Open Letter to Speaker of the House Paul Ryan on ACA

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Letters to the Editor

Dear Mr. Speaker,
If successful, the Republican campaign to abolish the Affordable Care Act (ACA) would repeal authorization for the Indian Healthcare Improvement Act (IHCIA), which was included in the ACA, and repeal other provisions that increased access to care for American Indians and Alaska Natives. Destroying the ACA will make America sick again, including Native Americans who already are disproportionately burdened by disease. We write to urge Congressional Republicans to reconsider the harmful impacts of ACA repeal on the First Americans we represent.

The Indian Health Service (IHS) provides healthcare for approximately 2.2 million Native Americans and Alaska Natives in 36 states, including inpatient, emergency, ambulatory, and dental care. IHS programs also provide preventive care aimed at reducing unacceptably high rates of infant mortality, diabetes, hepatitis B, alcoholism, and suicide among American Indians and Alaska Natives.

The Indian Health Service also funds construction and maintenance of hospitals and health centers, as well as water supply and sanitation facilities. The IHS has documented decreased rates of certain diseases among American Indians and Alaska Natives thanks to improvements in sanitation facilities.

The Indian Healthcare Improvement Act (IHCIA) was originally passed in 1976 but prior to passage of the ACA, authorization for the law’s programs had been lapsed for nearly a decade. The ACA included a permanent authorization, as well as significant improvements to the IHCIA.

The ACA expanded access to preventive and treatment services within IHS, including within urban areas in which the vast majority of Native Americans and Alaska Natives live. Those efforts included expanding mental health services, including programs related to youth suicide, to create a comprehensive behavioral health and treatment program within IHS. The ACA also allowed Urban Indian Organizations and Tribal Organizations to apply for grants and contracts, including through the Substance Abuse and Services Administration, for which they previously were not eligible.

The ACA also created a framework for Tribal health authorities to work with the Department of Defense and Department of Veterans Affairs to offer health services to Native veterans. This gives IHS a more prominent role in advocating for Indian Country within the Department of Health and Human Services and improves cost collection procedures between IHS and federal health programs like Medicare and Medicaid.
Perhaps most important, the ACA made IHS programs eligible for reimbursement through Medicare Part B, meaning that not only could hospital services be covered, but also services provided by physicians.

Repealing the Affordable Care Act would erase these programs and services.
Repealing the ACA threatens to turn the clock back for those 20 million Americans who gained health insurance thanks to the law; a time when those with pre-existing conditions could not get insurance and when young people were pushed off their parent’s insurance before they could afford coverage of their own.

But for the First Americans, access to quality healthcare continues to lag far behind that available outside Indian Country. Repealing the ACA could set many American’s back years, but it could set the First Americans back decades, if not return them to the healthcare dark ages. This vulnerable population – already the victim of historic, shameful mistreatment by the United States government – deserves better. We should be taking further steps forward toward improving the health of American Indians and Alaska Natives, rather than taking a giant leap back by repealing the Affordable Care Act.
Raul M. Grijalva, Ranking Member, House Natural Resources Committee

Frank Pallone, Jr., Ranking Member, House Energy and Commerce Committee