x
NEW! COVID-19 TRIBAL RESOURCE CENTER

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.

Read More

Legislative Action Alerts are only sent to your inbox when legislation relevant to Indian health is introduced, debated, or voted upon. These timely alerts will provide background information and a pathway for you to get involved in the issue at hand.

Legislative Archive

Posted: December 11, 2018

GAO releases report on IHS funding levels compared to other federal health programs

On December 10, 2018, the Government Accountability Office (GAO), which acts as the "audit, evaluation, and investigative arm of Congress", published a report considering spending levels for the Indian Health Service (IHS), compared to three other federal health care providers. The report comes at the request of Congressional leaders on the Interior appropriations subcommittee of the House of Representatives.

Read More



Posted: November 20, 2018

Report on Missing and Murdered Indigenous Women Presented to Congress

On November 14th, the Seattle Indian Health Board hosted a press event on Capitol Hill to release a report on Missing and Murdered Indigenous Women and Girls (MMIWG). There were several lawmakers in attendance who have been key advocates for MMIWG in the United States Senate. Senators Lisa Murkowski (R-AK), Heidi Heitkamp (D-ND), Patty Murray (D-WA), Maria Cantwell (D-WA) and Jon Tester (D-MT), all gave remarks in support of the report.

The report identified 506 unique cases of missing and murdered American Indian and Alaska Native women and girls, across 71 selected cities across 29 states. Of the cases reported 25% were missing persons cases, 56% were murder cases, and 19% had an unknown status.

Read More



Posted: November 9, 2018

Congressional Co-Chairs of IHS Task Force Request Input from Tribal Leaders

Today, the Co-Chairs of the House of Representatives Indian Health Service (IHS) Task Force released a letter to Tribal leaders requesting information regarding the IHS' accessibility, resources, patient outreach, workforce, cost and other effectiveness metrics...

Read More



Posted: November 2, 2018

NIHB Analysis of H.R. 6 - SUPPORT for Patients and Communities Act

On October 24, 2018, the President signed into law H.R. 6 - SUPPORT for Patients and Communities Act - a comprehensive package of bills to address the opioid overdose epidemic.

Addressing the opioid crisis has been a top priority in Congress, and this legislation fulfills a long anticipated promise of delivering more federal dollars and resources to assist communities in their response efforts. Passed by margins of 98-1 in the Senate and 396-14 in the House, the bipartisan and bicameral support for passage of H.R. 6 speaks directly to the heightened national urgency to turn the tide on the epidemic...

Read More



Posted: October 8, 2018

Comprehensive Opioids Bill Nears Finish Line

Trump Expected to Sign Bill Including Some of Indian Country's Opioid Prevention, Treatment, & Recovery Priorities

After months of continued advocacy, Tribes across the country are nearer than ever to receiving additional resources from the federal government to address the opioid epidemic in Indian Country.

In a 98-1 vote on Wednesday, October 3, the Senate passed H.R. 6, the Support for Patients and Communities Act. The House passed an identical bill on September 28, so the legislation now heads to the President, who is expected to sign it into law...

Read Full Article



Posted: October 2, 2018

House Passes Comprehensive Opioids Bill

Includes Tribal Data Collection Fix Recommended by NIHB

On Friday, the House of Representatives voted in favor of an amended comprehensive opioids bill. H.R. 6, the Support for Patients and Communities Act, passed in a vote of 393-8. The vote follows months of deliberations in both the House and Senate to work out differences between the House's H.R. 6 and the Senate's Opioid Crisis Response Act (OCRA).

The bill now heads to the Senate for a final vote. As NIHB reported previously, the legislation has important gains for Tribes. Most importantly, the bill provides a reauthorization of the State Targeted Response Grants, which states have used since 2016 to address the opioids crisis with flexible, effective community level programs...

Read Full Article



Posted: September 27, 2018

Congress Passes Health Funding Bill

Trump to Sign Fiscal Year 2019 Labor-HHS Appropriations Bill and Continuing Resolution for Several Agencies

The House of Representatives last night passed H.R. 6157, the Fiscal Year (FY) 2019 Labor-HHS Appropriations bill, which contains funding for the Department of Health and Human Services (HHS) as well as the Departments of Labor, Education, and Defense. The bill funds these agencies until September 30, 2019.

H.R. 6157 also contains a Continuing Resolution (CR) funding several other agencies, including the Indian Health Service (IHS), until December 7, 2018...

Read Full Article



Posted: September 25, 2018

Senate Passes Comprehensive Opioids Bill

Multiple Tribal Additions Included in Alexander Amendment

Today, the Senate passed its version of comprehensive opioids legislation. The Opioid Crisis Response Act (OCRA) passed as an amendment to H.R. 6, the Support for Patients and Communities Act, an opioids bill that passed the House on June 22, 2018.

The final version of OCRA, a bipartisan bill written by the Republican and Democratic leaders of the Health, Education, Labor, and Pensions (HELP) Committee, reflects many Tribal priorities and incorporates several suggestions from the National Indian Health Board (NIHB) and the Tribes. The original Senate bill, S. 2680, included Tribes in certain provisions...

Read Full Article



Posted: July 12, 2018

House Appropriations Committee Advances FY 2019 Labor-HHS Appropriations Bill

Programs of Significance for Tribes in the FY 2019 House and Senate Labor-HHS Appropriations Bills

On Tuesday, July 11, 2018, the full House Appropriations Committee held a markup hearing and voted to advance the FY 2019 Appropriations Bill for Labor, Health and Human Services, Education and Related Agencies (commonly referred to as Labor-HHS) by a vote of 30-22. No Tribally-specific amendments were adopted during the markup; however, representatives from both parties adopted a number of amendments aimed at addressing the impact of family separation policies at the border. The bill must now be voted on the House floor before being sent on to the Senate. The full Senate Appropriations Committee advanced their Labor-HHS bill prior to the July 4th recess...

Read More



Posted: February 27, 2018

Congress Renews Health Programs Important to Tribes as Part of Budget Deal

On February 9, 2018, Congress passed a budget agreement that funded the government until March 23, 2018, and reauthorized several public health programs. Many of the programs either benefit Tribal members directly or provide funding to support Tribal public health programs. Reauthorization for these programs varied in length and amount. Below is a summary of renewed programs important to Tribes.

The Special Diabetes Program for Indians (SDPI) was renewed through September 30, 2019. The program will be funded at $150 million per year, the same amount it has received since 2004. SDPI currently funds 301 Tribal diabetes programs through a competitive grant process. The program has existed since 1997 and has helped lessen diabetes’s negative health impacts in Tribal communities. It has been cited as the most successful public health program in Indian Country...

Read More (PDF)


Posted: February 13, 2018

President Trump Releases FY 2019 Budget Request: Major Cuts to Domestic Spending and Social Safety Net, Investments in Opioid Treatment and Prevention

On Monday, February 12, 2018 President Trump released his fiscal year (FY) 2019 Budget Request to Congress. This is the proposal that the Administration provides the Congress as they will develop the FY 2019 appropriation including funds for the Indian Health Service and other health programs serving Indian Country. It will be up to Congress to make any final spending decisions about appropriations for FY 2019, which will begin on October 1, 2018...

Read More



Posted: February 9, 2018

Congress Passes Spending Bill to Fund Government, Renews SDPI

Early this morning, both chambers of Congress approved a spending bill written by the Majority and Minority leaders in the Senate. Following the vote, President Trump signed the bill into law, reopening the federal government after an hours-long shutdown. The bill funds the federal government until March 23, 2018...

Read More



Posted: February 8, 2018

Budget Deal Includes 2 Year SDPI Renewal, Other Public Health Programs

Senate leadership has announced a two-year budget agreement to avoid another shutdown and lessen Congress's reliance on short term Continuing Resolutions to fund the government. It would fund the federal government through March 23, 2018, and provide a pathway for Congress to determine the final spending amounts for the remainder of FY 2018. Congress must pass a spending bill by the end of the day TODAY, February 8, 2018, to avoid another shutdown...

Read More



Posted: February 6, 2018

New Continuing Resolution Includes SDPI:
Bill Would Reauthorize Program for 2 Years

Last night, the House Appropriations Committee released the text of the latest Continuing Resolution to fund the government until March 23, 2018. Included in the legislative text is a 2 year reauthorization of the Special Diabetes Program for Indians!

NIHB has made long term renewal of SDPI our top legislative priority, and success is in sight. But the journey to secure renewal is not over yet: Congress must still pass the Continuing Resolution with SDPI included!

Click here to view background materials for SDPI.
Click here to view updated talking points on how SDPI can be renewed NOW.

Read More



Posted: January 25, 2018

SDPI Outreach Needed: Next Continuing Resolution MAY Include Long-Term Renewal

As the National Indian Health Board has previously reported, one of our top legislative priorities is the long-term renewal of the Special Diabetes Program for Indians. Funding for this highly effective, life-saving program will expire on March 31, 2018, unless Congress reauthorizes it before then.

When SDPI renewal was not included in the last Continuing Resolution despite Congressional promises to Indian Country, NIHB promised to provide Tribes and advocates with Congressional outreach guidance, materials, and information in order to secure renewal for the program...

Read More



Posted: January 22, 2018

Senate Reaches Deal to End Government Shutdown
New CR Expires February 8

At noon today, the Senate voted to pass a Continuing Resolution (CR) to end the shutdown and fund the government through February 8, 2018. This vote is the result of a deal reached between Senate Majority Leader McConnell (R-KY) and Minority Leader Schumer (D-NY). The CR includes a 6-year renewal of the Children's Health Insurance Program (CHIP). As part of the deal, the Majority Leader promised a vote on codifying the Deferred Action for Childhood Arrivals Program (DACA) before the CR expires. The House has not yet voted on the new CR but is expected to in the near future. The President has announced his support for the CR...

Read More



Posted: January 18, 2018

We Fight On: Special Diabetes Program for Indians Renewal Efforts Continue

The Work Continues... Thank you to everyone who participated in Congressional outreach for the Special Diabetes Program for Indians (SDPI) renewal today. Unfortunately, we just learned that SDPI is not likely to be included in the current Continuing Resolution (CR). The House Rules Committee is considering the CR now - we expect that the Committee will issue a Closed Rule, meaning no amendments will be allowed, and SDPI renewal is not in the CR. The CR being considered the Rules Committee today, if approved, will expire February 16, 2018. The CR does contain a 6-year reauthorization for the Children's Health Insurance Program (CHIP). For many months, lawmakers and Congressional Leadership assured NIHB and Indian Country that the SDPI renewal would be taken up with CHIP: that did not happen today.

It is worthy of note, and we are grateful, that CHIP will be reauthorized for 6 years - because this program is so vital to American Indian and Alaska Native children...

Read More



Posted: January 17, 2018

New Continuing Resolution Does NOT Include Special Diabetes Program for Indians Reauthorization

Yesterday, January 16, 2018, House Republican leadership released language for the next Continuing Resolution (CR), which will fund federal government agencies until February 16. The CR includes a six-year reauthorization for the Children's Health Insurance Program (CHIP). Many American Indian/Alaska Native (AI/AN) children and their families receive coverage from this program, and NIHB supports its renewal. Unfortunately, the CR does NOT include any language renewing the Special Diabates Program for Indians (SDPI), which now expires on March 31, 2018!

Up to this point, NIHB had been told by Congressional staff that SDPI would be renewed with the long-term CHIP reauthorization...

Read More



Posted: January 3, 2018

Legislation Introduced to Increase Tribal Opioid and Methamphetamine Resources

On December 21, 2017, Senator Steve Daines (R-MT), introduced S. 2270, which would include Tribes as eligible entities for resources authorized in the 21st Century Cures Act (Cures Act). The legislation is also sponsored by Senators Kamala Harris (D-CA), Jeff Merkley (D-OR), Amy Klobuchar (D-MN), Lisa Murkowski (R-AK) and Tammy Baldwin (D-WI).

Signed into law in 2016, the Cures Act is intended to expedite the discovery, development, and delivery of new treatments and cures. While Tribes were made directly eligible for some of the resources within the legislation, funding streams for opioid treatment went only directly to states through large per capita block grants. The legislation also allows funds to be used for treatment and prevention of methamphetamine use...

Read More



Posted: December 22, 2017

Congress Approves Continuing Funding Resolution - Includes SDPI Funding Through March 31

Last night, Congress approved a short-term continuing resolution (CR) that would fund the federal government - including the Indian Health Service and most other federal agencies - through January 19, 2018 at current year funding levels. The previous CR would have expired today. The legislation passed in the House of Representatives by a margin of 231-188 where 16 Republicans voted no and 14 Democrats voted for the bill. In the Senate the legislation was approved by a vote of 66-32. In the Senate, 17 Democrats supported the measure and 2 Republicans opposed.

Importantly, the bill also contained a short term extension for the Special Diabetes Program for Indians (SDPI). Funding for this life-saving program would have expired on December 31. The new extension funds SDPI through March 31. The House of Representatives has already approved a 2-year extension for SDPI but due to the way it was paid for (through cuts to the Prevention and Public Health Fund) that legislation did not make it through the Senate...

Read More



Posted: December 12, 2017

Congressional Leadership Needs to Hear from You on Renewing SDPI

Washington, DC - On September 29, 2017, President Trump signed a 3 month extension for the Special Diabetes Program for Indians (SDPI) into law as part of the Disaster Tax Relief and Airport and Airway Extension Act (H.R. 3823). The program is now set to expire on December 31, 2017. Congress must act immediately so this life-saving program can continue in 301 Tribal communities across the country. Tribal leaders, members, and SDPI allies, should contact Congressional leadership immediately to urge them to focus on long-term renewal of SDPI. Both Senate and House leadership are key because they must schedule time for SDPI-related legislation to be considered as soon as possible.

Read More



Posted: December 8, 2017

Government Shutdown Averted:
Talks Continue on Other Legislative Priorities

Yesterday, Congress passed a Continuing Resolution (CR) funding the federal government for two weeks, until December 22. This new CR will allow the federal government to operate under previously set funding levels until Congress can pass a longer-term spending bill.

Once the President signs the CR into law, Congress will have until December 22 to pass a longer term spending bill. Negotiations are expected to be contentious, with Democrats demanding a legislative solution to the Deferred Action for Childhood Arrivals (DACA) program benefiting the undocumented immigrant community as a precondition to supporting a long-term funding bill...

Read More



Posted: October 25, 2017

President Trump Sends Indian Health Service Director Nomination to Senate

On Tuesday, October 24, President Trump sent four nominations to the U.S. Senate for confirmation - including the Indian Health Service (IHS) Director nominee, Robert M. Weaver.

Who is Robert Weaver?
As indicated in the White House's original announcement, Robert Weaver is a member of the Quapaw Tribe of Oklahoma and has long worked in hospitals, healthcare facilities, and health insurance. He is the founder and owner of four companies that provide healthcare consulting services to Tribal governments, their enterprises, and their members. Currently, Mr. Weaver owns his own business as an insurance broker and serves as the consultative representative to U.S. government relations for his own Tribe on healthcare issues. Mr. Weaver lives in Oklahoma with his wife and four children...Read More



Posted: October 18, 2017

Congress Releases Bipartisan Deal to Stabilize Health Insurance Marketplaces

On October 17, the leading Senators on the Health, Education, Labor, and Pensions (HELP) Committee, Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) unveiled a bipartisan plan to stabilize health insurance marketplaces. In the wake of an announcement from the Administration last week on ending the monthly subsidies made to health insurance companies, Congress faced added pressure from health insurers to move quickly on some form of stabilizing efforts for health insurance marketplaces.

Read More



Posted: October 4, 2017

Congress Enacts 3-month Extension for the Special Diabetes Program for Indians

On September 29, 2017, President Trump signed a 3 month extension for the Special Diabetes Program for Indians (SDPI) into law as part of the Disaster Tax Relief and Airport and Airway Extension Act (H.R. 3823). The program would have expired on September 30, 2017, but now is set to expire on December 31, 2017. It is funded level funding from previous years ($150 million).

Read More



Posted: October 4, 2017

Affordable Care Act Repeal and Replace Efforts Will Not Move Forward in the Senate

Senate leaders announced today that they will not proceed with the latest legislative attempt to repeal and replace the Affordable Care Act and reform the Medicaid system. This news follows the announcement of Senator Susan Collins (R-ME) that said she would not vote for the proposal. This left the Republicans short of the needed 50 votes to pass the legislation.

Read More



Posted: August 17, 2017

Special Diabetes Program for Indians Outreach is Needed Now More Than Ever

While Members of Congress are home for Recess, the month of August is the perfect time to meet with your lawmakers or invite them to visit your Tribal or IHS healthcare facilities. A top priority for Indian health legislation this Recess is the much needed renewal of the Special Diabetes Program for Indians (SDPI).

SDPI impacts the lives of well over 782,000 American Indians and Alaska Natives each year by funding over 300 diabetes treatment and prevention programs across the nation. No one can deny that SDPI has been a remarkable success - since the program's beginning in 1997 American Indians and Alaska Natives have had improved health outcomes and, therefore, lower spending on expensive treatments.

Read More



Posted: July 28, 2017

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

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

Read More



Posted: July 27, 2017

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

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

Read More



Posted: July 26, 2017

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

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

Read More



Posted: July 26, 2017

Senate Votes to Advance Debate on Health Reform

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

Read More



Posted: July 13, 2017

Revised BCRA Released!
Vote Now Expected Next Week

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

Read More



Posted: July 13, 2017

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

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

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

Read More



Posted: June 28, 2017

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

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

Read More



Posted: June 27, 2017

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

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

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

Read More



Posted: June 27, 2017

HNIHB Testifies on IHS Reform Legislation 

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

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

Read More



Posted: June 27, 2017

Possible Legislative Vehicle for SDPI Receives Hearing 

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

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

Read More



Posted: June 22, 2017

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

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

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

Read More



Posted: June 20, 2017

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

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

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

Read More



Posted: June 20, 2017

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

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

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

Read More



Posted: June 12, 2017

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

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

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

Read More



Posted: June 7, 2017

NIHB -NCAI Letter on Senate Healthcare Reform Legislation

Read Letter Here



Posted: May 24, 2017

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

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

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

Read more



Posted: May 9, 2017

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

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

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

Read More



Posted: May 7, 2017

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

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

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

Read More



Posted: March 26, 2017

House Leadership Pulls Modified American Health Care Act

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

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

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



Posted: March 7, 2017

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

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

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

Read More



Posted: February 8, 2017

NIHB Heads to Capitol Hill to Advocate for SDPI

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

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



Posted: February 2, 2017

NIHB Board Heads to Capitol Hill to Advocate for Tribal Health

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

Read More



Posted: October 19, 2016

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

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

Read More



Posted: May 5, 2016

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

Dear Tribal Leaders, Tribal members and Advocates:

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

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

READ MORE



Posted: March 30, 2016

Disease Prevention and Control Highlighted in CDC Hearing

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

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

Read More



Posted: March 22, 2016

NIHB testifies before House Interior Appropriations Subcommittee

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

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

Read More



Posted: March 10, 2016

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

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

Read More



Posted: February 10, 2016

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

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

Read More



Posted: February 5, 2016

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

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

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

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

Read Full Story



Posted: January 26, 2016

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

John McCoy - The Seattle Times

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

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

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

Read Full Article



Posted: January 25, 2016

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

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

More Information



Posted: January 11, 2016

How Obamacare Will Cost Native American Tribes Millions of Dollars

The Daily Signal

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

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

Read full article at dailysignal.com



Posted: January 4, 2016

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

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

Read more at seattletimes.com



Posted: November 20, 2015

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

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

Read More



Posted: November 17, 2015

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

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

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



Posted: November 13, 2015

Public Health 101 Congressional Briefing to Feature Cherokee Nation

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

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

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

For more information on the briefing click here.



Posted: November 5, 2015

Mental Health Reform Legislation Moving Forward in the House

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

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

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



Posted: November 5, 2015

Bipartisan Budget Act Passes Congress, Work Moves to Appropriations Committee

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

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

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



Posted: October 5, 2015

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

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

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



Posted - July 30, 2015

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

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

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

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



Posted - February 10, 2015

Tribal Leaders Visit Capitol Hill in Support of SDPI

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

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

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



Posted - January 29, 2015

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

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

Read Full Media Release



Posted - January 28, 2015

Congress Begins Early Consideration of Legislative Vehicle for SDPI

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

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

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



Posted - January 20, 2015

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

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

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

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



Posted - January 13, 2015

House of Representatives Passes two bills aimed at employers under Obamacare

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

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

You can read more about these two bills here.



Posted - January 7, 2015

New Congress Convenes Today, Faces Many Challenges

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

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

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

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

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



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...

Read More



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...

Read More



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?...

READ MORE



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." ...

Read More



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.