Federal Update on Funding for the Indian Health Service and Reauthorization of the Indian Health Care Improvement Act

Below is an update on recent federal activities relating to funding for the Indian Health Service as well as reauthorization of the Indian Health Care Improvement Act (IHCIA). This update follows up on the meetings several CSWE members participated in with Federal officials at the Indian Health Service and staff on Congressional Committees last spring.

FY 2010 Funding for the Indian Health Service
In late June, both the House of Representatives and the Senate took action on their respective Fiscal Year (FY) 2010 appropriations bills that provide annual funding for the Indian Health Service (IHS) within the Department of Health and Human Services. On June 26, the House passed the FY 2010 Interior and Environment Appropriations bill. If enacted, this bill would provide a total budget of $4.052 billion for IHS for FY 2010, which is about $471 million or 13 percent above the FY 2009 (or current year) funding. This is also $18 million more than the amount requested by President Obama. Within this amount, the House bill would provide $3.642 billion for Indian health services (a $451 million increase) and $410 million for Indian health facilities (an increase of about $20 million). The House bill also includes $40.7 million for Indian health professions programs, an increase of $3.2 million over the FY 2009 funding level. This funding would be used for loan repayment and scholarship programs to attract and retain health professionals into the Indian Health Service.

Similarly, on June 25, the Senate Interior and Environment Appropriations Subcommittee passed its version of the IHS spending bill (the full Senate has yet to vote on the bill). The Senate bill would provide $4.034 billion for IHS, which is $453 million or 12.5 percent more than the FY 2009 level, equal to the President’s request, but about $18 million less than the House level mentioned above. This includes $3.639 billion for Indian health services (a $449 million increase) and $394 million for facilities (an increase of about $4.5 million). The Senate bill would provide $40.3 million for health professions programs, which is consistent with the President’s request but slightly less than the House number.

What’s Next – Once the Senate votes on its version of the IHS spending bill, the House and Senate committees will form a conference committee to sort out the differences between the bills and settle on a final appropriation for FY 2010, which begins on October 1, 2009. If the Congress does not finish its work on this or any other of its funding bills by October 1, they will enact a continuing resolution (CR), which is a temporary funding mechanism used to continue funding into the new fiscal year, usually at existing levels, until final passage can be achieved. CSWE government relations staff will continue to follow the progress of FY 2010 IHS funding and report on new developments. In the meantime, you are encouraged to reach out to your elected officials in the House and Senate to urge their support for the highest possible funding for IHS in FY 2010. You should express the importance of funding IHS at the level proposed by the House - $4.052 billion.

*Totals may not add due to rounding.

IHCIA Reauthorization
On June 11, 2009 the Senate Indian Affairs Committee held an oversight hearing on reforming the Indian health care system. Additionally, on June 25 the House Natural Resources Committee held a hearing to discuss the Indian Health Care Improvement Act (IHCIA) Amendments of 2009 (H.R. 2708). The focus of both of these hearings was on the reauthorization of IHCIA.

The Senate Committee on Indian Affairs hearing was chaired by Senator Jon Tester (D-MT) and witnesses included the Honorable Jefferson Keel, Vice-President, National Congress of American Indians; the Honorable Buford Rolin, Vice Chairman and Nashville Area Representative, National Indian Health Board; Mr. Geoffrey Roth, Executive Director, National Council on Urban Indian Health; Ms. Valerie Davidson, Senior Director, Legal and Inter-Governmental Affairs, Alaska Native Tribal Health Consortium; and Dr. Paul K. Carlton Jr. M.D., Director of Homeland Security, Health Science Center, Texas A&M University.

In his opening remarks, Senator Tester stated that the Indian health system is broken and that the Indian Health Service is funded at only about half of the actual need, though problems go beyond lack of funding. The witnesses stressed that “the system was not broken but starved” and is forced to provide health services to the Native American population with insufficient funds to do so. While Indian Country is working to be included in current ongoing comprehensive health care reform, they also are pursuing the passage of a stand-alone reauthorization bill this year. Witnesses also discussed making the law permanent so that it would not need to be reauthorized in the future. Witness testimony can be viewed here: http://indian.senate.gov/public/index.cfm?FuseAction=Hearings.Hearing&Hearing_ID=15b0ccf4-2e52-46f6-865a-46315213cd6c.

The House Natural Resources Committee hearing focused on the Indian Health Care Improvement Act Amendments of 2009 (H.R. 2708), which is cosponsored by Committee Chairman Nick J. Rahall (D-WV) and Representative Frank Pallone (D-NJ). The witnesses included Dr. Yvette Roubideaux, Director, Indian Health Service; Ms. Rachel Joseph, Co-Chair, National Steering Committee for the Reauthorization of the IHCIA; the Honorable Andy Joseph, Jr., Chairman, Northwest Portland Area Indian Health Board; and Ms. Valerie Davidson, Senior Director, Legal and Inter-Governmental Affairs, Alaska Native Tribe Health Consortium.

Chairman Rahall stated that Congress will make this issue a priority. H.R. 2708 would reauthorize the Indian Health Care Improvement Act until 2025, provide resources to attract and retain health care professionals, provide cancer screening consistent with national standards, create a new behavioral health initiative, and elevate the current position of IHS Director to that of Assistant Secretary, consistent with other HHS agencies. Chairman Rahall was optimistic about passage of this bill given its alignment with the priorities of the Obama Administration and requested that Dr. Roubideaux submit comments on the bill. The witnesses testified in support of the legislation and, as was suggested before the Senate Indian Affairs Committee, discussed making the law permanent.

Among the concerns expressed at the hearing were mismanagement of funds and assets within IHS and the need for increasing efforts for early detection and prevention strategies for suicide. Witness testimony can be viewed here: http://resourcescommittee.house.gov/index.php?option=com_jcalpro&Itemid=27&extmode=view&extid=267.

What’s Next – It doesn’t appear that IHCIA reauthorization made it into the current House or Senate health care reform proposals. It is likely that this bill will be considered as a separate measure after health care reform has wrapped up. For more information about the bill, including a comparison of how H.R. 2708 relates to existing law, check out the National Indian Health Board website: http://www.nihb.org/legislative/ihcia.php. At the appropriate time, CSWE will weigh in with the House and Senate Committees about IHCIA reauthorization and will seek your input.

HHS Secretary Announces Plan for IHS Improvements
Last month, Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS), announced the Federal government’s plan to launch a “multiyear effort to improve health care for American Indians.” Little detail is available about what this effort will entail, except that the strategy will include recruitment of more health providers for reservations, a focus on preventative care, and increasing the size of the U.S. Public Health Service Commissioned Corps., which dispatches doctors to reservations.

What’s Next – CSWE will continue to monitor HHS’s plans for IHS improvements and report on any major new developments.  If you have any questions about this or any other CSWE Public Policy activity, please do not hesitate to contact Wendy Naus at wendy@lewis-burke.com.