Brief History of the Indian Health Care Improvement Act


The Indian Health Care Improvement Act (IHCIA) along with the Snyder Act of 1921 provide the basis of health care for American Indians and Alaska Natives (AI/AN) pursuant to the treaty and trust obligations of the United States government. The IHCIA was passed by Congress in 1976 to address the health status of AI/AIN, which ranked far below the general population.


Until 2010, Congress had reauthorized the IHCIA four times. The last complete reauthorization occurred in 1992. In 1998, the National Steering Committee for the Reauthorization of the Indian Health Care Improvement Act (NSC) was created for tribes to work with the administration and Congress in a unified manner for the reauthorization of the IHCIA. The work of the NSC, under the leadership of Rachel Joseph, Lone Pine Paiute-Shoshone Tribe, and Buford Rolin, Poarch Creek Band of Indians, reviewed suggestions submitted during tribal consultation and then presented its recommendations which resulted in nearly identical legislation introduced by the House and Senate. During the 110th Congress, the Senate passed its version of the bill, S.1200, but the House was unable to report its version out of all the committees of jurisdiction before the Congress was adjourned. Both chambers had been unable to pass the legislation for more than ten years.

IHCIA and Health Care Reform:

By 2009, the IHCIA was the top priority of Indian Country. Indian Country worked to move the IHCIA during the 111th Congress, with the House and Senate introducing stand alone bills (S.1790, H.R. 2708). Health care reform was the focus of Congress and the Administration during 2009, and the House was first to vote on a bill in November 2009. A week before the bill was voted on, H.R. 2708 was added as part of the House health care reform bill. The bill passed the House of Representatives in November 2009. The Senate then considered its version of health care reform in December 2009, which included the IHCIA as reported by the Senate Committee on Indian Affairs on December 3, 2009. The Senate passed its bill on December 24, 2009.

After months of strategizing the best way for both chambers to pass identical bills, the House voted on the Senate passed bill, which included the permanent reauthorization of the IHCIA. The bill was signed into law by President Obama on March 23, 2010.