December 19, 2019

Contact: Carolyn Angus-Hornbuckle

IHCIA remains in place as Fifth Circuit Court Defers Question of ACA Constitutionality

The United States Court of Appeals for the Fifth Circuit has ruled that the Affordable Care Act’s (ACA) individual mandate is unconstitutional and remanded to the District Court the question as to whether or not the remaining portions of the law are constitutional. The Court found that since the failure to comply with the individual mandate no longer generates revenue, it is no longer constitutional. The Supreme Court had previously held that individual mandate was constitutional under Congress’s tax and spend authority because the penalty for failing to comply was a tax that generated revenue for the federal government.

The ACA included the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA) and other Indian-specific provisions. NIHB and Tribal partners across Indian Country filed an amicus brief in this case to convey the fact that the IHCIA and Indian specific provisions of the ACA served a distinct purpose from the rest of the legislation and should not be included in any striking down of the entire law. NIHB has argued that since these provisions exist to fulfill the federal government's constitutional obligations to provide health services to Tribal Nations and American Indian and Alaska Native Peoples, they are severable from the rest of the ACA.

The fate of Tribal specific provisions in the law were not addressed in the majority opinion. It was however mentioned in the minority opinion which used the IHCIA as an example of a provision that exists independent of the individual mandate. Both the ACA and the permanent reauthorization of IHCIA made significant changes to the entire Indian health system, and its preservation has been a top priority for many Tribal Nations as well as NIHB. 


National Indian Health Board |
910 Pennsylvania Avenue SE | Washington, DC 20003 | Phone: 202-507-4070