Presented by Caitrin Shuy, Director of Congressional Relations National Indian Health Board

Mission Statement: One Voice affirming and empowering American Indian and Alaska Native Peoples

to protect and improve health and reduce health disparities.

NationalIndianHealthBoard

Purpose: To advocate on behalf of all federally recognized American Indian and Alaska Native Tribes to ensure the

fulfillment of the trust responsibility to deliver health and public health services as assured through treaties, and

reaffirmed in legislation, executive orders and Supreme Court cases.

AffordableCareActRepeal/Replace•  PresidentTrumpandRepublicansinCongresshavevowedtorepealandreplacetheAffordableCareAct–aka“Obamacare”

•  RepublicanshavesaidthattheywillkeepIndianHealthcareImprovementActintact,aswellasotherprovisionsrelaDngdirectlytoIndianHealth•  IHSasPayorofLastResort(SecDon2901)•  PermanentauthoritytobillMedicaidPartB(Sec2902)•  TaxExempDonforTribalhealthbenefits(SecDon9021)

•  AmericanHealthCareAct(AHCA)(H.R.1628)introducedonFebruary7,2017,pulledfromfloorconsideraDononMarch24…but…

AmericanHealthCareActAHCALikelytobefutureunderlyingbill:•  RestructuresObamacarewithasystemthatwouldbemostlybasedontaxincenDvestopurchaseinsurance•  30%penaltyassessedtosomeonebuyingnewinsuranceiftheyhavenothavecoveragefor63daysormorepreviously

•  IHSaccessisconsideredcoverageforthispurpose•  Decreaseandmodifypremiumtaxcreditsby2020•  IncreasetheraDothatinsurancecompaniescanchargeolderenrolleesforpremiumscomparedtoyoungerenrollees.•  EndsMedicaidexpansiona_er2020,movestopercapitaallocaDonforstatesandMedicaid•  Establishesa$10billion(5years)fundforstatesthatdidn’texpandMedicaid

•  EncouragestheuseofHealthSavingsAccounts

AmericanHealthCareActHere’sthegoodparts:• KeepsIHCIAandotherIndian-specificprovisionsintact

•  EndstheEmployerMandateandIndividualMandatebyreducingpaymenttozero

• Keeps100%FMAPforTribesinMedicaid

TribalConcerns–AHCASomeofBADThings:•  Endscostsharingsubsidies

•  MajorConcernforAI/ANs–willhaveimpactonIndianhealthfunding

•  EndofMedicaidExpansionwillmeanmajorlossesforTribalhealthprograms

•  MedicaidPerCapitasystemtostateswillmeanlessservicesfromstates,andwillimpacttribes•  StateswillbeencouragedtobeinnovaDveandcouldimpactservicesandeligibilitytoTribes

•  EndsthePrevenDonandPublicHealthFund

•  ProvidestaxincenDvesforhealthinsurance,ratherthansubsidies

•  Farlessbenefitthancost-sharingsubsidiesandpremiumsubsidies

TribalConcerns–AHCANIHB/NCAIsentaleiertoSpeakerRyanaskingforTribalConcernstobeaddressonMarch22,2017

• PreserveMedicaidExpansionforallAmericansandespeciallyforindividualsreceivingMedicaidthroughanIndianHealthService(IHS)orTriballyoperatedhealthfacility

• ClarifythatAI/ANsshouldnotbesubjecttostate-imposedworkrequirementsundertheMedicaidprogram• ConDnuethecostsharingprotecDonsforAI/ANscontainedinsecDon1402(d)oftheAffordableCareAct

AmericanHealthCareActNewleakedAmendment–TomMacArthur(R-NJ):•  ReinstateEssenDalHealthBenefitsasthefederalstandard•  MaintainthefollowingprovisionsoftheAHCA:•  ProhibiDonondenyingcoverageduetopreexisDngmedicalcondiDons•  ProhibiDonondiscriminaDonbasedongender•  Guaranteedissueofcoveragetoallapplicants•  GuaranteedrenewabilityofcoverageoCoverageofdependentsonparents’planuptoage26•  CommunityRaDngRules,exceptforlimitedwaivers

•  OpDonforstatestoobtainLimitedWaiversfromcertainfederalstandards,intheinterestofloweringpremiumcostsandexpandingthenumberofinsuredpersons.StatescouldseekLimitedWaiversfor•  EssenDalHealthBenefits•  CommunityraDngrules,exceptforGender,Age,HealthStatus(unlessthestatehasestablishedahighriskpoolorisparDcipaDnginafederalhighriskpool)

•  Statesmustaiestthepurposeofwaiveristoreducepremiumcosts,increasethenumberofpersonswithhealthcarecoverage,oradvanceanotherbenefittothepublicinterestinthestate,includingtheguaranteeofcoverageforpersonswithpre-exisDngmedicalcondiDons.

AmericanHealthCareAct–What’sNext?• FinalversionbeingworkedbyjustafewselectCongressmenatTuesdayGroup(Moderates)andFreedomCaucus(ConservaDves)andGOPLeadership

• Likelytoseefinalbillbyendofweek,FloorconsideraDonnextweek

• SenateconsideraDon--??

• VotesinSenatewillbeDght–pleasereachouttoyourSenators!!• ViewNIHB/NCAIleierat:hip://nihb.org/legislaDve/ihcia_and_aca.php

LegislativeOutlookforSDPI•  SDPIExpiresonSeptember30,2017•  TypicalLegislaDveVehiclenotavailable•  PossibleonCHIP?

•  S.747-SpecialDiabetesProgramforIndiansReauthorizaDonActof2017introducedonMarch28bySenatorTomUdall(D-NM)

•  NIHBaskingforlong-termsupport;increaseinfunding.

•  PopularwithLawmakers:•  SDP/SDPISupportLeier–September2016•  356HouseMembers;75Senators

HowYouCanHelp!•  HostaSiteVisit!•  FactSheetsandSiteVisitToolkit:www.nihb.org/sdpi•  Havethemspeakwithhealthdirectors,administrators,paDents,employees

•  CollectSuccessStories–withdata!

• WritetoyourMemberofCongress•  SharewhythefundingiscriDcaltoberenewedearly•  Whydoyouneedanincrease?

•  Postcardsforthcoming.

Thank you!