Why Expanding Medicaid and Health Care Coverage Matters in Indian Country

There are a myriad of reasons why Montana should expand Medicaid – providing affordable health care coverage for up to 70,0000 Montanans and a boost to Montana’s economy. Medicaid expansion has a significant impact on Indian Country as well. By expanding Medicaid and providing coverage to more than 19,0000 American Indians, we can improve access to quality healthcare and provide needed revenue to the severely underfunded Indian Health Service (IHS) clinics and hospitals.

Traditionally, American Indians receive health care through IHS. Because American Indians rely on IHS as their primary healthcare provider, they are less likely to see the importance of purchasing health insurance through the exchanges. It should also be noted that American Indians have treaty agreements with the federal government that should provide access to quality healthcare in exchange for governance over this country.

But the failure to have health insurance has real repercussions on access to health care services for American Indians. IHS facilities receive funding for two purposes – operating funds and contract services. The operating funds are intended to provide services that are needed to meet the basic health needs of the community members. Contract fees are to cover services that are not provided at the facility, and require a referral to an outside provider (i.e., MRI, cancer treatment, etc.). What is important to remember is that at no point in the history of IHS has this agency ever been funded at the level needed to provide quality basic care to its patients. For this reason, IHS facilities oftentimes have limited services provided on site and patients must rely on being able to receive approval from their IHS clinic to receive services that require a referral to an outside provider (i.e., MRI, bone marrow transplant, etc.). To allow IHS patients to receive adequate care, they are sent somewhere else to get that MRI and then the IHS facility provides payment for the service. Again, because of lack of funding these “contract dollars” are finite and do not last long. A patient must be “approved” for the service, often dependent on whether it is a priority need and whether there are funds available (i.e., a life or limb litmus test).  When contract dollars run out, patients are denied approval, and without insurance, will either forgo the care or pay out of pocket.

Last week I read an article in the Washington Post that reported that an unusually low number of American Indians in Alaska have enrolled in the healthcare exchanges. Out of more than 100,000 people who identify as Alaska Native or American Indian, only 115 signed up. In an article written by Mark Trahant, Journalism Chair from the University of Alaska Anchorage, he notes some states have had more success. Washington expanded Medicaid and invested in outreach and now 10,000 more American Indians and Alaska Natives have insurance. 

Just like all individuals, having health insurance gives American Indians – just like everyone else – the peace of mind of knowing they will be covered for their health care needs. On top of this, more insured American Indians gives IHS a much-needed source to help pay for health care services its patients need.  This would ease funding shortages and allow IHS facilities to increase services and contract dollars would last longer.

One of the ways we can increase the number of insured American Indians is by expanding Medicaid which would help cover more than 19,000 American Indians in Montana.

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