Health Care Reform (American Health Care Act, Better Care Reconciliation Act)


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The Indian Health Care Improvement Act (IHCIA) is the landmark law that is designed to ensure the federal government fulfills its trust responsibility for Indian health care.

  1. IHCIA was enacted in 1976 and permanently reauthorized in 2010.
  2. IHCIA declares that federal policy is to “ensure the highest possible health status for Indians and urban Indians and provide all resources necessary…”
  3. IHCIA explicitly requires the provision of health care to urban Indians.
  4. IHCIA requires the Indian Health Service to provide modern, culturally competent health care.
  5. IHCIA authorizes IHS to be reimbursed by Medicare, Medicaid, and third-party insurers; and to collaborate with the Department of Veterans Affairs (DVA) on provision of care to veterans.
  6. IHCIA’s permanent authorization was included in the Affordable Care Act (ACA), aka “Obamacare”, and IHCIA could be repealed if ACA is repealed.
  7. IHCIA is substantively distinct from ACA, preceding ACA by 35 years, and its permanent authorization was included in ACA only for procedural reasons.
  8. IHCIA must continue to be permanently authorized, notwithstanding efforts to repeal ACA.
  9. In addition to IHCIA, Indian-specific provisions in ACA must also be retained, particularly Section 2901 which ensures that IHS is the payer of last resort and Section 2902 which authorizes IHS to collect reimbursements for all Medicare Part B services.
  10. The chronically underfunded IHS is able to stretch its limited resources by being able to charge other programs for its services.

AHCA/BCRA Fact Sheet