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Statement by Indian Health Service Director Yvette Roubideaux on IHS Implementation of Health Insurance Reform and the Indian Health Care Improvement Act

Indian Country continues to celebrate passage of the historic health insurance reform law, which included the reauthorization of the Indian Health Care Improvement Act (IHCIA). This law will improve the quality of health care and make it more accessible and affordable for the American people, including American Indians and Alaska Natives.

The new health insurance reform law builds on the health insurance system we have, and makes three key changes.

- First, it makes sure that every American who has an insurance policy gets real security by creating common sense rules of the road that require insurance companies to treat you fairly.

- Second, it makes insurance affordable for millions of Americans by creating a new insurance marketplace and providing tax credits for those who need additional help.

- Third, it starts to bring down costs for families, businesses, and governments with the broadest health care cost-cutting package ever – one that includes every serious idea for health savings that was proposed over the last year.

Here’s a link to a recent speech by Secretary Sebelius that describes in more detail what is in the new law, what will help Americans immediately, and how the Department of Health and Human Services is quickly working to implement these reforms.

There are several provisions in the new health insurance reform law that will specifically benefit American Indian and Alaska Native individuals, Tribes, and our Indian health facilities. For example:

- Health insurance reform creates a state-based health exchange through which individuals and small businesses can purchase health insurance coverage. This will create more affordable insurance options and allow comparison of plans.

- American Indians and Alaska Natives who purchase health insurance through the exchange do not have to pay co-pays or other cost-sharing if their income is under 300 percent of the federal poverty level.

- The value of health services/benefits from IHS-funded health programs or Tribes will be excluded from an individual’s gross income so it cannot be taxed.

- Health insurance reform also expands Medicaid coverage to individuals with incomes up to 133% of poverty level.

- For individuals who have Medicare Part D coverage (medication costs), I/T/U spending will count toward the coverage gap (donut hole).

One other note – many have worried that health reform would mean that the Indian Health Service would go away and everyone would have an insurance card. That was a myth and it is wrong. The IHS is still here, and the passage of the Indian Health Care Improvement Act along with the health reform law reaffirms that IHS is here to stay. The new law permanently reauthorizes the IHS and it contains numerous provisions to modernize and update the IHS. Here’s a link to a recent document that summarizes many of these provisions. As you may know, the Indian Health Care Improvement Act contains a number of changes in law, some of which will require new policies and regulations, and also includes provisions that we may be able to implement now or that may require additional funding to implement. Just like the health insurance reform law, we want to implement it quickly, but it is not possible to do it all at once. The implementation process will need to occur over time.

We are getting many questions on what we plan to do to implement the numerous provisions in the health insurance reform law and the reauthorization of the Indian Health Care Improvement Act. As you can imagine, implementation will be a complex undertaking. We are working closely with the Department of Health and Human Services and the Indian Health Service is currently reviewing every provision in the new laws that relates to Indian Country and quickly assessing next steps and timelines for implementation. We will share this information as we move forward.

In the weeks and months ahead, we will be reaching out to provide you with more information about the new law and how it will impact Indian Country. We also want to develop ways to consult with Tribes on the implementation process over the coming weeks, months and years. We will communicate directly to Tribes about the consultation process. You can also check the IHS website (, and in particular, my Director’s Blog at, for regular updates and information. You can also access the most recent information on health reform implementation in general at and at

We know that everyone is anxious for new information, and we will work quickly and carefully to ensure you have clear, accurate information.

NOTICE TO EDITORS: For additional information on this subject, please contact Public Affairs Staff at 301-443-3593. Additional information about the IHS is available on the IHS website at .