Action Alert

March 16, 2006

NCIL Supports Timely Reauthorization of Indian Health Care Improvement Act (IHCIA) [S 1057]

Yesterday, NCIL sent a letter to Senate leaders declaring our strong support for the timely approval of the reauthorization of S 1057 – the Indian Health Care Improvement Act (IHCIA). This bill reauthorizes the Indian Health Service, authorizes the delivery of home and community based services to Native Americans for the first time, addresses severe health disparities that have lowered life expectancy by six years among Native Americans as compared to the general population, and strengthens community mental health programs to address the mental health crisis facing Native Americans.

Native American leaders from the National Congress of American Indians have told us how crucial this legislation is to empower them to meet the needs of those with disabilities in their communities. According to Jefferson Keel, the Lieutenant Governor of the Chickasaw Nation, nearly 3 in 5 Native Americans have some kind of disability. Please find NCIL’s letter of support and a fact sheet outlining key background information on the legislation below and attached.

We believe that it is vital for this bipartisan legislation cosponsored by Indian Affairs Committee Chair John McCain (R-AZ) and Ranking Member Byron Dorgan (D-ND) be enacted before the close of the 109th Congress. This reauthorization is already several years overdue. It is important that we send a message that all Americans – including Native Americans – should have access to first-rate, quality, modern health care.

HOW YOU CAN HELP: Any advocates who are represented by Senators on the Finance Committee are encouraged to contact these Senators to urge support for expediting this important legislation and ensuring that it gets consideration by the full Senate ASAP.

>>To check if your Senator is on the Finance Committee, see
http://www.finance.senate.gov/sitepages/committee.htm.

FOR MORE INFORMATION: If you have questions, or need additional information, e-mail Daniel Davis at Daniel@ncil.org or call him at (202)-207-0334, ext# 1001.

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Attachment #1 NCIL Letter of Support

NCIL
National Council on Independent Living
1710 Rhode Island Avenue, NW, 5th Floor
Washington, DC 20036
Voice: (202) 207-0334
TTY: (202) 207-0340
FAX: (202) 207-0341
E-mail: ncil@ncil.org
Website: www.ncil.org

March 13, 2006

Re: National Council on Independent Living Support for the Reauthorization of the Indian Health Care Improvement Act [S 1057]

Dear Majority Leader Frist, Minority Leader Reid, Chairman Grassley and Ranking Member Baucus:

The National Council on Independent Living (NCIL) writes to inform you of our strong support for the long-overdue Reauthorization of the Indian Health Care Improvement Act [S 1057]. We believe that it is imperative that this bipartisan legislation supported by Indian Affairs Committee Chairman John McCain (R-AZ) and Ranking Member Byron Dorgan (D-ND) be adopted before the close of the 109th Congress. The last four Congresses have demurred from passing reauthorization legislation and the most recent authorization expired in 2001. Now is the time for us to begin to address the tremendous health disparities and to confront the mental health crisis facing Native American communities, and to ensure that community mental health and home and community based services are delivered to the first Americans.

NCIL is the oldest cross-disability, national grassroots organization run by and for people with disabilities. Our membership is comprised of centers for independent living, state independent living councils, people with disabilities and other disability rights organizations. As a membership organization, NCIL advances independent living and the rights of people with disabilities through consumer-driven advocacy. NCIL envisions a world in which people with disabilities are valued equally and participate fully. One of our top priorities is advancing the provision of health care to persons with disabilities in home and community based settings – an option that is not currently available to Native Americans.

Reasons why we believe that it is vital that this reauthorization be passed during the 109th Congress include

>>About three in five Native Americans are also persons with disabilities.

>>Under its current framework, the IHCIA does not even allow Native Americans to benefit from home and community based services.

>>The life expectancy of Native Americans is nearly six years less than any other race or ethnic group in America.

>>Thirteen percent of American Indian/ Alaskan Native deaths occur in those younger than 25, a rate three times higher than the average U.S. population.

>>Native American communities are facing a mental health crisis of such a severe magnitude that the current IHCIA framework is unequal to the challenge.

>>The U.S. Commission on Civil Rights reported in 2003 that “American
Indian youths are twice as likely to commit suicide…Native Americans are 630 percent more likely to die from alcoholism, 650 percent more likely to die from tuberculosis, 318 percent more likely to die from diabetes,
and 204 percent more likely to suffer accidental death compared with other groups.”

In our view, the need is so compelling that reasonable Senators should be able to put partisan differences aside and act in the best interest of the Native American community – THIS YEAR. This is an American issue.
It is an affront to American values to let these grievous health disparities remain unaddressed by the US Senate for another month – much less another year.

Please feel free to contact Daniel Davis at 202-207-0334 ext 1001 or Daniel@ncil.org if you have any
questions or wish to get further clarification about NCIL’s position on this vital issue.

Thank you for your timely consideration.

Respectfully,

John Lancaster
NCIL Executive Director

Kelly Buckland
NCIL President

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Attachment #2 IHCIA Fact Sheet

NATIONAL CONGRESS OF AMERICAN INDIANS AND NATIONAL INDIAN HEALTH BOARD

REAUTHORIZATION OF THE INDIAN HEALTHCARE IMPROVEMENT ACT: S. 1057 109th Congress Second Session

What is included in the Indian Health Care Improvement Act (IHCIA) Reauthorization, S. 1057?

· Establishes objectives for addressing the disparity in the health status of Indians as compared with other Americans

· Enhances the ability of IHS and tribal health programs to attract and retain qualified Indian health care professionals

· Provides innovative mechanisms for reducing the backlog in health facility needs

· Establishes a continuum of care through integrated behavioral health programs—both prevention and treatment –to address alcohol/substance abuse problems and the social service and mental health needs of Indian people

· Facilitates greater decision-making regarding program operations and priorities at the local tribal level in order to improve services to tribal populations.

What is the Indian Health Care Improvement Act (IHCIA)?

The United States has a longstanding trust responsibility to provide health care services to American Indians and Alaska Natives. This responsibility is carried out by the Secretary of the United States Department of Health and Human Services through the Indian Health Service. Since its passage in 1976 the Indian Health Care Improvement Act (IHCIA) has provided the programmatic and legal framework for carrying out the federal government’s trust responsibility for Indian health.

The Indian Health Care Improvement Act (IHCIA) is the law under which authority under which health care is administered to American Indians and Alaska Natives.

Why is it necessary to reauthorize the IHCIA?

It is customary for Congress, through the reauthorization process, to take a fresh look at major laws every 5-7 years to update, modernize and refresh them so that they reflect the evolution of conditions and needs. It has been 13 years since the Congress last performed a comprehensive review of the IHCIA (since 1992). IHCIA reauthorization proposals have been introduced in the last four Congresses, but, none have passed. Congress now has a new opportunity to reauthorize the IHCIA during the 109th Congress. It is time to do so.

The IHCIA contains a number of provisions that authorize appropriation of funds to support the programs set forth in the law; however, the life of these provisions ended in fiscal year 2001. Fortunately, a 1921 law, the Snyder Act (25 USA§ 13)1, provides permanent authority for appropriation of funds for Indian health, so Congress can and does continue to appropriate funds for these programs. Nonetheless, Congress should act to officially extend the life of the IHCIA authorization and to update the bill to reflect both current needs of Indian health and the current methods of health care delivery and systems enjoyed by most Americans.

· It has been 13 years since the Act was last reauthorized. In that time the American health care delivery system has been revolutionized while the AI/AN system of health care has not.

· Reauthorization, or modernization, of this law is necessary that achievements are made in the Indian health systems and to improve the health status of Indian people and to make further advancements.

· For example, mainstream American health care has moved out of hospitals and into people's homes; focus on prevention has been recognized as both a priority and a treatment; and, coordinating mental health, substance abuse, domestic violence, and child abuse services into comprehensive behavioral health programs is now standard practice. We are proud of the work tribes and Indian Health Service have done to incorporate these innovations into the current bill. Reflecting these improvements is a critical aspect of reauthorization.

· One highlight of the bill includes advances in the delivery of mental health services. Through adoption of a continuity of care and whole person approach, mental and behavioral health services will be brought into a system that moves away from treating symptoms and into a synthesized delivery system that treats the whole person. This method and approach to mental and behavioral health will integrate addressing areas such as substance abuse, suicide prevention, violence prevention, areas so critically in need of attention and action in Indian country.

Disease Prevention and Health Promotion

· There is also a critical need for health promotion and disease prevention activities in Indian Country and provisions of the IHCIA reauthorization would address this need.

· Disease prevention and health promotion activities elevate the health status at both the individual and community level.

· The need for these activities is clear: life expectancy of Native Americans is nearly six years less than any other race or ethnic group in America. Thirteen percent of AI/AN deaths occur in those younger than 25, a rate three times higher than the average U.S. population. The U.S. Commission on Civil Rights reported in 2003 that

“American Indian youths are twice as likely to commit suicide…Native Americans are 630 percent more likely to die from alcoholism, 650 percent more likely to die from tuberculosis, 318 percent more likely to die from diabetes, and 204 percent more likely to suffer accidental death compared with other groups.” Disease prevention and health promotion are at the core of this legislation.

Flexibility

· The IHCIA allows for greater flexibility in defining health care delivery models at the local level, where knowledge of “what works best” is most relevant. This takes the administrative burden off the Federal government and empowers local health care decision-makers to make assessment and delivery decisions while also creating accountability for outcomes.