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Health Coverage Could Improve With Affordable Care Act Education

Anxiety is rising among many here in New Mexico as the Obama administration works ‘round the clock to fix the new Affordable Health Care website and the first Obamacare enrollment deadline looms in the near distance. Not only that, some people’s health insurance policies are being dropped while others’ rates are rising.

But a leading Native American health advocate in New Mexico says that American Indians and Alaska Natives have fewer reasons to be anxious about the upcoming deadline for the new health insurance law.

“Native health care consumers have no reason to panic,” said Roxane Spruce Bly, director of Healthcare Education and Outreach for the Native American Professional Parent Resources based in Albuquerque. “In general, I think there’s a lot of anxiety for consumers around the country because they need to enroll in coverage by March 31, 2014, to avoid a penalty or a fee.

“For many Native American consumers, they are feeling that same sense of anxiety,” said Spruce Bly, who is from the Pueblo of Laguna. “They actually have plenty of time before they have to make a decision concerning their options for health coverage. There’s a big difference between a tribal consumer and a non-tribal consumer. It’s pretty dramatic.”

Under provisions of the Affordable Care Act, tribal members can apply for an exemption to the mandate to have coverage by the end of next March. They will continue to have the opportunity to enroll each proceeding month in a health plan through the New Mexico Health Insurance Exchange, or NMHIX.

Many Native health care providers working in the field of ACA advocacy and outreach to NMHIX tribal communities are concerned that many Natives are not paying attention to Obamacare because they believe they already have health insurance through the Indian Health Service (IHS), and all of their medical costs will be automatically covered.

“Most of the Pueblo Indians think that IHS is insurance, but it doesn’t cover everything,” said Gov. Mark Mitchell of the Pueblo of Tesuque. “You never know what’s going to happen when you don’t have health insurance. Then you’re stuck between a rock and a hard place.

“Here at Tesuque, we appointed one of our former governors to address this issue and gather information about the Affordable Care Act,” added Gov. Mitchell. “So he’s doing that and we’re trying to take care of the elders first and then move on from there. Hopefully we’re doing the right thing for them, notifying them and letting them know about this new insurance.”

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“A lot of American Indians who rely on the Indian Health Service who are healthy, they don’t necessarily recognize that if you need services outside the IHS, they may not be available,” said Spruce Bly. “So until you become seriously ill or have a significant health problem you may not realize that it’s not the same as insurance. There’s no protection for medical expenses.”

She explained that regardless of your income (you could be a Native American millionaire), if you’re a tribal member from a federally recognized tribe and you purchase your plan through the exchange – if you get your benefits through the IHS or another Indian health provider, there is no cost.

“Let’s say you end up needing surgery,” she noted. “In a normal situation your costs would be, say, $2,500. If you bought your plan through the exchange and get your referral from an Indian health provider, you shouldn’t have to pay any out-of-pocket expenses.

“So you could actually get a no-cost, private health insurance plan and have no costs to carry. I can’t overstate this,” said Spruce Bly, who is providing outreach to tribal members in New Mexico about the state’s health insurance exchange. “There are real opportunities for Indian people to get coverage like never before. The implications for Indian health providers, when they can capitalize on those reimbursements – we could be looking at a dramatic increase in services.”

Indian health experts including Ed Fox, Port Gamble S’Klallam Tribal Health Director, believe it’s up to tribal leaders to take advantage of the Affordable Care Act. As a member of a tribal advisory group to the Centers for Medicare and Medicaid, Fox estimates the ACA could bring in up to $4 billion for Indian health providers.

“We’re going to have to be extremely careful about how those reimbursements come into IHS,” said Gov. Mitchell. “I think all the New Mexico tribes are going to utilize that. For example, when some of our tribal members go to IHS for any special help, when we send them out for referrals, the IHS doesn’t have the money to cover those costs. What happens is the bill gets sent out to our individual members. We’ve been working hard to straighten that out.”

“Right now the IHS is funded at only 54 percent of the actual need,” said Spruce Bly, “but if enough Indians start using the exchange system that money (the reimbursements) could go right back into the (IHS) system. It’s pretty astounding actually.”

“Our members (at Tesuque) have been refused service because the IHS doesn’t have the money to cover treatment,” said Gov. Mitchell. “Lately, what I’ve seen and heard is that wherever our members get referred, the (non-Indian hospitals or specialists) are not accepting because the feds are not paying their bills. That’s why we’re brainstorming and looking at Obamacare, to see whether it can help us or hurt us.”