WASHINGTON – Historic national health care legislation, which includes reauthorization of the Indian Health Care Improvement Act and other Indian country provisions, has passed Congress and received the president’s signature.
In the late hours of Sunday, March 21, the House of Representatives voted to approve a sweeping health bill the Senate had passed just before Christmas. President Barack Obama signed it into law March 23.
Yvette Roubideaux, the Rosebud Sioux director of the IHS, spoke before Indian leaders last fall. She has long been advocating for the reauthorization of the Indian Health Care Improvement Act.
The final vote was 219-212, with no Republicans voting in favor, and 34 Democrats voting against.
The bill is expected to provide health coverage to approximately 32 million Americans who currently do not have any. It aims to reform the health insurance system in a number of ways, including banning pre-existing condition exemptions, capping out-of-pocket expenses, increasing competition and providing increased government oversight.
Under the legislation, most Americans will be required to buy health insurance. Support for low-income citizens is part of the plan. Special provisions for Native Americans, given their unique political status, are also included.
Analysts said the legislation equates to the largest expansion of federal health care guarantees since Medicare and Medicaid were enacted in the 1960s.
The bill costs $940 billion, and the non-partisan Congressional Budget Office anticipates it will cut the federal deficit by more than $1 trillion over the next two decades.
Every Democratic president since Harry Truman has pushed for universal health coverage. The legislation is widely seen as a significant step toward that goal, and is a major victory for Obama. He and Congress spent more than a year hashing out details of the plan, and more than once faced collapses in moving forward.
“This is what change looks like,” Obama said in a speech given soon after Congress passed the bill. “It’s a victory for the American people, and it’s a victory for common sense.”
In terms of Indian health, the legislation permanently reauthorizes IHCIA, a law which provides an array of support to IHS and other programs that aid Native American health. It was first made law in 1976 and had not been reauthorized since 2001.
Obama said in a statement after signing the bill into law that he co-sponsored IHCIA in 2007 when he was in Congress because he “believes it is unacceptable that Native American communities still face gaping health care disparities.”
The president added that it is the government’s responsibility to provide health services to American Indians and Alaska Natives due to the nation-to-nation relationship between the federal and tribal governments. Along those lines, the overall health bill includes an exemption of American Indians and Alaska Natives from individual penalties and cost sharing associated with the law.
“This inclusion of the IHCIA reaffirms the government’s trust responsibility to provide health care to our people,” said Rachel Joseph, a citizen of the Lone Pine Paiute-Shoshone Tribe of California and co-chair of the National Steering Committee for the Reauthorization of the IHCIA.
Indian advocates have said throughout the lengthy time it took to pass the bill that permanent reauthorization of the IHCIA was crucial, so they don’t have to ask Congress every few years to approve policies that a majority already agree
Congress has failed many times over the years to reauthorize the law in a timely manner, so its permanent reauthorization is seen by many Indian advocates as a major victory.
“It was a long time coming, but we finally got it done,” said Tom Rodgers, a Blackfeet lobbyist who worked on getting several Indian health provisions included in the bill. “It’s a big win for Indian country.”
Chris Stearns, a Navajo lawyer and former congressional staffer, said several members of Congress deserve thanks for their support of Indian health inclusions, including House Speaker Nancy Pelosi, D-Calif., Sen. Byron Dorgan, D-N.D., and Reps. Nick Rahall, D-W.Va., and George Miller, D-Calif.
Yvette Roubideux, IHS director, said the reauthorization will help update the services the agency provides.
“We also know this is an important and historic event after all the hard work over the past decade by the tribes that we serve,” said the Rosebud Sioux citizen. “This reaffirms our responsibility to provide health care to the AI/ANs that we serve, and helps us greatly as we move forward in our efforts to change and improve the IHS.”
Joe Finkbonner, the Lummi executive director of the Northwest Portland Area Indian Health Board, said the law will help IHS bolster many of its programs, including provisions for new long-term care services, additional mental and behavioral health services, and mammography and other cancer screening.
Support is also included for additional programs for health care facility construction, including demonstration programs for modular component construction and mobile health stations.
Plus, there are new grant opportunities to prevent, control and eliminate other communicable and infectious diseases in addition to tuberculosis, including hepatitis and HIV.
Finkbonner noted, too, that Indian country is included in many of the other, non-IHCIA sections of the law, including provisions focused on excluding qualified Indian health benefits from being taxed as gross income.
According to the National Indian Health Board, the legislation’s influence on Indian country is multi-fold. Officials with the organization said it improves workforce development and recruitment of health professionals in Indian country; provides funds for facilities construction as well as maintenance and improvement funds to address priority facility needs; creates opportunities for access to and financing of necessary health care services for Indians; and assists with the modernization in the delivery of health services provided by IHS.
The White House said in the days leading up to passage of the legislation that it would “modernize the Indian health care system and improve health care for 1.9 million American Indians and Alaska Natives.”
Also passed by the House as part of the reform package was a list of compromises to the Senate bill; as of press time, the Senate was working through a process of voting on the reconciliation.