Writings and observations

trahant MARK
TRAHANT

 
Austerity

The Affordable Care Act is a grand promise. Basically it’s a complicated insurance mechanism that’s designed to reduce the number of uninsured Americans, including those who rely on the Indian health system.

But one thing the ACA is not: Transparent.

This is a critical flaw because we are near another major deadline — March 31 — and some six months into the Act’s implementation and there is not one official scrap of information reporting how well Indian Country is being served. We don’t know how many folks across the country have signed up for Medicaid or how many have purchased insurance or how many individuals have policies that were purchased by tribes as sponsors.

Why does this matter? Because policy is being implemented on assumptions, not data. We don’t know what we don’t know.

This we do know: March 31 is an odd deadline. It’s the day when open enrollment ends for most Americans, including Native Americans who are not tribal members. But that deadline does not apply to American Indians and Alaska Natives who are tribal members. Then a monthly enrollment is possible. (I know, confusing, right?)

Native Americans still can receive a life-time exemption from the insurance mandate. Fill out a simple form and mail to get a certificate that could be included in your next tax return.

But we also know that the individual exemption is not enough. The Indian health system is underfunded and third-party billing — money from private insurance, Medicaid, Medicare, and other programs — is the only way funding will improve. Like it or not, Treaty or not, the Congress is not going to pay for Indian health through appropriations. The $6 billion budget for the Indian Health Service shows the agency collecting more than a billion dollars from Medicaid and only $90,307,000 from private insurance. So there is a lot of room for growth. Again, if folks sign up, the Affordable Care Act is a different course from appropriations; it’s a money stream that’s automatic.

We also know that Indian Country has some of the highest uninsured rates in the nation, roughly one in three people. So every new insured American Indian and Alaska Native adds resources to the Indian health system (and especially medical care that is purchased outside of Indian health facilities).

This week there is a last minute push to get people in Indian Country to sign up. On Monday there was a national Tribal Day of Action sponsored by the White House. And in Montana, the state’s Insurance Commissioner, Monica J. Lindeen, has been traveling to the state’s reservations and urban Indian centers to sell the plan.

But it’s hard to know how well those efforts are working. There are too many questions: How many people signed up early? What’s the goal? Where is the transparency?

Early Affordable Care Act numbers are found in Washington state. Ed Fox, who directs health services for Port Gamble S’Klallam Tribe of Washington, said the Washington Health Care Authority released preliminary figures to tribes for consultation. These are early numbers and will change, but they are an open important look in a state where the Affordable Care Act is working.

Some key findings: Washington probably ranks first in the nation in Medicaid “take-up” for the newly eligible. Some 6,000 or so of the newly insured Native Americans were enrolled by urban programs or tribes, and one-third with state worker assistance, and one-third a bit uncertain (possibly by someone with assistance or on their own). Washington also shows some 7,000 Medicaid re-certifications.

Washington’s data indicates that American Indians and Alaska Natives are slow to buy insurance through the exchanges or qualified health plans, less than five hundred (compared to more than 13,000 for Medicaid).

Fox said this could be seen as a “dismal failure,” but he suggests it’s more complicated that that. People at the state have made a tremendous effort to inform people about these plans, and the numbers might not reflect what’s really occurring. For example a purchased insurance plan requires the company to report and that might take longer than Medicaid data to be complete.

Of course Washington is a state that is passionate about making the Affordable Care Act work. Indian Country has benefited already because of the expansion of Medicaid, the driver of people getting new benefits under the law.

Unfortunately about half the states have not expanded Medicaid — and that will result in far fewer people in Indian Country receiving benefits under the Affordable Care Act. But, again, that’s back to the realm of data we don’t know.

The Affordable Care Act is complicated and its full implementation is going to take a while as customers in the Indian health system adapt to the new landscape. But this much is certain: Transparency would make this whole enterprise a lot easier.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. Comment on Facebook at: https://www.facebook.com/TrahantReports

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Trahant

news

Here’s what public affairs news made the front page of newspapers in the Northwest today, excluding local crime, features and sports stories. (Newspaper names contracted with location)

Treefort Music nearing profotability (Boise Statesman)
Parking garages move toward auto-pay (Boise Stastesman)
Stillaguamish mudslide toll hits 14 (Boise Statesman, Lewiston Tribune, Moscow News)
Lewiston High plan released (Lewiston Tribune)
More building activity in Pullman (Moscow News)
Supercomputer arriving at UI (Moscow News)
Nampa district, common core tests (Nampa Press Tribune)
New apartment group planned (Nampa Press Tribune)
Idaho Youth Ranch plans second Nampa store (Nampa Press Tribune)
Big game hunting rules changed a bit (Pocatello Journal)
Otter signs bill to nullify federal gun laws (Pocatello Journal)
Sandpoint Arts Alliance shuts down (Sandpoint Bee)
Library bond ahead for Boundary County (Sandpoint Bee)
Rancher at Hailey kills wolf (TF Times News)

Cities deciding whether to hold off on pot (Eugene Register Guard)
Stillaguamish mudslide toll hits 14 (Portland Oregonian, Eugene Register Guard, Salem Statesman Journal, Medford Tribune, Pendleton East Oregonian, KF Herald & News)
PUD at Klamath may dissolve (KF Herald & News)
Liquid gas terminal okayed for Coos Bay (KF Herald & News)
Mt Ashland Ski borrows to stay afloat (Medford Tribune, Ashland Tidings)
Pot store at Medford closes (Medford Tribune)
Loren Parks contributes big to Barreto, H58 (Pendleton East Oregonian)
New critics of Salem Civic Center plans (Salem Statesman Journal)

Stillaguamish mudslide toll hits 14 (Seattle Times, Spokane Spokesman, Tacoma News Tribune, Everett Herald, Yakima Herald Republic, Kennewick Herald, Port Angeles News, Longview News)
Hanford Reach expansion concerns (Kennewick Herald)
Pot options other than smoking (Longview News)
Troubled Seqium museum seeking help (Port Angeles News)
Group Health ending employment plans (Spokane Spokesman)
McMorris Rodgers on campaign finance issues (Spokane Spokesman)
World Vision will hire same-sex marrieds (Tacoma News Tribune)
Possible replacement high school at East Valley (Yakima Herald Republic)

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