Native American health advocates are worried the legal battle over the Affordable Care Act will end significant gains for Indian health care.
They say if the Obama-era healthcare act is dismantled, that would also strip away laws that provide funding for tribal health care.
"A lot of folks don't know this, but the Indian Healthcare Improvement Act, which is really the backbone legislation for the entire Indian health system, was permanently reauthorized with the Patient Protection and Affordable Care Act," says Devin Delrow, director of policy at the National Indian Health Board.
On Monday his group, along with nearly 500 tribes and tribal organizations, filed a brief with the court which will soon decide whether to uphold a federal judge’s December ruling that the Affordable Care Act is unconstitutional.
Delrow’s organization argues that no matter what the court decides for the fate of the ACA, specific provisions for Native Americans within the act need to be protected.
"Those provisions are completely severable from the ACA, so they should remain intact and should not be struck down," he says.
Delrow says protecting the Indian Healthcare Improvement Act, or IHCIA is a main priority.
IHCIA allows the Indian Health Service to be reimbursed by Medicare, Medicaid, and other third party insurers. It’s been around since 1976 and was permanently reauthorized in 2010 when it was embedded into the Affordable Care Act.
Delrow says there are other Indian-specific parts of the ACA that need to be protected too, like a requirement that Indian health organizations be the payer of last resort for medical costs.
"The loss of IHCIA and the other provisions would certainly have a really devastating impact."
It’s an impact that would be felt by tribal and urban Indian health centers across the country. And would strain an already chronically underfunded system.
Delrow says this isn’t the first time Native American health advocates have been concerned about the potential demise of the Affordable Care Act.
When Congress tried to repeal and replace the law in 2017, the National Indian Health Board worked with legislators to make sure that every piece of new legislation introduced preserved ICHIA and Indian-specific provisions.
"Because members of Congress realize Indian health care is a bipartisan priority," Delrow says.
For now, while the the Indian health care system and the ACA remain intertwined, advocates like Delrow will have to wait to see how things unfold in the Fifth Circuit Court of Appeals.