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INDIAN HEALTH CARE IMPROVEMENT ACT

ISSUE

The Indian Health Care Improvement Act (IHCIA), Public Law 94-437, expired on September 30, 2000, and was extended through 2001 in anticipation that Congress would consider the reauthorization proposals pending in Congress. Since 2001, the Congress has held hearings on the reauthorization proposals. While there have been various versions of the bill considered by the Congress since that time, the work on reauthorization of the IHCIA has not been completed.

BACKGROUND

The IHCIA is considered to be the cornerstone legal authority for the provision of health care to American Indians and Alaska Natives. This authority builds upon the Snyder Act of 1921, which is the basic and first legislative authority for Congress to appropriate funds specifically for health care provided by the IHS. The IHCIA of 1976 was enacted into law based upon findings that the health status of Indians ranked far below that of the general population. The Act declared that it was this Nation’s policy to elevate the health status of the Indian population to a level at parity with the general U.S. population. Since its first passage in 1976, the Act has been reauthorized four times.

SITUATION

During late 1998 and 1999, the IHS actively consulted with Indian country on amendments to the existing Act to provide tribal and urban Indian health programs with the programmatic and administrative capabilities to provide high quality health care to their constituents. A National Steering Committee (NSC) on the reauthorization of the IHCIA was established in the summer of 1999 to review the recommendations received during the consultation process, to reconcile differences in the recommendations from the various areas of Indian country, and then to complete a legislative draft that reflected the final recommendations. In October of 1999, the NSC forwarded their legislative proposal to the leadership of the Executive and Legislative Branches, as well as to tribal governments and urban Indian health programs. The House Committee on Resources and the Senate Committee on Indian Affairs both introduced legislation almost identical to the NSC draft. Both chambers have held hearings on the reauthorization proposals since 2000 and both reported the reauthorization bills out of committee on September 22, 2004.

During the second session of the 108th Congress, the IHS and the Department of Health and Human Services (Department) worked with the congressional committees to resolve areas of concern with the pending legislative proposals. Time ran out before a bill could be finalized that would address the Department’s concerns. A reauthorization proposal was reintroduced in the Senate in the 109th Congress and was favorably reported with amendments by the Senate Committee on Indian Affairs on October 27, 2005. No further action occurred on the proposals before the end of the 109th Congress. In the 110th Congress, both chambers introduced similar proposals, H.R. 1328 and S. 1200, to reauthorize the IHCIA. The Senate Committee on Indian Affairs held a hearing on S. 1200 on March 8, 2007, and reported the bill out of Committee on May 10. On February 26, 2008, the Senate passed S. 1200. The House Committee on Resources reported the bill favorably on April 25, 2007. The Health Subcommittee of the House Energy and Commerce Committee held a hearing on H.R. 1328 on June 7 and reported the bill on November 7, 2007. The full committee had not held a hearing on the measure. In Spring 2008, the House Speaker gave the Energy and Commerce Committee and the Ways and Means Committee until June 6 to report H.R. 1328 out of those committees; those committees did not meet the deadline. As of mid-June, the House is considering what version of the bill to bring to the floor. The Department and IHS have continued to work with the congressional committees of jurisdiction on the IHCIA reauthorization. A bill report on H.R. 1328 was sent to the committees of jurisdiction in the fall of 2007 that detailed the Administration’s concerns with the legislation.

OPTIONS/PLANS

By the end of the first session of the 110th Congress, the IHS and the Department had testified at 13 hearings on the reauthorization of the IHCIA. Work will continue on the reauthorization effort in the second session of the 110th Congress. Tribal governments and urban Indian health program leaders will continue to push for passage of the reauthorization legislation this year.

ADDITIONAL INFORMATION

For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.

June 2008

This file last modified:   Thursday June 26, 2008  7:08 AM