By YVETTE TUELL
Office of Public Affairs
The Northwest Portland Area Indian Health Board (NPAIHB) provides updates and summaries of congressional legislative and policy updates to the tribes in the northwest. This is the latest summary provided from Laura Platero, who is the Executive Director of the NPAIHB, that identifies the current discussions occurring in various congressional committees.
This fall, Congress has been working on numerous appropriation bills on tribal health care. Congress is now on recess for the Thanksgiving holiday and both the House of Representatives and the Senate will reconvene on November 30.
Tribal Health Bills Advance: On November 16, by voice vote, the House of Representatives passed House Subcommittee on Indigenous Peoples of the United States Chairman Gallego’s bill which would amend the Indian Health Care Improvement Act to clarify the requirement of the Departments of Veterans Affairs and Defense to reimburse the Indian Health Service, tribes and tribal organization for certain health care services provided to Native veterans (H.R. 6237). The House-passed bill has been referred to the Senate Indian Affairs Committee. On November 18, the Senate Indian Affairs Committee held a business meeting and approved four bills on which Committee hearings have been held.
New Bills of Interest: On November 17, Senators Murkowski and Hassan in the Senate and Representative Keating in the House of Representatives introduced companion (or similar) legislation which would extend the end date by which tribes, states and territories must expend their Coronavirus Relief Fund monies under the CARES Act from this December 30 to September 31, 2021 (S. 4898 and H.R. 8742). The Senate bill was referred to the Senate Finance Committee, while the House bill was referred to the House Oversight and Reform Committee.
Status of FY 2021 Appropriations: Congress faces the December 11 deadline set by the continuing appropriations resolution when federal funding will expire. One of the highly-anticipated and key items of business during this “lame duck” session is negotiations between Senate Majority Leader McConnell and House Speaker Pelosi on some final FY 2021 appropriations deal. If agreement can be reached, an FY 2021 omnibus appropriations package that will combine all 12 FY 2021 appropriations bills will be developed. Additional coronavirus relief assistance that both chambers and both political parties agree on may be included, or may separately. If agreement is not achieved by December 11, another FY 2021 continuing resolution may extend federal funding at current levels until late February or early March, 2021.
The House Appropriations Committee marked up all 12 of its FY 2021 bills in July, and the full House passed 10 of them, (the Legislative Branch and Homeland Security bills were not brought to the House floor). The White House threatened to veto all 10 of the House spending measures.
The House passed the 10 FY 2021 appropriations bills in two packages: the FY 2021 Military Construction and Veterans Affairs appropriations bill (H.R. 7608), which included the FY 2021 Agriculture and Rural Development (H.R. 7610), Interior and Environment (H.R. 7612), and the State and Foreign Operations (H.R. 7608) appropriations measures, and the FY 2021 Defense appropriations bill (H.R. 7617), which included the Commerce, Justice, Science (H.R. 7667), Energy and Water Development (H.R. 7613), Financial Services and General Government (H.R. 7668), Labor, Health and Human Services, Education (H.R. 7614), and Transportation, Housing and Urban Development (H.R. 7616) appropriations bills.
As included in H.R. 7608, the Indian Health Service is increased overall by $445 million over FY 2020, for a total of $6.5 billion. There is an increase of $225 million for Services, totaling $4.5 billion, and an increase of $23 million for Facilities, totaling $935 million. Every IHS account but one would receive an increase over the current level. (Community Health is proposed to be level-funded at the FY 2020 level.) Purchased/Referred Care would be increased by $47.1 million over FY 2020, for a total of just over $1 billion. The House bill rejects the Administration’s proposed cuts and eliminations that were contained in the FY 2021 budget request to Congress.
The newly-created IHS Payment for Tribal Leases account would be funded by the House at $101 million. IHS Contract Support Costs would be funded at $916 million, a $96 million increase over the FY 2020 enacted amount. Like approved by the House, the Senate “mark” would fund Payment for Tribal Leases at $101 million, and IHS Contract Support Costs at $916 million.
The Senate Appropriations Committee did not officially mark up any of the 12 FY 2021 appropriations bills in Subcommittee. On November 10, the Committee released the bill text and explanatory statements for all the FY 2021 spending measures for use in negotiations with Senate and House Democrats on a final package.
Overall, the Senate Appropriations Committee recommends a total of $6.2 billion for IHS, of which $4.3 billion is for Services, a decrease of $49 million from the FY 2020 enacted level, and $927 million for Facilities, an increase of $15.2 million. While all Facilities line items are proposed for increases over FY 2020, and most Services line items are level-funded at or increased over FY 2020, there is a $78.6 million reduction to the Hospitals and Health Clinics line item.
The explanatory statement of the Committee offers this:
The decrease in funding for this subactivity is directly related to the establishment of a separate appropriation account for the mandatory costs associated with Tribal leases under section 105(l) of the Indian Self-Determination Act (Public Law 93–638). The Committee notes that while a separate account is being established for the lease costs, enacted funding levels have been continued for Village Built Clinics, and the bill language has been amended to reflect the changes necessary for the new structure for Tribal leases payments [emphasis added. Thus, not only will House and Senate negotiators have to resolve differences in funding levels, but differences in bill language, as well].
Purchased/Referred Care would be funded at $977.2 million, in contrast to $1 billion in the House-passed bill.
Within the Hospitals and Health Clinics section of the explanatory statement, the following may be of interest to Idaho tribes, even though only the Coeur d’Alene Tribe is utilizing the dental health therapy program:
Within the funds provided, $2,000,000 is to be used for the dental health therapy education program that currently trains students in Alaska, Washington, Idaho, and Oregon. The Committee also directs the Service to continue the cooperative agreement with the National Indian Health Board from within existing funds.