Letter to Hon. Nancy Pelosi, Speaker of the House and Hon. Kevin McCarthy, House Minority Leader - Mullin Urges House Leaders to Include Funding for IHS, Tribal Health Facilities in Next Relief Package

Letter

Dear Speaker Pelosi and Minority Leader McCarthy,

As you continue to work on legislation to provide economic support and relief to Americans across the country, we urge you to include a significant coronavirus relief appropriation dedicated to Indian Health Service (IHS), Tribal Health Programs and Urban Indian Organizations (I/T/U) to recover from significant COVID-19 related losses in revenue.

One issue that has continued to strain IHS resources during the COVID-19 pandemic is the lack of a specific emergency coronavirus relief fund to replace third-party reimbursement revenue for the I/T/U system. Third-party billing receipts are integral to the financial stability of the I/T/U system because the funding that Congress appropriates each year for the Indian Health Service is insufficient to cover the cost of all of the health care needs for American Indian and Alaska Native individuals. Third-party reimbursements from private insurance as well as Medicare, Medicaid and the Veterans Health Administration make up a significant portion of funding for tribal health care facilities.

In 2019, federally-operated IHS facilities alone reported $1.14 billion in third-party collections, equaling roughly a fifth of the entire IHS budget for that year. For Tribal health programs, third- party dollars can equate to over half of their operating budgets for healthcare. Third-party reimbursements for Urban Indian Organizations (UIOs) now total more than the entire urban Indian health annual appropriation.

During the course of the COVID-19 pandemic, many I/T/U facilities have stopped conducting elective procedures and limited most non-COVID-19 related care. As a result, these facilities have experienced a drastic reduction in third-party reimbursements. These reimbursements are essential to allow programs to make payroll, expand services, and provide quality care to patients.

Without an emergency coronavirus relief fund to help I/T/U sites, tribal health care facilities may be in danger of closing, and the health disparities that already exist in Indian Country will become further exacerbated. For example, American Indian and Alaska Native communities suffer disproportionately from many health issues that make them highly susceptible to COVID-19, including hypertension, asthma, cancer, and heart and cardiovascular disease. Failure to secure the necessary funds and resources to provide COVID-19 related care is putting these communities at risk.

In order to ensure the sustainability and operational health of I/T/U sites around the country, we urge you to include a significant coronavirus relief appropriation specifically dedicated to supporting I/T/U health care facilities. This will ensure that funding is provided in a way that more closely meets the needs of all IHS assisted facilities.

The CARES Act allocated $100 billion for hospitals and providers of which the Department of Health and Human Services provided $400 million to IHS. According to analysis by the National Indian Health Board and the National Council of Urban Indian Health, this funding will be insufficient to address the need in Indian Country and we urge you to explicitly provide direct coronavirus relief funding to help I/T/U facilities replenish lost revenue.

Thank you for your consideration of this request to include a specific coronavirus relief fund to help I/T/U facilities replace lost third-party reimbursement revenue. We look forward to continuing to work with you to fulfill the trust and treaty responsibilities of the United States Government to provide for the health and well-being of American Indians and Alaska Natives.