The fight over the Affordable Care Act continues. A conservative “replacement” would create health savings accounts for patients in the Indian health service. That measure would also repeal the Indian Health Care Improvement Act.

Frightening Words: Indian Health Service Is Out of Money; Will You Die Waiting?

Mark Trahant
2/5/14

On a tribal bulletin board this week these chilling words were posted: “Due to budget issues, Contract Health Service will be on Priority One until further notice.”

Why are these words frightening? It means the underfunded local unit of the Indian Health Service is out of money on an important line item. It means that unless your illness is serious -- threatening life or limb -- you will have to wait.
Sometimes that wait can be deadly. And it’s wrong. It reflects a system that is out of balance and the consequences are life threatening to American Indians and Alaska Natives.

A couple of years ago, at a Senate hearing, a story was told about a heart attack patient who was left on a gurney with a note taped on her thigh that read: “If you admit this person, understand we're out of contract health care money. Do it at your risk.”

The Affordable Care Act, or Obamacare, is supposed to eliminate this underfunding. The complicated mechanism is designed to increase the number of American Indians and Alaska Natives with basic insurance, Medicaid, tribal insurance, or a policy from a marketplace exchange, money that then goes into the Indian health system directly. The Affordable Care Act is designed to substantially increase third-party billing, a revenue stream that does not require appropriation from Congress. And, I should add, a revenue stream that could add a couple of billion dollars to the Indian health system. Full funding ... in theory.

So what’s the problem? Why is there a bulletin board warning patients that’s there is not enough money?

The main reason is that critics of the Affordable Care Act are determined to make certain that this law is a wreck. Instead of figuring how to make it so, many so-called leaders are working overtime to tank every aspect of the act.
Just a couple of weeks ago, Wisconsin Republican Sen. Ron Johnson said it was time to “recognize reality” and “deal with the people that are currently covered under Obamacare.”

But that was then. Now three Republican senators, Richard Burr (N.C.), Tom Coburn, (Okla.), and Orrin Hatch (Utah), are launching a campaign to start the debate all over, promoting a “replacement” plan for Obamacare.  That plan would make it even more difficult to fund the Indian health system. “Under our proposal, restrictions that limit the ability for veterans, service members, and individuals receiving care through the Indian Health Service would be

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