Fact Sheet: How Does the Affordable Care Act Impact American Indians and Alaska Natives?

A major goal of the Affordable Care Act is to put American consumers back in charge of their health care.  The law puts into place comprehensive health insurance reforms that will hold insurance companies more accountable and will lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans, including the First Americans.  The Affordable Care Act also includes the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), which extends current law and authorizes new programs and services within the Indian Health Service (IHS).

Listening to American Indians and Alaska Natives: Tribal Consultation regarding Implementation of the Affordable Care Act

The Obama Administration is committed to regular and meaningful consultation and collaboration with tribal officials in policy decisions that have implications for American Indian and Alaska Native communities. At the Department of Health and Human Services (HHS), tribal consultation is a critical ingredient of a sound and productive Federal-tribal relationship, and crucial to the successful implementation of the Affordable Care Act.

Consultation and outreach efforts continue to provide more education and information about the new law, plans for its implementation and how it will impact Indian Country. The HHS Office of Intergovernmental Affairs works closely with all operating divisions in HHS to ensure the input of American Indian and Alaska Native individuals is considered as provisions are implemented. Activities include written and electronic communication, monthly outreach calls, and listening sessions. 

In addition, IHS Director, Yvette Roubideaux, has also begun a series of letters to Tribes to provide updates on implementation of the IHCIA. The IHS Director’s blog is a key source of information for Tribes: http://www.ihs.gov/PublicAffairs/DirCorner/index.cfm?module=blog.   

For the most recent information on Affordable Care Act and IHCIA implementation, please visit: www.HealthCare.gov and www.ihs.gov. 

The Affordable Care Act and Benefits for American Indians and Alaska Natives

In addition to specific provisions benefiting eligible American Indians and Alaska Natives, the Affordable Care Act gives new rights and benefits to all American Indians and Alaska Natives, including Urban Indians.

For example:

• State-based Health Exchanges: The law creates what is known as state-based health exchanges. Through an exchange, individuals and small businesses can purchase health insurance coverage. This will give them the ability to comparison shop and choose the affordable insurance option that is right for them.
• No Cost-sharing or Co-payments: Certain American Indians and Alaska Natives who purchase health insurance through the exchange do not have to pay co-pays or other cost-sharing if their income is under 300 percent of the federal poverty level, which is roughly $66,000 for a family of four ($83,000 in Alaska).
• Value of Health Services Cannot Be Taxed: The value of health services and benefits from IHS-funded health programs or Tribes will be excluded from an individual’s gross income so it cannot be taxed.
• Medicaid Expansion: Health insurance reform also expands Medicaid coverage to individuals with incomes up to 133% of poverty level (about $30,000 for a family of four). This provides more American Indians and Alaska Natives an opportunity for coverage while expanding the opportunity for Indian health programs’ third-party collections.
• Closing the Donut Hole: For individuals who have Medicare Part D drug coverage, IHS, Indian tribe or tribal organization, or urban Indian organization spending will count toward the annual out-of-pocket threshold in the donut hole as of January 1, 2011. Starting in 2011, individuals with this coverage will receive a 50% discount on brand-name drugs in the donut hole and will pay less for their generic Part D drugs in the donut hole.  By 2020, the coverage gap will be closed, meaning there will be no more “donut hole,” and individuals will only pay 25% of the costs of their drugs until they reach the yearly out-of-pocket spending limit.
• Reimbursements from Third Parties: Third party reimbursements from Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and private insurance help IHS fund needed health care services. The provisions of the new law that improve reimbursements and strengthen these programs will also benefit Indian health programs. 

Reauthorization of the Indian Health Care Improvement Act

Within the Affordable Care Act, the Indian Health Care Improvement Act Reauthorization (IHCIA) helps American Indians and Alaska Natives as well. The Indian Health Care Improvement Act, which authorizes health care services for American Indians and Alaska Natives through the Indian Health Service, was originally approved by Congress in 1976 and last reauthorized in 2000. The Affordable Care Act makes the reauthorization of this law permanent and authorizes new programs within the Indian Health Service to ensure the Service is more equipped to meet its mission to raise the health status of American Indians and Alaska Natives to the highest level.

For example:

• Expanded IHS services, including Mental and Behavioral Health: The law gives IHS authority to establish expanded health care services such as mental and behavioral health treatment and prevention, long-term care services, dialysis services, facilitation of care for Indian veterans, and urban Indian health programs.
• Increasing Clinician Recruitment and Retention in Tribally Operated Health Programs: This section of the law exempts a health care professional  employed by a tribally operated health program from State licensing requirements if the professional is licensed in any State (as is the case with IHS health care professionals). It also encourages health professionals to join or continue in an Indian health program and to provide services in rural/remote areas in which a significant portion of Indians reside.
• Access to Federal Insurance: The IHCIA also allows a tribe or tribal organization carrying out a program under the Indian Self-Determination and Education Assistance Act and an urban Indian organization carrying out a program under Title V of IHCIA to purchase coverage for its employees from the Federal Employees Health Benefits Program.

Posted: March 21, 2011