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The Affordable Care Act, which is priority one for repeal and replacement, uses third-party billing as a funding source for Indian health programs because that money can grow without congressional appropriations. The idea is that when a person is eligible, the money is there. The Indian Health Service budget in fy 2017 includes $1.19 billion in third-party billing, $807 million from Medicaid programs. This funding source is especially important because by law third-party billing remains at the local clinic or other unit. And, most important, when the Indian Health Service runs short of appropriated dollars, it rations health care. That’s not the case with Medicaid funding. But that program is now up for debate as Republicans explore alternatives.
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