WINDOW ROCK, Ariz. — Navajo Nation President Russell Begaye says passage of the American Health Care Act (AHCA), which passed the House of Representatives May 4, could result in diminished health care services to tribal communities.
The bill aims to repeal many portions of the Patient Protection and Affordable Care Act (ACA), while also reforming the nation’s health care insurance system.
The bill narrowly passed the House with a vote of 217-213 and it will now move to the Senate, where both parties will debate the measure through the legislative process.
Begaye said the bill is a concern for tribal nations because it affects the Medicaid program by eliminating cost-sharing protections. Medicaid represents 67 percent of third party revenue at the Indian Health Services (IHS) and 13 percent of overall IHS spending.
“The Navajo Nation is pleased to see that H.R.1628 preserves the Indian Health Care Improvement Act (IHCIA) and other tribal specific portions of the ACA that have major impacts on tribal health programs,” Begaye said. “However, the proposed changes to the Medicaid program will result in [fewer] services to be provided within tribal communities, while adding increased pressure to the IHS systems already in place.”
Begaye said Medicaid expansion has been beneficial in decreasing the number of uninsured tribal members and loss of this option will negatively impact tribal nations beyond IHS and tribal providers.
“Since Medicaid expansion was put in place, Medicaid revenues at IHS and tribal facilities have increased by approximately 20 percent,” said Vice President Jonathan Nez. “For the first time, IHS patients have been able to receive care beyond just life or limb services.”
Amendments to AHCA implement work requirements on Medicaid recipients, which could serve to incentivize patients to not get off Medicaid because they already have access to free care through IHS.
“We recommend adding language to the AHCA that would specifically exempt American Indians and Alaskan Natives from work requirements under Medicaid,” Begaye said.
Tribes have increasingly secured coverage through the Marketplaces in order to access additional federal resources for health care services. By doing this, a portion of the congressional appropriation made to tribes is used to purchase comprehensive health insurance coverage. This is referred to as Tribal Sponsorship, accessing the premium tax credits and Indian-specific cost-sharing protections.
“Ending the cost-sharing protections would destabilize the IHS system by decreasing available 3rd party revenue and limiting services for patients,” Nez said. “Congress should continue the cost-sharing protections for tribal nations by amending Section 131 of the AHCA to continue the cost-sharing protections for American Indians and Alaskan Natives contained in Section 1402(d).”
The bill, if enacted into law, would have a significant impact on the IHS, tribal health care, and urban Indian health care (I/T/U) delivery systems, the administration said.
In an amendment made by Congressman Tom MacArthur (R-NJ) to the bill, states could receive waivers exempting insurance companies in the state from federal requirements protecting people with preexisting conditions, which could impact American Indians and Alaska Natives with private insurance and prevent them from receiving care that is not otherwise provided at I/T/U facilities.
An amendment made by Congressman Fred Upton (R-MI) provides $8 billion to help lower premiums for high-risk insurance plans. While this allocation is designed to help Americans with preexisting conditions with their higher premiums, it is unclear if $8 billion over five years is sufficient to meet the actual need.
Because the amended legislation has not yet been analyzed by the Congressional Budget Office (CBO), it is unclear how much this bill would cost and how it would affect insurance rates. The original legislation would have reduced the deficit by $337 billion and increased the number of uninsured Americans by 24 million.
“In light of the passing of this bill through the House, it’s critical that tribal leaders work with advocates in the Senate to ensure tribal concerns with the AHCA are addressed,” Begaye said. “We strongly encourage tribal nations to express their concerns with their Senators about the legislation.”