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Washington Report

An NIHB Publication

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

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SCIA Legislative Hearing on February 8, 2024

The Senate Committee on Indian Affairs (SCIA) held a legislative hearing on February 8th to receive testimony on various pieces of legislation, including the Indian Health Service (IHS) Workforce Parity Act of 2023 (S. 3022) and the Tribal Access to Clean Water Act of 2023 (S. 2385). The witnesses before the committee were HHS Assistant Sec. for Legislation Melanie Anne Egorin; DOI Indian Affairs Deputy Assistant Secretary Kathryn Isom-Clause; Chairman Manuel Heart, Ute Mountain Ute Tribe; Chief Douglas Lankford, Miami Tribe of Oklahoma; President Robert Larsen, Lower Sioux Indian Community; Chairwoman Victoria Kitcheyan, Winnebago Tribe of Nebraska; Executive Director Angie Wilson, Reno Sparks Indian Colony Tribal Health Center.

IHS Workforce Parity Act of 2023

Senators Cortez Masto (D-NV) and Mullin (R-OK) introduced the IHS Workforce Parity Act in October 2023. The legislation amends the Indian Health Care Improvement Act (IHCIA) to allow IHS scholarship and loan recipients to fulfill service obligations through half-time clinical practice. The statute previously only allowed for full-time recipients who agreed to serve at least two years in an Indian health program. Whereas this legislation would allow half-time recipients to serve at least four years to qualify for the program, and if the four years is not met, the provider must complete no less than two years with the caveat that the recipient is required to pay half of the loan repayment amount.

Additionally, the bipartisan legislation would bring IHS in line with the National Health Service Corps (NHSC) loan and scholarship programs and aims to recruit more doctors and health care providers to Indian Country. In a statement on the release of the legislation, Senator Mullin states that “rural health care providers like IHS have unique staffing needs, and this amendment to the IHS scholarship and loan service obligation offers a flexible, cost-effective solution to ensure IHS maintains a competitive edge when considering new recruits.” Further, the Government Accountability Office (GAO) reported in 2018 the average vacancy rate for IHS clinics is 25%. Further, during a hearing before the House Natural Resources Committee in May 2023, Director Tso said the IHS needs over 1,300 clinical providers due to the vacancy rate being 28%.

During the recent SCIA hearing, the consensus among the witnesses was S. 3022 is critical to the future of IHS’ ability to provide health care to Indian Country. HHS Assistant Secretary Egorin noted that “this bill…builds capacity and it builds the ability to recruit and retain [health care providers], which is a critical need.” The legislation creates the opportunity for clinics and providers to have flexibility in meeting the various needs which each community faces. Director Wilson touched on the different hats a provider wears on any given day due to communities not having access to general urgent care facilities and that “allowing flexibility [with the providers] helps us strategize and more conveniently utilize their skills for what we need.”

The legislation still awaits a committee vote, which has yet to be scheduled. Additionally, a companion bill has not been introduced in the House.

In a statement on the release of the legislation, NIHB shared, “the current requirement for providers to work in a full-time capacity discourages other providers from serving Tribal communities. The proposed legislation would bring more doctors, nurses, and other providers, to AI/AN communities throughout Indian Country.”

Tribal Access to Clean Water Act of 2023

Senator Michael Bennet (D–CO) reintroduced the Tribal Access to Clean Water Act (S. 2385) in July 2023 alongside eight (8) cosponsors, Senators Heinrich (D-NM), Hickenlooper (D-CO), Warren (D-MA), Wyden (D-OR), King (I-ME), Padilla (D-CA), Sanders (I-VT), and Markey (D-MA). The bill intends to provide access to reliable, clean, and drinkable water on Tribal lands.

The current draft bill makes changes to statute, which would clarify terms applicable to the IHS Sanitation and Facilities Construction Program (SFC) and would authorize funding for the first time to SFC operation and maintenance, among other changes. The bill includes roughly $150 million in annual funding from 2024 to 2028 to IHS for Tribal sanitation facilities and services, technical assistance, and operation and maintenance of water facilities.

During his testimony, Chairman Heart shared, “access to clean water is a basic human right. It is essential for people to live with dignity and foundational for human health, growing economies, and a basic level of existence for communities. It is unacceptable that in the 21st Century, many Native Americans must travel for miles to collect water that is safe for drinking and everyday use. An estimated 48% of households on Indian reservations do not have access to reliable water sources, clean drinking water, or adequate sanitation.” In August 2022, the Department of Health and Human Services (HHS) reported that “Native American households are 19 times more likely than white households to lack indoor plumbing.”

The Senate legislation is a companion bill to the House version (H.R. 4746) introduced by Representatives Joe Neguse (D-CO-02), Gwen Moore (D-WI-04), Melanie Ann Stansbury (D-NM-01), Eleanor Holmes Norton (D-DC-At Large), and Mike Thompson (D-CA-04) in July 2023. The House bill has been referred to the Committees on Natural Resources, Energy and Commerce, and Agriculture; the first hearing in the House has yet to be scheduled.

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