News Release

National Indian Health Board

The National Indian Health Board (NIHB), representing the health interests of all 574 federally recognized Tribes, applauds the United States Supreme Court for upholding the Affordable Care Act (ACA) in a 7-2 decision on California v. Texas that challenged the law as unconstitutional. The high court’s decision protects Medicaid Expansion and secures the Indian Health Care Improvement Act (IHCIA) which is the foundation of the modern Indian health care system. 

“The National Indian Health Board is pleased with the Supreme Court’s decision to protect the Affordable Care Act, which also secures the Indian Health Care Improvement Act, a primary legal foundation and the framework for the entire American Indian and Alaska Native health system,” said National Indian Health Board Chairman and Alaska Area Representative William Smith who is also Vice President of the Valdez Native Tribe of Alaska. “The Affordable Care Act and Indian Health Care Improvement Act offers American Indians and Alaska Natives new and viable options for health coverage, and that coverage brings peace of mind and added security of knowing that the poorly funded Indian Health Service (IHS) system is bolstered. If our people need specialty care, then they can get it. It is a giant step away from rationing health care and provides the opportunity for our people to get the care they need when they need it.”

In 2012, the Supreme Court (the Court) upheld the individual mandate and its associated penalty as an allowable “tax.” At that time, the Court determined that the law was Constitutional under a tax and spend analysis. In this most recent challenge, the California v. Texas lawsuit focused on whether the Affordable Care Act was Constitutional after the Tax Cuts and Jobs Act of 2017 had reduced the individual mandate penalty to zero. Because the Indian Health Care Improvement Act was passed as part of the Affordable Care Act, this recent challenge also threatened the Indian Health Care Improvement Act.

National Indian Health Board has consistently maintained that the Indian Health Care Improvement Act can operate separately, without the individual mandate in place, even filing an amicus brief to affirm the position. In the brief, National Indian Health Board outlined the Indian Health Care Improvement Act’s legislative history that shows it originated as a freestanding bill in 1976 and remained freestanding throughout the nearly 20 years that Tribes worked for its reauthorization and modernization – separate from the rest of the Affordable Care Act.

“The Indian Health Care Improvement Act’s permanent reauthorization almost did not happen. It was made possible because of the fierce, relentless advocacy of National Indian Health Board and key Tribal leaders, the dedication of then Senate Committee on Indian Affairs Chairman Byron Dorgan and his staff and House leaders like Speaker Nancy Pelosi, who decided to include Indian Health Care Improvement Act in the Affordable Care Act,” said Bohlen. “It was a victory 11 years ago when President Obama signed the Affordable Care Act into law and this decision renews that triumph. With this decision, the highest court secured access to health coverage for American Indian and Alaska Native people and all Americans.”

National Indian Health Board celebrates with many loyal Tribal health advocates across Indian Country who worked for a decade to permanently reauthorize Indian Health Care Improvement Act and expand Tribal health programs, including former Chairman of the Chairman of the Poarch Band of Creek Indians Buford Rolin and former Chairwoman of the Lone Paiute Shoshone Tribe Rachel Joseph who were the co-chairs of the National Steering Committee for the Reauthorization of the Indian Health Care Improvement Act and co-recipients of the 2007 National Indian Health Board’s prestigious Jake Whitecrow Award.

“When I heard the Supreme Court’s decision on the news, I was just elated, I wanted to cry. I thought about all the Americans who will continue to have health coverage, especially those with pre-existing conditions,” said Joseph, who was also the Co-Chair of the Indian Health Service National Budget Formulation Workgroup and Chair of the Indian Health Service Tribal Behavioral Health Committee. “It was a feeling of happiness and gratitude because we spent many long hours during the Bush years to get broader authorizations of the Indian Health Care Improvement Act and more opportunities for Tribes to expand care. We refused to go backwards, and we put a lot of heart and soul into that work.”

Originally enacted in 1976, the Indian Health Care Improvement Act was included in the Affordable Care Act and permanently reauthorized when President Obama signed the Affordable Care Act into law in 2010. Tribal advocates like Rachel Joseph, Buford Rolin and Reno Franklin advocated for specific Indian provisions in the Affordable Care Act and funding and expanding programs for long-term care and cancer screenings in the Indian Health Care Improvement Act.

“The Indian Health Care Improvement Act is the cornerstone of Indian health. You can stack it up and measure all the lives that have been saved as a result of the Tribal specific provisions in the Indian Health Care Improvement Act and Affordable Care Act,” said Reno Keoni Franklin, Chairman Emeritus of the Kashia Band of Pomo Indians and former National Indian Health Board Chairman during the 2010 Indian Health Care Improvement Act reauthorization. “The Supreme Court decision speaks to much larger picture of the nation fulfilling its promise to American Indian, Alaska Native and Native Hawaiian people to provide healthcare. Part of that promise means that Tribes never have to rely on just one method of healthcare as it always expands and grows and the healthcare that is offered to our people should be expanding as well, especially in areas of technology.”

Through its Affordable Care Act outreach and education efforts, National Indian Health Board learned of a Tribal member who was ineligible for Medicaid because he was over income. He decided to apply for Health Insurance Marketplace plan and learned he was eligible for a zero-cost sharing plan. After claiming the advance premium tax credit, the monthly premium for the Tribal member’s Marketplace plan was $1.00. The Tribal member pays only $1.00 a month for health coverage Marketplace plan, and he also qualified for a zero-cost sharing plan which means he does not pay for co-payments, deductibles or co-insurance when getting care from an Indian health care provider. These types of stories will continue under Affordable Care Act.

Medicaid is a critical resource for eligible American Indian and Alaska Natives who either have no insurance or are experiencing inadequate care through Indian Health Service’s rationed system. Through the Affordable Care Act, 38 states have expanded Medicaid, which has resulted in an increase in American Indian and Alaska Native participation in the program. Medicaid is an important third-party payor for the Indian health care facilities and Medicaid Expansion has been a key component of securing additional funding. Medicaid Expansion has contributed to roughly 300,000 AI/ANs obtaining health coverage.

“We are forever grateful for the Tribal health advocates who journeyed with National Indian Health Board all those years to get the Indian Health Care Improvement Act permanently authorized. We give our thanks to Rachel Joseph, Buford Rolin, former Chairwoman of the Alaska Native Health Board Sally Smith from the Yupik Tribe and former National Indian Health Board Chairperson and citizen of the Sault Ste. Marie Tribe, Cathy Abramson – all who were dedicated to fighting for the best quality health outcomes for our people. They paved the way for stronger Tribal health advocacy and expanded programs and services,” said Chairman Smith.

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About the National Indian Health Board

Founded in 1972, National Indian Health Board is a 501(c) 3 not for profit, charitable organization providing health care advocacy services, facilitating Tribal budget consultation and providing timely information, and other services to all Tribal governments. National Indian Health Board also conducts research, provides policy analysis, program assessment and development, national and regional meeting planning, training, technical assistance, program and project management. National Indian Health Board presents the Tribal perspective while monitoring, reporting on and responding to federal legislation and regulations. It also serves as conduit to open opportunities for the advancement of American Indian and Alaska Native health care with other national and international organizations, foundations corporations and others in its quest to build support for, and advance, Indian health care issues.

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