Feds Must Pony Up More for Tribal Health Care

(CN) - Stopping short of ordering the U.S. government to octuple funding that provides health care for Alaska Natives, a federal judge said the status quo must go.

A nonprofit called the Maniilaq Association initiated the dispute to remedy chronic underfunding of one of several health clinics it operates for the benefit of 12 Alaska Native tribes in the northwestern part of the state.

Though the U.S. Department of Health and Human Services had allocated just $30,921 in federal funds toward the Kivalina clinic's rent for more than 20 years, Maniilaq said it needed $249,842 a year to meet clinic operating costs.

When the HHS Secretary Sylvia Burwell demurred, Maniilaq sued in Washington, D.C.

U.S. District Judge John Bates awarded Maniilaq summary judgment Tuesday, citing ambiguity in Section 105(l) of the Indian Self-Determination and Education Assistance Act.

Whether Maniilaq's reading is correct - that the statute compels HHS to cover the clinic's operating costs - Bates would not say.

"But Maniilaq offers a reasonable interpretation of an ambiguous statute and its ambiguous regulations," the 22-page opinion states. "Because the secretary has not shown that her alternative reading is compelled by those sources, the court will - as it must - construe the ambiguity in Maniilaq's favor."

What is clear, Bates said, is that "Section 105(l) requires the secretary to enter a lease with Maniilaq for its Kivalina clinic."

"It also requires the secretary to pay compensation," he added.

Meanwhile, the secretary's understanding of the statute "has some gaps," the ruling states.

"In multiple instances, the secretary's arguments collide with the loose language of the regulations," Bates wrote. "And the secretary has not offered the court easily accessible routes around the textual obstacles."

Though the secretary was entitled to decline duplicative or unreasonable compensation, Bates said "she was not entitled to use section 106(a) to cap the 'applicable funding level to which [Maniilaq is] entitled' at $30,921."

Bates said he was sympathetic to the difficulty of the situation in which this ruling places Burwell, "but the court may not properly bend the text of the statute and regulations to maintain the funding status quo."

"If Congress or the secretary objects to the result reached here, they may clarify the meaning of the statute and regulations on which it is based," the ruling continues. "But for the time being, based on the act and regulations as they exist today, Maniilaq must prevail."

Though Bates vacated Burwell's refusal, he stopped short of ordering that she pay the full six-figure amount Maniilaq demands.

Instead, Bates directed the parties to discuss "the proper amount of compensation for the Kivalina clinic lease for the period from February 1, 2015, to September 30, 2015, and how the amount of lease compensation shall be determined in subsequent years."

The Maniilaq Association praised the decision, noting that without fair payment on the leases the clinics are forced to reduce operations and, accordingly, the care provided to villages.

"Maniilaq is pleased that Judge Bates' decision acknowledges that fairness under the law requires more than what the IHS currently provides," the association told Courthouse News. "We look forward to negotiating the proper amount of compensation with the IHS consistent with Judge Bates' decision."

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