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American Indians and the Affordable Care Act

Robyn Sunday-Allen
11/13/13

With open enrollment now started, Oklahomans can enroll in the Affordable Care Act’s (ACA) Marketplace to shop for an insurance plan that fits their health needs and budget, as required by the mandate that goes into effect in 2014.

While federally-recognized American Indians and Alaska Natives are one of several groups exempt from the insurance mandate, those that are recognized only at the state level are not. Regardless of an American Indian’s tribal affiliation or federal status, we are recommending to all our patients – and all American Indians – that they enroll in the Marketplace. Here’s why.

Despite American Indian and Alaska Natives being covered by Indian health care systems, which will continue when Marketplace enrollment starts, the new program offers new options for health coverage, helps increase information to decrease health disparities and supplies organizations more money to invest in additional health care programs. It is another way that the federal government meets its responsibility to provide health care for American Indians and Alaska Natives.

Historically, this group has faced significant barriers to accessing affordable health insurance and these barriers have contributed to significant health disparities, including having the highest rate of Type 2 diabetes of any group in the United States, 600 percent more likely to die from tuberculosis, 510 percent more likely to die from alcoholism and suffer from a 71 percent higher infant mortality rate than the general population.

New benefits mean more services for individuals and the communities we serve, and new rights and protections make coverage fair and easier to understand. The ACA provides families and individuals security in their health coverage in many ways. It prohibits insurance companies from dropping coverage if you get sick, it removes lifetime or annual limits, it covers preventive care like mammograms and it ends discrimination against anyone with a pre-existing condition.

Additionally, under the new health care law, American Indians and Alaska Natives joining new insurance plans have the freedom to choose from any primary care provider and OB-GYN in their health plan’s network, without a referral. The new health care law also invests in increased data collection and research about health disparities to better understand and ultimately eliminate health disparities.

The ACA permanently reauthorizes the Indian Health Care Improvement Act, which authorizes Congress to fund health care services for American Indians and Alaska Natives through Indian health facilities. Urban Indians who use additional insurance at the Oklahoma City Indian Clinic, or any other Native clinic, will be contributing resources to help fund more programs like fitness centers, substance abuse services and counseling.

Overall, the Indian health system experiences high vacancy rates in health care providers at a rate of 26 percent for nurses, 24 percent for dentists and 21 percent for physicians. The new law also includes new resources that will boost the number of health care providers in communities where they are needed most, as well as diversify the workforce, so racial and ethnic minorities are better represented.

With Oklahoma having the second largest American Indian population in the nation, enrolling in the ACA Marketplace makes sense not only for Oklahoma’s Native community but also the community at large.

Robyn Sunday-Allen is CEO of Oklahoma City Indian Clinic. The Oklahoma City Indian Clinic was established in 1974 to provide high-quality health care and wellness services to urban Indians in central Oklahoma. The clinic staff cares for more than 18,000 patients from more than 220 federally recognized tribes every year.
 

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Anonymous's picture
There are tribal members waiting to apply for the health insurance through the Affordable Care Act - since October. However, there is a barrier to just getting information. For federally-recognized tribal members, is income from trust lands counted as "income" by the Affordable Care Act? After asking this question, I was referred to an Affordable Care Act "navigator" who specializing in helping tribal members apply for the ACA health insurance. Several weeks later, I'm still waiting for an answer on this income eligiblity question. With at least three (3) years to prepare for the implementation of ACA, this is a basic question that could have been anticipated in Indian Country. The specialized ACA navigators need to be on the national 'Native America Calling' program, providing answers to questions that are unique to Indian Country?
Anonymous
Anonymous's picture
Part of the trouble (as of now) is getting the Exchange website to recognize and correctly handle AI/AN status. For example, AI/ANs with households under 300% of the federal poverty line should be exempt from cost-sharing requirements. And, those AI/ANs should be able to change their plans monthly and not wait for the usual annual enrollment period. The problem is, as of now that functionality seems to be broken and the ability to "fix" and recognize it still isn't there. I know this all too well as I'm one of the people fighting with the system to get it to recognize and accept that status (which I did enter in my application).
Anonymous