Arizona leaders fear cuts to tribal health care if Affordable Care Act is repealed

Eliza Collins
Republic Washington Bureau
Arizona U.S. Rep. Raul Grijalva says that if the Indian Healthcare Improvement Act is scrapped along with the Affordable Care Act, “we’ll go back to where we were but we’ll be struggling year to year trying to cobble together some Indian health services budget.”

WASHINGTON — Native Americans, Alaska Natives and a bipartisan group of their allies — including current and former Arizona lawmakers — are worried that repeal of the Affordable Care Act will also eliminate a non-controversial portion of that law that commits federal funding for tribal health care around the country, a move that the National Indian Health Board warns would be “catastrophic.”

The Indian Healthcare Improvement Act is a separate piece of legislation that has been around for decades. However, it expired in 2000 and wasn’t reauthorized until 2010, when it was lumped into the ACA bill. Now some worry that the association with the controversial bill could mean it gets eliminated in the Republican effort to get rid of the ACA.

Arizona Democratic Reps. Raul Grijalva and Tom O’Halleran are both writing letters to Republican leadership in an attempt to convince them to keep the law.

If the law is scrapped along with the ACA, “we’ll go back to where we were but we’ll be struggling year to year trying to cobble together some Indian health services budget,” Grijalva said.

“I don’t want Republican leadership down the road saying, ‘Oh, it was an unintended consequence, we’ll deal with it down the road in replacement,’ ” he added. Grijalva has three tribes in his district.

Grijalva, in his role as ranking member of the House Natural Resources Committee, will send a letter over the next couple of weeks. O’Halleran has a letter of his own he hopes to introduce soon with the Native American Caucus.

“It’ll have a devastating impact on Native American health care in America,” O’Halleran said. The congressman’s district includes 12 tribes.

Tribal health care at risk, some say

Tribal leaders say that the Indian Health Service — which provides care to 2.2 million people — is already underfunded. The IHCIA allows for the Indian Health Service to be reimbursed by Medicare, Medicaid and third-party insurers, which is crucial to providing supplemental funding to keep the system running. The law also provides scholarships to Native Americans and Alaska Natives to get medical degrees if they come back and work in their tribes.

“It would hurt, I mean, everyone, not just us but across the country. Every tribal health facility would suffer because of budget cuts,” said Jefferson Keel, who is the lieutenant governor of the Chickasaw Tribe in Oklahoma. Chickasaw Nation operates one of the largest tribal hospitals in the country, and Keel said the current relationship with the federal government is “working very well for us.”

“Indian policies that affect Indian people, they’re not partisan,” said Keel, who is also the former president of the National Congress of American Indians. “It’s a real issue and so I think Congress understands that. But you know, Congress right now is so unpredictable, we don’t know what they’re going to do.”

“I don’t think it’s our view that it’s the Indian Healthcare Improvement Act is a target of ACA repeal,” said Denise Desiderio, who is a policy director for the National Congress of American Indians. “Oftentimes it’s not that there’s intentional harm for our programs, it’s just that people aren’t thinking about us.”

Carlyle Begay, a former Arizona state senator who said he will be joining the Trump administration to work on Native American issues, said he believes protecting Indian health care is critical.

The White House did not immediately respond to request for confirmation about Begay’s role in the administration.

“I, for my part, will try to do my best as to simply educate as many members of the administration, as well as members of Congress and their staff, on the Indian Healthcare Improvement Act,” Begay said. “It’s really going to be a fast-moving process so we’ll try our best to keep our tabs on the discussion and debate in the coming weeks.”

“We’re hoping in this process, to get commitments from members of both sides to say, ‘Yes, this is a nonpartisan issue and let’s fight together to work on legislation and language that would keep the Indian Healthcare Improvement Act,’” he added.

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Fighting to keep funding

And it isn’t just officials reaching out. Tribes and groups such as the NCAI are dispatching representatives to Capitol Hill to lobby members of Congress to fight to keep what they believe is a crucial part of the law.

Oklahoma Republican Rep. Tom Cole represents Keen’s tribe along with 10 others in his district, and he has been very vocal about making sure the IHCIA is safe.

Cole is a member of the Chickasaw Tribe and said he is willing to vote against any repeal plan that doesn’t include a path forward for the IHCIA, whether it’s part of the replacement or a separate bill. He told USA TODAY he wasn’t the only one.

“We have more than enough votes to stop repeal,” he said.

Mike Andrews, staff director and chief counsel for Republicans on the Senate Indian Affairs Committee, said the ACA repeal could provide an opportunity to improve the health care provided to tribes.

“We’re confident working with leadership that whatever mechanism (is used for replacement) that the Indian Healthcare Improvement Act will be part of that discussion and part of that bill process,” Andrews said. “I just think it’s a great opportunity to improve the process, and to improve (the Indian Health Service).”