NCUIH TESTIFIES BEFORE CONGRESS ON “NATIVE VETERANS’ ACCESS TO HEALTHCARE”

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On October 30, 2019, the House Committee on Veterans’ Affairs, Subcommittee on Health conducted an oversight hearing entitled “Native Veterans’ Access To Healthcare”. NCUIH Board Vice President and CEO of the Indian Health Center of Santa Clara Valley Sonya Tetnowski (Makah) testified before the Subcommittee with Rep. Brownley presiding.

“While we know Native Americans serve at higher rates than anyone else they also endure the lowest health status of anyone else. This is a national shame, and a terrible violation of the trust responsibility the United States government is obligated to uphold. We must do better,” said House Committee on Veterans’ Affairs Chairman Mark Takano.

“We serve, we protect and yet we struggle to have parity in the system. I’m sad to report that American Indians and Alaska Natives have the highest poverty rate and the highest uninsured rate of any veterans. Urban Indian Organizations (UIOs) provide high-quality, culturally competent care to urban Indians, which consists of 75% of all American Indians and Alaska Natives (AI/ANs). We ask that the Department of Veterans Affairs (VA) fully implement the VA and Indian Health Services’ Memorandum of Understanding (VA-IHS MOU) and Reimbursement Agreement for Direct Health Care Services. This action would allow UIOs to be reimbursed for providing healthcare to AIAN Veterans. Most AI/AN veterans live in urban areas and would benefit from the culturally competent care provided at UIOs,” said Sonya Tetnowski in her testimony.

More Information

https://veterans.house.gov/events/hearings/subcommittee-on-health-oversight-hearing-native-veterans-access-to-healthcare

Panel One

  • Andrew C. Joseph Jr., Chairman of the Northwest Portland Area Indian Health Board, National Indian Health Board (NIHB)
  • President, National Congress of American Indians (NCAI)
  • Chief William Smith, Vice Chairperson, Alaska Native Health Board (ANHB)
  • Sonya M. Tetnowski, Vice-President, National Council on Urban Indian Health (NCUIH)
  • Chief Marilynn Malerba, Mohegan Tribe of Connecticut, Indian Health Service Tribal Self-Governance Advisory Committee (IHS TSGAC)

Panel Two

  • Dr. Kameron Matthews, Deputy Under Secretary for Health for Community Care, Veterans Health Administration

Accompanied by

  • Dr. Thomas Klobuchar, Executive Director, Office of Rural Health, Department of Veterans Affairs
  • Benjamin Smith, Deputy Director for Intergovernmental Affairs, Indian Health Service

Video

President Trump Announces Intent to Nominate Michael D. Weahkee for IHS Director, Other Nomination Updates

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On Tuesday, October 22, the White House announced on its website the President’s intent to nominate Michael D. Weahkee to the post of Director of the Indian Health Service (IHS).  Rear Admiral Weahkee has served as Principal Deputy Director and Acting Director of IHS and also as Assistant Surgeon General of the United States Public Health Services at the Department of Health and Human Services.  RADM Weahkee previously served as the chief executive officer at the Phoenix Medical Center.

In addition, on Wednesday, October 23, sources including Politico and Bloomberg Government reported that President Trump plans to nominate Stephen M. Hahn to the post of Commissioner of the Food and Drug Administration, pending clearance of a background check.  Hahn currently serves as a radiation oncologist at the M.D. Anderson Cancer Center in Houston, Texas.

NCUIH to Testify before Congress on “Native Veterans’ Access to Healthcare”

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The hearing hosted by the House Veterans’ Affairs, Subcommittee on Health will take place on Wednesday, October 30, 2019 at 10:00 AM EST.

On Wednesday, October 30, 2019, the Committee on Veterans’ Affairs, Subcommittee on Health will hold a hearing entitled “Native Veterans’ Access to Healthcare.” This oversight hearing will examine the unique barriers American Indian and Alaska Native veterans continue to face when seeking access to quality, culturally competent care from VA and tribal health systems. NCUIH Board Vice President and CEO of the Indian Health Center of Santa Clara Valley Sonya Tetnowski (Makah) will be testifying before the Subcommittee. With Rep. Brownley presiding, the hearing will take place in House Visitors Center 210 at 10:00 AM EST.

More Information

https://veterans.house.gov/events/hearings/subcommittee-on-health-oversight-hearing-native-veterans-access-to-healthcare

Panel One

  • Andrew C. Joseph Jr., Chairman of the Northwest Portland Area Indian Health Board, National Indian Health Board (NIHB)
  • President, National Congress of American Indians (NCAI)
  • Chief William Smith, Vice Chairperson, Alaska Native Health Board (ANHB)
  • Sonya M. Tetnowski, Vice-President, National Council on Urban Indian Health (NCUIH)
  • Chief Marilynn Malerba, Mohegan Tribe of Connecticut, Indian Health Service Tribal Self-Governance Advisory Committee (IHS TSGAC)

Panel Two

  • Dr. Kameron Matthews, Deputy Under Secretary for Health for Community Care, Veterans Health Administration

Accompanied by

  • Dr. Thomas Klobuchar, Executive Director, Office of Rural Health, Department of Veterans Affairs
  • Benjamin Smith, Deputy Director for Intergovernmental Affairs, Indian Health Service

Update: Plaintiffs in ICWA Litigation Petition Court for Rehearing

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On October 1, Plaintiffs in Brackeen v. Bernhardt, the case centering on the constitutionality of the Indian Child Welfare Act (ICWA), filed petitions for rehearing of the case en banc. Essentially, the Plaintiffs are asking the entire 17-member U.S. Court of Appeals for the Fifth Circuit to rehear the case, in effect setting aside the decision a panel of three Fifth Circuit judges issued in August.

As previously reported, in its August decision the court overturned a District Court finding that held ICWA unconstitutional declaring it creates a separate set of practices for a racial group. In doing so, the Fifth Circuit affirmed that ICWA and its implementing regulations are constitutional, recognizing the unique political status of tribes, American Indians, and Alaska Natives. On October 2, the court ordered the U.S. and Intervenor Tribes (Cherokee Nation, Morongo Band of Mission Indians, Oneida Nation, Quinault Indian Nation, and Navajo Nation) to respond to the petitions by Tuesday, October 15.

During the 2018 litigation, NCUIH joined an amicus brief with nearly 400 Indian organizations and tribes in support of ICWA. Typically, courts deny petitions for rehearing and leave the court’s prior decision to stand. However, there is no guarantee. The court could choose to rehear aspects of the case, the mechanics of which (timing, extent of new briefing, etc.) the court would subsequently determine, or it could change parts of its decision without even granting the petition.

NCUIH will continue to monitor progress in the case, along with other amici curiae, and will provide updates as we receive them. It is important to note that although the Fifth Circuit will first have to act on the petition for rehearing, Plaintiffs will still be able to petition the ruling to the U.S. Supreme Court.

White House Expected to Sign Short Term Renewal by Sept. 30 with Funding for SDPI through November 21

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The Senate cleared the bill today and it now heads to the President for a signature.

  • Today, the Senate cleared the stopgap government funding bill and it now awaits the President’s signature. The bill is a Continuing Resolution (CR) that will keep the government open beyond September 30, when it is set to expire, through November 21. The CR that moved forward in the Senate today and the House version include funding for the Special Diabetes Program for Indians (SDPI) and other public health extenders through November 21, 2019.
  • The bill will keep the government operating at current levels giving Congress five legislative weeks to negotiate the Fiscal Year 2020 budget and departmental appropriations.
  • The President is expected to sign the bill before the funding expires on September 30 and will avert a government shutdown.

 Current Legislation

For questions, comments or concerns, feel free to contact NCUIH Director of Congressional Relations Carla Lott at cmlott@ncuih.org.

House Subcommittee Reviews the Health Care Access for Urban Native Veterans Act

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A legislative hearing was held on H.R. 4153.

September 19, 2019 (Washington, DC) – On Thursday, September 19, 2019, the House Subcommittee for Indigenous Peoples of the United States held a Legislative Hearing on H.R. 4153 (Rep. Ro Khanna), “Health Care Access for Urban Native Veterans Act” in 1324 Longworth. Expert witness testimony was provided by Sonya Tetnowski (Makah), Chief Executive Officer of the Indian Health Center of Santa Clara Valley in California, Vice President of the National Council of Urban Indian Health (NCUIH), President of the California Consortium for Urban Indian Health (CCUIH).

“Serving our urban Native Veterans is not a partisan issue – it is an obligation of the United States government to our veterans and American Indians and Alaska Natives. We are glad to see Members of Congress from both sides of the aisle come together to take action to help Native veterans in urban areas receive greater access to health care. Thank you to Chairman Ruben Gallego and Ranking Member Paul Cook for conducting a hearing and bringing NCUIH as an expert witness. We look forward to seeing the full Committee take up this legislation soon,” said NCUIH Executive Director Francys Crevier.

Representative Ro Khanna and Senator Tom Udall, Vice Chairman of the Senate Committee on Indian Affairs, introduced the Health Care Access for Urban Native Veterans Act, a bill to improve health care access for Native American Veterans by providing Department of Veterans Affairs (VA) coverage for care that Native American Veterans receive at urban Indian health centers.  This legislation would include “urban Indian organizations” in the statute requiring the VA to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans. According to the VA, 61% of Native American veterans do not reside in rural areas.

VA-IHS MOU Background

Bill Background

NCUIH Submits Comments to IHS on a Fiscal Year (FY) 2019 Opioids Grant Program

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On Tuesday, September 3, NCUIH submitted comments to the Indian Health Service (IHS) on its Urban Confer regarding FY 2019 opioid funding for a Special Behavioral Health Pilot Program (SBHPP).  In the comments, NCUIH provided the following recommendations:

In the comments, NCUIH provided the following recommendations:

  • The SBHPP objectives should be clearly stated and well-designed to address the opioid epidemic, and include sufficient flexibility
  • The SBHPP must be flexible and allow creativity in program design in order to be most effective
  • Adequate funding for UIOs to combat the opioid epidemic is key to advancing the goal of quality data collection and evaluation
  • It is important that any effectiveness measures are not prescriptive and allow for flexibility because using a sole metric may work well in some areas but for a variety of reasons not be an adequate representation of success in others
  • Sufficient data and appropriate evaluation metrics are important for the longevity of the program

The comments reiterated support for a SBHPP and the importance that UIOs be included in any such program design.

ICWA Held Constitutional in a Big Win for Indian Country

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Today, the U.S. Court of Appeals for the Fifth Circuit found the Indian Child Welfare Act (ICWA) constitutional, overturning a decision from the U.S. District Court for the Northern District of Texas. Last October, a U.S. district judge declared ICWA unconstitutional under the Fifth Amendment’s Equal Protection Clause, arguing that it creates a separate set of practices for a racial group. The Brackeen v. Bernhardt case was appealed to the U.S. Court of Appeals for the Fifth Circuit, where NCUIH joined nearly 400 Tribes and Indian organizations in filing an amicus curiae brief in support of ICWA’s constitutionality.

In its opinion filed today, the Court rendered judgment in favor of the defendants (the federal government and four tribes) on all claims. The Court held that ICWA is constitutional because: it is based on a political classification that is rationally related to the fulfillment of Congress’s unique obligation toward Indians; ICWA preempts conflicting state laws and does not violate the Tenth Amendment anticommandeering doctrine; and ICWA does not violate the nondelegation doctrine. The court also concluded that a Bureau of Indian Affairs Final Rule implementing ICWA is valid and constitutional.

Tribal leaders, Indian organizations, child advocates, and attorneys specializing in Indian law had been concerned that if the Texas ruling were upheld, it could have opened the door to constitutional challenges of other federal laws based on the special political relationship between AI/ANs and the U.S. government – including laws and regulations affecting health care, housing, criminal jurisdiction, gaming, and the environment.

Recent federal actions related to Medicaid and Native American Housing Block Grants have also signaled that a redefinition of “Indian” as racial could be used to take away benefits that fulfill the federal government’s trust responsibility to American Indian and Alaska Native people.

You can view the opinion here.

UIO Call to Action Toolkit: Health Care Access for Urban Native Veterans Act

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Call to Action: Ask Congress to Authorize the VA to Reimburse UIOs for Health Care

Representative Ro Khanna and Senator Tom Udall, vice chairman of the Senate Committee on Indian Affairs, introduced the Health Care Access for Urban Native Veterans Act, a bill to improve health care access for Native American Veterans by providing Department of Veterans Affairs (VA) coverage for care that Native American Veterans receive at urban Indian health centers.  This legislation would include “urban Indian organizations” in the statute requiring the VA to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans. To ensure that the Health Care Access for Urban Native Veterans Act receives as much support as possible, we encourage you to contact your Member of Congress and request that they sign on as a cosponsor of this bill (if they have not already).

Write to Your House Member

Please use the following text below as a template to call or email to your Representatives. You should call and email your representative; you can find your representative here.

Dear Representative [ ],

On behalf of [program] and the communities we serve, we respectfully request you sign on as a cosponsor to the Health Care Access for Urban Native Veterans Act recently introduced by Representative Ro Khanna and Senator Udall.  This bill is a critical language fix that would include “urban Indian organizations” in the statute requiring the Department of Veterans Affairs (VA) to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans.

Urban Indian Organizations (UIOs) are an integral part of the American Indian and Alaska Native (AI/AN) health care delivery system. However, due to an oversight in legislation UIOs are the only part of the IHS Indian/Tribal/Urban (I/T/U) system that do not receive reimbursement under the VA-IHS MOU reimbursement agreement. However, UIOs were created by Congress as a response to Tribes that wanted to ensure their members would receive quality health care off of reservations as part of the trust obligation.

The Department of Veterans Administration has stated that it cannot address the issue on its own, and that only Congress has the authority to correct this oversight. The Health Care Access for Urban Native Veterans Act of 2019 would ensure that all three branches of the I/T/U system receive reimbursement for health care services delivered to AI/AN veterans.   At [Your Program] we offer [services you provide]. With reimbursement under the VA-IHS MOU reimbursement agreement we could [expand services/hire additional staff/etc].  We hope you will become a cosponsor of the Health Care Access for Urban Native Veterans Act and show your support for the health of urban AI/AN Veterans.

For the sake of the health of American Indian and Alaska Native Veterans and the fulfillment of the U.S. trust obligation,  we request your support of this simple language fix. To sign on, please contact Mr. Will McKelvey (Will.Mckelvey@mail.house.gov ) 202-225-2631 from Congressman Ro Khanna’s office.

Sincerely, [Executive Director/CEO]

Write to Your Senator

Please use the following text below as a template to call or email to your Senators.  You can find your Senators here.

Dear Senator [ ],

On behalf of [program] and the communities we serve, we respectfully request you sign on as a cosponsor to the Health Care Access for Urban Native Veterans Act (S.2365) recently introduced by Senator Udall and Representative Ro Khanna.  This bill is a critical language fix that would include “urban Indian organizations” in the statute requiring the Department of Veterans Affairs (VA) to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans.

Urban Indian Organizations (UIOs) are an integral part of the American Indian and Alaska Native (AI/AN) health care delivery system. However, due to an oversight in legislation UIOs are the only part of the IHS Indian/Tribal/Urban (I/T/U) system that do not receive reimbursement under the VA-IHS MOU reimbursement agreement. However, UIOs were created by Congress as a response to Tribes that wanted to ensure their members would receive quality health care off of reservations as part of the trust obligation.

The Department of Veterans Administration has stated that it cannot address the issue on its own, and that only Congress has the authority to correct this oversight. The Health Care Access for Urban Native Veterans Act of 2019 would ensure that all three branches of the I/T/U system receive reimbursement for health care services delivered to AI/AN veterans.

At [Your Program] we offer [services you provide]. With reimbursement under the VA-IHS MOU reimbursement agreement we could [expand services/hire additional staff/etc].  We hope you will become a cosponsor of the Health Care Access for Urban Native Veterans Act and show your support for the health of urban AI/AN Veterans.

For the sake of the health of American Indian and Alaska Native Veterans and the fulfillment of the U.S. trust obligation, we request your support of this simple language fix. To sign on, please contact Ms. Kim Moxley (Kim_Moxley@indian.senate.gov ) 202-224-2251 from Senator Udall’s office.

Sincerely, [Executive Director/CEO]

Press Release: Bipartisan, Bicameral Legislation Introduced to Improve Health Care Access for American Indian and Alaska Native Veterans in Urban Areas

Washington, DC (August 2, 2019) — Today, Senator Tom Udall (D-NM) and Representative Ro Khanna (D-Calif.) introduced the Health Care Access for Urban Native Veterans Act (S. 2365) which would improve health care access for American Indian and Alaska Native (AI/AN) veterans by providing Department of Veterans Affairs coverage for care that AI/AN vets receive from Title V Urban Indian Organizations (UIOs). The legislation allows AI/AN veterans better access to culturally-competent care and alleviates burdens on the VA system. In addition to Udall and Khanna, the bill is co-sponsored by U.S. Senators Jerry Moran (R-Kan.), Jon Tester (D-Mont.), ranking member of the Senate Committee on Veterans Affairs, Mike Rounds (R-S.D.), and Tina Smith (D-Minn.) and U.S. Representatives Paul Gosar (R-Ariz.), Ben Ray Luján (D-N.M.), Don Young (R-Alaska), Gwen Moore (D-Wis.), Paul Tonko (D-N.Y.), Greg Gianforte (R-Mont.), Don Bacon (R-Neb.), and Deb Haaland (D-N.M.).   

The National Congress of American Indians (NCAI) passed a resolution in July supporting this legislative fix to help UIOs have the resources to better serve AI/AN veterans. The bill is also supported by the Iraq and Afghanistan Veterans of America and VoteVets.

“The Health Care Access for Urban Native Veterans Act is important legislation to ensuring that our veterans in urban areas are no longer left behind. Now, the Department of Veterans Affairs will have the explicit authority to reimburse the 41 Title V Urban Indian Organizations who are already providing critical resources for American Indian and Alaska Native veterans who have served the United States,” said NCUIH Executive Director Francys Crevier.

“The National Council of Urban Indian Health has made it a priority to ensure that Urban Indian Organizations are included in the IHS-VA MOU to help provide health care to American Indian and Alaska Native veterans. As a Native veteran myself, I understand the importance of coming home and knowing I have a safe space to receive care. Thank you to my own Representative Ro Khanna,  and we are grateful for the leadership of the 116th Congress in introducing this landmark legislation,” said NCUIH Vice President Sonya Tetnowski.

“At First Nations Community HealthSource, we never turn anyone – veteran or not – away. Native veterans in Albuquerque consider our facility a safe, accessible space to receive health care. With critical underfunding, this legislation would allow all Urban Indian Organizations to finally be reimbursed for the necessary care we already provide to our Native veterans,” said Linda Son-Stone, NCUIH Secretary and Chief Executive Officer of First Nations Community HealthSource, an Urban Indian Organization and member of NCUIH.

The NCAI resolution states: “The National Congress of American Indians (NCAI) urges Congress to pass legislation that amends the Indian Health Care Improvement Act at 25 U.S.C. §1645(c) to insert UIOs after IHS and Tribal Organizations and require VA to reimburse for services provided to AI/AN veterans at all of the IHS, Tribal, and urban (I/T/U) system, in order to protect the health and welfare of AI/AN veterans living in urban centers, thereby honoring their sacrifices.”