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Republicans take initial steps to dismantle Indian health care law

Wednesday, January 4, 2017

From left: Lester Secatero, chairman of the National Indian Health Board; Rep. Tom Cole (R-Oklahoma); and Lincoln Bean, Alaska area representative for the NIHB. Photo: NIHB

With backing from president-elect Donald Trump, Republicans in Congress are making good on their promise to dismantle Obamacare, a move that would eliminate a landmark Indian health care law.

Legislation introduced on the first day of the 115th Congress on Tuesday begins the process for repealing the Affordable Care Act (ACA). Trump and his fellow Republicans have called the law, which requires most Americans to maintain health coverage, a disaster.

"We must remember this — this law has failed. Americans are struggling," Rep. Paul Ryan (R-Wisconsin), the Speaker of the House, said at a press conference on Wednesday with vice-president elect Mike Pence at his side. "The law is failing while we speak. We need to reverse the damage that has been done."

But in their push to rebuke President Barack Obama, Republican leaders have yet to offer a solution that would protect the Indian Health Care Improvement Act (IHCIA). The law, which updates crucial programs to address the unique and pressing health needs of the first Americans, was made permanent when Congress passed the ACA in 2010.

Hit the Ground Running
We are going to make sure President-elect Trump can hit the ground running when he takes office on the 20th.
Posted by Speaker Paul Ryan on Wednesday, January 4, 2017

Speaker Paul Ryan on Facebook: Hit the Ground Running on Obamacare

That achievement came after more than a decade of work, during which tribes and their advocates faced opposition from Republican lawmakers and from the administration of then-president George W. Bush. So many are worried about having to start over if Obamacare ends up going away.

With the new political landscape in mind, tribal leaders have been meeting with key Republicans and with Trump's greatagain.gov transition team since the November election. While the initial legislation to repeal the ACA does not yet address the Indian Health Service, many remain hopeful that they will be able to come up with a solution.

"I am confident that it is these kinds of conversations and the work that you all do that will get us successfully through this administration and on to the next," Victoria Kitcheyan, a council member for the Winnebago Tribe in Nebraska, said during a transition summit hosted by the National Indian Health Board last month.

The task is bigger than just preserving the IHCIA, though, because other parts of the ACA have benefited Indian Country. One provision, for example, prevents tribal benefits from being taxed by the Internal Revenue Service, an issue that was affecting tribal citizens nationwide. The expansion of Medicaid has brought more money not just the IHS system but to tribally-managed hospitals and clinics as well.

"Medicaid has had the single biggest impact at the local level," Angela Wilson, the executive director of the health clinic operated by the Washoe Tribe in Nevada and California, said during last month's summit.

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With Republicans in control of both chambers of Congress and Trump on their side, the campaign to repeal the ACA is bound to move quickly on Capitol Hill. But Democrats are vowing to fight.

"If there is an attempt to destroy the guarantee of harm Medicare, Social Security or the Affordable Care Act, Democrats will stand our ground," Rep. Nancy Pelosi (D-California), the top Democrat in the House said on Tuesday.

Beyond the repeal effort, Trump will be making his mark on Indian health in other ways. He has nominated Rep. Tom Price (R-Georgia), a critic of the ACA, to lead the Department of Health and Human Service. He also will be choosing a new director of the IHS, although an announcement hasn't been made.

In the coming months, Trump is expected to submit a budget for the IHS, which grew by more than 50 percent during the Obama era. The agency's funding level is currently being held flat by a continuing resolution that expires in April.