Washington Health Benefit Exchange
  • Tribal Premium Sponsorship is the only realistic path to Marketplace Insurance for Active Users of Indian Health Service programs, but Indians without access to IHS paid health care services should "consider buying insurance" if they are eligible for tax subsidies, especially if they are enrolled tribal members.
  • Tribes are less likely to sponsor community members if health plans do not contract with their health programs (and recognize unique contracting requirements -included in the PROPOSED Indian Addendum).
  • Sponsorship option is not available to the urban Indian population without a special effort to establish an Urban Indian sponsorship program/foundation with funding to pay all or part of premiums for Urban Indians who face higher cost of living and little discretionary income for health insurance. Enrolled tribal members without access to IHS should consider buying insurance,that is very reasonable for those under 300% of FPL if they buy the bronze plan because they do not have to pay deductible,copays, or cost sharing (% of bill charges).
  • If not an enrolled tribal member. remember only silver plan offers cost sharing to descendents who are not enrolled (again, if not yet enrolled in a tribe---3 times repeated here).
March 15, 2013 Ed Fox, Confederated Tribes of Colville, Presentation on Uninsured in Eastern Washington
Affordable Care Act and Direct Service Tribes Presentation.
  • GAO report (9-2013) says 2.5 million Washingtonians potentially eligible for Premium Tax Credits in 2014.
  • However, most have private insurance and would only be eligible if they left their employment or employer ended health benefits (thus they are 'potentially eligible').
  • Few IHS users will enroll without financial  assistance. 

  • Patients with access to IHS less likely to 'buy' health insurance, no matter the cost.
  • Estimated 5,000 who have access to IHS services are between 139- 300% of poverty,  potentially eligible for tribal premium sponsorship
  • Another 2,000 (300% to 400%), or 7,000 total with IHS between 139-400%.

  • 36,000 AIANs with private insurance are between 139-400% of FPL, but not likely eligible for tax credits with the exception of 4-5,000 with non-group coverage.
Over 40,000 Washington State AIANs with Employer Insurance are under 400% of FPL

  • 17,000-19,000 uninsured potentially eligible, but family glitch reduces by 1/2 or more.
  • Another 4-5,000 who are insured may have plans they can drop and switch to QHPs.

  • 1,350 enrolled tribal members have QHPs; perhaps 1,000 to 2,000 additional AIANs (not enrolled tribal members) also have obtained coverage in a QHP.
50 State Estimates of Private Coverage for AIANs
WA State Estimates of Private Coverage for AIANs
 American Indian Health Commission
for assister training.
October 2014 Enrollment Report
​2016 Enrollment 
Suggested Citation: Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2016 Website.
Free and unlimited use granted with citation (suggested citation above).  
2014-2105 Reports
  • A Website is not an exchange, but a functioning website is essential for Medicaid Enrollment.
  • An exchange is a marketplace where one chooses between more than one health plan.