Presented by Caitrin Shuy, Director of Congressional Relations National Indian Health Board
Mission Statement: One Voice affirming and empowering American Indian and Alaska Native Peoples
to protect and improve health and reduce health disparities.
NationalIndianHealthBoard
Purpose: To advocate on behalf of all federally recognized American Indian and Alaska Native Tribes to ensure the
fulfillment of the trust responsibility to deliver health and public health services as assured through treaties, and
reaffirmed in legislation, executive orders and Supreme Court cases.
AffordableCareActRepeal/Replace• PresidentTrumpandRepublicansinCongresshavevowedtorepealandreplacetheAffordableCareAct–aka“Obamacare”
• RepublicanshavesaidthattheywillkeepIndianHealthcareImprovementActintact,aswellasotherprovisionsrelaDngdirectlytoIndianHealth• IHSasPayorofLastResort(SecDon2901)• PermanentauthoritytobillMedicaidPartB(Sec2902)• TaxExempDonforTribalhealthbenefits(SecDon9021)
• AmericanHealthCareAct(AHCA)(H.R.1628)introducedonFebruary7,2017,pulledfromfloorconsideraDononMarch24…but…
AmericanHealthCareActAHCALikelytobefutureunderlyingbill:• RestructuresObamacarewithasystemthatwouldbemostlybasedontaxincenDvestopurchaseinsurance• 30%penaltyassessedtosomeonebuyingnewinsuranceiftheyhavenothavecoveragefor63daysormorepreviously
• IHSaccessisconsideredcoverageforthispurpose• Decreaseandmodifypremiumtaxcreditsby2020• IncreasetheraDothatinsurancecompaniescanchargeolderenrolleesforpremiumscomparedtoyoungerenrollees.• EndsMedicaidexpansiona_er2020,movestopercapitaallocaDonforstatesandMedicaid• Establishesa$10billion(5years)fundforstatesthatdidn’texpandMedicaid
• EncouragestheuseofHealthSavingsAccounts
AmericanHealthCareActHere’sthegoodparts:• KeepsIHCIAandotherIndian-specificprovisionsintact
• EndstheEmployerMandateandIndividualMandatebyreducingpaymenttozero
• Keeps100%FMAPforTribesinMedicaid
TribalConcerns–AHCASomeofBADThings:• Endscostsharingsubsidies
• MajorConcernforAI/ANs–willhaveimpactonIndianhealthfunding
• EndofMedicaidExpansionwillmeanmajorlossesforTribalhealthprograms
• MedicaidPerCapitasystemtostateswillmeanlessservicesfromstates,andwillimpacttribes• StateswillbeencouragedtobeinnovaDveandcouldimpactservicesandeligibilitytoTribes
• EndsthePrevenDonandPublicHealthFund
• ProvidestaxincenDvesforhealthinsurance,ratherthansubsidies
• Farlessbenefitthancost-sharingsubsidiesandpremiumsubsidies
TribalConcerns–AHCANIHB/NCAIsentaleiertoSpeakerRyanaskingforTribalConcernstobeaddressonMarch22,2017
• PreserveMedicaidExpansionforallAmericansandespeciallyforindividualsreceivingMedicaidthroughanIndianHealthService(IHS)orTriballyoperatedhealthfacility
• ClarifythatAI/ANsshouldnotbesubjecttostate-imposedworkrequirementsundertheMedicaidprogram• ConDnuethecostsharingprotecDonsforAI/ANscontainedinsecDon1402(d)oftheAffordableCareAct
AmericanHealthCareActNewleakedAmendment–TomMacArthur(R-NJ):• ReinstateEssenDalHealthBenefitsasthefederalstandard• MaintainthefollowingprovisionsoftheAHCA:• ProhibiDonondenyingcoverageduetopreexisDngmedicalcondiDons• ProhibiDonondiscriminaDonbasedongender• Guaranteedissueofcoveragetoallapplicants• GuaranteedrenewabilityofcoverageoCoverageofdependentsonparents’planuptoage26• CommunityRaDngRules,exceptforlimitedwaivers
• OpDonforstatestoobtainLimitedWaiversfromcertainfederalstandards,intheinterestofloweringpremiumcostsandexpandingthenumberofinsuredpersons.StatescouldseekLimitedWaiversfor• EssenDalHealthBenefits• CommunityraDngrules,exceptforGender,Age,HealthStatus(unlessthestatehasestablishedahighriskpoolorisparDcipaDnginafederalhighriskpool)
• Statesmustaiestthepurposeofwaiveristoreducepremiumcosts,increasethenumberofpersonswithhealthcarecoverage,oradvanceanotherbenefittothepublicinterestinthestate,includingtheguaranteeofcoverageforpersonswithpre-exisDngmedicalcondiDons.
AmericanHealthCareAct–What’sNext?• FinalversionbeingworkedbyjustafewselectCongressmenatTuesdayGroup(Moderates)andFreedomCaucus(ConservaDves)andGOPLeadership
• Likelytoseefinalbillbyendofweek,FloorconsideraDonnextweek
• SenateconsideraDon--??
• VotesinSenatewillbeDght–pleasereachouttoyourSenators!!• ViewNIHB/NCAIleierat:hip://nihb.org/legislaDve/ihcia_and_aca.php
LegislativeOutlookforSDPI• SDPIExpiresonSeptember30,2017• TypicalLegislaDveVehiclenotavailable• PossibleonCHIP?
• S.747-SpecialDiabetesProgramforIndiansReauthorizaDonActof2017introducedonMarch28bySenatorTomUdall(D-NM)
• NIHBaskingforlong-termsupport;increaseinfunding.
• PopularwithLawmakers:• SDP/SDPISupportLeier–September2016• 356HouseMembers;75Senators
HowYouCanHelp!• HostaSiteVisit!• FactSheetsandSiteVisitToolkit:www.nihb.org/sdpi• Havethemspeakwithhealthdirectors,administrators,paDents,employees
• CollectSuccessStories–withdata!
• WritetoyourMemberofCongress• SharewhythefundingiscriDcaltoberenewedearly• Whydoyouneedanincrease?
• Postcardsforthcoming.
Thank you!