Federal Appeals Court that Affirmed ICWA Rules ACA Mandate Unconstitutional; Lower Court Will Reconsider the Entire Law’s Validity

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Today, the U.S. Court of Appeals for the Fifth Circuit ruled that the Patient Protect and Affordable Care Act (Affordable Care Act / Obamacare) individual mandate is unconstitutional. The appeals court narrowed a broader ruling from a Texas federal district court that found the entire Affordable Care Act was unconstitutional.  The appeals court did not invalidate the entire law, but instead sent it down to a lower court to reconsider whether any of the law can survive.

Whenever part of a statute is ruled unconstitutional, a court must then determine how much of the statute to invalidate. This is known as the severability doctrine. The U.S. Supreme Court test for severability is whether other provisions can exist with independent legal effect. Courts typically avoid striking entire laws if they can stand without the provisions that are found invalid. Many legal scholars have pointed to Congress’s decision to zero out just the mandate penalty in 2017 as proof that lawmakers meant for the rest of the ACA to stand.

This challenge to Obamacare was brought by more than a dozen Republican-led states that argued the law is no longer constitutional after Congress removed the penalty for not purchasing insurance in the 2017. The majority of the appeals court panel was made up of Republican-appointed judges, although they said the entire law did not need to fall. The other judge on the panel (Democratic-appointed) disagreed with the majority’s decision in a lengthy dissent.

In August, this same appeals court published its decision in Brackeen v. Bernhard, which was a challenge to the Indian Child Welfare Act (ICWA).  The appeals court affirmed that ICWA is constitutional recognizing the unique political status of tribes and American Indians and Alaska Natives. This was a big win for Indian Country.

The future of the law remains uncertain. It is highly likely to be challenged to the Supreme Court. This development could renew pressure on Obamacare opponents to explain how they plan to preserve the law’s insurance protections, after failing to agree on a replacement for years. If the entire Affordable Care Act is found invalid, it will jeopardize health care coverage for the roughly 20 million Americans covered through the law and its preexisting conditions protections.

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NCUIH End of Year Giving Campaign

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The 2019 NCUIH End of Year Giving Campaign will support critical but unmet policy needs and marginalized issues: Missing and Murdered Indigenous Women, Elder Health, Youth Suicide Prevention and Environmental Health!

“At NCUIH we are extremely inspired by the progress we have made in 2019 and look forward to even more exciting work in 2020. As we prepare for the New Year, we’re thrilled and excited by the community’s generosity. Now, more than ever, we need your help,” said Francys Crevier, Executive Director of NCUIH.

Donate to become an advocate while sharing the love of the season!

Why?

  • NCUIH is devoted to protecting and advocating for AI/AN needs and to ensure a future for our Urban Indian Organizations (UIOs) across the nation. For over 20 years, NCUIH has devoted all of its efforts to advocate for Urban Indian Health Programs’ interests and needs before Congress and Federal agencies. NCUIH works with Congress to promote awareness of AI/AN disparity issues and resources to better serve our AI/AN communities in urban settings.

Donate at least $10 per month and be an integral part of NCUIH’s life-changing work (less than 2 drinks at Starbucks and it is going to protect the future of Indian health!).

This year’s 2019 NCUIH End of Year Giving will support and expand our work on:

Urban Indian Youth and Suicide Prevention Council

  • The Youth Advisory Council needs your help to:
    • Expand the training and opportunities for the Council to be equipped to be the future Urban Indian Health Leaders—and to
    • Increase the number of forums for our Urban Indian Youth to educate all of us on the optimal way to keep our youth safe and healthy!

Donate

Missing and Murdered Indigenous Women Initiative

Donate Learn more

AI/AN Urban Environmental Health Initiative

Donate Learn more

Elder AI/AN Urban Health Improvement Initiative

Donate

More detail on each initiative supported here

Three (3) our ways you can make an impact this year:

  1. Donate at least $10 per month and be an integral part of NCUIH’s life-changing work (less than 2 drinks at Starbucks and it is going to protect the future of Indian health!) or through the CFC Campaign
  2. Donate a one-time lump amount
  3. Share our Facebook posts and retweet us to spread the message #NCUIH and share the #NCUIHLove

Donate

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Policy Alert: Congress Passes FY20 Minibus with $6M Increase for Urban Indian Health and Renews SDPI, CHC Through May

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This is the highest increase for the urban Indian line item. President Trump is expected to sign the bill before midnight.

On Thursday, December 19, 2019, the Senate passed the first part of the legislation to fund the federal government through fiscal year 2020. Congress decided to split all twelve appropriations bills into two different minibus bills, one without national security funding and a separate bill with national security-related items. The package with Interior Appropriations (H.R. 1865) has passed out of both chambers. This bill includes funding for the Department of Interior’s Indian Health Service and the urban Indian health line item through the September 30 end of the fiscal year. The President is expected to sign the bill before the current continuing resolution expires at midnight on Friday.

Indian Health Service and Urban Indian Line Item
As NCUIH reported earlier this week, the bill provides $6.047 billion for the Indian Health Service (IHS), $243 million more than fiscal year 2019 and $138 million more than the President’s budget request. IHS will see a 4% increase over FY19. The agreement includes $6 million in additional funds for the Urban Indian Health Programs, a long-overdue increase. NCUIH has long-advocated for an increase of at least $30 million for urban Indian health, however, this increase sets a higher water mark for next year’s negotiations.

105(l) Leases
The bill includes increases of $125 million to meet court-ordered requirements for tribal lease operating costs owed to tribes. The bill includes Senate report language directing IHS to implement better budget procedures to address this in the future.

Health Extenders
The health extenders including SDPI and CHC has been extended until May 22, 2020. This date provides additional time for negotiations on a longer-term reauthorization. NCUIH will continue to try to ensure the programs are extended for a longer-term, hopefully, 5 years, and to fight for further increases.

FY2020 Interior Appropriations

  • Indian Health Service – $6.04 Billion
  • Urban Indian Health Line Item – $57 Million

FY2019 Interior Appropriations

  • Indian Health Service – $5.8 Billion
  • Urban Indian Health Line Item – $51 Million

Press Contact:
Meredith Raimondi
mraimondi@NCUIH.org
202-417-7781

Policy Contact:
Carla Lott
cmlott@NCUIH.org

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NCUIH 2020 Conference Sponsorship

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Download Sponsorship Guide

All sponsors will receive:

  • Logo and website link on conference website, NCUIH newsletter, social media
  • Verbal recognition at the conference
  • Inclusion in the press releases before, during and after the
  • conference
  • Logo and name on the sponsor signage
  • Branded materials in conference bag

Sponsorship Levels

Platinum – $30,000 (1 available)

  • Logo on all printed and virtual signage
  • 15-minute speaking opportunity
  • 4 conference registrations ($1000 value)
  • 2 exhibitor booth (up to $2000 value)
  • 2 full-page color ad in the program ($1500 value)

Gold- $20,000 (1 available)

  • 12-minute speaking opportunity
  • 4 conference registrations ($1000 value)
  • 2 exhibitor booths (up to $2000 value)
  • 2 full-page color ad in the program ($1500 value)

Silver-$14,000 (1 available)

  • 10-minute speaking opportunity
  • 4 conference registrations ($1000 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1.5 full-page color ad in the program ($1000 value)

Bronze-$10,000(1 available)

  • 10-minute speaking opportunity
  • 3 conference registrations ($750 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1.5 full-page color ad in the program ($1000 value)

Lunch – $8,000 (1 available)

  • Logo on poster at lunch
  • 5-minute speaking opportunity at lunch
  • 2 conference registrations ($500 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1 full-page color ad in the program ($750 value)

Conference Bag – $8,000 (1 available)

  • Logo on all giveaway bags
  • 5-minute speaking opportunity
  • 2 conference registrations ($500 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1 full-page color ad in the program ($750 value)

Audio/Visual – $8,000 (1 available)

  • Logo on all NCUIH slideshow presentations
  • 5-minute speaking opportunity
  • 2 conference registrations ($500 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1 full-page color ad in the program ($750 value)

Networking Reception – $6,000 (2 available)

  • Logo on poster at reception
  • 5-minute speaking opportunity at reception
  • 2 conference registrations ($500 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1 full-page color ad in the program ($750 value)

Conference Program – $5,000 (1 available)

  • Logo on cover of program
  • 2 conference registrations ($500 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1 half-page color ad on the back page of the program ($500 value)

Internet – $4,000 (1 available)

  • Logo on all Wifi place cards at the table
  • 2 conference registrations ($500 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1  half-page color ad on the back page of the program ($500 value)

Photo Booth – $3,000 (1 available)

  • Logo on photo booth
  • 2 conference registrations ($500 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1 half-page color ad on the back page of the program ($500 value)

Name Badge – $3,000 (SOLD OUT)

  • Logo on all name badges
  • 5-minute speaking opportunity
  • 2 conference registrations ($500 value)
  • 1 exhibitor booth (up to $1000 value)
  • 1 half-page color ad on the back page of the program ($250 value)

Coffee Break – $2,000 (4 available)

  • Logo on poster at coffee break
  • 1 half-page color ad in the program ($250 value)

Friend – $1,000 (8 available)

  • 1 quarter-page color ad in the program ($125 value)

Contact: Meredith Raimondi, 202-417-7781, mraimondi@NCUIH.org

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PRESS RELEASE: Congress Announces $6M Increase for Urban Indian Health and Renews SDPI, CHC Through May

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This is the highest increase for the urban Indian line item ever.

WASHINGTON, DC  (December 16, 2019)  – On Monday, December 16, 2019, the House announced a $1.4 trillion bipartisan, bicameral agreement to fund the federal government through fiscal year 2020. The House will begin the process imminently and a vote is expected later in the week.

The bill provides $6.047 billion for the Indian Health Service (IHS), $243 million more than fiscal year 2019 and $138 million more than the President’s budget request. The IHS will see a 4% increase over FY19. The agreement includes $6 million in additional funds for the Urban Indian Health Programs, a long-overdue increase.

“The National Council of Urban Indian Health endorses the FY20 Minibus Appropriations Bill that includes the highest-ever increase for urban Indian health. Over 41 urban Indian health programs will be able to provide more essential resources to American Indians and Alaska Natives at a time when it is most critical. We are extremely encouraged by Congress coming together with help from countless advocates on both sides of the aisle and both chambers to reach this deal. We are especially grateful to House Interior Chairwoman Betty McCollum and Ranking Member David Joyce and Senators Tom Udall and Chuck Schumer and Senate Majority Leader Mitch McConnell,” said Francys Crevier, Executive Director of NCUIH.

The bill includes increases of $125 million to meet court-ordered requirements for tribal lease operating costs owed to tribes. The bill includes Senate report language directing IHS to implement better budget procedures to address this in the future.

The health extenders including SDPI and CHC has been extended until May 22, 2020. This date provides additional time for negotiations on a longer-term reauthorization. NCUIH will continue to try to ensure the programs are extended for a longer-term, likely 5 years, and to fight for any increases we can for the programs that have not seen any.

NCUIH will continue to monitor the process and provide further updates.

###

Contact:
Meredith Raimondi
mraimondi@NCUIH.org
202-417-7781

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NCUIH Joins Coalition in Amicus Curiae Brief in Support of the Indian Child Welfare Act

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On December 13, NCUIH joined nearly 400 Tribes and Indian organizations in an amicus curiae brief filed in support of the Indian Child Welfare Act (ICWA). The brief, which was filed in the U.S. Court of Appeals for the Fifth Circuit, largely mirrors the brief filed in the lawsuit last year. As a reminder, a three-judge panel of the Fifth Circuit issued an opinion in August finding ICWA constitutional in part because it is not a race-based law.  However, the judges granted an order to rehear the case en banc — before the entire 17-judge panel. Defendants in the case, the federal government and Intervenor-Tribes, filed their supplemental briefs for the en banc stage on Friday, December 6.

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NCUIH Submits Joint Comments on Colorado Medicaid Waiver

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On December 8, NCUIH submitted joint comments with the National Indian Health Board on Colorado’s proposed Section 1115 Medicaid waiver, Expanding the Substance Use Disorder Continuum of Care. In the comments, we noted the trust obligation and the importance of Medicaid to Tribes and Urban Indian Organizations (UIOs).  o that end, the comments expressed concern with lack of meaningful state consultation and encouraged the state to conduct further engagement with Indian Health Care Providers within the state and also advised that the expanded continuum of care program must be inclusive of I/T/U facilities.

View letter.

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PRESS RELEASE: NCUIH AND IHS HOST LISTENING SESSION ON ELIMINATING HEPATITIS C AND HIV IN INDIAN COUNTRY

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THE LISTENING SESSION FOCUSED ON URBAN INDIAN HEALTH SUCCESSES AND BARRIERS AND INCLUDED INFORMATION FROM A RECENT UIO SURVEY ON CAPACITY TO ADDRESS THE ISSUE.

Panelists: Walter Murillo, Kerry Hawk Lessard, Rick Haverkate, LCDR Danica Brown, Robyn Sunday-Allen, Francys Crevier

FOR IMMEDIATE RELEASE

Contact: Meredith Raimondi, mraimondi@ncuih.org, 202-417-7781

WASHINGTON, DC – (December 13, 2019) On Tuesday, December 10, 2019, the National Council of Urban Indian Health (NCUIH) hosted a Listening Session in partnership with the Indian Health Service (IHS) on “Eliminating Hepatitis C and HIV in Indian Country: A Focus on Urban Indian Health”. Over 15 federal agencies were represented with nearly 100 participants in person and online. This listening session was created in response to the announcement in March 2019 from IHS to create an “Eliminating Hepatitis C and HIV/AIDS in Indian Country Initiative”.

“We are looking forward to a strong partnership between federal agencies and Urban Indian Organizations (UIOs) in reducing the rates of Hepatitis C and HIV/AIDS in Indian Country.  Although UIOs are successfully implementing innovative measures to combat HIV and viral hepatitis for their American Indian and Alaska Native (AI/AN) patients, AI/ANs are ranked 4th in the nation for new HIV diagnoses and insufficient funding of programs directed at this crisis continues to be an issue.  NCUIH is excited to know that IHS has implemented this critical initiative, however it is important for IHS to hear directly from UIOs to truly understand the needs of the programs and AI/AN patients in urban areas.  As IHS and CDC apply for additional funding to reduce infections and provide resources, we urge them to consult and engage with UIOs – to ensure that urban Indian health care is able to provide the same quality of care as the other partners within the IHS I/T/U system,” said Executive Director Francys Crevier.

“Combating Hepatitis C and HIV/AIDS in communities most impacted by these epidemics—including AI/ANs in urban centers—must be a top priority for lawmakers.  Methamphetamine and opioid use have been key drivers of rising Hepatitis C and HIV/AIDS rates in Indian Country and across the United States.  That is why I introduced the Comprehensive Addiction Resources Emergency (CARE) Act, ambitious legislation to tackle the opioid and substance use epidemic head-on.  The CARE Act—which is modeled after the Ryan White HIV/AIDS Program—would invest $100 billion over ten years to fight the epidemic, including over $800 million annually provided directly to tribal governments, tribal epidemiology centers, urban Indian health organizations, and other entities serving Native communities.  I appreciate NCUIH’s support for the CARE Act,” said Senator Elizabeth Warren in a statement.

“In a recent survey of UIOs, many report that the services they provide are making an impact upon the urban communities they serve – and although insufficient funding is an issue, UIOs are able to conduct ongoing activities to fight HIV/HCV while finding opportunities to increase access for AI/AN patients,” said Dr. Kimberly Fowler, Director of Technical Assistance and Research Center at NCUIH.

Rick Haverkate, National HIV/AIDS & Hep C Program Director for IHS provided an update from IHS on HIV/HCV Prevention and Treatment. Dr. Kimberly Fowler and Julia Dreyer, Director of Federal Relations of NCUIH moderated a session with UIOs who provided an overview of the current status of HIV/HCV prevention and treatment at Urban Indian Organizations (UIOs).

Representatives from Oklahoma City Indian Clinic, Robyn Sunday-Allen, CEO and LCDR Danica Brown, Clinical Pharmacist, gave a presentation on the clinical aspects of the current state of prevention and treatment. Kerry Hawk Lessard, Executive Director of Native American Lifelines, presented on the role of the community and support mechanisms in place currently. Finally, Walter Murillo, CEO, Native Health, initiated a discussion on the policy considerations of eliminating Hepatitis C and HIV in urban Indian communities.


Community Support by Kerry Hawk Lessard

In February 2019, the current Administration announced the Ending the HIV Epidemic: A Plan for America initiative with a primary goal to reduce new HIV infections in the United States by 75 percent in five years and by 90 percent by 2030. Additionally, in March 2019, IHS introduced and highlighted the Eliminating Hepatitis C and HIV/AIDS in Indian Country Initiative under the administration’s A Plan for America initiative. The president’s fiscal year 2020 budget proposed $25 million in new investments to expand partnerships between IHS and Native communities to end the HIV epidemic in Indian Country.

Additionally, it has been proven that reoccurring health problems are more acute for AI/ANs living in urban areas. Urban Indians have greater rates of mortality from chronic disease compared to all other races. Urban Indians are also less likely to receive preventive care compared with the non-Indian urban population and less likely to have health insurance. Survival rates for AI/AN peoples living with HIV/AIDS are lower than any other population. Additionally, Native peoples who have been diagnosed with HIV/AIDS most often suffer from related diseases, such as diabetes, tuberculosis and hepatitis. Mental health, substance abuse and addiction complicate primary care-seeking behaviors of Native people with HIV. Data have shown that HIV diagnoses have steadily increased in Indian Country over the last few years.

Across the country, UIOs provide culturally competent health care services and resources that are critical to addressing these health care challenges while struggling with constant underfunding.  This listening session served as a platform for UIOs to express their community’s circumstances, needs, identify gaps, and to share their perspectives and interests with others who are diligently working to support the “Eliminating Hepatitis C and HIV in Indian Country Initiative”.

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PRESS RELEASE: Senate Committee on Indian Affairs Advances “Health Care Access for Urban Native Veterans Act” and Nomination of RADM Weahkee

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FOR IMMEDIATE RELEASE

Contact: Meredith Raimondi, 202-417-7781, mraimondi@NCUIH.org

The National Council of Urban Indian Health was one of 88 organizations providing letters of support for RADM Weahkee.

NCUIH Representatives at the Hearings Today: Carla Lott, Francys Crevier, Kerry Hawk Lessard, Maureen Rosette, Walter Murillo, Jamie Ishcomer-Aazami

Washington, DC (December 11, 2019)— Today, December 11, 2019, the Senate Committee on Indian Affairs held a markup on S. 2365, the Health Care Access for Urban Native Veterans Act and a Nomination Hearing to consider RADM Michael D. Weahkee, of New Mexico, to be Director of the Indian Health Service, U.S. Department of Health and Human Services. S. 2365 was ordered to be reported favorably by voice vote by the Senate Committee on Indian Affairs.

“Passing the Health Care Access for Urban Native Veterans Act through the Senate Committee on Indian Affairs is a monumental step in ensuring the health and wellness of urban Native Veterans,” said Francys Crevier, Executive Director of the National Council of Urban Indian Health, “Native people serve in the military at a higher rate than any other population and when they come home from serving our country, Native Veterans deserve the right to access culturally competent health care at an Urban Indian Health program. We thank Chairman Hoeven and the Committee for their outstanding leadership on moving this legislation forward to help our Native Veterans.”

“We write to express our support of the nomination of Rear Admiral (RADM) Michael D. Weahkee. Despite comprising over two-thirds of AI/ANs, urban Indians are too often excluded from federal policies and programs designed to carry out the trust responsibility. While serving in his post, RADM Weahkee has repeatedly established his understanding that UIOs are an integral part of the Indian health system, which is comprised of the Indian Health Service (IHS), Tribes, and tribal organizations, and urban Indian organizations (collectively, I/T/Us),” wrote NCUIH Board President Maureen Rosette in the nominating letter.

“In partnership with Tribes and Urban Indian Organizations, we have developed a comprehensive and aggressive five-year strategic plan for the IHS, focused on expanding access to care, improving the quality of care that we provide, and improving the management and operations of the Agency,” said Rear Admiral Michael D. Weahkee, Nominee for Director of the Indian Health Service, Department of Health and Human Services in his opening statement.

The IHS is an agency within the U.S. Department of Health and Human Services responsible for providing federal health care to approximately 2.6 million American Indians and Alaska Natives. In 37 states, there are over 605 hospitals, clinics, and health stations located on or near tribal communities under the purview of the IHS and 41 urban Indian health programs. The Director of the IHS oversees the administration of health care programs and services within the agency, including management of the budget of approximately $6.9 billion and employment of more than 15,000 professionals.

More Information

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