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Wednesday, November 18, 2015

Health Insurance Is Key to Addressing Native American Health Disparities

Yasmin Peled

Health Equity Intern

November is Native American Heritage Month, a time for the country to remember and honor the histories, contributions, and struggles of the 566 federally recognized tribes and the 5.4 million American Indians and Alaska Natives (AI/AN) living in the United States. November is also the first month of open enrollment for the Affordable Care Act’s (ACA) 2016 marketplace coverage. While the federal government is obligated to provide health care to Native Americans through the Indian Health Service (IHS), this blog explains why getting marketplace coverage is a good idea for many AI/AN consumers.

Serious health disparities persist for American Indians and Alaska Natives—but free preventive care can help

Glaring disparities in American Indian and Alaskan Native health and health care pose serious challenges for these communities. Benefits offered through marketplace plans include access to free preventive services that address many of the health conditions that disproportionately affect American Indians and Alaska Natives. [See our infographic for specific examples.]

Native Americans have a long history of experiencing higher rates of disease and poorer health compared to non-Hispanic whites. Some of this can be traced directly or indirectly to government actions or neglect. To this day, significant health disparities persist, including barriers that AI/AN health consumers face when trying to obtain high-quality, culturally-competent care.  

For example, AI/AN babies are 50 percent more likely to die before their first birthday than babies of non-Hispanic whites. American Indian and Alaska Native adults are 2.5 times as likely to be diagnosed with diabetes, and overall, they are 80 percent more likely to die from that condition. American Indian and Alaska Native adults are also 2.1 times as likely to have had a stroke.  

Additional preventive care could help to improve these outcomes, and thanks to the ACA, private insurance plans must cover such care at no additional cost. For instance: 

  • Diabetes screenings can help catch the condition early enough to allow for effective management to help prevent life-threatening complications. 
  • Blood pressure and cholesterol screenings can uncover a higher risk of stroke that can be reduced with the right treatments and lifestyle changes. '
  • Free preventive services include certain prenatal screenings and six well-baby” check-ups during the first year of life, which can help keep babies healthy, safe, and strong. 

The ACA provides additional protections for American Indians and Alaska Natives and special incentives to enroll in marketplace plans

The ACA provides specific protections and rights for American Indians and Alaska Natives, 23 percent of whom lack health insurance. First, the ACA permanently reauthorized the Indian Health Care Improvement Act (IHCIA), which includes the Indian Health Service (IHS)—the federal program that is responsible for providing health care to Native Americans.  [See “What is the Indian Health Service (IHS)?”]

The ACA offers American Indian and Alaska Natives specific incentives to enroll in coverage

In addition, the ACA provides Native Americans with enhanced access to marketplace plans and tax credit subsidies. These plans do not replace the health care that the federal government is obligated to provide through the IHS. Instead, this additional health coverage supports more comprehensive and continuous care, and in a wider geographic area. Marketplace plans also cover services that may not be available at some IHS facilities, such as specialty care.  For Native Americans who don’t live near IHS providers, having marketplace insurance is key to getting timely, appropriate care.  

Marketplace insurance for IHS patients also provides much-needed additional resources to local providers. This is important because the IHS is so severely underfunded that some facilities literally run out of money in a given year, and necessary services are postponed until the start of the next fiscal year. The additional payments from marketplace plans can make a huge difference to these facilities. 
The ACA makes it especially easy for eligible Native Americans to enroll in and afford marketplace coverage. Alaska Natives and American Indians are given specific incentives to enroll in coverage, including: 

  • Year-round enrollment: Native Americans may enroll at any time of the year—open enrollment deadlines don’t apply
  • No cost-sharing (for example, out-of-pocket expenses like copayments) for those earning less than 300 percent of the federal poverty level (which is about $72,750 for a family of 4) 
  • No cost-sharing for those at any income level who receive care through the IHS, Tribal, or Urban Indian Health Programs

Consumers must enroll before December 15 to have coverage for 2016

The open enrollment period for buying 2016 marketplace health insurance began on November 1 and ends on January 31, 2016. While American Indians and Alaska Natives are allowed to enroll at any time, in order to have coverage that begins on January 1, people must select their new marketplace plan by December 15. 

For more information and resources, see the National Council of Urban Indian Health’s Affordable Care Act Resource Center

Families USA thanks the National Council of Urban Indian Health for their assistance in preparing this blog and accompanying infographic.

What is the Indian Health Service (IHS)?

The Indian Health Service (IHS) system is the federal agency responsible for carrying out the federal government’s treaty-based obligation to provide for the health of American Indian and Alaska Native communities, as well as their main source of health care. It’s made up of IHS Facilities, Tribal Organizations, and Urban Indian Health Programs. The IHS directly operates 31 hospitals and 52 health centers, and it provides funding for other facilities, including more than 30 Urban Indian Health Programs in 20 states. Individuals who meet IHS definition of American Indian and Alaska Native can receive care in both tribal and urban facilities, but there are large geographic areas where these facilities simply don’t exist. 

Note: The phrases “Native American” and “American Indian/Alaska Native” are used interchangeably in this blog.