A Comparative Analysis of the Indian Health Care Provisions of House-Passed H.R. 3962and Senate-Passed H.R. 3590

Elayne J. Heisler
Analyst in Health Services

Roger Walke
Specialist in American Indian Policy

On November 7, 2009, the U.S. House of Representatives approved health reform legislation, H.R. 3962, the Affordable Health Care for America Act. On December 24, 2009, the Senate approved health reform legislation, H.R. 3590, the Patient Protection and Affordable Care Act. Both of these bills include provisions that would amend and reauthorize the Indian Health Care Improvement Act (IHCIA). IHCIA authorizes many programs and services provided by the Indian Health Service (IHS), sets out the national policy for health services administered to Indians, and states the federal goal to ensure the highest possible health status for Indians, including urban Indians. In addition, it authorizes direct collections from Medicare, Medicaid, and other third-party insurers. This report, one of a series of CRS products on health reform, compares many of the IHCIA provisions included in H.R. 3962 (the House-passed bill) and H.R. 3590 (the Senate-passed bill). 

The two bills would amend IHCIA in different ways. H.R. 3962 would replace the current IHCIA with new language. In contrast, H.R. 3590 would retain the current IHCIA but would amend a number of provisions included in the act. Both bills would include provisions that would amend the Social Security Act (SSA) and other laws as they relate to American Indians and Alaska Natives. 

There are a number of similarities between the two bills. For example, both bills would extend authorizations of appropriations for IHCIA programs indefinitely. Both bills would also permit tribal organizations (TOs) and urban Indian organizations (UIOs) to apply for contract and grant programs for which they are not eligible under the current IHCIA. Each bill would also expand mental health services authorized under IHCIA to create comprehensive behavioral health and treatment programs. 

There are also some salient differences between the two bills. The House-passed bill, but not the Senate-passed bill, would elevate the position of the IHS Director to that of Assistant Secretary of Indian Health. Both bills contain provisions related to American Indians and Alaska Natives in SSA health benefit programs—Medicare, Medicaid and the Children's Health Insurance Program (CHIP)—however, these provisions differ. The House-passed bill contains provisions related to billing SSA health programs, and provisions requiring studies related to American Indians and Alaska Natives enrolled in, and receiving services from, SSA health benefits programs. The Senate-passed bill contains provisions that would permit specified Indian entities to determine Medicaid and CHIP eligibility and provisions that would prohibit cost sharing for Indians whose incomes are at or below 300% of the federal poverty level, who are enrolled in a qualified health benefit plan in the individual private insurance market through the exchange (that would be established in H.R. 3590). The Senate-passed bill, but not the House-passed bill, contains a provision that would require that IHS establish an Office of Direct Service Tribes to serve tribes that receive their health care and other services directly from IHS as opposed to receiving services through IHS-funded facilities or programs operated by Indian tribes or tribal organizations. The Senate-passed bill also includes provisions requiring demonstration projects to construct modular and mobile health facilities and provisions requiring programs related to youth suicide prevention. .


Date of Report: March 19, 2010
Number of Pages: 22
Order Number: R41050
Price: $29.95

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