The Affordable Care Act, Obamacare, has been fully repealed six times and crippled 54 times in legislation passed by the Republican controlled House of Representatives. All of these bills died in the Democrat controlled Senate. In the last election, GOP numbers in the House increased and the Republicans took the Senate, so we know the Obamacare wars are about to heat up even more.
As has been pointed out in these pages, Obamacare contains funding mechanisms for the Indian Health Service that simply would not be possible in the time of budget sequestration without Obamacare. Indians have many more reasons to ride to the sound of the guns in this political battle.
Individual Indians who are enrolled or otherwise eligible for Indian Health Service but who live outside an IHS service area, like myself, as well as Alaska Native Claims Settlement Act Corporation shareholders, have special status in Obamacare as individuals.
Enrolled Indians and Alaska Natives can purchase private insurance coverage off the Obamacare exchanges at any time, rather than having to wait for the annual enrollment period.
You may also change plans from one month to the next, although that must be done carefully to avoid gaps in coverage.
Enrolled Indians and Alaska Natives who make less than around $70,650 for a family of four ($88,320 in Alaska)—and that’s many of us—can enroll in a zero cost sharing plan, which means no deductibles or copayments or coinsurance required.
If your income is above those limits and you currently are served by Indian Health Service, you can enroll in a limited cost sharing plan, which means you pay nothing out of pocket at IHS or any other provider when you have a referral from an IHS doctor.
If you have access now, you may choose to keep getting services from Indian Health Service.
Enrolled Indians and Alaska Natives who use Medicaid and Children’s Health Insurance Program (CHIP) have no premiums, enrollment fees, or out of pocket costs.
Persons who are eligible for Indian Health Service are exempt from the “Shared Responsibility Payment,” also known as the penalty for failure to purchase health insurance.
To qualify for these benefits, you need a tribal membership card or a Certificate of Degree of Indian Blood from the BIA or a document from an ANCSA Corporation showing shareholder status.
There are at least two reasons to buy insurance off the exchange if you can afford it even if IHS is your primary provider. One is that the policies available on the exchanges cover more services than IHS can cover, and the other is that your IHS clinic can bill the insurance company for your care, opening another income source in addition to the federal government and helping provide services for other Indians.
The Healthcare.gov website, reputed to be working well now after the first year debacle, has information directed specifically for Indians and Alaska Natives. The political fight to keep Obamacare working is about to heat up, but as long as it is working, there will be advantages for Indians and Alaska Natives both as individuals and as clients of the Indian Health Service.