September 22, 2017

Udall: Graham-Cassidy TrumpCare Bill Disastrous for Indian Health Care

Calls for bipartisan approach to improve health care for Native Americans

WASHINGTON – Today, U.S. Senator Tom Udall, vice chair of the Senate Committee on Indian Affairs, released the following statement on the Graham-Cassidy TrumpCare bill’s effects on health care in Indian Country:

“Senate Republicans are trying to force through the Graham-Cassidy repeal bill -- another version of TrumpCare that would be truly disastrous for American Indians and Alaska Natives. The bill’s massive cuts to the Medicaid program would devastate access to life-saving health care across Indian Country. The Graham-Cassidy TrumpCare legislation is an irresponsible and dangerous abdication of our federal government’s trust responsibilities to Tribes. If enacted, this bill would jeopardize the health and lives of Native Americans in Tribal and urban Indian communities everywhere.

“This damaging bill would totally dismantle all of the advancements we’ve made to expand access to quality health services for American Indians and Alaska Natives. The Medicaid expansion under the Affordable Care Act has provided a lifeline to Indian Country, filling persistent funding gaps at the Indian Health Service and enabling IHS facilities to provide essential services beyond the ‘life and limb only‘ level. Underfunding at IHS has forced Native health care facilities to ration care – and prior to the Affordable Care Act, people across Indian Country lived by the unofficial motto: ‘Don’t get sick after June.’ Now, thanks to the Medicaid expansion, many Native Americans finally have access to the services they need to keep themselves and their families healthy. But Graham-Cassidy would undo all that progress.

“Republicans are clearly having trouble even selling this misguided bill to senators and governors in their own party. As vice chair of the Indian Affairs Committee, I’ve heard from too many Native Americans who are disturbed by the lack of Tribal consultation in the reckless Republican repeal effort – and who fear the devastating consequences of this TrumpCare approach to legislating. Instead of dismantling the gains we’ve made under the Affordable Care Act, we should be working in a bipartisan way to build on our progress, improve health care, and fully uphold our duties to Tribes. I encourage senators on both sides of the aisle to come together to oppose the Graham-Cassidy Trumpcare legislation and, instead, work to find solutions to ensure that everyone in Indian Country has access to the care they need."

Udall also highlighted a report from the Center on Budget and Policy Priorities (CBPP), which shows the devastating consequences of the Graham-Cassidy bill for American Indians and Alaska Natives.

In July, Udall led a day of action in the Senate to increase awareness about the devastating impacts TrumpCare would have on Indian Country. Udall chaired an emergency roundtable to hear directly from Tribal leaders about the importance of the Affordable Care Act for Native health. Udall also delivered a floor speech with several colleagues from the Indian Affairs Committee to encourage more members of Congress to consider Indian country during any discussion about health care.

The CBPP report is available below and here.

Like Prior Repeal Bills, Cassidy-Graham Puts Coverage for American Indians, Alaska Natives at Risk
By Jessica Schubel

American Indians and Alaska Natives (AI/ANs) benefit greatly from the Affordable Care Act’s (ACA) coverage expansions, with 290,000 AI/ANs now enrolled in Medicaid, as we’ve explained. The ACA repeal bill from Senators Bill Cassidy and Lindsey Graham includes two provisions that purport to help AI/ANs, but the bill’s overall changes to Medicaid would ultimately mean less health coverage for that group, not more.

Let’s take these provisions one at a time.

First, Cassidy-Graham would end the ACA’s Medicaid expansion starting in 2020, but it would let AI/ANs who remain continuously enrolled in Medicaid remain covered after the expansion ends for everyone else. Any help that this exception provides would be short-lived, however. Low-income people frequently move on and off Medicaid, depending on their economic circumstances, so most AI/ANs would likely lose Medicaid eligibility within a year or two because, starting in 2020, anyone who dropped off Medicaid and then became eligible again wouldn’t be able to get back on.

Second, Medicaid currently pays 100 percent of the cost of services that Indian Health Service (IHS) and Tribally operated facilities provide for AI/ANs. Like the ACA repeal legislation that the Senate rejected in July, Cassidy-Graham would enable Medicaid to also pay 100 percent of the cost of services that non-IHS and Tribally operated facilities provide for AI/ANs.

This provision, too, could benefit states with large AI/AN populations in the short term, but it wouldn’t help states, AI/ANs, or IHS or Tribally operated facilities in the long run. That’s because Cassidy-Graham has the same core structural elements of prior Senate ACA repeal bills, which would jeopardize coverage for AI/ANs and the financial stability of IHS and Tribally operated facilities.

In addition to ending the Medicaid expansion in 2020, Cassidy-Graham fundamentally overhauls Medicaid’s financing, ending the current federal-state financing partnership and converting all of Medicaid to a per capita cap that would not keep pace with rising per capita health care costs. These changes would force states to make cuts in eligibility and benefits (on top of ending their expansions) that would grow deeper over time. While payments for services to AI/ANs would fall outside of the per capita cap, AI/ANs would not be immune to benefit and eligibility cuts. If, say, a state cut home- and community-based services or organ transplants, these cuts would apply to everyone, including AI/ANs. If Medicaid no longer covers a service, Medicaid funding for that service isn’t available for anyone — period.