Native Americans ramp up calls for longer-term health funding


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Good morning, and welcome to Friday. We’ve made it. Got tips? Send them to rachel.roubein@washpost.com.

Today’s edition: The Senate approved its package repealing the coronavirus mandate for the military, but an amendment to reinstate troops failed. Resistance to routine vaccinations for children is growing, a new poll shows. But first …

American Indians and tribes mount a year-end push for more stable funding

Time is running out for advocates of various health measures to notch wins before the new Congress takes over. And that means lobbying campaigns have gone into overdrive.

One such effort has come from Native American groups and their congressional allies, who have mounted perhaps their largest effort yet to pressure Congress to provide more stable funding for the federal health agency that helps serve roughly 2.6 million American Indians and Alaska Natives.

The Indian Health Service (IHS) is the only major federal health-care provider funded through the regular appropriations process on an annual basis, leading to a degree of uncertainty over its cash flow that other health programs don’t have to deal with.

The dynamic has frustrated tribal leaders who say it has posed an array of challenges for the Indian health system, such as the inability to plan long-term projects and make upfront purchases. So they’re ramping up calls for a commitment from Congress to also provide funding for the next year, similar to how Capitol Hill funds the Veterans Health Administration.

Both Democrats and Republicans supporting the policy say they’ve pitched the idea to key negotiators of Congress’s year-end spending package, and the prospects are unclear as congressional staff spend the next few days hashing out a broader deal on a bill to fund the government through September.

  • “This has been a fight for 10 years. It’s not just like people showed up yesterday and asked for this,” said Meredith Raimondi, the vice president of public policy for the National Council of Urban Indian Health (NCUIH). “Because uncertainty is looming with the upcoming divided Congress, I think the urgency is seen.”

National Council of Urban Indian Health:

The American Indian community is specifically calling for something called advance appropriations.

The idea is to get funding assurances for the upcoming year. For instance, the 2023 fiscal year spending bill for IHS would also include an appropriation for fiscal 2024. That way the health program would receive its full budget when FY2024 rolls around, instead of being subjected to temporary funding measures when Congress almost inevitably fails to pass a full budget before Sept. 30.

Stopgap spending bills are a frequent ploy on Capitol Hill to buy more time to clinch a deal on a larger spending package. But reports from the Congressional Research Service and the Government Accountability Office have detailed the impact they’ve had for IHS-funded health care.

  • Many of IHS’s services are provided by tribes that contract with the federal government. Those contracts have to be modified when there’s a new temporary funding bill, which can last weeks to months.
  • Tribes have reported that it can be difficult to plan improvement projects since they may not be able to provide a large amount of cash upfront, such as for electronic medical record systems.
  • Amid government shutdowns, health providers aren’t paid until Congress reaches a deal.

The lobbying effort has come from several different corners.

Over 120 tribal nations and groups like NCUIH, National Indian Health Board and Families USA sent a letter to leadership calling for advance appropriations in the year-end package.

Meanwhile, bipartisan members of the House Congressional Native American Caucus pushed the chamber’s appropriations leaders on the issue, writing in a letter last week that “this change in the appropriations schedule will help the federal government meet its trust obligation to tribal governments and bring parity to federal health care systems.”

Several lawmakers like Reps. Tom Cole (R-Okla.) and Raúl Grijalva (D-Ariz.) — a co-chair and vice chair, respectively, of the Congressional Native American Caucus — and Sen. Jon Tester (D-Mont.) told The Health 202 that they’ve discussed the idea with their colleagues.

  • “Those discussions have been very positive with [House Appropriations Chair Rosa] DeLauro staff and others,” Grijalva said Wednesday. But he added: “We have no guarantees right now. Everything is unsettled.”

Getting new policies into the broader package can be an uphill climb, as leadership contends with a slew of asks from almost every policy area under the sun.

The funding change for IHS was at “a stalemate” for a while earlier this year, said one House staffer on a committee involved in the work who spoke on the condition of anonymity to be candid. “But I think tribal leaders and organizations really did a good job of educating” Hill offices about the policy.

But does that mean appropriators will ultimately include the measure in a year-end package? “They’ve been very closed-door about what’s in and out,” the staffer said.

On tap today: President Biden will deliver remarks today promoting the Pact Act, a new law that extends health-care and disability benefits to veterans exposed to toxic substances during their service.

The legislation marks a significant achievement for Biden, who has wondered publicly whether the brain cancer that killed his 46-year-old son Beau Biden was linked to his exposure to burn puts during his time in the Iraq War.

Biden is speaking at an event at the Delaware National Guard headquarters hosted by Sen. Tom Carper (D-Del.), VA Secretary Denis McDonough and the Delaware congressional delegation, per a White House official.

Senate passes defense bill, rescinds military coronavirus vaccine mandate

The Senate approved the annual defense policy bill, sending the $858 billion package that cedes ground on vaccine policies to Republicans to President Biden’s desk, our colleague Karoun Demirjian reports.

The bill, which passed with bipartisan support by a vote of 83-11, directs how federal dollars can be spent on the Pentagon and rolls back the Biden administration’s coronavirus vaccine mandate for service members, among other measures.

Lawmakers passed the legislation after rejecting an amendment sponsored by Republican Sens. Ted Cruz (Tex.) and Ron Johnson (Wis.), which would have reinstated and provided back pay for troops kicked out of the military for refusing to comply with the vaccine mandate. The amendment, which failed by a vote of 40-54, needed 60 votes to pass.

But wait … With Democrats and Republicans locked in a faceoff over how to fund the federal government, it remains unclear exactly how much of the defense bill will be underwritten. While Congress passed a stopgap bill last night to fund the government through next week, a final deal on a longer-term spending measure to carry it through September remains incomplete.

Sen. James Lankford (R-Okla.):

Democratic Sens. Tammy Duckworth (Illinois), Patty Murray (Wash.) and Rep. Susan Wild (D-Pa.) introduced legislation aimed at codifying access to fertility treatments, such as in vitro fertilization amid the roiling landscape of reproductive politics.

In late January 2020, U.S. intelligence agencies reported to senior White House officials that the coronavirus threatened to become a pandemic. But then-President Trump’s public statements “did not reflect the increasingly stark warnings,” The Post’s Shane Harris writes, citing a report released yesterday from the House Intelligence Committee. (The report was staffed by bipartisan aides and written by Democrats.)

A growing share of parents oppose routine childhood vaccine requirements

Nearly a third of parents now oppose requiring students in public schools to receive vaccines for childhood illnesses such as the measles, mumps and rubella, according to a new poll from the Kaiser Family Foundation.

The resistance to routine vaccinations for children has increased since the pandemic began, amid an influx of conspiracy theories about the coronavirus vaccine, debate over immunization requirements and a growing distrust of public health figures. The shift has largely occurred along partisan lines:

  • About 44 percent of people who identify as Republican or lean Republican now say that parents should be able to opt their child out of the vaccines, up from 20 percent in 2019.
  • Among Democrats and those who lean Democratic, 88 percent support requiring the shots for public school children, a slight increase from 86 percent in 2019.
  • Overall, roughly 28 percent of adults nationally now believe parents should be able to decide not to vaccinate their children, up from 16 percent in a 2019 Pew Research Center poll.

Conservative states have worse mortality outcomes

As the country confronts a growing list of public health crises, two studies reveal an uncomfortable truth: The toxicity of partisan politics is fueling an overall increase in mortality rates for working-age Americans, The Post’s Akilah Johnson reports.

Here’s a snapshot of what researchers found:

  • Covid-19 outcomes: The more conservative the voting records of members of Congress and state legislatures are, the higher the age-adjusted coronavirus mortality rates are among the people they represent, according to a recent study published in the Lancet Regional Health — Americas.
  • Overall health outcomes: The more conservative a state’s policies are, the shorter the lives of its working-age people are, per an October study published in the journal PLOS One.

The reasons are many, but, increasingly, it is state — and not just federal — policies that have begun to shape the circumstances that affect people’s well-being. Some states have expanded their social safety nets, raising minimum wages and offering earned income tax credits while using excise taxes to discourage behaviors — such as smoking — that have health consequences. Other states have moved in the opposite direction, Akilah writes.

  • The Centers for Disease Control and Prevention is extending the charts that doctors use to track children’s growth to include a body mass index of 60 — up from the previous threshold of 37 — due to rising cases of severe obesity in young people in the United States.
  • In Virginia: Parents of students with disabilities enrolled in Virginia public schools have the right to require that their children’s peers and teachers wear face coverings, after the state government agreed to a settlement with several families who had filed a lawsuit challenging a statewide mask-optional policy, The Post’s Hannah Natanson writes.
  • AbbVie is leaving the drug lobbying groups Pharmaceutical Research and Manufacturers of America as well as the Biotechnology Innovation Organization, two of the nation’s most prominent pharmaceutical trade associations, Politico reports.

As Workers Battle Cancer, The Government Admits Its Limit for a Deadly Chemical Is Too High (By Sharon Lerner | ProPublica)

How a Sprawling Hospital Chain Ignited Its Own Staffing Crisis (By Rebecca Robbins, Katie Thomas and Jessica Silver-Greenberg | The New York Times)

How a viral siege is making some people sick for weeks, even months (By Ariana Eunjung Cha | The Washington Post)

Helping Trans Kids Means Admitting What We Don’t Know (Jonathan Chait)

Thanks for reading! See y’all tomorrow.





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