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McCollum Introduces Bipartisan Legislation to Improve Access to Health Care for Native Americans

June 12, 2014
Press Release


Washington, DC – This week, Rep. Betty McCollum (D-MN) and Rep. Tom Cole (R-OK) introduced the Native Contract and Rate Expenditure (CARE) Act (H.R. 4843), a bill that will provide an additional 250,000 physician services annually for Native Americans through payment reforms within the Indian Health Service (IHS). 

“Our nation has a legal and moral responsibility to provide for the health care of Native Americans.  For far too long, Congress has failed to meet that responsibility and that needs to change,” said Congresswoman McCollum.  “There is an infamous warning in Indian Country: 'Don't get sick after June.'  The current system causes IHS to consistently run out of money for referred care months before the end of the fiscal year, denying Native people critical health care services for extended periods of time.

“By paying health care providers the Medicare-rate, rather than the provider billed rates, IHS will be able to double the number of physician services provided to Native Americans – that means hundreds of thousands of additional patient visits. The common sense, bi-partisan legislation I have introduced will ensure that federal tax dollars already being spent on Indian health care go further.

“We have the opportunity to dramatically expand access to quality care and preventive services that would have previously been deferred or denied. This bipartisan legislation is an important step in our common goal to reduce health disparities for Native Americans and make the Indian Health Service a world class health system.”

The Native CARE Act would result in more health care services under the Purchased/Referred Care program for Native people who are referred by the Indian Health Service and tribal health programs to non-IHS facilities when necessary. Under current law, only hospital providers are required to accept Medicare-rates from Purchased/Referred Care programs.  IHS continues to routinely pay full billed charges to non-hospital providers, which quickly diminishes the limited pool of Purchased/Referred care funds.  Under the reforms set forth in this bill, IHS would reimburse Medicare-participating providers for services at a rate that is no greater than what Medicare would pay for the same service.  The Native CARE Act is a revenue-neutral proposal and is consistent with how the VA and DOD pay for non-hospital services. 

In 2013, the Government Accountability Office (GAO) issued a report that concluded that IHS and tribal facilities would be able to provide millions of dollars in additional care to Native people if the Medicare-like rate cap was imposed on non-hospital providers and suppliers.  The President’s FY2015 Budget Request for the Indian Health Service included support for a legislative proposal to implement GAO’s suggestions.   On June 11th, the National Congress of American Indians passed a resolution calling on Congress to work to pass legislation to enact the Medicare-like rate cap.

Congresswoman McCollum worked closely with the National Indian Health Board, the United South and Eastern Tribes, and the Self-Governance Communication & Education Tribal Consortium to develop this legislation.  The Native CARE Act has been cosponsored by Rep. Tom Cole (R-OK), Rep. Ben Ray Luján (D-NM), Rep. Darrell Issa (R-CA), Rep. Raúl Grijalva (D-AZ), Rep. John Kline (R-MN), Rep. Frank Pallone (D-NJ), Rep. Ron Kind (D-WI), Rep. Don Young (R-AK), and Rep. Jared Huffman (D-CA).

Congresswoman Betty McCollum serves on the House Appropriations Committee.  She is Democratic Co-Chair of the Congressional Native American Caucus.