The Center on Budget and Policy Priorities (CBPP) on July 12 released a detailed analysis that shows just how bad the proposed Senate bill to repeal and replace the 2010 Affordable Care Act (ACA, also called Obamacare) would be for American Indian and Alaska Native people.
Coverage for American Indians and Alaska Natives at Risk Under Senate GOP Health Bill states that the Republican health care initiative would effectively end Medicaid expansion and that in turn would directly affect the ability of the Indian Health Service to care for patients.
Medicaid expansion has “provided much-needed revenue to Indian Health Service (IHS) and tribally operated facilities, allowing them to expand services and hire and retain more staff. Ending Medicaid expansion would … reduce revenue for IHS and tribally operated facilities, forcing them to revert to pre-ACA service levels,” according to the analysis.
Changing how Medicaid is paid for – moving it from a federal entitlement program based on reimbursement for services provided to a per capita or block grant program run by states – would force cuts in eligibility and benefits, and those cuts would affect AIAN Medicaid recipients, wrote the CBPP. Reducing the number of eligible Medicaid recipients and the benefits available to those who did qualify would have the same impact on IHS and tribally run medical facilities as ending Medicaid expansion. Fewer dollars coming into the system would mean fewer services for fewer people.
These cuts would be imposed on an already grossly underfunded system that is charged with caring for some of the sickest and most vulnerable people in the country. “Medicaid is an important source of affordable coverage for AI/ANs, a population with significant physical and mental health disparities. Compared to non-Hispanic whites, AI/AN adults are twice as likely as to be overweight, obese, diagnosed with diabetes, and experience feelings of sadness, hopelessness, and worthlessness,” notes the report.
Further, “Medicaid coverage is particularly important for AI/AN children, who – like their parents – face significant health disparities. For example, compared to non-Hispanic white children, AI/AN children are 60 percent more likely to have asthma, twice as likely to die from sudden infant death syndrome, and 70 percent more likely to die from accidental deaths before age 1.”
Currently, “Medicaid is a key source of financing for IHS and other Indian health providers,” the report notes. Medicaid expansion cut the uninsured rate for AI/ANs from 29 percent (compared to 16 percent for the general population) in 2010 to 21 percent in 2105. It made coverage available to all adults with incomes below 138 percent of poverty level in states that elected to expand the program. And the ACA makes affordable insurance coverage available to AI/ANs with incomes between 100 percent and 400 percent of the poverty level through tax credits and subsidies. “Eliminating these subsidies would make coverage unaffordable for nearly 30,000 AI/ANs, jeopardizing their coverage,” according to the analysis.
The report also looks at the cuts to Indian Health Service funding in President Trump’s 2018 budget proposal, which pulls 14 percent, or $76 million, from IHS’s facilities budget. “Most of the IHS’ budget goes to the provision of direct health care services, but the lack of funding for its facilities has dire consequences, including death, for thousands of AI/ANs,” the report reads.
“The lack of funding also has hindered IHS’ ability to hire and retain high quality physicians and other providers. In South Dakota, a high schooler died from a blood clot in her lung after being misdiagnosed with a cough and anxiety. In Nebraska, a man died of kidney failure after not being hospitalized when a test showed his kidneys were shutting down,” the analysis states.
Whether the funding cuts result from the proposed Republican health care bills or the president’s proposed budget is of no consequence. The result is the same – lost lives as the federal government again fails to meet its trust responsibility to provide health care for American Indians and Alaska Natives.
The analysis pertains to the first version of the Senate legislation, made public on June 22. The Senate released a revised version of the Better Care Reconciliation Act on July 13, but the CBPP has determined that the changes were not substantive in regard to the Medicaid-related health consequences for the 2.2 million AI/ANs who get their care from the Indian Health Service.