The Indian Health Care Improvement Act Reauthorization and Extension as Enacted by the ACA: Detailed Summary and Timeline

Summary

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148). Among its provisions, the ACA reenacts, amends, and permanently reauthorizes the Indian Health Care Improvement Act (IHCIA). IHCIA authorizes many specific Indian Health Service (IHS) activities, sets out the national policy for health services administered to Indians, and sets health condition goals for the IHS service population to reduce “the prevalence and incidence of preventable illnesses among, and unnecessary and premature deaths of, Indians.” The reauthorization of IHCIA in the ACA amends the IHCIA to, among other changes, expand programs that seek to augment the IHS health care workforce, increase the amount and type of services available at facilities funded by the IHS, and increase the number and type of programs that provide behavioral health and substance abuse treatment to American Indians and Alaska Natives.

This report provides a brief overview of IHCIA and summarizes the provisions of the Indian Health Care Improvement Reauthorization and Extension Act of 2009 as enacted and amended by Section 10221 of the ACA. Appendix A presents a timeline of the deadlines included in the act. Another report, CRS Report R41152, Indian Health Care: Impact of the Affordable Care Act (ACA), by Elayne J. Heisler, more briefly summarizes the major changes made by the ACA to IHCIA and includes a discussion of other provisions in the ACA that may affect IHS and American Indian and Alaska Native health and their access to health care.

This report is primarily for reference purposes. The material in it is intended to provide context to help the reader better understand the intent of ACA’s individual provisions at the time of enactment. The report does not track or discuss ongoing ACA-related regulatory and other implementation activities.