The Affordable Care Act: What’s in it for American Indians and Alaska Natives?
Department of Health and Human Services Secretary Kathleen Sebelius, Vice President of Navajo Nation Rex Lee Jim and Administration for Native Americans Commissioner Lillian Sparks Robinson attend a recent HHS Consultation in Washington, D.C.
By Lillian Sparks Robison, Administration for Native Americans Commissioner
With so many competing priorities and social and economic needs in Indian Country, it is often tough to arrange the needs of American Indians and Alaska Natives in an order that fits for all communities. There are times though, that we have to choose our health, and our communities health and make that the priority above all else. Now is that time.
For nearly two decades Tribes and health advocates, including myself, fought for reauthorization of the Indian Health Care Improvement Act, the “cornerstone legal authority for the provision of healthcare to American Indians and Alaska Natives.” Finally, through the Affordable Care Act, we have permanent reauthorization of Indian Health Services.
Additionally, Indian Country has experienced gains in the funding of Indian healthcare over the years, but it still is not enough to make up the gap between what is needed to fully-fund health care for American Indians and Alaska Natives. That is why it is so important for us to sign up for Medicaid or the Children’s Health Insurance Program, or to purchase health insurance through the marketplace. Choosing to protect and care for our health does not jeopardize the future of Indian Health Service as some may worry, in fact it may do just the opposite!
IHS facilities have the ability to bill Medicare/Medicaid and CHIP, as well as private health insurance, for services provided, which means that when you are insured, you bring more health care dollars to your local service provider, which improves the care you receive and the care available in the community. Our communities face some very dire health disparities including diabetes mortality rates that are still nearly three times higher for American Indians and Alaska Natives than for the general U.S. population. We still need Congress to do their part for funding, but now is a chance for you to do something today, that can benefit the situation. Here are three things you need to know about the ACA and American Indians and Alaska Natives.
1. IHS will continue to provide quality, culturally appropriate services to eligible American Indians and Alaska Natives.
2. Under the new health care law, everyone is required to maintain minimum essential coverage or pay a fee (known as the shared responsibility payment). Being eligible for IHS services alone does not meet the minimum essential coverage requirement.
a. If you do not have health insurance coverage and receive care from IHS, you will need to either: (1) sign up for health insurance coverage, (2) pay the shared responsibility payment, or (3) apply for an exemption.
b. If you have health insurance coverage from your employer that meets the minimum essential coverage requirement, or have other health care coverage (through Medicare, Medicaid, CHIP, VA Health Benefits, or TRICARE), you are covered and don't need to worry about paying the shared responsibility payment or enrolling for health coverage available through the Health Insurance Marketplace.
c. If you are offered and decline health insurance coverage (that meets the minimum essential coverage requirement) from your employer, you must pay the shared responsibility payment or obtain an exemption, if eligible. Members of federally recognized tribes and other individuals who are eligible to receive services from Indian health care providers will have access to a special exemption, but other exemptions are available.
d. If you are not offered health insurance coverage through your employer or are unemployed, you may be eligible for coverage through the Health Insurance Marketplace. To learn more about health insurance options, please visit Healthcare.gov.
e. If you are interested in applying for an exemption, please visit Healthcare.gov.
3. American Indians and Alaska Natives have access to affordable health care coverage options through the Health Insurance Marketplace. You may now be eligible to purchase insurance coverage or determine if you qualify to enroll in Medicaid. If you qualify for and enroll in a plan through the Health Insurance Marketplace, you may be eligible for premium tax credit assistance (which is based on your income) and/or cost sharing waivers (based on being a member of a federally recognized tribe). To find out what you're eligible for, please visit and fill out an application on Healthcare.gov
If you haven’t been to Healthcare.gov, or tried earlier and were discouraged, I encourage you to look again. Sign up before March 31, to send a message that the health of our people matter!
Lillian Sparks Robinson, a Lakota woman of the Rosebud and Oglala Sioux Tribes, is the Commissioner of the Administration of Native Americans. Miss Sparks was confirmed by the United States Senate as the Commissioner on March 3, 2010, and was sworn in on March 5, 2010. She has devoted her career to supporting the educational pursuits of Native American students, protecting the rights of indigenous people, and empowering tribal communities.