Indian Health Care Choices Widen Through State 'Exchanges'

For too many Native Americans, the adage “Don’t get sick after June" once applied—because Indian Health Service (IHS) funds sometimes dwindled then—but soon it may be a different story with different outcomes.

For example, Colorado’s two tribal nations can keep IHS health care as it is at present, create a tribal health plan for their members, or craft a hybrid IHS/tribal plan through the Colorado Health Benefit Exchange (Exchange), slated to open in October 2013. Tribes in other states would also have options.

The possible Native plans and state health exchanges are a part of the federal Affordable Care Act, which is to enable low- and moderate-income individuals and small employers to obtain affordable health coverage. It also permanently authorizes the Indian Health Care Improvement Act.

The Southern Ute Indian and Ute Mountain Ute Tribes “are exploring their options,” Myung Oak Kim, Exchange communications and outreach specialist, said of the tribes in southwestern Colorado.

“The two tribes could say that they want to create a health plan for their members,” she said. “Then they could calculate the premium for their members and they could also include choosing the providers.”

“They could go to the Exchange and say, ‘Yes, we want to use the Exchange and we want this kind of plan with these providers and we will pay the costs,’” she said.

Kim stressed that there is no requirement for anyone to use the Exchange, which is an information and assistance program. There is no requirement for Native Americans to obtain health insurance.

She also emphasized that exchanges are not health plans in themselves, but can streamline the determination of eligibility for Medicaid, Medicare and Child Health Insurance programs and “the main change is simplification of application.”

Colorado is one of 12 states creating state exchanges, while others are in planning stages. In states that don’t plan exchanges, federal exchange programs will be available, she said.

There are two kinds of financial assistance through the exchange: Premium subsidies and copay and deductible reduction or elimination, she explained.

Native Americans and other Coloradans who earn between about $15,000 and $45,000 a year (families of four who earn between about $34,000 and $92,000 a year) could be eligible for financial assistance to reduce the cost of private health insurance, she said.

“In addition, Native Americans who earn between about $15,000 and $33,000 a year will not be responsible for additional costs like deductibles or co-pays,” Kim said.

“Native Americans will continue to be able to obtain health care services through [IHS] facilities even if they enroll in a private or public health plan,” she summarized. “Enrolling in a private or public health plan through the Exchange will provide Native Americans with more choices of doctors and medical facilities for their medical care. Tribal leaders will also have the ability to work with the Exchange to tailor provider networks and health plans to meet the needs of their members.”

Kim said Colorado’s program concerning the two Ute tribes seems unique because it is “trying to provide the two federally recognized tribes more flexibility with the exchange through frequent consultation with them, to help them accomplish whatever they choose.”