health Service, mental health studies, and suicide prevention grant programs.

Click here to read the testimony


Senators Urge Improvements to IHS Contract Health Services

On September 27th, seven senators from the Senate Committee on Indian Affairs sent a letter to HHS Secretary Sebelius and IHS Director, Dr. Yvette Roubideaux, urging the Secretary and other top administration officials to act quickly to improve health care delivery to American Indians and Alaska Natives. The Senators pointed to a U.S. Government Accountability Office (GAO) report issued September 23rd that highlights billing and other problems in the IHS system that make it difficult for American Indians and Alaska Natives to receive care from health providers and makes it difficult for health care providers offering the services to get reimbursed.

The senators requested that IHS submit a comprehensive corrective action plan to address each of the problems and recommendations made in the GAO report, including a timeline for (1) corrective actions, (2) a date when each action will be commenced, (3) a date when each action is expected to be completed, and (4) identifiable goals that will lead to completion of each corrective action.

To view the letter, please visit: http://bingaman.senate.gov/policy/gao_ihs.pdf


Indian-Specific Health Care Provisions Must Stay

By Geoffrey Strommer
April 28, 2011

A year after passage of national health care reform with the Patient Protection and Affordable Care Act (ACA or “Act”), the entire Act, including the many Indian-specific provisions within, is in danger of being taken away. This is why 349 tribes, either directly or through a tribal organization, signed on to a friend of the court brief filed this month in federal court which argues that these provisions are separate from other provisions in the Act and should stand on their own even if the controversial individual mandate provision is held to be unconstitutional. Many tribes have already implemented these new authorities to address critically important health care needs of Indian people.

Judge’s Improper Departure from Supreme Court Precedent
Federal district courts in Virginia and Florida held the “individual mandate” to be unconstitutional, but Judge Vinson in the Florida case took a huge step beyond that. In a January 31, 2011, decision, he not only ruled that the “individual mandate” was unconstitutional, he went on to declare the entire ACA unconstitutional. Judge Vinson reasoned that the Act was finely crafted by Congress and that if the individual mandate must be removed because it is unconstitutional the entire statute cannot function as originally designed, so the entire Act must be struck down. In contrast, the normal rule, based on decades of established Supreme Court precedent, is that when a court finds a portion of a statue unconstitutional, they have an obligation to preserve as a much of a statute as can be preserved, by separating and saving those portions that are practically and legally independent.

The tribal amicus brief argues that the Indian-specific provisions, including the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), have a separate history from the individual mandate provision, that they involve legally independent rights and obligations related solely to Indian tribes and Indian people and should remain valid if the individual mandate is severed from the ACA. In fact, the IHCIA component was added at the last minute to the bill that became the ACA because it was a moving legislative vehicle, not because it was related to the “individual mandate” component.

A Major Setback
If the Indian-specific provisions sink with other sections of the health care reform ship, Indian Country would suffer a major setback. The IHCIA is critically important legislation that helps address chronic health disparities in Indian country. Tribes worked tirelessly for ten years to enact these provisions. If the entire Act is held to be unconstitutional, tribes will need to start the lobbying process again, losing valuable time and money. More importantly this would delay the implementation of the vital programs and services that these provisions authorize in Indian country. Such reforms include enhanced authorities to recruit/retain health care professionals to overcome high vacancy rates, comprehensive behavioral health initiatives, and expressed authority to operate modern methods of health care delivery such as long-term care and home- and community-based care, among others.

Tribes Already Taking Advantage of the New Reforms
Many tribes and tribal organizations are already taking advantage of these Indian specific provisions and have included them in agreements with the Indian Health Service. For example, the Maniilaq Association, a large tribal organization in rural Alaska, has incorporated into its agreement several provisions that expand its authority to provide both home and facility based long-term care programs. This expanded authority is critical for Maniilaq as it readies to open a new long-term care center that will provide desperately needed services to the elder population in the region. The Seminole Tribe of Florida has also included a number of these new provisions in its agreements with IHS. With these new provisions the Tribe has established a comprehensive program to protect children and preserve families that involves coordinating medical and mental health services with support from education, social services, counseling, and other tribal and non-tribal services. The Houlton Band of Maliseet Indians of Maine have been able to hire a much needed physician because of a change of the law that allows tribes to hire physicians licensed anywhere in the United States just like the Indian Health Service.

The Strong Voice of Indian Country
It is expected that the Supreme Court will ultimately decide if the individual mandate is constitutional. It is important for tribes to ensure that the courts that are wrestling with these questions understand clearly the independent nature of the Indian-specific health care provisions and urge that they be upheld regardless of what happens to the individual mandate provisions. The recently filed tribal amicus brief reflects the unqualified unity of tribes on these questions. We hope that the Courts are listening.

Geoff Strommer is the managing partner of the Portland, Oregon, office of Hobbs, Straus, Dean & Walker. Geoff headed up the effort to file an amicus brief on behalf of the National Indian Health Board and many tribes in State of Florida, et al., v. HHS.

For this article – click here


President Obama’s FY 2012 Budget Request For the
Indian Health Service (IHS)

February 16, 2011

The President’s Indian Health Service (IHS) budget request for Fiscal Year (FY) 2012 totals $4.624 billion. This figure represents a 14.1% increase over the FY 2010 appropriated level and 4.9% increase over the President’s budget request for FY 2011.

Click here to download summary.


Proposed Continuing Resolution for FY 2011 continues Current IHS Funding Levels with adjustments

February 16, 2011

With the current Continuing Resolution (CR) expiring on March 4, 2011, Congress is racing to enact a budget proposal to fund the federal government through the remaining seven months of FY 2011. The House Appropriations Committee has proposed H.R. 1, a bill that would cut $100 billion from the President’s original FY 2011 budget request ($60 billion from current funding levels) in order to achieve deficit reduction. While a number of government agencies and programs would suffer major reductions - and even elimination - under this proposal, the Indian Health Service (IHS) remains intact by FY 2010 standards.

Click here to download summary.

 


Health Care Reform Archive

Congressman Rahall Needs Your Support!

Congressman Rahall is introducing an Indian health amendments package to H.R. 3200 to ensure that the necessary protections are in place for the Indian health care system.
Click here for a copy of the legislative alert about what you can do to help!
 
Health Care Reform Support Letter template
 
The California Rural Health Board and the Northwest Portland Health Board support Rahall’s amendments. Please click here to see their letter of support.

Various national organizations and councils on healthcare or community coalitions have submitted a written letter of support for the Rahall amendments. For a copy of the letter please click here.

To understand more about the Rahall proposed amendments changes that protect the Indian health care system there are two documents provided. Click on the title below to view the document:
 
Description - SECTION BY SECTION OF RAHALL AMENDMENT INDIAN HEALTH PROVISIONS TO H.R. 3200, "AMERICA'S AFFORDABLE HEALTH CHOICES ACT OF 2009"

Amendment Language - EN BLOC AMENDMENTS OFFERED BY MR. RAHALL TO THE AMENDMENT IN THE NATURE OF A SUBSTITUTE OFFERED BY MR. WAXMAN TO H.R. 3200

AMENDMENT TO THE AMENDMENT IN THE NATURE OF A SUBSTITUTE TO HR 3200 OFFERED BY MR. PALLONE


Health Care Reform in Indian Country

Congress is in the final stage of developing a final health care reform bill. Here are key documents for your use and review.

Recommendations

Letters

Northwest Federation Community Organizers and members of the Health Rights Organizing Project Letter to Congressional Leaders supporting IHCIA in Health Care Reform, dated January 12, 2010.

NIHB, NCAI & NCUIH joint letter to President Obama, Majority Leader Reid and Speaker Pelosi, dated January 7, 2010

Indian Country Recommendations Regarding Indian Provisions in Health Care Reform Bills, dated December 23, 2009.
This is a cover memo describing the recommendation charts below.

Charts

Recommendations regarding the Indian Health Care Improvement Act (IHCIA) Provisions in the House and Senate Bills

Recommendations regarding Indian Specific Provisions, other than the IHCIA, in the House and Senate Bills Comprehensive chart

Bills

House Bill, Affordable Health Care for America Act (H.R. 3962)

Senate Bill, Patient Protection and Affordable Care Act, (H.R. 3590)

Congress

Senator Reid included the IHCIA bill reported out of the Senate Committee on Indian Affairs on December 16, 2009, in his manager’s amendment.

To download the manager’s amendment, click here.

Version of IHCIA (S. 1790) reported out by the Senate Committee on Indian Affairs with the House version as adopted in House health care reform bill (H.R. 3962), as of 11/28/09, click here

For a condensed table of contents of the comparison place click here


During Senate Floor Debate, Senator Tom Udall (D-NM) talks about why “Health Reform Must Include Indian Country"


Senate Unveils Health Care Reform Bill - the Patient Protection and Affordable Care Act.

To view the bill, please click here or visit http://democrats.senate.gov/.

To view the congressional budget office report, please click here.

To view a list of Indian Specific Provisions in the Senate Health Care Reform Bill, please click here.


Overview of Health Care Reform for Indian Country


Senate Finance Chairman Releases Chairman’s Mark – America’s Healthy Future Act of 2009


Recommendations for Reform from Indian Country

  • Montana-Wyoming Tribal Leaders Council: A Resolution on Indian Health Care reform strongly urging the application of these Core Requirements and Principles for the Large Land Base Tribes Of Montana and Wyoming
  • Northwest Portland Area Indian Health Board and ATNI Recommendations on Health Care Reform Policy Options for the Indian Health System
  • The Navajo Nation Initial Response to the National Health Care Reform Initiative   
  • Cherokee Nation Perspective on National Health Care Reform

White House Creates Video to Address the Myths of Health Insurance Reform and the Indian Health Service

  • Kimberly Teehee, Senior Policy Advisor for Native American Affairs at the White House Domestic Policy Council has posted a video regarding the myths and rumors surrounding health insurance reform and the Indian Health Service (IHS).

    To view this video blog click here


FAQs of American Indian and Alaska Natives in Health Care Reform

 


Indian Health Care Improvement Act Archive

THANK YOU for YOUR Support of H.R. 3962 - the Affordable Health Care for America Act and the Reauthorization of the Indian Health Care Improvement Act

The Indian Health Care Improvement Act (IHCIA), the foundation for the health care delivery system of American Indians and Alaska Natives, has been waiting for reauthorization for 10 years and Indian Country is one step closer to reauthorization of the IHCIA.

The House successfully passed H.R. 3962 – the Affordable Health Care for America Act by a vote of 220-215. To read the NIHB press release click here.

Please reach out to your congressional members and thank them for their support.


Contact Senate Majority Leader Harry Reid Today!!

The Indian Health Care Improvement Act (IHCIA) has not been included in the Senate Health Care Reform Bill. Majority Leader Reid needs to hear from YOU! Let him know that IHCIA is a top priority for Indian Country.

Call Senator Reid’s Office (202) 224-2158 and ask him to include IHCIA in the Senate’s health reform legislation.

To download copy of the NIHB Legislative Alert click here.


Senator Dorgan Files Two (2) Indian Health Amendments To National Health Care Reform!

Senator Dorgan, Chairman of the Senate Committee on Indian Affairs, filed two amendments to the Senate health care reform bill – the Patient Protection and Affordable Care Act (H.R. 3590). The Senate bill does not include the IHCIA language. Including the IHCIA in the Senate bill will help strengthen the chances of the IHCIA remaining in the bill when the House and Senate health care reform bills are merged.

With the filing of these amendments, Indian Country is one-step closer to passage of the reauthorization of IHCIA and additional appropriations for contract care.

To view Dorgan Amendment SA 2923 - Adding the Indian Health Care Improvement Act Reauthorization and Extension Act (S. 1790). click here!

To view Dorgan Amendment SA 2922 - Adding funding for Contract Medical Care click here!

To download a copy of the legislative alert released on December 10, 2009 regarding, the Inclusion of the IHCIA in Senate Health Care Reform Bill click here.


We Need Your Help to ensure that the Indian Health Care Improvement Act (IHCIA) is included in the Senate Health Care Reform Bill.

To ensure that the amendments are debated and passed, we need your help!  Contact your Senators and ask them to support Dorgan’s amendments.  
It has taken more than 10 years to get to this point, and we are getting closer, but we need your help to reach the finish line.

Call and write your Senators TODAY!!
Urge them to include IHCIA in health care legislation!

Call the Capitol Switch Board (202) 224-3121 to speak with you Senator.

To find out your Senator’s contact information click here!

Send a letter to your Senator today!

To download a sample letter that you can use to contact your Senator click here!

To download a copy of the IHCIA Fact Sheet please click here.

To download a copy of this legislative alert, please click here.


House Bill - H.R. 2708

Copy of H.R. 2708

Side by Side Comparison of HR 2708 with previous bills and current law


Senate Bill – S. 1790

Senator Dorgan, Chairman of the Senate Committee of Indian Affairs with 15 originals cosponsors introduced a bill to reauthorize the Indian Health Care Improvement Act (IHCIA) S. 1790.

To download a copy of S. 1790 click here.

A chart that summarizes the amendments offered during the mark up of S. 1790 and the amendments to S. 1790 are available for download:  

·        Summary Chart

·        Senator Dorgan’s Manager’s Amendment (#892)

·        Cantwell-Udall Amendment (#816)

·        Tester Amendment (#833)

·        Franken Amendment (#824)

·        Murkowski Amendment (#823, #771, #826)

·        Murkowski Amendment (#852 -853)

For a side by side comparison of senate version of IHCIA (S. 1790) with the house version as adopted in house health care reform bill, as of 11/28/09, click here.

To download a copy of the Comparison of the Senate Version of Indian Health Care Improvement Reauthorization and Extensions Action of 2009 with Current Law and 2nd Report on Recommendations from the National Tribal Steering Committee for the Reauthorization of the Indian Health Care Improvement Act click here.

A concept paper written by the Senate Committee on Indian Affairs click here to read the paper in full (pdf).


Tribal Action


How can I help?

Please contact your congressional members and ask them to support the H.R. 2708.