Reports of poorly equipped facilities, poorly delivered care and continued poor health among Indians alarmed congressional committees during the 114th Congress.

In field hearings and listening sessions, as well as in Congressional hearings in Washington, members of Congress struggled to understand what was going wrong and how they could fix the system. In spite of many hours of focused work, and a small handful of substantive bills, Congress hasn’t yet addressed the core issues.

The story isn’t finished – it will be taken up again in the 115th Congress. We can already see that the conversation about the Indian Health Service will play out against a background of debates about how to repeal and replace the Affordable Care Act. This context is important for two reasons:

  • The Affordable Care Act incorporated by reference the Indian Health Care Improvement Act (IHCIA), thereby permanently reauthorizing the Indian Health Service, and including a number of significant expansions and improvements in the system. If the Affordable Care Act is repealed, members of Congress must be alerted to preserve the IHCIA.
  • Health care services in Indian Country make good use of the expansions in Medicaid and Medicare to offer more services to more eligible people. Due to the low average income of the Native American population, many qualify for and rely on these broader services.

As debates about new designs for health care go forward in Congress, concepts such as efficiency, competition, and outcomes will be part of the discussion. Advocates for Indian health care should ask members of Congress to consider how these concepts will work in Indian country, where sparse populations may be spread over wide geographic areas, medical facilities may be undersourced and ill equipped, chronic diseases are more common, and rapid communications may be more challenging. Some of the tribally operated health care systems are able to incorporate practices, and will be able to adapt new financial models to the needs of their patients. But not everyone is in the same place.

Return to [December 2016 Native American Legislative Update] (https://www.fcnl.org/updates/native-american-legislative-update-518).

Ruth Flower

Ruth Flower

Annual Meeting 2018 Keynote Speaker, Consultant, Native American Policy

Ruth’s work with FCNL began in 1981, when she joined the staff to lobby on domestic issues. After a decade with the American Association of University Professors, she rejoined the staff in 2006 to lead FCNL’s domestic lobbying team.

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