Indian Health Care Improvement Act Not Targeted in House Health Reform Plan

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On Monday night, House Republican leadership of two key committees, Energy & Commerce and Ways & Means, each released legislation to reform the nation's healthcare systems and change many aspects of the Affordable Care Act.
Crucially, neither committee's draft legislation included repeal of the Indian Healthcare Improvement Act (IHCIA), which was passed in 2010 as part of the ACA but remains unrelated to the main structure of the law's healthcare reforms. Other Indian-specific pieces of the ACA are also left intact.
The bill would make significant changes to the private insurance system: the tax penalty for individuals not purchasing and employers not offering healthcare would be $0, effectively repealing the individual and employer mandates.
  • However, to incentivize coverage, insurance companies would be allowed to surcharge premiums by 30% for one year for individuals who go without insurance coverage for 63 days or more.
To provide assistance to Americans who struggle to purchase health insurance, the bill creates refundable tax credits based on income and age.
  • These credits replace subsidies in the ACA for those with incomes below 400% of the poverty level.
  • The credits are most generous to Americans with income below $75,000 and are gradually phased out as income rises.
  • The credits to older Americans are more generous than the credits to younger Americans, but not by enough to close the gap between the higher premiums older Americans pay and the less expensive premiums the younger pay.
The taxes currently financing the ACA would be repealed starting in 2018, except for the "Cadillac Tax" on high-cost insurance plans, which would take effect in 2025. It is unclear at this time if the proposed reforms are sufficient to cover the cost of the bill.
Medicaid Expansion is preserved as is until 2020, after which federal funds stop going to the states to fund the expansion and states are no longer allowed to offer the program to the expansion population. The legislation also includes $15 billion dollars in annual grants through 2026 to states for a "Patient and State Stability Fund" to assist in covering uninsured populations.
Medicaid is reformed to a per capita system, capping the program's overall spending. The bill would also eliminate the mandate for state Medicaid programs to offer "essential services." The 100% federal reimbursement rate for American Indians and Alaska Natives remains in place.
Due to the vital role the Medicaid program plays in fulfilling the federal trust responsibility, NIHB is extremely concerned about the changes the bill enacts to Medicaid Expansion.
Both the House Ways and Means Committee and House Energy and Commerce Committee will mark up the legislation tomorrow morning. You can read the text of the Ways and Means legislation here and the section by section here. You can read the Energy and Commerce text here and the section by section here
Indian Healthcare Improvement Act Introduced
Also last night, Congressman Tom Cole (R-OK) introduced H.R. 1369 which would include the text of the IHCIA as enacted as part of the Affordable Care Act (except for date changes). His office said that they do not expect that IHCIA would be repealed, but wanted to have this legislation as a safeguard should anything unexpected occur. 

If you have any questions about the American Health Care Act or H.R. 1369 please contact NIHB's Director of Congressional Relations, Caitrin Shuy at or (202) 507-4085.