Analysis

Supreme Court affirmed the Indian Health Care Improvement Act Too

Levi Rickert, editor-in-chief in Native Health. Discussion »

WASHINGTON – Thursday's US Supreme Court decision on the constitutionality of the Affordable Care Act was the most significant decision since the high court decided the 2000 presidential election.

US Supreme Court Indian Health Care Improvement Act

In its affirmation of Affordable Care Act by a 5-4 decision, the Supreme Court also affirmed the Indian Health Care Improvement Act, which passed along with the Affordable Care Act on March 23, 2010.

The National Congress of American Indians President Jefferson Keel issued the following statement after Thursday's decision was announced:

“This is an important step for healthcare in Indian Country; the permanence of the Indian Health Care Improvement Act has been affirmed and NCAI will stay focused on working with all members of Congress to uphold the trust responsibility to tribes. Moving forward, we are focused on improving health care for Indian Country, while ensuring the Indian Health Care Improvement Act remains protected and implemented as enacted.”

The Indian Health Care Improvement Act permanently authorizes daily healthcare delivery to nearly two million American Indians and Alaska Natives served by the Indian Health Service, who are in critical need of improved health care services. A snapshot of health conditions highlights the critical need for improving healthcare in Indian Country; Native people suffer from higher rates of diabetes and related illness, heart disease, and substance abuse than any other group.

The Indian Health Care Improvement Act authorizes new programs within the IHS to ensure the Service is more equipped to meet its mission to raise the health status of American Indians and Alaska Natives to the highest level.

For example, it includes:

Authorities for new and expanded programs for mental and behavioral health treatment and prevention;
Expanded authorities for long term care services, including home healthcare, assisted living and community-based care;
New authorities for development of health professional shortage demonstration programs;
Expanded authorities for funding of patient travel costs;
New authorities for demonstration projects for innovative healthcare facility construction;
New authorities for the provision of dialysis services;
Improvements in the Contract Health Services program, which pays for referrals;
New authorities for facilitation of care for Indian veterans; and
New authorities for urban Indian health programs.

The passage of the Indian Health Care Improvement Act in 2010 represented a fourteen year-long effort by the National Congress of American Indians, tribal leaders, and advocates to make permanent the legislative commitment by the federal government to deliver healthcare for American Indian and Alaska Natives.

The Indian Health Care Improvement Act was originally passed in 1976 and last reauthorized in 2000.

For states, the ruling means they now have to get to work to implementing their obligations under the law - setting up health benefit exchanges.

States face a November 16 deadline to file for federal approval of their health exchanges, which will serve the individual and small group insurance markets.

The decision also means the law's complex framework remains intact.

Employers with 50 workers or more will be required to provide health insurance or pay penalties. Insurers will not be able to discriminate against sick people.

Subsidies to help pay for insurance will be extended to people earning up to 400 percent of the federal poverty level. Insurance companies will be forced to meet standards for how much money they spend on health care as opposed to administrative costs. And the Medicare prescription drug coverage gap known as the doughnut hole will eventually disappear.

posted June 30, 2012 7:00 am edt