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Indian health care law safe for now as GOP targets Obamacare

Wednesday, March 8, 2017

The Choctaw Nation opened the doors to the new Choctaw Nation Regional Medical Clinic in Durant, Oklahoma, on February 21, 2017. Photo: Deidre K. Elrod / Choctaw Nation

Indian Country is breathing a sigh of relief as Republicans move forward with efforts to repeal Affordable Care Act, popularly known as Obamacare.

After months of rumors and speculation, top GOP lawmakers unveiled the American Health Care Act on Monday. The bill consists of two separate packages that repeal Obamacare and replace it with new or modified programs.

But the repeal portion does not touch the Indian Health Care Improvement Act, which was made permanent by the Affordable Care Act. Other pro-tribal provisions are not affected either, according to the National Indian Health Board.

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

At the same time, the NIHB pointed out that Rep. Tom Cole (R-Oklahoma), a citizen of the Chickasaw Nation, introduced H.R.1639 on Monday. The bill includes the entire text of the IHCIA and is seen as a "safeguard" to protect Indian health as the repeal campaign moves forward.

Still, the American Health Care Act proposes critical changes that will impact tribes and their citizens. It stops the expansion of Medicaid in 2020 despite the popularity of the program in states across the nation.

The bill also transforms the Medicaid program itself. Funds will be delivered to states on a per capita basis, or based on the number of participants, which the NIHB said would result in lower funding levels.

"Due to the vital role the Medicaid program plays in fulfilling the federal trust responsibility, NIHB is extremely concerned about the changes the bill enacts to Medicaid Expansion," the organization said in its update.

Amid the uncertainty, Republicans are moving quickly on the American Health Care Act. The House Committee on Ways and Means and the House Energy and Commerce Committee are meeting on Wednesday morning to advance the two components of the bill, with the latter focusing on the Medicaid reforms.

FACT: The American Health Care Act repeals #Obamacare’s taxes, spending, and mandates. #ReadTheBill pic.twitter.com/Lcc6ENXZp1
— Paul Ryan (@SpeakerRyan) March 8, 2017

Throughout the debate, key Republicans -- including Cole and Rep. Markwayne Mullin (R-Oklahoma) -- have repeatedly promised tribes that Indian health won't be harmed by the Obamacare repeal. The two lawmakers are the only enrolled tribal citizens in Congress.

“It is vitally important to Indian Country," Mullin, who is from the Cherokee Nation, said of the IHCIA during the winter session of the National Congress of American Indians last month. "We are not wanting to see a lot of changes."

The inclusion of the IHCIA in Obamacare represented a huge milestone for Indian Country. Tribes were strongly pushing to reauthorize the law, which had expired in 2000, but ran into opposition from Republican lawmakers and the George W. Bush administration.

One tribal leader accused the Bush administration of a "last minute ambush" in 2006 as yet another version of IHCIA failed to pass under Republican rule. Another said the executive branch was failing to live up to its government-to-government responsibilities.

After a decade of setbacks, the situation changed with Democrats in control of Congress and with Barack Obama in the White House. The IHCIA was added to Obamacare and was made permanent in 2010, ensuring that tribes wouldn't face obstruction as they sought the health care promised by numerous treaties and federal laws.

But Democrats did not actually insert the text of the IHCIA into Obamacare. Instead, they included a reference to S.1790, which was the legislative vehicle for the bill at the time.

The procedural move is now providing an extra layer of protection for the landmark law. As the NIHB pointed out, the American Health Care Act does not specifically repeal the section of the Affordable Care Act that references the IHCIA, meaning it should stay intact for now.