1. 1 Legislative & Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting July 9, 2013

2. Overview Legislative & Budget Updates – IHS Budget Updates – Sequestration – Indian Definition Fix – Expansion MLR Legislation IHS Director Confirmation Hearing DTLL & Update on the issues White House Council on Native American Affairs Questions

3. IHS FY 2013 Final Operating Plan Posted to IHS Budget Website No Detail of Changes Table available $228.6 Sequestration to IHS Budget; Portland Area Share was $14.2 million Operating Plan indicates overall reduction of $175.6 million – Difference of $52.9 million – H.R. 933 included $49.7 increase; Staffing Package of $52 million(?) – This the case, reduces sequester amount down.

4. FY 2013 Budget Decreases Not knowing completely the Detail of Changes for staffing package is a problem: – H&C reduced $61.8 million (-3.4%) – Dental & Mental Hlth ~ $2 million (< 2%) – A&SA reduced $9.1 million (-4.7%) – CHS reduced $42.3 million (-5%) – PHN reduced $350K; Hlth Ed $505K – Most other service accounts reduced by 5% – HFC reduced 9.2% all other facility accounts reduced by 5% with exception of Facilities & Environmental Support

5. FY 2014 IHS President’s Budget President’s Request based on FY 2012, provides $124 million increase (2.9%) Because of sequestration, this can appear to better comparing to FY 2013, which makes it $300 million increase* – This is an illusion due to $175 million loss in FY 2013 – Do not let the Administration or Congress tell us they are giving a $300 million increase in FY 2014!

6. FY 2014 Sequestration? IHS budget loss was $228 million in FY 2013*** (Operating Plan = $175 million) Legislative effort to amend Budget Control Act to exempt IHS or limit to 2% similar to other health programs Year 1 of a Ten Year process! “No more across the board cuts—reductions will happen via statutory caps” President’s 2014 budget proposal includes enough reductions to satisfy BCA requirements – $1.8 trillion over ten years, replace sequestration with other deficit-reduction measures – Congress/Administration need to agree to deal to avoid government shut-down in 2014 and to raise Debt Ceiling – House & Senate Budget Resolutions not close

7. Senate & House Budget Resolutions

8. Contract Support Cost Update July 31-August 1: CSC Summit Hosted by ANHB, ANTHC, CRIHB, NPAIHB, USET & NTCSCC 3 Supreme Court cases have affirmed Tribes right to be paid full CSC payments Ramah decision requires federal government to pay Tribes full CSC if the agency has sufficient appropriation Administration proposed statutory ‘amendment-by- appropriation’ – Eliminate Tribes’ future contract recovery rights – Proposal gives legal effect to a “table” provided to the Appropriations Committees specifying the maximum amount each tribal contractor would receive – Since each tribal contract is “subject to the availability of appropriations,” the Administration hopes this language will limit what is “available” to the amount in the “table” and would limit the ability of Tribes to seek legal remedy for funding that the Supreme Court has ruled is due to Tribes – No Tribal consultation on the Administration’s proposal!

9. IHS Director Confirmation Hearing Senate Committee on Indian Affairs convened confirmation hearing June 12, 2013 SCIA has elected not to recommend floor vote on IHS Director until they are satisfied and received reports: – Four Areas has conveyed dissatisfaction on issues – Aberdeen Investigation continues to plague IHS – Area Office Reviews: SCIA wants report of finding and outcome of Portland Area Office review on staffing – CHS formula: adding mortality and morbidity to formula – Health Facilities construction issues – CSC issues and Administration’s proposal in FY 2014 budget. Tribes want Congress to reject proposal. SCIA advised they this will be an “on-going” issue they monitor What next? Receive items and then go to floor for vote? Or, convene another hearing? Oppose?

10. IHS Dear Tribal Leader Letters 1.DTLL on Special Diabetes Program for Indians – June 19, 2013. 2.DTLL on Contract Support Costs – June 12, 2013. 3.DTLL on Contract Health Services – May 6, 2013. 4.DTLL on MSPI & DVPI – May 6, 2013. 5.DTLL on CSC Follow-up 9/24/2012 – March 26, 2013. 6.DTLL on draft IHS Sexual Assault Policy, Part 3, Chap. 29 – March 22, 2013. 7.DTLL on CHS increases for referrals for prevention services in follow-up to 8/2/2012 – January 15, 2013 8.DTLL on CSC Issues in follow-up to 9/24, 2012 letter – January 14, 2013. 9.DTLL on UIHP Conferring Policy – January 11, 2013. 10.DTLL on OIT PFSA and Tribal Shares – January 11, 2013.

11. WHITE HOUSE COUNCIL ON NATIVE AMERICAN AFFAIRS Presidential Executive Order establishing White House Council on Native American Affairs – Will be coordinated by White House Domestic Policy Council – Structure includes heads of the major executive departments, agencies and offices – OMB is required to have representation – The Secretary of the Interior will serve as the Chair of the Council – The Council required to meet three times a year, other meetings convened as deemed necessary by the Chair – Make recommendations to President thru Director of DPC – Coordinate w/Director of Public Engagement on Tribal government issues and tribal stakeholders – Assist to plan and carry out annual White House Tribal Nations Meeting

12. Discussion?