Category Archives: health care legislation

Medicare and Medicaid Funding in Jeopardy

USET and other organization are asking for help lobbying for tribal consultation on the changes to Medicare and Medicaid funding to Indian country.  The rules have changed that leave it to State’s to set work requirements for eligibility for Medicaid funding through the 1115 waiver process.  This could severely impact Indian Health service funding.  Therefore AI/AN Medicaid recipients must be made exempt from these barriers to accessing the health care to which they are entitled, and CMS has a duty to ensure that this occurs as a part of the waiver process. Medicaid currently represents 67% of 3rd party revenue at IHS, and 13% of overall IHS spending.   Tribal organization are advocating that any proposed changes to the administration of Medicaid must be preceded by comprehensive consultation with Tribal Nations. Currently, the 1115 waiver process requires that states engaged in Tribal Consultation prior to submission of 1115 Demonstrations to CMS. CMS must ensure Tribal consultation with Tribal Nations occurs at both the state and federal levels before state waiver applications can proceed.

See USET Letter

 

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Washington Update: Budget, Health Care, and Tribal Energy

 
WASHINGTON LEGISLATIVE UPDATE:  
Budget – Health Care – Special Diabetes Program  and Tribal Energy 

 

On Oct. 5, the House passed a bill for the 2018 budget that lays out the foundation to take advantage of Senate rules for recent tax reform proposals. The Senate allows tax and spending measures to pass with a simple majority. The House budget plan accommodates $203 billion in future spending cuts meant to offset the tax reform’s projected $1.5 trillion increase to the deficit. Meanwhile, budget legislation has gone through committee in the Senate, poised for a floor vote later this month. This bill directly allows a $1.5 trillion deficit increase to be written into tax legislation. Republicans believe that the deficit increase will be offset by economic growth but this conclusion has yet to be thoroughly researched.
The House’s budget will allow $203 billion in spending cuts. These cuts have yet to be finalized and negotiations will likely be stalled by discussion on the pending tax bill. GOP leaders have made a point of prioritizing tax reform and writing the budget to reflect this emphasis. Senate Republicans are skeptical of tax reform proposals like repealing the state and local tax deduction, but are willing to support the budget to move along tax negotiations. The Senate has asked the Energy and Natural Resources Committee to find $1 billion in deficit savings. These savings would likely come from the opening of the Arctic National Wildlife Refuge to fossil fuel extraction. The two budget proposals expect to balance by 2027, mostly through cuts to federal entitlement in future legislation.
The Senate pulled its most recent healthcare reform effort, the Graham-Cassidy proposal, from the voting schedule, due to a lack of support within the party. The legislation would have removed Medicaid expansion, cost-sharing protections, and premium subsidies. The bill also would have transferred federal trust responsibility over Medicaid to the states. On Sept. 29, President Trump signed into law FAA appropriations that included $37.5 million in funding for the Special Diabetes Program through the first quarter of FY2018. Rep. Mullin (R-OK) has introduced a bill, H.R.3917, which will supplement this funding with $112.5 million for the remainder of FY2018 and $150 million for FY2019.
The House Committee on Natural Resources is waiting to vote on H.R. 210, the Native American Energy Act. The Indian Tribal Energy Development and Self-Determination Act Amendments, S.245 (Hoeven R-ND), has passed through committee and has been waiting for a floor vote since May. The two measures work to support tribal energy independence. The House initiative would streamline the land asset appraisal process, support biomass production, and add tribal consent restrictions for Interior rules on energy production. The Senate bill extends to tribes the state and municipality hydroelectric license preference and DOE energy development loans. DOE would allow inter-tribal organizations to qualify for grants and Interior would provide technical assistance with energy resource development. Additionally, Interior would defer to tribal resource agreements and certified tribal energy development organizations for energy-related leases, rights-of-way, and business agreements. See Washington Post Article for further developments
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