March 19, 2015 |  Issue 15-09





AI/AN Public Witness Day - House Interior Appropriations 

March 24-25, 2015

Washington, DC 


NIHB Tribal Public Health Summit 

April 7-9, 2015

Palm Springs, CA


Tribal Self-Governance Consultation Conference

April 26-30, 2015

Reno, NV


NIHB Annual Consumer Conference

September 21-24, 2015

Washington, DC

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In This Issue 

NIHB Updates

The National Indian Health Board's Tribal Public Health Summit will take place at the Agua Caliente Casino, Resort and Spa in Rancho Mirage, California  from April 7-9, 2015.  The Summit has continued to grow each year, and now in its 6th year, this promises to be the largest Summit to date.  


REGISTRATION IS LIVE. You can click here for more information or call our offices at (202) 507-4070. 


Click here to view the draft agenda. 

Information technology has made revolutionary changes to the way people do business and live their lives. It comes as no surprise that information technology also is galvanizing tremendous change in the field of health care. We are seeing this sea change in the area of electronic health records, with many providers adopting electronic health record (EHR) systems and striving to achieve meaningful use of the technology. While EHRs hold tremendous potential to give doctors an integrated view of a patient's medical history (including tests, treatments, and medications), this shift also has brought many challenges. 

EHR systems can be very expensive, may require special training and workflow adjustments, and often times fail to provide seamless communication when a patient goes to an outside health system using a different EHR. To help smooth some of these transitions the federal government has provided incentives for adoption of EHRs and the meaningful use of the same. In addition to this scheme of incentives, health systems also are beginning to experience penalties for the failure to adopt the new technology. 

This conference will explore health information technology as it impacts the Indian Health System, from potential opportunities, to challenges in the field, to solutions and a vision of the future of health IT. 

To view an agenda for this event click here
Capitol Hill Updates

Senate Appropriations Committee Hears Testimony on IHS Budget 

On Wednesday, March 11, 2015, the Senate Interior Appropriations Subcommittee heard from Administration Officials on the Indian Health Service (IHS) FY 2016 Budget.  Testifying for the Administration were, Dr. Yvette Roubideaux, Senior Advisor to the Secretary for American Indians and Alaska Natives and Robert G. McSwain Acting Director of the IHS.   


Dr. Yvette Roubideaux Testifies before the Senate Appropriations Committee on the FY 2016 Budget Request for IHS on March 11, 2015

Dr. Roubideaux's testimony noted, "Since FY 2008, Indian Health Service Appropriations have increased 39%. ... The FY 2016 President's budget proposes to continue that progress by increasing the IHS budget by $460 million...This budget continues the Administration's Commitment to Improving health care for American Indians and Alaska Natives."


The Senators in attendance largely expressed strong support for Indian Health Care.  For example, when addressing potential sequestration cuts in FY 2016, Subcommittee Chairwoman Lisa Murkowski (R-AK) said, "I am committed to working with the Budget Committee to provide sequester relief for the IHS in the same fashion as the relief that is provided to the VA.  I believe that all federal health care providers should be placed on equal footing, particularly when the VA and IHS work cooperatively to provide services to both Veterans and Native Americans... " 


The top Democrat on the panel, Tom Udall (D-NM) discussed the low funding levels at IHS by saying, "These funding limitations are a major factor in health disparities faced by our Native population.  Including higher rates of diabetes, suicide and preventable illnesses.  We need to close this gap and we need to close it now." 

You can read the written testimony and watch a webcast of the hearing here


NIHB will continue to provide outreach and education to the Appropriations Committees in the coming months on the Indian Health priorities.  NIHB Chairman Lester Secatero will be providing testimony to the House Appropriations Interior Appropriations Subcommittee on Wednesday, March 25, 2015.  You can learn more about the status of FY 2016 Appropriations here

Administration Updates

HRSA Addresses Health Workforce Needs of Tribal Communities

On March 10, 2015, the Health Resources and Services Administration (HRSA) sent out a "Dear Tribal Leader Letter," committing to assist Tribes in addressing the health workforce needs of Tribal communities.  The letter summarizes HRSA's Health Professional Shortage Areas (HPSA) scoring process and advises Tribes on how to recruit more providers.  All Federal Indian Health Service Clinics, Tribal Health Clinics, Urban Indian Health Clinics, and dually funded Tribal Health Clinics/Community Health Centers, are automatically designated as a HPSA but are required to submit certain data to receive an initial score.


Information necessary for calculating or recalculating a HPSA score includes the population to provider ratio, the travel time or distance to the nearest source of available care, as well as the infant mortality rate or low birth weight and poverty rate for the population served.  HPSA scores range from 0-25 for primary care and mental health and 0-26 for dental.  A higher score indicates greater need.  National Health Service Corps (NHSC) resources for providers are given to those sites with the highest need.  A higher HPSA score can substantially assist with the recruitment of providers to Tribal sites.


HRSA also suggests using the NHSC Job Center Website  to reach thousands of providers that are looking for placement.  Over 14,000 users visit their site every month.  Job announcements expire every 90 days but can be renewed until the positions are filled.


Employer Mandate - Update on Northern Arapaho Case

On February 26th, 2015, the U.S. District Court in Wyoming denied the Northern Arapaho Tribe's motion for a preliminary injunction to exempt the Tribe from the Affordable Care Act (ACA) employer mandate.  The Court Order denying the injunction came as a result of a December 8, 2014 complaint from the Tribe seeking  declaratory and injunctive relief from the employer mandate.   The Court found that the employer mandate penalty is considered a tax, and cannot be challenged because of the Tax Anti-Injunction Act, which says you must pay the tax first before you can sue for a refund. 


In addition, the Court said that Northern Arapaho had waived its ability to seek relief from the mandate because it failed to first submit comments regarding its concerns during the Treasury's notice-and-comment period which is required by the Administrative Procedure Act.  The Court also found persuasive that no other comments were received during the rulemaking period that raised Tribal concerns to the employer mandate.  The Tribe attempted to argue that an injunction should be granted because there was a "substantial likelihood" its case would succeed on the merits that the regulations conflict with the ACA.  However, the Court determined that since Indians are specifically exempted from the individual mandate and not from the employer mandate, Congress intentionally meant for Indians to be included in the mandate.  In order for Indians to be exempted, Congress would need to explicitly state it.


Although this decision does not bode well for a judicial solution to this issue, it does not foreclose a legislative or administrative fix.  The National Indian Health Board is continuing to provide outreach and education on the issue with both the Congress and the Administration, highlighting the inconsistency of the employer mandate to the intent and purpose of the Affordable Care Act (ACA) as it applies to Tribes.  With the employer mandate undermining the special protections and benefits afforded to American Indian and Alaska Natives under the ACA,  Tribes and advocates will continue to press for a Tribal exemption to the Employer mandate.  



U.S. Supreme Court Hears Arguments on ACA Subsidies

On March 2, 2015, HHS Secretary Sylvia Burwell stated that 87% of the 11.7 million people who signed up for health insurance under the Affordable Care Act received subsidies.  She noted that this shows "just how important tax credits are to millions of Americans and to the insurance markets in those states."  


Meanwhile, the U.S. Supreme Court heard arguments on March 4th in the King v. Burwell case which challenge the statute that allows federally facilitated Marketplaces (FFM) in 34 states to offer federal tax credits to individuals which subsidizes insurance costs.  The Court is deciding Congressional intent when Congress wrote the phrase, "an exchange established by a state..."  


The challengers to the health care law (P.L. 111-148, P. L. 111-152) contend this language does not apply to the 34 states that established FFMs but only to those states which set up their own Marketplaces.  If the Supreme Court agrees with this interpretation then the FFMs in the 34 states would no longer be allowed to offer tax subsidies to those enrolled in health plans received under the Affordable Care Act.  The Solicitor General, arguing for the government stated, "That cannot be the statute that Congress intended."  The Supreme Court's decision is expected sometime this summer. 

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