Native Americans would be among those hardest hit by this disastrous Senate TrumpCare bill. As vice chair of the Senate Indian Affairs Committee, I’ve heard from many Tribes who are deeply concerned about the lack of Tribal consultation in TrumpCare – and about how devastating this bill would be for access to life-saving health care services in Indian Country.
The Affordable Care Act has helped to fulfill our federal government’s trust responsibility by providing much needed resources to fill the funding gap facing Tribal health facilities. Many Native Americans get care through the Indian Health Service, but IHS has not always been able to provide needed services due to a persistent lack of funding. As a result, IHS facilities are heavily dependent on third-party collections – through programs like Medicaid – for clinical services. Fortunately, the Medicaid expansion in the Affordable Care Act has greatly increased revenue for IHS facilities, directly leading to increased access to care in Indian Country. The Medicaid expansion has enabled IHS facilities to provide key health services to Native Americans above the ‘life and limb only’ level.
TrumpCare destroys all the progress Tribes have seen under the Affordable Care Act – ending the Medicaid expansion, reducing support for private insurance, and thus greatly reducing Native Americans’ access to health care.
But TrumpCare destroys all the progress Tribes have seen under the Affordable Care Act – ending the Medicaid expansion, reducing support for private insurance, and thus greatly reducing Native Americans’ access to health care. This bill would be catastrophic for Indian Country, and I’m going to keep fighting in the Senate to defeat it.
At a recent hearing of the Senate Indian Affairs Committee, I questioned Acting IHS Director Chris Buchanan about how a rollback of the Medicaid expansion would hurt IHS’ delivery of health care in Indian Country. Buchanan testified that IHS Medicaid reimbursements have increased 21 percent between 2012 and 2016 and that all IHS service regions are now able to pay for medical services above the “life and limb only” level. Responding to my question, Buchanan confirmed these increases were linked to billing increases brought by the ACA’s Medicaid expansion. Buchanan confirmed that a rollback of the Medicaid expansion would severely hamper IHS’ health care delivery advancements.
With the expansion of Medicaid, third-party billing for Medicaid services provided at IHS facilities brought in more than $800 million in revenue by Fiscal Year 2016. These Medicaid funds have allowed the majority of IHS Service Areas to move from “life and limb only” care to offering preventative and primary care services. Currently, Medicaid reimbursements represent 67 percent of third-party revenues at IHS, and provide 13 percent of IHS’ total operating budget.
By Tom Udall
Tom Udall is a Senior Senator in New México and vice chair of the Senate Committee on Indian Affairs.