Credit: (Image: National Council of Urban Indian Health Facebook Page)

News Release

National Council of Urban Indian Health

Credit: (Image: National Council of Urban Indian Health)

Senators Tina Smith (D-MN) and James Lankford (R-OK) introduced the Urban Indian Health Confer Act (S. 4323). This legislation would require the Department of Health and Human Services (HHS) to confer with urban Indian organizations (UIOs) on policies and initiatives regarding health care for the over 70% American Indians and Alaska Natives (AI/ANs) living off of reservations.

The National Council of Urban Indian Health (NCUIH) worked closely with Senators Smith and Lankford on the introduction of this Senate companion bill to H.R. 5221. Representatives Raúl Grijalva (D-AZ-3), Betty McCollum (D-MN), Tom Cole (R-OK), Karen Bass (D-CA), Eleanor Holmes Norton (D-DC), and the late Don Young (R-AK) were original cosponsors of the House legislation. On November 2, 2021, the Urban Indian Health Confer Act (H.R. 5221) passed the House of Representatives by 406 to 17.

The National Council of Urban Indian Health has long advocated for the importance of facilitating confer between numerous federal branches within the Department of Health and Human Services to ensure access to high-quality health services for all Native people. At a hearing on October 5, 2021, the Department of Health and Human Services explained that rollouts of COVID-19 vaccines were delayed to urban Indians due to lack of an urban confer policy.

The National Congress of American Indians (NCAI) has also passed a resolution to “Call for the U.S. Department of Health and Human Services (HHS) Secretary to Implement an Urban Confer Policy Across the Department and its Divisions” showing broad support among stakeholders in Indian Country. It is important to note that Urban Confer policies do not supplant or otherwise impact tribal consultation and the government-to-government relationship between tribes and federal agencies.

“Proper urban confer policies across all Department of Health and Human Services agencies has been long overdue and exacerbated amid the current public health crisis ravaging Indian Country. We welcome the federal government’s effort to further fulfill their trust and treaty obligation for all American Indians and Alaska Natives, including those residing in urban areas,” said Walter Murillo (Choctaw Nation of Oklahoma), Chief Executive Officer of NATIVE HEALTH and National Council of Urban Indian Health Board Member.

Next Steps

The bill was referred to the Senate Committee on Indian Affairs. It currently awaits consideration. Please get in touch with your Senator to ask them to request that the Senate Committee on Indian Affairs to move forward on this legislation.

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Background

Urban Confer policies are a response to decades of deliberate federal efforts (i.e. forced assimilation, termination, relocation) that have resulted in over 70% of American Indian and Alaska Native people living outside of tribal jurisdictions, thus making Urban Confer integral to addressing the care needs of most American Indian and Alaska Native persons. Currently, only the Indian Health Service (IHS) has a legal obligation to confer with urban Indian organizations. According to the Congressional Research Services, the Department of Health and Human Services would have to confer with urban Indian organizations on “provisions of law relating to health care for American Indians and Alaska Natives.”

Missed opportunities for awareness and information provided to urban Indian organizations regarding American Indian and Alaska Native healthcare can be avoided through a confer process. For instance, key information regarding vaccine distribution for the initial COVID-19 vaccine rollout was poorly communicated to urban Indian organizations and created unnecessary hardship. The Department of Health and Human Services addressed initial communications only to tribes and did not direct it to the urban Indian organization component of the Indian Health Service system. When the Department of Health and Human Services was asked about whether urban Indian organizations needed to similarly decide between an Indian Health Service or state vaccine allocation, it was unclear for weeks as to whether they were expected to make such a decision. Eventually, the Department of Health and Human Services asked urban Indian organizations to decide between receiving their vaccine distribution from either their state jurisdiction or IHS the same day as the initial deadline (which thankfully the Department of Health and Human Services subsequently extended for several days). Some urban Indian organizations were informed of the deadline by their Area office with no formal national communication. As a result, many of our clinics experienced delays in vaccine rollout.

“Agencies have been operating as if only the Indian Health Service has a trust obligation to American Indians and Alaska Natives, and that causes an undue burden to the Indian Health Service to be in all conversations regarding Indian Country in order to talk with agencies. It is imperative that urban Indian organizations have avenues for direct communication with agencies charged with overseeing the health of their American Indian and Alaska Native patients, especially during the present health crisis,” said National Council of Urban Indian Health CEO, Francys Crevier (Algonquin).

The disregard by some agencies to communicate with urban Indian organizations is not only a failure to urban Indians and is inconsistent with the government’s responsibility, but it is contrary to sound public health policy. The bill would codify the intent of the Federal Trust Responsibility to ensure equitable health care access to American Indian and Alaska Native by amending legislative text in Section 514, Subsection (b) of the Indian Health Care Improvement Act (25 USC § 1660d) (IHCIA).

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Credit: (Image: National Council of Urban Indian Health)