Letter to Senators in re: Sponsor and Support Senator Udall’s SA 341 in order to Save Indian Country from Medicaid Cuts

July 27, 2017

In re: Sponsor and Support Senator Udall’s SA 341 in order to Save Indian Country from Medicaid Cuts

Dear Senator:

On behalf of the National Council of Urban Indian Health (NCUIH), which represents 44 urban Indian health programs (UIHPs) across the nation, I urge you to support SA 341, an amendment sponsored by Senator Tom Udall (D- NM), which would save Indian Country from significant cuts in Medicaid.

UIHPs are part of the Indian Health Service (IHS) I/T/U system (Indian Health Service/Tribal facilities/ Urban Indian Health Programs), and are public-private partnerships that employ their own staffs. UIHPs receive slightly more than 1% of the Indian Health Service’s budget, but still manage to provide high-quality culturally-competent health care to urban Indians, i.e., those American Indian/Alaska Native people who live off of reservations, because of the federal government’s forced relocation policy or they seek greater economic or educational opportunities. AI/AN people who live on and off reservations experience health conditions and outcomes markedly worse than non-AI/AN people.

Both the House-passed American Health Care Act (AHCA) as well two versions of the Better Care Reconciliation Act (BCRA) would impose significant cuts in federal contributions towards Medicaid. Even if the Senate’s health care legislation does not reduce federal contributions towards Medicaid, such cuts would be considered in the House-Senate conference because they are included in AHCA.

AI/AN people are disproportionately reliant on Medicaid, the federal contributions towards which AHCA and BCRA would cut by more than $700 billion over ten years through the imposition of per capita caps or block-granting. Thanks largely to Medicaid, the national uninsured rate for AI/AN adults declined from 36 percent to 28 percent between 2008 and 2015, according to the Georgetown University Health Policy Institute. In 2015, 54 percent of AI/AN children were enrolled in Medicaid or CHIP as compared to 39 percent of all children, also according to the Institute.

Inevitably, states, in order to offset the reduced federal support, would reduce the benefits available under Medicaid, narrow eligibility for benefits, and reduce payments to providers. Access to service would be greatly diminished. Those AI/AN people deprived of Medicaid coverage would instead fall back on an underfunded IHS system which already rations health care.

House and Senate lawmakers seem to understand that cuts would be inconsistent with the federal government’s Trust Responsibility, as set forth in countless treaties, to provide health care to AI/AN people in exchange for vast swathes of land, because they attempted to exempt from Medicaid cuts IHS and Tribal facilities—but not UIHPs. If it is necessary to reduce spending on Medicaid, then all of Indian Country should be exempted from any such cuts included in health care reform legislation.

Senate Udall’s amendment would make the conference report vulnerable to a point of order in the unlikely event it included a provision which would “reduce or limit federal payments for spending under the Medicaid program with respect to services provided by” IHS, Tribal facilities, and UIHPs to AI/AN people. Senator Udall’s amendment must be included in the health care reform legislation passed by the Senate, whether or not it includes Medicaid cuts, in order to ensure that the conference report is consistent with the Trust Responsibility.

Thanks for your consideration. Please contact NCUIH’s Director of Governmental Affairs Francys Crevier, fcrevier@ncuih.org, if you have any questions.


Ashley Tuomi National