When President Barack Obama signed the Patient Protection and Affordable Care Act last week, he also made permanent The Indian Health Care Improvement Act, the cornerstone legal authority for the provision of healthcare to Native Americans.
The authorization of appropriations for the IHCIA had expired in 2000, and while Congress considered various versions of the bill since then, the act now has no expiration date.
"The Indian Healthcare Improvement Act ... is critical to modernizing and improving the healthcare we provide to American Indians and Alaska Natives," said Health and Human Services Secretary Kathleen Sebelius. "This administration is intent on honoring the obligations of our government-to-government relationship with American Indian tribes, including the promise of adequate healthcare."
The Indiana Health Service, which is funded via the IHCIA, provides a comprehensive health service delivery system for approximately 1.9 million of the nation's estimated 3.3 million American Indians and Alaska Natives.
The version of the IHCIA signed into law last week differs in several respects from the original version passed by Congress in 1976. It includes many major changes, such as:
- Enhancement of the authorities of the IHS director, including the responsibility to facilitate advocacy and promote consultation on matters relating to Indian health within the Department of Health and Human Services.
- Provides authorization for hospice, assisted living, long-term and home- and community-based care.
- Extends the ability to recover costs from third parties to tribally operated facilities.
- Updates current law regarding collection of reimbursements from Medicare, Medicaid and CHIP (Children's Health Insurance Program) by Indian health facilities.
- Allows tribes and tribal organizations to purchase health benefits coverage for IHS beneficiaries.
- Authorizes IHS to enter into arrangements with the Departments of Veterans Affairs and Defense to share medical facilities and services.
- Allows a tribe or tribal organization carrying out a program under the Indian Self-Determination and Education Assistance Act and an urban Indian organization carrying out a program under Title V of IHCIA to purchase coverage for its employees from the Federal Employees Health Benefits Program.
- Authorizes the establishment of a Community Health Representative program for urban Indian organizations to train and employ Indians to provide healthcare services.
- Directs the IHS to establish comprehensive behavioral health, prevention and treatment programs for Indians.
Obama noted that he co-sponsored the act as a senator in 2007.
"Since 2000, tribes and tribal organization have been strongly advocating for the updating and reenacting of the IHCIA," said Yvette Roubideaux, director of the Indian Health Service. She called the permanent authorization a "key component of the federal government's trust responsibility."