NCAI Action Alert: American Health Care Act – Vote Planned for Today – Contact Your Congressional Members Now!

May 4, 2017

Today the House of Representatives plans to vote on the H.R. 1628, the American Health Care Act, the Republican-led legislation intended to repeal and replace the Affordable Care Act. The vote is scheduled to take place this afternoon and while House leadership feels they will have the 216 votes needed for passage, 18 Republicans have publicly stated they will vote no. With Democrats committed to voting along party lines and about two dozen Republicans undecided, it would only take 5 more no votes to defeat the legislation in the House.

The base language of the American Health Care Act remains, with an added amendment by Congressman MacArthur (R-NJ) that would allow states to opt out of federal requirements that disallow insurance companies from discriminating based on certain pre-existing conditions if they decide to create high-risk pools of other financial backstops. In last minute negotiations with the President, Representatives Upton (R-MI) and Long (R-MO) secured an increase of $8 billion for high-risk pools to help alleviate the financial impact to those with pre-existing conditions. This amendment for high risk pools is fashioned after the Maine model but it is not clear whether tribes would have access to this pool.

Although the Indian Health Care Improvement Act remains intact in the current repeal efforts, tribes will be significantly impacted by language that would phase out Medicaid. This change would impact 491 tribes in 18 states where Medicaid expansion has already occurred. In addition, Medicaid represents 13% of the Indian Health Service budget, so any cuts will directly impact the level of care tribes are able to provide to their citizens.

If the legislation is passed by the House of Representatives today, it will be sent to the Senate where it will likely face major revision. Several Senators have already expressed concerns about the language contained in the American Health Care Act, including Senator Murkowski.

NCAI is asking all tribal leaders to CONTACT YOUR CONGRESSIONAL MEMBERS NOW!

  • Ask them to vote no on the American Health Care Act, unless:
    • Medicaid protections for Indian Health Service and Tribally Operated Health Care facilities are continued;
    • American Indians and Alaska Natives are exempted from the state-imposed work requirements under the Medicaid program;
    • Cost sharing protections are continued for American Indians and Alaska Native in section 1402(d) of the Affordable Care Act;
    • Tribes will have direct access to the funding allocated for high risk pools.
  • Contact your Senators now and ask them to vote no on this legislation in its current form it it is passed by the House of Representatives.

If you have questions contact Denise Desiderio, NCAI Policy Director at

Founded in 1944, the National Congress of American Indians is the oldest, largest and most representative American Indian and Alaska Native organization in the country. NCAI advocates on behalf of tribal governments, promoting strong tribal-federal government-to-government policies, and promoting a better understanding among the general public regarding American Indian and Alaska Native governments, people and rights.