Making America Sick Again: What a Repeal of the Affordable Care Act Could Mean

Republicans in Congress tend to forget about Native Americans, and it looks like they are about to do so again. When Republicans in Washington brag about repealing the Affordable Care Act (ACA), there is something they forget to mention: repealing the Affordable Care Act would repeal authorization for the Indian Health Care Improvement Act (IHCIA), which was included in Obamacare. Destroying the Affordable Care Act will indeed make America sick again, and it could make Native Americans sickest of all.

The Indian Health Service (IHS) provides health care for approximately 2.2 million Native Americans and Alaska Natives in 35 states, including inpatient, emergency, ambulatory and dental care. IHS programs also provide preventive care aimed at reducing unacceptably high rates of infant mortality, diabetes, hepatitis B, alcoholism, and suicide among American Indians and Alaska Natives.

The IHS funds construction and maintenance of hospitals and health centers as well as water supply and sanitation facilities. The IHS has documented decreased rates of certain diseases among American Indians and Alaska Natives thanks to even modest sanitation improvements. Unfortunately, more of these improvements are needed and funding for these projects is at risk. The Democratic staff of the House Natural Resources Committee documented the deplorable lack of access to clean water in Indian country in an October 2016 report titled “Water Delayed is Water Denied.”

The Indian Health Care Improvement Act was originally passed in 1976. Prior to passage of the Affordable Care Act, authorization for the law’s programs had been lapsed for a decade. The Affordable Care Act permanently reauthorized the law and made several significant improvements. Since reauthorization, health care facilities on tribal lands have been able to recoup the cost of providing care from third parties such as insurance companies, HMOs and employee health plans – an authority that was previously unavailable and brought in an estimated $1.2 billion in reimbursements in fiscal year 2017. This funding helps address IHS’ chronic funding gap and translates into patients receiving needed surgeries and preventive care, saving lives and taxpayer dollars.

While the vast majority of Native Americans and Alaska Natives in this country live in urban areas, before health care was reformed in 2010, the IHS only operated on Native land. The Affordable Care Act reestablished the agency’s authority to offer grants and share resources with urban entities, making it possible to reach many more patients than IHS could operating in Indian country alone.

The Affordable Care Act also created a framework for tribal health authorities to work with the Department of Defense and Department of Veterans’ Affairs to offer health services to Native veterans. It gives IHS a more prominent role in advocating for Indian country within the Department of Health and Human Services and improves cost collection procedures between IHS and federal health programs like Medicare and Medicaid. It allows tribal organizations and urban Indian organizations to apply for grant programs for which they were previously not eligible. It expands mental health services and requires IHS to establish new youth suicide prevention programs.

Perhaps most importantly, the Affordable Care Act made IHS programs eligible for reimbursement through Medicare Part B, meaning that services provided by physicians, in addition to services offered through a hospital, can now be covered.

Repealing the Affordable Care Act would erase each of these advances.

The Republican effort to repeal the Affordable Care Act is an attempt to turn the clock back for millions of Americans to a time when those with pre-existing conditions could not get insurance and when young people were pushed off their parents’ insurance before they could afford coverage of their own – a time when more than 40 million Americans were uninsured.

Access to quality health care in Indian country continues to lag far behind that available elsewhere. Repealing the Affordable Care Act would set most Americans back years, but it would set Native American communities back decades, if not return them to the health care dark ages. We cannot allow Congressional Republicans to forget that.

Rep. Raúl M. Grijalva (D-Ariz.) is the ranking member of the House Committee on Natural Resources.

By:  Ranking Member Raúl M. Grijalva (D-Ariz.)
Source: Indian Country Today