September 26, 2017

VIDEO: Udall on Senate Floor: ACA Repeal Would Devastate Health Care for Indian Country

VIDEO: https://youtu.be/0EZvk1qfzbo

WASHINGTON — Today, U.S. Senator Tom Udall, vice chairman of the Senate Committee on Indian Affairs, denounced the devastating impact Senate Republicans' efforts to dismantle the Affordable Care Act (ACA) would have on Indian Country. In remarks on the Senate floor, Udall said repeal of the ACA and Medicaid expansion would be disastrous for Indian Country and violate the government's trust and treaty obligation to ensure Native Americans receive quality health care. He and Senate Indian Affairs Committee Democrats Heidi Heitkamp (D-N.D.) and Catherine Cortez Masto (D-Nev.) gave back-to-back speeches in what is known as a “colloquy.”

Before the ACA, Udall said, "'Don’t get sick after June' was a familiar refrain on many reservations, pueblos, and villages. Limited funding meant medical services were often rationed to emergency care or 'life and limb' only." He noted that Native organizations describe the ACA and Medicaid expansion as an “unqualified success“ for Indian Country. Udall continued, “The ACA has brought new hope to Native families and communities."

But the latest version of Trumpcare, sponsored by U.S. Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), would have violated the federal government's trust and treaty responsibility by gutting the ACA and taking away health care from hundreds of thousands of Native Americans, Udall said.

“It is difficult to adequately describe the recklessness, cruelty, and cynicism apparent in the Republicans’ rush to tear down the ACA," Udall said, urging Senate Republicans to stop the attacks on the ACA and work with Democrats on bipartisan solutions to improve health care across Indian Country. "Partisan repeal of the ACA is not right for Indian Country or for America," he said.

The full text of Udall’s remarks is available below.

Mr. President, I rise today with my colleagues from the Senate Committee on Indian Affairs – Senators Heitkamp, and Cortez Masto – to talk about how the Republicans’ latest – and most heartless – health care bill hurts American Indians and Alaska Natives.

I’ve just heard some good news that this bill might not be brought up for a vote this week. But Republicans insist that they will continue their efforts to repeal the Affordable Care Act and raid the Medicaid program, which will devastate Indian Country so this latest withdrawal is great. But they're saying it's not going away and so we have to maintain vigilance on this issue.

We came together before in July when the Republicans’ Better Care Reconciliation Act threatened to roll back health care for Native communities.

With that bill’s defeat, we hoped the debate over legislation that jeopardized health care for Native communities was behind us, and we hoped that we could begin to work in earnest on a bipartisan basis to address the real health care problems that all Americans face.

Given this new threat, my Indian Affairs Committee colleagues and I must remind this chamber, once again, that the federal government bears a solemn trust and treaty responsibility and obligation to ensure that Native Americans receive quality health care.

Each version of Republican repeal we have seen so far violates that trust responsibility by taking health care away from hundreds of thousands of Native Americans and abdicating the federal government’s Native health care responsibilities.

If any of these proposals pass, Native Americans’ health and lives will be endangered.

These efforts must be stopped.

Everyone familiar with Indian Country knows that the Indian Health Service is severely underfunded.

“Don’t get sick after June” was a familiar refrain on many reservations, pueblos, and villages. Limited funding meant medical services were often rationed to only emergency care or “life and limb." IHS patients were not guaranteed access to comprehensive medical services, specialized services, or preventive care.

The Affordable Care Act and Medicaid expansion changed this equation.

The ACA alone has increased third-party billing revenues to IHS more than 25 percent, and Medicaid funding for IHS has increased nearly 50 percent. Tribal and urban health facilities have been able to move away from health care rationing.

Medicaid expansion has provided health insurance to an additional 290,000 Native Americans from 492 Tribes – almost 90 percent of all Tribes. This includes 45,600 Tribal members from my home state of New Mexico.

Uninsured rates in Indian Country have decreased from 53 percent to 39 percent.

And many Tribal communities’ uninsured rates are even lower:

•At the Santo Domingo Pueblo in New Mexico, 22 percent of Kewa Pueblo Health Corporation’s patients were uninsured in 2013. In 2016, the uninsured rate was down to 7 percent.
•At the Santa Fe IHS Service Unit in New Mexico, 84 percent of our patients now have some sort of insurance.
•On the Turtle Mountain reservation in North Dakota, they’ve seen a 14 percent reduction in uninsured Tribal members.
•At the Portland Urban Indian Health Center, the rate of uninsured has gone from 56 percent to 8 percent, solely due to Medicaid expansion.

This is impressive. Let me just say this again, gone from 56 percent to 8 percent.

Medicaid expansion has helped make up for the historic underfunding of IHS services:
•Third party billing revenue through Medicaid now makes up 35 percent of Kewa Pueblo Health Corporation’s total budget.
•For the Jicarilla Apache Tribe in New Mexico, Medicaid makes up more than 75 percent of their third party billing revenue.
•And, at Navajo Crownpoint IHS Hospital, 50 percent of their budget comes from Medicaid third-party billing revenue.
•For Seattle’s urban Indian health clinic, operated by the Seattle Indian Health Board, Medicaid and Medicaid expansion have resulted in a revenue increase of 146 percent since 2012.

And Medicaid expansion has allowed IHS to expand services and build new facilities.
•Kewa Pueblo Health Corporation has used some of its third party billing to offer new specialty care services – like obstetrics and podiatry – and to build new clinic space.
•Santa Fe IHS used its additional funds to build new examination rooms for Santa Clara Pueblo, establish a mobile health service unit for San Felipe Pueblo, and update
outpatient rooms at the main clinic in Santa Fe.
•The Seattle urban Indian clinic uses its additional revenue to expand patient services to include a pilot opioid addiction program.

In the words of the National Council on Urban Indian Health Medicaid expansion has been an “unqualified success” for Indian Country. The ACA has brought new hope to Native families and communities.

But this latest Republican plan will undo this success. Thank goodness it's been withdrawn. In it, they claimed they will preserve Medicaid expansion eligibility for Tribes, this offers false hope.

Like most people on Medicaid, Tribal members go on and off the rolls as their income fluctuates.

Proposals like Graham-Cassidy would require that they be continuously enrolled in Medicaid expansion and work to receive benefits. If not, they will be dropped permanently from the program.

Section 128 of Graham-Cassidy is also being pushed as “helpful to Indian Country.” This section expands IHS’s federal reimbursement rate to non-Native providers. But, really, it is a veiled attempt to buy off state leaders concerned about massive cuts to the Medicaid program.

It will not improve Tribal health facilities. It will undercut the IHS. And, it will undermine Tribal self-determination by bypassing Tribal input in the federal Medicaid reimbursement process.

And there are 30,000 Native Americans who now have private individual health insurance thanks to the ACA.

Every Republican plan so far strips away the ACA’s cost-sharing subsidies and tax credits that help make private insurance affordable for many of these Tribal members and for millions of working Americans.

The Republican bill does nothing to help these Native Americans keep their health insurance.

The sponsors can try to dress this bill up, but the glaring reality is that TrumpCare 2 would be terrible for Indian Country. In fact, it is worse for Tribes than any other proposed repeal plan so far.

It’s no surprise that prominent Native organizations -- the National Indian Health Board, the National Congress of American Indians, and the National Council on Urban Indian Health -- oppose Graham-Cassidy and proposals like it.

They join virtually all major patient advocate and medical organization in their opposition, including the American Heart Association, American Cancer Society, American Lung Association, and the American Medical Association.

Eighty percent of the American people disapproves of the Republicans’ attempts to undermine health care.

Graham-Cassidy is woefully out of touch with the American people and, especially, with Indian Country. I am glad that this bill won’t receive a vote this week.

Mr. President, just like tens of millions of our fellow Americans, Tribes, Tribal organizations, and individual Native Americans all around the country are worried what Republicans will do to their health care.

I’ve received a record 15,000 calls, emails, and letters from constituents about health care this year. Almost all of them have been opposed to the Republicans’ relentless attacks on health care, and not a single Tribe has reached out to my office in support of this bill.

These attacks are happening behind closed doors. There was only one rushed hearing – and it was yesterday! There was no formal Congressional Budget Office analysis. And there has been no meaningful consultation with Tribes. Although many of us have called for that, there has been no consultation.

It is difficult to adequately describe the recklessness, cruelty, and cynicism in the Republicans’ rush to tear down the ACA.

The Senate Health, Education, Labor and Pension Committee started a bipartisan effort to address the real health care needs in this country, but Republicans froze it once Graham-Cassidy was introduced. I'm really hoping now that Chairman Lamar Alexander and Vice Chairman Patty Murray can get back to the bipartisan work that needs to be done.

Other time-sensitive legislation with broad bipartisan support – like reauthorization of the Children’s Health Insurance Program and the Special Diabetes Program for Indians, which need to be enacted before the end of September – were pushed aside.

Congress needs to change focus. We need to work across the aisle to meet the needs of the American people.

And we need to improve Native health care. We have come a long way under the ACA and Medicaid expansion, but we are far from being able to declare victory.

I echo our colleague from Arizona, Senator McCain, given the enormous impact of health care on the lives of Americans and on our economy, we need to find bipartisan solutions through regular order.

Partisan repeal of the ACA is not right for Indian Country or for America.