PRESS RELEASE: First-Ever Standalone NCUIH Bill Passes Congress to Shore Up Resources for Urban Indians

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FOR IMMEDIATE RELEASE

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Press Contact: Sara Williams, swilliams@NCUIH.org

December 20, 2020 (Washington, DC) – On December 20, the Senate voted to pass to H.R. 6535 by unanimous consent to pass H.R. 6535 to extend Federal Tort Claims Act (FTCA) coverage to urban Indian organizations (UIOs) instead of having to divert scarce resources away from health care to foot exorbitant insurance costs. On December 17, the United States House of Representatives passed by unanimous consent under suspension of the rules. The passage of this non-controversial bill is a step forward in creating parity within the Indian Health System to ensure that the trust and treaty responsibility is upheld by the US government.

“We applaud Congress and the Administration for their steadfast efforts to help urban Indian health workers get coverage like their other IHS and Tribal counterparts as we are in the midst of a pandemic. As our frontline workers risk their lives in this pandemic that is devastating Indian Country, this will be critical to saving Native lives and will increase available health care services. We are thankful to Senators Smith, Lankford, Udall, Hoeven and Schumer along with our House leaders, Representatives Gallego, Mullin, Grijalva, Pallone, Young, and Cole” said Francys Crevier (Algonquin), NCUIH CEO.

In August, the Centers for Disease Control and Prevention (CDC) reported that across 23 states, cumulative incidence rates of lab-confirmed COVID-19 among AI/ANs are 3.5 times higher than for non-Hispanic Whites. Also, according to CDC, COVID-19 hospitalization among AI/ANs were 4.7 times higher than for non-Hispanic Whites. As this pandemic devastates Indian Country, UIOs have been forced to make extremely difficult choices – facing competing priorities and expenses, like increased PPE and renovation costs, in addition to very costly malpractice insurance. As of November, “the Oklahoma City IHS Area now has the highest total number of cases” and the Oklahoma City Indian Clinic is one of the UIOs that pays the highest annual rate for medical malpractice insurance. If provided insurance parity with IHS and Tribal facilities, this UIO alone could direct up to an additional $250,000 to patient care at a time when increased access to care is needed most.

This legislation has broad bipartisan support in both chambers and is endorsed by IHS. NCAI also has a standing resolution supporting this legislation, Resolution #PDX-20-038, “Supporting Extension of Federal Tort Claims Act (FTCA) Coverage to Urban Indian Organizations.”

Next Steps

H.R. 6535 will now go to the President for his signature.

House Passes NCUIH Bill to Extend FTCA Coverage to Urban Indian Health Workers

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December 17, 2020

Today, the United States House of Representatives voted to pass H.R. 6535 to extend Federal Tort Claims Act (FTCA) coverage to urban Indian organizations (UIOs), which would put a stop to having to divert scarce resources away from health care to foot exorbitant insurance costs. This bill was passed by unanimous consent under suspension of the rules and will now be referred to the Senate for further consideration.

“We applaud the House, especially Rep. Ruben Gallego and Rep. Markwayne Mullin, for their steadfast efforts to help urban Indian health workers get coverage like their other IHS and Tribal counterparts. We urge the Senate to move quickly to pass this law before the end of this Congress. As we battle this pandemic that is devastating Indian Country, this will be critical to save Native lives and will increase available health care services,” said Francys Crevier (Algonquin), NCUIH CEO.

In August, the Centers for Disease Control and Prevention (CDC) reported that across 23 states, cumulative incidence rates of lab-confirmed COVID-19 among AI/ANs are 3.5 times higher than for non-Hispanic Whites.1 Also, according to CDC, COVID-19 hospitalization among AI/ANs were 4.7 times higher than for non-Hispanic Whites. As this pandemic devastates Indian Country, UIOs have been forced to make extremely difficult choices – facing competing priorities and expenses, like increased PPE and renovation costs, in addition to very costly malpractice insurance. As of November, “the Oklahoma City IHS Area now has the highest total number of cases” and the Oklahoma City Indian Clinic is one of the UIOs that pays the highest annual rate for medical malpractice insurance. If provided insurance parity with IHS and Tribal facilities, this UIO alone could direct up to an additional $250,000 to patient care at a time when increased access to care is needed most.

This legislation has broad bipartisan support in both chambers and is endorsed by IHS. NCAI also has a standing resolution supporting this legislation, Resolution #PDX-20-038, “Supporting Extension of Federal Tort Claims Act (FTCA) Coverage to Urban Indian Organizations.”

Next Steps

H.R. 6535 will now be referred to the Senate for further consideration. On December 4, 2020, NCUIH and the National Congress of American Indians sent a letter to Congress to urge them to pass this bill before the end of the year and will continue to work with the Senate to encourage swift passage.

Background

Contact:

Meredith Raimondi

Director of Congressional Relations

mraimondi@ncuih.org

COVID-19 RELIEF BILLS Include Support for Indian Country Including Urban Indians

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The proposal begins to address the many urgent needs of Indian Country.

On December 14, a bipartisan group of lawmakers released two bills totaling $908 billion that would provide economic relief amid the COVID-19 pandemic, including several Indian Country relief measures. The first bill titled “Emergency Coronavirus Relief Act of 2020,” provides $748 billion in unemployment assistance, COVID-19 vaccine funding, health care funding, and other emergency relief. The second bill, “Bipartisan State and Local Support and Small Business Protections Act,” allocates $160 billion for state, local, and tribal government aid and liability protection for business.

In summary, the first bill provides the following for IHS, tribal organizations and Urban Indian Organizations (UIOs):

  • $1 billion in to IHS in Provider Relief Funds
  • $350 million to IHS for COVID-19 testing and contact tracing purposes
  • $129 million from CDC to IHS to carry out activities with respect to coronavirus vaccine distribution, administration, and communications
  • $185 million set aside for Indian tribes, Tribal organizations, and urban Indian organizations for substance use disorder and behavioral health efforts

On December 4, 2020, NCUIH, NCAI, and NIHB wrote a letter to Congress regarding this COVID-19 package. In the letter, the organizations requested $2 billion in emergency funds to Indian Health Service (IHS) for immediate distribution to Indian Health Service/Tribal Health Program/UIO (I/T/U) system, minimum $1 billion to replenish lost third-party reimbursements across the I/T/U system, a minimum five percent I/T/U funding set-aside for vaccine distribution and administration, and long-term reauthorization of the Special Diabetes Program for Indians (SDPI).

Next Steps

  • Congress is close to an agreement and will continue negotiations to pass a final relief package.
  • NCUIH will continue to monitor developments.

Summary

FUNDING: EMERGENCY CORONAVIRUS RELIEF ACT OF 2020

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

  • This bill provides $1 billion in Provider Relief Funds to IHS to assist IHS directly operated programs, programs operated by tribes and tribal organizations, and urban Indian organizations
    • $700 million shall be used to supplement reduced third-party revenue collections
    • $200 million shall be allocated at the discretion of the Director of IHS for maintenance and improvement projects or construction of existing or new temporary structures necessary to the purposes specified in this Act, for water and sanitation infrastructure, or for other needs at IHS and tribal facilities
    • $100 million shall be allocated at the discretion of the Director of the IHS for additional expenditures necessary to the purposes specified within this Act

VACCINE TESTING AND CONTACT TRACING

  • Provides $350 million to IHS, which may allocate the funds to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes for COVID-19 testing and contact tracing purposes

 

VACCINE DISTRIBUTION AND ADMINISTRATION

  • Provides $6 billion for CDC-wide activities and program support with $2.58 billion to be made available for vaccine distribution and administration
    • $129 million shall be allocated to IHS to fund IHS directly operated programs, programs operated by tribes and tribal organizations, urban Indian organizations, and health service providers to tribes to carry out activities with respect to coronavirus vaccine distribution, administration, and communications
    • The remainder of the $2.58 billion allocation can be made available for other activities regarding COVID-19, including grants, contracts, or cooperative agreements to States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes to provide additional assistance with distribution and administration of coronavirus vaccines, as determined appropriate by the Secretary.

 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES

  • $3.15 billion allocated for the Substance Abuse and Mental Health Administration (SAMHSA) program support
    • $1.3 billion shall be for the State Opioid Response Grant
    • $50 million shall be made available to Indian Tribes and Tribal organizations
    • $185 million set aside for Indian tribes, Tribal organizations, and urban Indian organizations for substance use disorder and behavioral health efforts

 

FUNDING: BIPARTISAN STATE AND LOCAL SUPPORT AND SMALL BUSINESS PROTECTIONS ACT

CORONAVIRUS LOCAL COMMUNITY STABILIZATION FUND

  • Provides $160 billion to the Coronavirus Local Community Stabilization Fund for State and Tribal entities
    • Of this amount, $8 billion shall be reserved for Tribal entities and 60 % be allocated based on relative population of each Tribal entity and 40% based on the number of employees for each Tribal entity

 

Topic Funding/Section Language
Public Health and Social Services Emergency Fund $1,000,000,000 “That of the amount made available under this paragraph in this Act, not less than $1,000,000,000 shall be transferred to the Indian Health Service, which may allocate the funds for Indian Health Service directly operated programs, programs operated by tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act (25 U.S.C.5301 et seq.), and contracts or grants with Urban Indian organizations under title V of the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.)”
$700,000,000 “$700,000,000 shall be used to supplement reduced third party revenue collections”
$200,000,000 “$200,000,000 shall be allocated at the discretion of the Director of the Indian Health Service for maintenance and improvement projects or construction of existing or new temporary structures necessary to the purposes specified in this Act, for water and sanitation infrastructure, or for other needs at Indian Health Service and tribal facilities”
$100,000,000 “$100,000,000 shall be allocated at the discretion of the Director of the Indian Health Service for additional expenditures necessary to the purposes specified within this Act”
Vaccine Testing and Contact Tracing $350,000,000 “transfer $350,000,000 to the Director of the Indian Health Service, which may allocate the funds to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes for such purposes.”
Vaccine Distribution and Administration $6,000,000,000,

 

 “For an additional amount for ‘‘CDC-Wide Activities and Program Support’’, $6,000,000,000 to remain available until expended, to prevent, prepare for, and respond to coronavirus, domestically or internationally, including for distribution and administration of and communications about coronavirus vaccines”
$2,580,000,000 “From the $6,000,000,000 appropriated under the heading ‘‘Department of Health and Human Services—Centers for Disease Control and Prevention—CDC-Wide Activities and Program Support’’, the Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’) shall make available— $2,580,000,000 for activities described in paragraph (3) (Vaccine distribution and administration)”
$129,000,000 “$129,000,000 shall be transferred to the Indian Health Service, which may, in consultation with the Director of the Centers for Disease Control and Prevention, allocate the funds for Indian Health Service directly operated programs, for programs operated by tribes and tribal organizations

under the Indian Self-Determination and

Education Assistance Act (25 U.S.C. 5301

10 et seq.), for contracts or grants with urban

Indian organizations under the Indian Health Care Improvement Act (25 U.S.C.

13 1601 et seq.), and for health service providers to tribes to carry out activities with respect to coronavirus vaccine distribution, administration, and communications.”
Remainder of $2,580,000,000 “From the amount made available under paragraph (1)(B) and not allocated under subparagraph (A), the Secretary shall make available the remainder of such amount for other activities to prevent, prepare for, and respond to coronavirus, domestically or internationally, including—[…] a contingency fund for additional amounts the Secretary may award, including through grants, contracts, or cooperative agreements, to States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes to provide additional assistance with distribution and administration of coronavirus vaccines, as determined appropriate by the Secretary.”
Substance Abuse and Mental Health Services $3,150,000,000 “Provided, That in addition to amounts provided herein, for an additional amount, $150,000,000 for grants to communities and community organizations who meet criteria for Certified Community Behavioral Health Clinics pursuant to section 223(a) of Public Law 113–93 […] For an additional amount for carrying out titles III and V of the PHS Act, including grant programs under such title V, with respect to substance abuse treatment and prevention, $3,000,000,000”
$1,300,000,000 “Provided, That of such amount, $1,300,000,000 shall be for the State Opioid Response Grants for carrying out activities pertaining to opioids, stimulants, and alcohol undertaken by State agencies responsible for administering the substance abuse prevention and treatment block grant under subpart II of part B of title XIX of the PHS Act (42 U.S.C. 300x–21 et seq)”
$50,000,000 “Provided further, That of such amount, $50,000,000 shall be made available to Indian Tribes and Tribal organizations”
$185,000,000 “For an additional amount for carrying out titles III, V, and XIX of the PHS Act, in coordination with the Indian Health Service, with respect to substance use disorder and behavioral health among Indian tribes, tribal organizations, and urban Indian organizations, $185,000,000: Provided, That such amount is designated by the Congress as being for an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 901(b)(2)(A)(i)).”
Coronavirus Local Community Stabilization Fund $160,000,000,000 “Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated for making payments to States and Tribal entities under this section, $160,000,000,000 for fiscal year 2021, to remain available until expended.”
$8,000,000,000 “Of the amount appropriated under paragraph (1), the Secretary shall reserve $8,000,000,000 of such amount for making payments to Tribal entities under subsection (c)(7), subject to subparagraph (B).”

 

 

Why is this important to UIOs?

  • UIOs need additional funding to provide adequate health care for American Indians/Alaska Natives and ensure successful COVID-19 vaccine distribution and administration.

NCUIH SIGNS THREE JOINT LETTERS URGING CONGRESSIONAL ACTION BEFORE THE END OF THE YEAR

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The National Council of Urban Indian Health (NCUIH) signed three letters urging Congress to act on priority issues in Indian Country: COVID-19 stimulus health funds for Indian Country, extension of Federal Tort Claims Act (FTCA) coverage to Urban Indian Organizations (UIOs), and passage of several tribal Veteran bills.

COVID-19 Stimulus Health Funds for Indian Country

This letter, signed by NCUIH, the National Indian Health Board (NIHB), and the National Congress of American Indians (NCAI), advocates for COVID-19 pandemic relief and includes the following funding priorities:

  • Minimum $2 billion in emergency funds to Indian Health Service (IHS) for immediate distribution to Indian Health Service/Tribal Health Program/UIO (I/T/U) system
  • Minimum $1 billion to replenish lost third-party reimbursements across the I/T/U system
  • Minimum five percent I/T/U funding set-aside for vaccine distribution and administration
  • Long-term reauthorization of the Special Diabetes Program for Indians (SDPI)

Read the letter.

FTCA Coverage for UIOs

The letter, signed by NCUIH and NCAI, advocates for parity in the Indian Health System (IHS) by urging Congress to pass H.R. 6535 / S. 3650. This legislation would extend the same insurance coverage as IHS and Tribal facilities to UIOs. This bill has passed the House Natural Resources Committee and is awaiting action to be added to the House suspension calendar.

Read the letter.

Tribal Veterans Bills

This letter, signed by NCUIH, NCAI, and NIHB, deals with several bills supporting Native Veterans including NCUIH’s H.R. 4153 which was passed in the House on Thursday, December 3 by unanimous consent. It now awaits further consideration by the Senate where NCUIH is advocating for it be hotlined before the end of the year.

Read the letter.

Why is this important to UIOs?

  • Passage of these bills would mean liability coverage for UIOs, improved health care delivery for Native Veterans, and increased funding to respond to the pandemic.

NCUIH Contact: Meredith Raimondi, Director of Congressional Relations, (mraimondi@ncuih.org)

 

LETTERS:

 

December 4, 2020

Re: COVID-19 Stimulus Health Funds for Indian Country

Dear Speaker Pelosi, Leader McConnell, Leader McCarthy, and Leader Schumer:

On behalf of the undersigned national organizations collectively serving all 574 sovereign federally-recognized American Indian and Alaska Native (AI/AN) Tribal Nations and all 41 urban Indian organizations (UIOs), we write to urge you to include the following emergency funding and technical resources for Indian Health Service (IHS), Tribal governments, and urban Indian organizations (collectively “I/T/U”) in any year-end COVID-19 stimulus package, omnibus appropriations package, or in a separate legislative vehicle, before the end of the 116th Congress.

  • Minimum $2 billion in emergency funds to IHS for immediate distribution to I/T/U system
  • Minimum $1 billion to replenish lost 3rd party reimbursements across the I/T/U system
  • Minimum 5 percent I/T/U funding set-aside for vaccine distribution and administration
  • Minimum $1 billion for water and sanitation systems across IHS and Tribal communities
  • Long-term reauthorization of the Special Diabetes Program for Indians(SDPI)

Over the course of this pandemic, Tribal Nations, Tribal organizations, and UIOs have submitted countless letters to Congress outlining the devastating toll of COVID-19 across Indian Country. Most recently, on September 8, we wrote to you about the urgent need for Congress to pass the same critical priorities outlined in this letter. Back in July of this year, the bipartisan Congressional Native American Caucus submitted a letter to House Appropriations Committee Chair Lowey and Ranking Member Granger, urging inclusion of the Tribal priorities outlined in our joint letters. But as of this writing, we still await congressional action on these priorities while COVID-19 conditions in Indian Country have only worsened.

Since mid-July,therehasbeena390% increase in COVID-19 case infections among AI/ANsreportedbyIHS1, and a 179% increase in hospitalization rates among AI/ANs.2 According to the Centers for Disease Control and Prevention (CDC), COVID-19 death rates among AI/ANs are 2.6 times the rate for non-Hispanic Whites.3As of November 30, IHS has reported a 7-day rolling average positivity rate of 14.5% nationwide, with some IHS Areas experiencing positivity rates at above 26%.4 In comparison, according to CDC data, the nationwide average 7-day positivity rate has not surpassed 15% since week 19 of the pandemic (ending May 9, 2020). These sobering data points only affirm the fact that Indian Country continues to bear the brunt of this crisis. Just this week, CDC Director Dr. Redfield warned that COVID-19 deaths could reach as high as 450,000 come February – demonstrating that the toll of the virus is far from over. Without sufficient additional congressional relief sent directly to I/T/U systems, these shocking upward trends will likely continue because I/T/U systems have limited resources to mitigate, treat, and respond to the virus.

Meanwhile, the Special Diabetes Program for Indians (SDPI) – a program that is instrumental for COVID-19 response efforts in Indian Country because it is focused on prevention, treatment, and management of diabetes, one of the most significant risk factors for a more serious COVID-19 illness5 – has endured five short-term extensions since last September, placing immense and undue strain on program operations. In fact, a national survey conducted by the National Indian Health Board (NIHB) found that nearly 1 in 5 Tribal SDPI grantees reported employee furloughs, including for healthcare providers, with 81% of SDPI furloughs directly linked to the economic impacts of COVID-19 in Tribal communities. Roughly 1 in 4 programs have reported delaying essential purchases of medical equipment to treat and monitor diabetes due to funding uncertainty, and nearly half of all programs are experiencing or anticipating cutbacks in the availability of diabetes program services – all under the backdrop of a pandemic that continues to overwhelm the Indian health system.

To be clear, we appreciate the over $1 billion to IHS under the CARES Act and the $750 million Tribal testing set-aside under the Paycheck Protection Program and Health Care Enhancement Act; however, these investments have been necessary but insufficient to stem the tide of the pandemic in Tribal and urban AI/AN communities. While were main optimistic that Congress can pass an omnibus appropriations package for Fiscal Year (FY)2021 by December 11, the possibility of another continuing resolution (CR) remains. We remind you that IHS is the only federal healthcare delivery system that is not exempt from CRs and government shutdowns.

If Congress fails to provide sufficient emergency appropriations for the I/T/U, a stopgap measure will force a health care system serving roughly 2.6million AI/ANs to continue operating under a pandemic without an enacted budget or even adjustments for medical and non-medical inflation. In addition, IHS will be forced to coordinate distribution and administration of a COVID-19 vaccine without additional federal resources and funding. In short, that is a recipe for even more disaster, death, and despair. You can prevent that from happening, and we implore you to do so by acting swiftly on the recommendations in this letter.

We thank you for your continued commitment to Indian Country, and as always, stand ready to work with you in a bipartisan fashion to advance the health of all AI/AN people.

Sincerely,

National Indian Health Board

National Congress of American Indians National Council of Urban Indian Health

1 Number of COVID-19 cases reported by IHS increased from 27,233 positive cases on July 19, 2020 to 106,393 cases as of November 30, 2020

2 On July 19, 2020, CDC had reported an age-adjusted cumulative COVID-19 hospitalization rate of 272 per 100,000 among AI/ANs; as of November 21, rates among AI/ANs were at 487.3 per 100,000.

3 Centers for Disease Control and Prevention. COVID-19 Hospitalization and Death by Race/Ethnicity. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html#footnote03

4 Indian Health Service. COVID-19 Cases by IHS Area. Retrieved from https://www.ihs.gov/coronavirus/

5The Centers for Disease Control & Prevention includes diabetes in a list of medical conditions that increase the chance of severe illness from COVID-19. Centers for Disease Prevention & Control, People with Certain Medical Conditions (Aug. 14, 2020), https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.

 

December 4, 2020

Re: FTCA Coverage for UIOs

Dear Speaker Pelosi, Leader McConnell, Leader McCarthy, and Leader Schumer:

On behalf of the undersigned national organizations collectively serving all 574 sovereign federally recognized American Indian and Alaska Native (AI/AN) Tribal Nations and all 41 urban Indian organizations (UIOs), we write to urge you to pass H.R. 6535 / S. 3650 in this Congress to provide parity in the Indian Health System. Specifically, UIOs would be extended the same insurance coverage as Indian Health Service (IHS) and Tribal facilities instead of being forced to divert scarce resources away from health care in order to foot exorbitant insurance costs.

In August, the Centers for Disease Control and Prevention (CDC) reported that across 23 states, cumulative incidence rates of lab-confirmed COVID-19 among AI/ANs are 3.5 times higher than for non-Hispanic Whites.1 Also, according to CDC, COVID-19 hospitalization among AI/ANs were 4.7 times higher than for non-Hispanic Whites.2 As this pandemic devastates Indian Country, UIOs have been forced to make extremely difficult choices – facing competing priorities and expenses, like increased PPE and renovation costs, in addition to very costly malpractice insurance. As of November, “the Oklahoma City IHS Area now has the highest total number of cases3” and the Oklahoma City Indian Clinic is one of the UIOs that pays the highest annual rate for medical malpractice insurance. If provided insurance parity with IHS and Tribal facilities, this UIO alone could direct up to an additional $250,000 to patient care at a time when increased access to care is needed most.

As you know, the trust responsibility to provide health care extends to urban Indians, as well as those Indians residing on reservations. Enacting this law before the end of this Congress would undoubtedly save AI/AN lives and increase available health care services. This legislation has broad bipartisan support in both chambers and is endorsed by IHS. NCAI has a standing resolution supporting this legislation, Resolution #PDX-20-038, “Supporting Extension of Federal Tort Claims Act (FTCA) Coverage to Urban Indian Organizations.”

We thank you for your continued commitment to Indian Country and, as always, stand ready to work with you in a bipartisan fashion to advance the health status of all AI/AN people.

Sincerely,

National Congress of American Indians National Council of Urban Indian Health

1 Hatcher SM, Agnew-Brune C, Anderson M, et al. COVID-19 Among American Indian and Alaska Native Persons — 23 States, January 31–July 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1166–1169.

2 Centers for Disease Control and Prevention. COVIDView Weekly Summary.

3 COVID-19 Data – Situation Summary (November 25, 2020)

 

December 4, 2020

Re:  Request Passage of Tribal Veterans Bills this Congress

Dear Speaker Pelosi, Majority Leader McConnell, Minority Leader McCarthy, and Minority Leader Schumer:

On behalf of the undersigned national organizations collectively serving all 574 sovereign federally-recognized American Indian and Alaska Native (AI/AN) Tribal Nations and all 41 urban Indian organizations (UIOs), we write to urge you to ensure the passage of the following tribal veteran bills in any legislative vehicle before the end of the 116th congress:

  • H.R. 4908 / S. 4909 – Native American Veterans PACT Act
  • S. 524 / H.R. 2791 – Veterans Affairs Tribal Advisory Committee Act of 2019
  • S. 2365 / H.R. 4153 – Health Care Access for Urban Native Veterans Act of 2019
  • H.R.6237 – PRC for Native Veterans Act

AI/ANs have a long history of distinguished service to this country. Per capita, AI/ANs serve at a higher rate in the Armed Forces than any other group of Americans and have served in all the nation’s wars since the Revolutionary War. In fact, AI/AN veterans served in several wars before they were even recognized as U.S. citizens. Despite this esteemed service, AI/AN veterans have lower personal incomes, higher unemployment rates, and are more likely to lack health insurance than other veterans.

The United States must honor its commitments to AI/AN veterans. The federal government’s responsibility to provide quality healthcare to AI/AN veterans comes both from their service to this country and the federal government’s treaty and trust obligations to AI/AN people. If enacted, the legislation listed above, and detailed below, moves us closer to fulfilling the federal government’s dual responsibility to AI/AN veterans, regardless of whether they are living on rural reservation lands or in major urban areas.

H.R. 4907 / S. 4909 – Native American Veterans PACT Act

Currently, AI/AN veterans are required to pay a copayment before receiving services at the VA. In the fiscal year 2017, approximately 30 percent of AI/AN veterans were charged copayments, averaging approximately $281.56 per veteran,1 representing a significant barrier to care for AI/AN veterans. The Native American Veterans PACT Act would eliminate copayments for AI/AN veterans accessing VA health care and would bring parity between those AI/AN veterans receiving services at VA and those who receive services through the Department of Health and Human Services (HHS) Indian Health Service (IHS) and under Medicaid.

The House passed H.R. 4907 on September 22, 2020, and S. 4909 was introduced on November 18, 2020, with bipartisan support. We thank Representative Ruben Gallego for introducing H.R. 895, and Senator Jon Tester and Jerry Moran for introducing S. 4909. In 2020, NCAI passed Resolution #PDX-20-008 in support of this legislation.

S. 524 / H.R. 2791 – Veterans Affairs Tribal Advisory Committee Act of 2019

AI/AN veterans, tribal leaders, and GAO have expressed the need for VA to engage with tribal stakeholders when assessing, developing, and implementing AI/AN veterans’ policy. The Veteran Affairs Tribal Advisory Committee Act of 2019 would help fulfill this need by establishing a VA Tribal Advisory Committee (VATAC). A VATAC would advise the Secretary on improving programs and services for AI/AN veterans, identify timely issues related to VA programs, propose solutions to identified issues, provide a forum for discussion, and help facilitate getting useful feedback from Indian Country. Building a strong relationship between the VA and tribal nations will increase awareness and understanding across the VA of the unique issues affecting AI/AN veterans in tribal communities. This awareness paired with more direct interaction with tribal leaders who regularly hear from AI/AN veteran constituents will ultimately produce faster solutions and better services for AI/AN veterans.

The Senate Committee on Veterans Affairs ordered S. 524 out of Committee favorably on January 29, 2020. The House Committee on Veterans’ Affairs ordered H.R. 2791 favorably on July 30, 2020. We thank Senator Jon Tester for introducing S. 524 and Representative Deb Haaland for introducing H.R. 2791. In 2019, NCAI passed Resolution #REN-19-033 in support of this legislation.

S. 2365 / H.R. 4153 – Health Care Access for Urban Native Veterans Act of 2019

UIOs are an essential part of the Indian healthcare delivery system. AI/AN veterans often prefer to use Indian healthcare providers, including UIOs, for reasons such as cultural competency, community and familial relations, and shorter wait times. However, UIOs are currently ineligible to be reimbursed for the services they provide to AI/AN veterans. The Health Care Access for Urban Native Veterans Act of 2019 would amend the Indian Health Care Improvement Act (IHCIA) to enable the VA to reimburse UIOs for services to VA beneficiaries at urban Indian health centers.

The Senate placed S. 2365 on the Senate Legislative Calendar under General Orders on December 18, 2019. The House H.R. 4153 on December 3, 2020. We thank Senator Tom Udall for introducing S. 2365 and Representative Ro Khanna for introducing H.R. 4153. In 2019, NCAI passed Resolution #REN-19-034 in support of this legislation.

H.R. 6237 – PRC for Native Veterans Act

Currently, VA reimburses IHS and tribally-run health programs for costs related to direct care to AI/AN veterans within IHS and tribal facilities. Unfortunately, the VA does not reimburse either entity for the cost of services provided by the Purchased Referred Care (PRC) program, despite IHS being codified under federal law as the payer of last resort. The PRC for Native Veterans Act would amend the IHCIA to clarify that the VA and the Department of Defense are required to reimburse the IHS and tribally-run health programs for healthcare services provided to AI/AN veterans through an authorized referral.

The House passed H.R. 6237 on July 29, 2020. We thank Representative Ruben Gallego for introducing H.R. 6237. In 2020, NCAI passed Resolution #REN-19-054 in support of this legislation.

We thank you for your continued commitment to Indian Country, and as always, stand ready to work with you in a bipartisan fashion to advance the wellbeing of our AI/AN veterans.

Sincerely,

National Indian Health Board

National Congress of American Indians National Council of Urban Indian Health

1 U.S. Gov’t Accountability Office, GAO-19-291, Actions Needed to Strengthen Oversight and Coordination of Health Care for American Indian and Alaska Native Veterans (2019).

Senate Releases FY21 Funding Bills with Increase for Urban Indian Health from FY20

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The Senate bill includes $9.6 million above the Administration’s request for urban Indian health.

Today, the Senate Appropriations Committee released its FY21 funding bills, which included their proposals for the Indian Health Service and urban Indian health. The Senate Appropriations Committee will not move forward with mark ups, but instead use these bills for spending talks with the House as they work toward a full funding package before the year ends.

The Senate proposal includes $6.2 billion for the Indian Health Service, which is $49 million less than FY20. The Senate included $59.3 million for urban Indian health, which is $1.6 million above the FY20 amount and $9.6 million above the Administration’s budget request. The language in the report states: “The Committee strongly supports this program and does not concur with the proposal to reduce the program.”

“During a tough fiscal climate, NCUIH is encouraged by the Committee’s bipartisan commitment to urban Indian health and their decision to propose an increase to the President’s request. As Native families in urban areas face the COVID-19 pandemic that is impacting our populations at devastating rates, these resources offer a literal lifeline,” said Francys Crevier, CEO of National Council of Urban Indian Health.

 Line Item  FY20 Enacted  FY21 Tribal
Budget
Formulation
Request		  FY21
President’s
Budget		  FY21 House
Proposed		  FY21 Senate
Proposed
 Urban Indian
Health		  $57,684,000  $106,000,000  $49,636,000  $66,127,000  $59,314,000

Next Steps


Senate and House appropriators must negotiate funding levels and policy provisions across the dozen bills. Congressional leaders are aiming to pass a full-year spending package before the end of the year. Lawmakers have until Dec. 11 to enact more funding before the government shuts down.

Resources

2020 Election Results in UIO Areas

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On November 7, Democratic Presidential nominee Joe Biden and running-mate Kamala Harris surpassed the required 270 electoral votes to win the oval office after securing Pennsylvania, electing them as President and Vice President-elect of the United States. Highly anticipated election results came days after Election Day on November 3 as the nation saw historic voter turnout and mail-in ballots. Counting is still being done to determine some winners of the Senate and House of Representatives seats up for election.

Three states containing Urban Indian Organizations (UIOs)—Michigan, Wisconsin, and Arizona—flipped from red states to blue states during this Presidential election compared to the 2016 election, allocating 37 electoral votes to Joe Biden. Previous blue states containing UIOs—Washington, Oregon, California, Colorado, Nevada, New Mexico, Minnesota, Illinois, New York Massachusetts, and Maryland—all remained blue states while previous red states—Montana, Utah, Texas, Oklahoma, Kansas, Nebraska, South Dakota, and Missouri—all remained red states.

Pre-election, Republicans held a 57-43 majority of the upper chamber. The Senate is currently at a deadlock with Republicans and Democrats each holding 48 seats. Of the 35 Senate seats up for election for the 117th Congress, 31 have been called. Republicans have so far won 18 seats—losing 1, and Democrats have won 13 seats—gaining 1. Senate control cannot be determined until January, as Georgia has entered a run-off for both of its Senate seats. Georgia’s GOP incumbent Senator, David Perdue, and Democrat opponent, Jon Ossoff, will face each other again in January along with Republican Kelly Loeffler and Democrat Raphael Warnock. Arizona and Colorado, both containing UIOs, flipped their Senate seats from red to blue with the election of Mark Kelly (D-AZ) and John Hickenlooper (D-CO).

The Democratic party is expected to maintain majority control in the House of Representatives. So far, 411 of the 453 seats have been processed with House Democrats holding 215 seats—losing 5 seats from the 116th Congress, and Republicans holding 194 seats—gaining 6 seats. UIO area states where neither party has flipped a House seat so far are Washington, Oregon, California, Nevada, Arizona, Utah, Montana, Colorado, South Dakota, Nebraska, Kansas, Texas, Missouri, Wisconsin, Illinois, New York, Massachusetts, and Maryland. New Mexico, Oklahoma, Minnesota, and Michigan are states that contain UIOs where Republicans flipped one House seat and Democrats flipped 0 seats.

Some states are still processing ballots that can impact these current results.

FDA Advisory Committee, VRBPAC, Holds Public Covid-19 Vaccine Development Meeting

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On October 22, a Food and Drug Administration (FDA) advisory group, Vaccines and Related Biological Products Advisory Committee (VRBPAC), and Center for Biologics Evaluation and Research’s (CBER) held a 9-hour meeting to discuss the authorization of a COVID-19 vaccine. This meeting highlighted what is known about COVID-19 and touched on major key points and challenges facing vaccine development and distribution: how trials will be conducted in terms of safety and efficacy in the event of an Emergency Use Authorization (EUA), instilling the public’s trust in the vaccine, and the inclusion of underserved minority groups and high risk populations.

The safety and efficacy of a COVID-19 vaccine raised concerns and was discussed among the committee in yesterday’s meeting. Dr. Doran Fink, Deputy Director in the Division of Vaccines and Related Products at CBER, presented on data to support a COVID-19 vaccine EUA, highlighting that there is a 2-month minimum follow-up for vaccine participants after completing the full vaccine process. Concerns were raised that the time allotted for monitoring was too short to evaluate safety and effectiveness. It was noted that and issuance of an EUA can risk unblinding a trial, and cause trial participants who are both interested in the emergency COVID-19 vaccine and approved under the EUA to withdraw— resulting in insufficient enrollment in placebo-controlled trials.

The topic of gaining the public’s trust in a COVID-19 vaccine was also of top concern among committee members. The CEO of the Reagan-Udall Foundation, Susan Winckler, presented on their COVID-19 Vaccine Confidence Project that assists the FDA with understanding public perception about the vaccine by: identifying themes in the media about the vaccine, hosting listening sessions to gather opinions, addressing concerns and questions, and checking the credibility and relevancy of messages regarding the COVID-19 vaccine. Direct quotes from their listening sessions echo concerns about the speed of the process, distrust of government, distrust of the healthcare system, concerns that politics and economics will be prioritized over science, fears that the vaccine will not work for individuals or their community, and fears based on past experiences.

Many concerns were raised among committee members regarding the inclusion of minority groups, such as American Indians/Alaskan Natives (AI/AN) and African Americans, in trials as well as high-risk groups like those with comorbidities and the elderly. Dr. Hilary Marston, Medical Officer and Policy Advisor for Pandemic Preparedness at National Institute of Health (NIH) presented that trials overseen by NIH have explicit parameters for volunteer enrollment with risk factors. She also stressed that proactive community engagement with minority groups is a top priority for NIH. VRBPAC committee members emphasized that AI/AN and other underserved minority groups are often unrepresented in medicine and are imperative to ensure widespread efficacy in the COVID-19 vaccine.

Learn more: https://www.youtube.com/watch?v=1XTiL9rUpkg&feature=youtu.be

UIOs Included in Community Care Act to Provide COVID-19 Resources to Underserved Communities

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On September 9, 2020, Representatives Lee (CA-13), Bass (CA-37), Kelly (IL-2), Chu (CA-27), Castro (TX-20), Haaland (NM-1), and Davids (KS-3) introduced the COVID Community Care Act. The bill, if passed, would establish a contact tracing program through community-based organizations and nonprofits. The bill would also provide $8.4 billion in grants to community based programs and nonprofits to conduct contact tracing with $400 million dollars going to fund COVID-19 programs administered by IHS, Tribal organizations, and urban Indian organizations (UIOs).

The COVID Community Cares Act also requires that the Secretary of Health and Human Services participate in an urban confer with UIOs before implementing the program. The bill will provide this funding to organizations that conduct contact tracing in areas with higher rates of COVID-19, a high percentage of minority residents, or those who have historically lacked access to healthcare. In order to access the funds, those hired must have experience and relationships with the people living in the community being served. The COVID Community Care Act aims to ensure that communities subject to institutionalized racism have the tools to protect themselves from the coronavirus. The bill is supported by both co-chairs of the Congressional Native American Caucus.

https://lee.house.gov/news/press-releases/reps-lee-bass-kelly-chu-castro-haaland-davids-introduce-legislation-to-provide-covid-19-resources-to-community-based-organizations-in-underserved-communities_-

NCUIH Bills on FTCA for UIOs Advance Out of House and Senate Committees

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On July 29, H.R. 6535 passed the House Natural Resources Committee. “Urban Indian organizations like the ones that serve my constituents in Phoenix are already working off shoestring budgets and shouldn’t have to sacrifice patient care to shell out millions for liability coverage,” said Rep. Ruben Gallego, who introduced H.R. 6535. The bill has also been referred to the House Energy and Commerce and Judiciary Committees where it awaits further action.

On July 29, the Senate Committee on Indian Affairs advanced their companion bill S. 3650 with an amendment to extend FTCA to Native Hawaiians.  The link to the hearing can be found here. The bill awaits further action for consideration before the full Senate, however, due to a full calendar including COVID-19 relief funding and FY21 Appropriations, passage looks unlikely.

On July 22, Robyn Sunday-Allen, NCUIH Vice President and Chief Executive Officer of the Oklahoma City Indian Clinic, testified in front of the House Subcommittee for Indigenous Peoples of the United States. Ms. Allen testified in support of H.R. 6535, the Coverage for Urban Indian Health Providers Act. H.R. 6535 would extend Federal Tort Claims Act (FTCA) coverage to urban Indian organizations (UIOs). Passage of H.R. 6535 would ensure that UIOs achieve parity with the rest of the IHS/tribal health providers/urban Indian organizations system (I/T/U system). Currently, UIOs are the only part of the I/T/U system that do not receive FTCA coverage. This Act, if passed, would save UIOs up to $250,000 a year on medical malpractice insurance-money that could be used to hire additional providers, provide additional programs, and to respond to COVID-19 and future public health emergencies.

NCUIH Vice President Testifies on FTCA Coverage for UIOs

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On July 22, Robyn Sunday-Allen, NCUIH Vice President and Chief Executive Officer of the Oklahoma City Indian Clinic, testified before the House Subcommittee for Indigenous Peoples of the United States. Ms. Sunday-Allen testified in support of H.R. 6535, the Coverage for Urban Indian Health Providers Act. H.R. 6535 would extend Federal Tort Claims Act coverage to urban Indian organizations (UIOs).

“At the Oklahoma City Indian Clinic, we spend approximately $200,000 annually on malpractice insurance, money which would be more effective if used to provide culturally competent health care to urban AI/ANs. If UIOs were covered under the FTCA, we would put every one of these dollars back into services including, but not limited to mammograms, pap smears, immunizations (adult and children), and dental sealants,” said Ms. Sunday-Allen.

During the hearing multiple parties expressed support for H.R. 6536:

“This fix would save UIOs up to $250,000 per year in coverage costs, money that can be instead spent directly on patient care. This is especially important during the current crisis which has hit UIOs extremely hard, with over 80 percent of clinics reporting cuts to services due to resource shortages. 70 percent of Native Americans today live in urban settings making our support for urban Indian organizations essential to ensuring that health care is accessible to all native people and that our trust responsibility is upheld.” said Chairman Gallego.

“COVID-19 has had a devastating impact on Native communities. In Chicago, Native Americans chart a 15 percent COVID-19 mortality rate, but we know these numbers could be higher. COVID-19 did not cause these disproportionate outcomes, rather it has exposed longstanding, systemic inequities. We cannot afford to leave urban Indians without access to care during this public health crisis. It’s long overdue to give our Urban Indian Health Centers a boost in resources to ensure our Native communities have access to high-quality health care. The ability of urban Indian organizations to provide cost-effective health services has been jeopardized by the lack of FTCA coverage commonly afforded to other federally funded Indian health programs. This should not be the case, especially during a pandemic,” said Representative Jesús “Chuy” García.

“UIOs are purchasing liability insurance with resources that could be better utilized to expand services available to Urban American Indian and Alaska Native patients. The rising cost of liability insurance and the general cost of providing health care services adversely impact the ability of UIOs to provide needed services. As a result, UIOs have had to substantially reduce or eliminate certain kinds of staff and health services, such as dental services. UIOs are an integral part of the IHS health care system. They provide high quality, culturally relevant health care services and are often the only health care providers readily accessible to Urban American Indian and Alaska Native patients. IHS endorses the policy to extend FTCA coverage to UIOs, which is consistent with the FY 2021 Budget request,” said Rear Admiral Weakhee, IHS Director.

NCUIH is grateful for the support of our Congressional and IHS partners and will continue to push for FTCA coverage and parity for urban AI/ANs and UIOs.

The Senate held a hearing on the companion bill (S. 3650) on July 1, 2020.