Tribes Seek Protection Of Native Health Care Gains In "Obamacare" Lawsuit

The National Indian Health Board and a consortium of Tribes and Tribal agencies have filed an amicus brief in the “Obamacare” lawsuit, where a federal judge in Florida ruled the federal government’s landmark healthcare reform unconstitutional. The lawsuit was filed after President Obama signed into law the Patient Protection and Affordable Care Act, which is designed to provide health care coverage to all Americans.

The primary issue in the lawsuit, which is now on appeal, is whether the Constitution allows the federal government to require individual Americans to purchase health care insurance. Over two dozen states joined together to oppose the reform legislation, arguing that the federal government does not have the power to compel individuals to purchase health care insurance. The lawsuit was filed in federal court in Florida, and the trial judge ruled the legislation unconstitutional. The matter is now being reviewed by the 11th Circuit Court of Appeals.

Within the federal health care reform legislation, there are sections that provide significant benefits for Native American health care programs. The legislation permanently re-authorized the Indian Health Care Improvement Act, which provides funding and administrative support for health care in Native communities throughout the country. In their amicus brief, Tribes have asserted that the portions of the health care legislation that impact Native Americans are constitutional and should be “severed” from any portions of the legislation that are ultimately determined to be unconstitutional. That would allow for funding and other improvements to Tribal health care to continue even if other portions of the new law are overturned.

Interestingly, the portions of the law applicable to Native American health care actually provide and exemption for Native Americans from the individual insurance purchase requirement – which is consistent with the goals of the states seeking to have the new laws overturned. This provides a potential opportunity for agreement between the states and Tribes, where all sides could concur on the validity of the sections that improve health care for Native communities.

Arctic Slope Native Association Launches Major Native Hospital Construction Project

Arctic Ocean Beach in Barrow, Alaska (Nels Akerlund)

In a landmark event that will provide a quantum leap forward in health care for Alaska Natives residing above the Arctic Circle, the Arctic Slope Native Association (ASNA) has issued an $82 million contract for construction of a modern hospital in Barrow, Alaska – the northernmost city in North America. ASNA’s project team worked for more than a decade in cooperation with the federal Indian Health Service to plan, design, and obtain funding for the facility, which will provide much-needed health services to Native communities located in Alaska’s northernmost region.

After signing the historic contract, ASNA President and CEO Marie Carroll stated:

“The ASNA Board of Directors from the Native communities in the Arctic region are happy to see progress on a long-awaited project, which will replace a 2x4 constructed, 45-year old hospital opened in 1964. Everyone in our region is looking forward to having a modern hospital to go to where there are no other options for primary care or hospital services -- the next closest hospital is nearly 300 miles away in Fairbanks, Alaska.”

In addition to the ultimate goal of improved health care for the local Native communities, the project will provide a significant economic stimulus to the region during the two-year construction period. Another noteworthy aspect of the project: the prime contractor that will build the hospital is a joint venture between UIC Construction LLC and SKW/Eskimos, Inc. – both of which are Native-owned businesses. Foster Pepper attorney Greg Guedel, who served as ASNA’s legal advisor during the contract negotiations, noted: “This project is an inspiring example of Native government, Native-owned businesses, and the federal government working together to improve the quality of life for Alaska Natives. The benefits of this work will accrue to the Native communities in the region for generations.”

Hope for Change: Improving Health Care in Indian Country

Last month President Obama invited leaders from 564 American Indian tribes to discuss important issues in Indian Country, including the delivery of better health care.

Congress is currently debating a health care overhaul and it might just be the catalyst for significant improvements to the Indian health system. According to experts, if the overhaul was to happen there would be direct streams of money to the Indian health care system which would give Native Americans more treatment options over time. The Senate Indian Affairs Committee will meet this week to discuss other Indian health issues that could end up in the overhaul bill.


President Obama also proposed a budget increase of 13 percent for the federal Indian Health Service, which provides free care to 1.9 million Indians who are members of federally recognized tribes, most of whom live on tribally owned land. The service, which had a budget this year of $3.3 billion, has also received $500 million in stimulus money for construction, repairs and equipment. Many Native American leaders believe this is a positive step in narrowing the gap in Indian health care, which is substantially underfunded.


The Indian Health Care Improvement Act also stands a good chance of being reauthorized by Congress for the first time since 2001, and it would enhance programs, physician recruitment and hospital construction. Although it approves no funding, advocates hope it will prompt additional money.

Given the current climate in Congress, and the President’s support, some believe it will be easier to get Native American provisions in the health care bills, but for now there is no guarantee, just hope.


Re-Examining Native American Health Care

Earlier this month, the Senate Committee on Indian Affairs discussed a report that indicates Native Americans suffer disproportionately from poor health due to underfunding of the Indian Health Service.

According to the National Steering Committee for Reauthorization of the Indian Health Care Improvement Act (IHCIA),  Native Americans have a level of health care funding that would be considered unacceptable for other American citizens.

The Northwest Portland Area Indian Health Board then cited alarming statistics that show that Native Americans are 638 percent more likely to die from alcoholism, 400 percent more likely to die from tuberculosis, 291 percent more likely to die from diabetes complications, 91 percent more likely to die from suicide and 67 percent more likely to die from pneumonia and influenza.

In order to improve the quality of the healthcare that Native Americans receive, supporters are encouraging Congress to reauthorize IHCIA. The law has not been reauthorized since 1992 and ideally, any reauthorization legislation would put important decision-making powers in the hands of tribal leaders. Not just because these leaders understand the needs of their own people the best (which they do) but also because tribal nations are capable of managing their own health care systems.

According to the Aberdeen Area Tribal Chairman’s Health Board and the Standing Rock Sioux Tribe, IHCIA is a good framework for a Native American health care overhaul, but safeguards need to be in place to assure that tribal sovereignty is protected. Congressmen say they understand the sovereignty issue but still believe the government should establish general eligibility rules so there is a fair distribution of funds for tribes in all parts of the country.

The sooner a compromise is achieved and the sooner IHCIA is reauthorized, the better healthcare will be for those that need, and deserve it, the most.