The Indian Health Care Improvement Act provisions (IHCIA) was reauthorized as part of the Patient Protection and Affordable Health Care Act, and is considered one of the Obama Administration's top priorities. The reauthorization makes permanent the IHCIA, originally passed in 1976, and improves upon the Indian Health Service (IHS) to "assure the highest possible health status for Indians and urban Indians." The IHS provides medical services specifically to American Indian and Alaskan Native communities and provides care tailored for the health challenges facing those communities such as maternal and child health, diabetes, hepatitis B, and alcohol substance abuse. The IHS serves approximately 1.9 million American Indians and Alaskan Natives.
The reauthorized IHCIA includes:
- Enhancement of the authorities of the IHS Director, including the responsibility to facilitate advocacy and promote consultation on Indian health within the Department of Health and Human Services.
- Authorizing hospice, assisted living, and home and community care.
- Extending the ability to recover costs from third parties to tribal facilities.
- Updating reimbursement law on Medicare, Medicaid, and Children's Health Insurance Program by Indian health facilities.
- Allowing tribes and tribal organizations to purchase health benefits coverage for IHS beneficiaries and to carry out a program to purchase coverage for its employees under the Federal Employees Health Benefits program.
- Authorizing IHS to enter arrangements with the Department of Veterans Affairs and Defense to share facilities and service.
- Authorizing the establishment of a Community Health Representative program for urban Indians to train and employ them in health services.
- Directing the IHS to establish comprehensive behavioral health, prevention, and treatment programs for Indians.
The IHCIA represents 11 years worth of legislative work, and is critical to the continued health of Native communities. This Congress, as the Republicans battle to repeal the Patient Protection and Affordable Health Care Act and health care reform generally, the IHCIA could be in danger. A repeal of the law would delay much needed health programs, such as behavioral health initiatives, and general improvements to the Indian health care system, such as maintenance of modern health facilities and personnel. Many Native communities have already begun to take advantage of the IHCIA reauthorization provisions and, if repealed this would jeopardize the benefits Native communities are already receiving in the short term as well as eliminate the long term benefits of increased funding and more affordable and accessible healthcare to the first Americans on a nationwide basis.