NIHB and 19 National Organizations Send Letter to House and Senate Leadership Demanding Long-Term Reauthorization of Special Diabetes Program for Indians and other Expiring Health Extenders


Contact: Shervin Aazami 202-507-4088

NIHB joined by 19 National Organizations in Letter to House and Senate Leadership Regarding Special Diabetes Program for Indians (SDPI) and other Health Extenders

WASHINGTON, DC—December 9, 2019— Today, the National Indian Health Board (NIHB), joined by 19 national organizations including the National Congress of American Indians and the National Council of Urban Indian Health, submitted a letter to House and Senate leadership demanding immediate action on long-term reauthorization of expiring health extenders, including the Special Diabetes Program for Indians (SDPI).

Specifically, the letter urges congressional leadership to prioritize long-term reauthorization of the following five programs, all of which expire on December 20, 2019:

  • Special Diabetes Program and Special Diabetes Program for Indians
  • Community Health Center Fund
  • National Health Service Corps
  • Teaching Medical Centers Graduate Education

The House letter is addressed to Speaker Nancy Pelosi (D-CA) and Minority Leader Kevin McCarthy (R-CA), along with leadership from the House Energy and Commerce (E&C) Committee with jurisdiction over SDPI: Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR). The Senate letter is addressed to Majority Leader Mitch McConnell (R-KY) and Minority Leader Charles Schumer (D-NY) and includes leadership from the Senate Health, Education, Labor, and Pensions (HELP) Committee with jurisdiction over SDPI: Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA).

In addition to the National Congress of American Indians and National Council of Urban Indian Health, the following national partner organizations are signatories on the joint letter:
  • Academy of Nutrition and Dietetics
  • American Association of Colleges of Pharmacy
  • American Association of Diabetes Educators
  • American Diabetes Association
  • American Society of Nephrology
  • Association of Maternal & Child Health Programs
  • Endocrine Society
  • JDRF
  • National Alliance of State & Territorial AIDS Directors
  • National Association of Community Health Centers
  • National Kidney Foundation
  • NephCure Kidney International
  • Organic Academia Association
  • Pediatric Endocrine Society
  • Physician Assistant Education Association
  • Trust for America’s Health

To read the letter sent to the House, click here
To read the letter sent to the Senate, click here

Next Steps on SDPI Reauthorization
The vehicle for long-term reauthorization of SDPI and the other expiring health extenders is legislation aimed at addressing the market failure around surprise medical billing. Both House E&C and Senate HELP cleared legislation at the Committee level back in the summer to address this market failure. Both packages also included long-term reauthorization of SDPI, but for a different amount of time. The House version renews SDPI at its current funding level of $150 million for 4 years, while the Senate package renews SDPI at its current funding level for 5 years.

Despite passing the packages with bipartisan support during the summer months, many bicameral lawmakers expressed concerns with the primary solution proposed in both packages: namely, to establish a median in-network reimbursement rate for all out-of-network providers. Multiple lawmakers and many external stakeholders would prefer that disputes be settled through a "baseball-style" arbitration approach, which several state governments have opted to use to address surprise billing.

Those conversations have stalled action on surprise billing for months; however, over the weekend, E&C and HELP leadership announced a breakthrough agreement on the surprise billing package that the White House has also indicated support for. That agreement includes a new system for settling disputes through arbitration, raises the legal age for purchasing tobacco to 21, and includes new tools to increase competition in the pharmaceutical sector while increasing prescription drug price transparency. Importantly, the new bicameral agreement renews SDPI and the other expiring health extenders for a period of five years! While the reauthorization does not include a funding increase for SDPI to $200 million as Tribes have repeatedly requested, NIHB remains fully committed to securing a funding increase for SDPI to include annual adjustments per medical inflation.

Pathway Forward
Despite the new announcement of a breakthrough, some obstacles still remain. For instance, the Ranking Member for the HELP Committee, Senator Murray, has yet to sign off on the agreement. In addition, external stakeholders such as hospital and provider associations are hoping to see more widespread use of arbitration, as opposed to the more narrow scope proposed in the new agreement. Lawmakers are hoping to smooth over those differences with the goal of passing the surprise billing package by the end of the calendar year. Although it remains unclear if this can be achieved in that time frame, the announcement over the weekend was a strong signal of progress and growing support for the legislation.

As NIHB has previously reported, SDPI is currently reauthorized under a Continuing Resolution until December 20, 2019. Thus, the surprise billing package would need to move by that date or earlier, otherwise another short-term extension of SDPI will be necessary to avoid expiration of the program. NIHB will provide updates on SDPI renewal and the surprise billing package as they become available.

For more information about NIHB’s legislative efforts, please contact NIHB Deputy Director of Congressional Relations, Shervin Aazami, at


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