Sen. Murkowski questions definition of 'Indian' for health care

The Alaska Native Medical Center in Anchorage. Photo from Alaska Native Tribal Health Consortium

Sen. Lisa Murkowski (R-Alaska) is asking the Obama administration to explain why it won't expand the definition of "Indian" under the Affordable Care Act.

The law's definition is more restrictive than the one found in the Indian Health Care Improvement Act. As a result, some American Indians and Alaska Natives are being treated differently because they aren't enrolled in a federally recognized tribe or an Alaska Native corporation.

"The definition currently used by the ACA is not consistent with the definitions used for delivery of other federally-supported health services," Murkowski said in a letter to Secretary Sylvia Mathews Burwell, the head of the Department of Health and Human Services.

Indianz.Com SoundCloud: Interior & Environment Subcommittee Hearing March 11 2015

Murkowski, who chairs the Interior Appropriations Subcommittee, brought up the issue at a March 11 hearing to discuss the Indian Health Service budget. At the time, former director Yvette Roubideaux, who has since left the Obama administration, said the definition can't be changed without an act of Congress.

Murkowski, in her letter, called that response was "unsatisfactory." She said the administration has made 30 "unilateral changes" to address other issues raised by the health care law.

"Since all of these directives appear to be contrary to statutory language, why can the administration make a small change that would allow more Alaska Natives the ability to qualify for an exemption?" Murkowski asked.

In July 2013, HHS issued a rule that attempted to address the limited definition in the law. It allows American Indians and Alaska Natives to seek a "hardship exception" and avoid tax penalties for failing to buy mandatory health insurance. The exception is also supposed to allow these individuals to sign up for insurance through the health exchange system at any time, just like members of tribes and Native corporations.

The Senate Appropriations Committee approved the fiscal year 2016 Interior appropriations bill on June 18. It provides $3.5 billion for the IHS, plus nearly $718 million in a separate account to address contract support costs, for total of nearly $4.3 billion.

The House version of the Interior appropriations bill includes a lower level of funding for the IHS. The agency would see nearly $4.2 billion, a figure that includes the same amount for contract support costs as the Senate measure.

The House began consideration of H.R.2822 last Thursday before going on a break this week. Any funding differences with the Senate would have to be addressed later in legislative process.

Get the Story:
Sen. Murkowski Pushes For Tweaks To Affordable Care Act (APRN 6/29)

Federal Register Notice:
Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions; Miscellaneous Minimum Essential Coverage Provisions (July 1, 2013)

Fiscal Year 2016 Budget Request:
IHS Budget Overview | HHS Budget in Brief

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