Bipartisan Urban Indian Health Confer Act Introduced by Grijalva, McCollum and Cole

This bipartisan legislation will improve access to health care for urban Indians.

On September 10, 2021 the Urban Indian Health Confer Act was introduced by Chairman Raúl M. Grijalva (D-AZ), Rep. Betty McCollum (D-MN), Rep. Tom Cole (R-OK), Rep. Don Young (R-AK), Rep. Karen Bass (D-CA), and Del. Eleanor Holmes Norton (D-DC). As an ongoing effort to rectify longstanding parity issues within the Indian health system, this legislation would require agencies and offices within the U.S. Department of Health and Human Services (HHS) to confer with Urban Indian Organizations (UIOs) on policies and initiatives related to healthcare for urban American Indians and Alaska Natives (AI/AN).

 

The National Council of Urban Indian Health (NCUIH) has long advocated for the importance of facilitating confer between numerous federal branches within HHS and UIO-stakeholders without any resolve. Currently, only the Indian Health Service (IHS) has a legal obligation to confer with UIOs. It is important to note that Urban Confer policies do not supplant or otherwise impact tribal consultation and the government-to-government relationship between tribes and federal agencies.

 

“Agencies have been operating as if only IHS has a trust obligation to AI/ANs, and that causes an undue burden to IHS to be in all conversations regarding Indian Country in order to talk with agencies. It is imperative that UIOs have avenues for direct communication with agencies charged with overseeing the health of their AI/AN patients, especially during the present health crisis,” said NCUIH CEO, Francys Crevier (Algonquin).

 

“HHS’ failure to communicate with UIOs about healthcare policies that impact urban Indian communities is inconsistent with the federal trust responsibility and contrary to sound public health policy. The Urban Indian Health Confer Act will establish direct communication for UIOs across the entire department and ensure that urban Indian communities are aware of healthcare policy changes,” said Chairman Raúl M. Grijalva (D-AZ).

 

Support for confer with UIOs is strong among stakeholders in Indian Country. Recently, the National Congress of American Indians (NCAI) passed a resolution to “Call for the U.S. Department of Health and Human Services Secretary to Implement an Urban Confer Policy Across the Department and its Divisions.” NCUIH is grateful for the support of NCAI and Indian Country and commends Chairman Raúl M. Grijalva (D-AZ), Rep. Betty McCollum (D-MN), Rep. Tom Cole (R-OK), Rep. Don Young (R-AK), Rep. Karen Bass (D-CA), and Del. Eleanor Holmes Norton (D-DC) on taking bold action to resolve this parity issue for UIOs in the I/T/U system.

Background

 

Urban Confer policies are a response to decades of deliberate federal efforts (i.e. forced assimilation, termination, relocation) that have resulted in 70% of AI/AN people living outside of Tribal jurisdictions, thus making Urban Confer integral to address the care needs of most AI/AN persons.

 

The Urban Indian Health Confer Act will ensure the many branches and divisions within HHS and all agencies under its purview establish a formal confer process to dialogue with UIOs on policies that impact them and their AI/AN patients living in urban centers.  In fact, absent a confer policy, several agencies within HHS continue to reject repeated attempts to convene with UIOs and agencies to discuss critical urban Indian health issues. Such blatant disregard to communicate with UIOs is not only a failure to urban Indians and is inconsistent with the government’s responsibility, but it is contrary to sound public health policy. The bill would codify the intent of the Federal Trust Responsibility to ensure equitable health care access to AI/AN by amending legislative text in Section 514, Subsection (b) of the Indian Health Care Improvement Act (25 U.S.C. § 1660d) (IHCIA).

ENERGY AND COMMERCE COMMITTEE MARKS UP BILL INCLUDING URBAN INDIAN ORGANIZATIONS

The mark up is the Committee’s portion of the Build Back Better Act

 

Washington, D.C. -The Energy and Commerce Committee, led  by Chairman Frank Pallone, Jr. (NJ-06), met on September 13 -14 to mark up their portion of the Build Back America Act. Bills for committee markup included issues tackling the affordability of healthcare and prescription drug costs, closing the Medicaid gap, expansion of services for seniors and those with disabilities and critical in investments in public health and preparedness following the breakdowns during the COVID-19 pandemic.

 

“The Build Back Better Act is transformational legislation that invests in the American people, responds to the challenges of our time, and builds back a better future for generations to come” said Chairman Frank Pallone, Jr. (NJ-06).

Committee Mark Up Highlights

 

Key Components

  • $50,000,000 for funding to grow and diversify the doula: Workforce grants to health professions schools, academic health centers, State or local governments, territories, Indian Tribes and Tribal organizations, urban Indian organizations, or other appropriate public or private nonprofit 7 entities (or consortia of entities, including entities promoting multidisciplinary approaches), to establish or expand programs to grow and diversify the doula workforce
  • $75,000,000 for grants to health professions schools, academic health centers, State or local governments, territories, Indian Tribes and Tribal organizations, urban Indian organizations, or other appropriate public or private nonprofit 14 entities (or consortia of entities, including entities promoting multidisciplinary approaches), to establish or expand programs to grow and diversify the maternal mental health and substance use disorder treatment workforce.
  • $2,500,000,000 for community violence and trauma interventions. Competitive grants or contracts to local governmental entities, States, territories, Indian Tribes and Tribal organizations, urban Indian organizations, hospitals and community health centers, nonprofit community-based organizations, culturally specific organizations, victim services providers, or other entities as determined by the Secretary (or consortia of such
  • entities) to support evidence-based, culturally competent, and developmentally appropriate strategies to reduce community violence, including outreach and conflict mediation, 19 hospital-based violence intervention, violence interruption, and services for victims and individuals and 21 communities at risk for experiencing violence, such 22 as trauma-informed mental health care and counseling, school-based mental health services.
  • Includes $15 billion in new investments for pandemic preparedness and $3 billion to establish the Advanced Research Projects Agency for Health (ARPA-H).

Bill Mark Up Summary

 

Comprehensive Plan for Addressing High Drug Prices: A Report in Response to the    Executive Order on Competition in the American Economy” -released by Health and Human Services Secretary  Xavier Becerra

Key  Components

  • Makes drug prices more affordable and equitable for all consumers and throughout the health care system-support drug price negotiation with manufacturers and stop unreasonable price increases to ensure access to drugs that can improve health for all Americans
  • Improves and promotes competition throughout the prescription drug industry – Support market changes that strengthen supply chains, promote biosimilars and generics, and increase transparency
  • Fosters scientific innovation to promote better health care and improve health – Support public and private research and make sure that market incentives promote discovery of valuable and accessible new treatments, not market gaming

 

Key Component:

  • Ensures affordability of coverage for certain low-income populations by expanding the Affordable Care Act (ACA) premium tax credits to below 100% of the federal poverty level in 2022 through 2024 and reduce cost sharing for these individuals as well.

 

Key Component:

  • Establishes a federal Medicaid program by 2025 in states that have not yet expanded their programs under the ACA.

 

Key Component:

  • Permanently extends the Children’s Health Insurance Program (CHIP); require continuous twelve-month coverage for children in Medicaid and CHIP; and make permanent one full year of postpartum Medicaid coverage for pregnant women.

 

Key Components:

  • Energy and Commerce text includes provisions analogous to the House Ways and Means Committee with addition of dental, hearing and vision benefits to Medicare.
  • $190 billion proposal for investment in home and community-based services (HCBS).

Next Steps

Markups are scheduled to be completed next week. Members will then begin to package them into one bill for consideration in the House. Timing of that vote is uncertain, but the target is to complete this by the September 27 agreed upon date to consider it in tandem with the bipartisan infrastructure package.[1]

[1] Updates on Budget Reconciliation; HHS Drug Pricing Proposal (natlawreview.com)