H.R. 6535, a bill to deem an urban Indian organization and employees thereof to be a part of the Public Health Service for the purposes of certain claims for personal injury, and for other purposes

H.R. 6535 would include Urban Indian Health Programs (UIHPs) and their employees in the pool of individuals and entities that receive liability protection under the Federal Tort Claims Act (FTCA). Under the FTCA, the federal government pays for court judgments and compromise settlements of lawsuits out of the Judgement Fund. The Judgment Fund is a permanent, indefinite appropriation that is available to pay monetary awards against the United States that are judicially or administratively ordered. Under current law, UIHPs are health care organizations that are grantees of the Indian Health Service (IHS) but are not considered federal entities and therefore their employees are not covered under the FTCA.

For this estimate, CBO used information from the Department of Treasury’s Bureau of the Fiscal Service about the number and level of payments from the Judgement Fund that were used to settle claims and litigation on behalf of IHS employees. While UIHPs are not part of IHS, they provide similar services, and CBO expects they would experience a similar rate of lawsuits and settlements.

According to the Judgement Fund data, over the last five years an average of about $19.5 million has been paid out for medical malpractice claims against IHS employees, or about $2,700 per year per IHS clinical employee. UIHPs employ about 1,150 clinical workers and CBO estimates that payments from the Judgement Fund would total about $3 million per year once fully implemented. CBO expects that it would take some time for patients to initiate legal action against UIHPs and for the legal system to finalize judgements and settlements against the UIHPs. Therefore, CBO estimates that the outlays from the Judgement Fund would gradually increase until reaching a stable level by 2025. In total, CBO estimates that H.R. 6535 would increase direct spending from the Judgement Fund by $22 million over the 2020-2030 period.

The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. The net changes in outlays that are subject to those pay-as-you-go procedures are shown in Table 1. The costs of the legislation fall within budget function 800 (general government).