• Affordable Care Act seeks to reduce the number of uninsured from 50 million(2010) to 10-20 million-2015 CBO estimates 31 million uninsured in 2025(see above).

  • Phase 2 of ACA, under way in only a few states, focuses on improved value by transforming Medicaid's delivery and payment system with attention to the private insurance market, public health and social and economic determinants of health.

  • In 2011 there were an estimated 1.14 million American Indians and Alaska Natives without insurance (2.4% of the nation's uninsured). 

  • In 2014 the number of uninsured American Indians and Alaska Natives dropped to 955,000, 190,000 fewer than 2011,150,000 fewer than 2013
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  •  $100 billion in new spending annually to cover 40 million uninsured: Potentially over $2 billion annually for AIANs ​with majority of new spending Medicaid payments for health services. This total is not likely to be reached without great effort by States and Tribes.
  • 2016-2025 CBO and JCT currently estimate that the ACA’s coverage provisions will result in net costs of $76 billion in 2015 and $1,350 billion to the federal government.

  • In 2015 CBO estimates $1.35 Trillion 2015-2025 net cost of coverage provisions.
Kaiser Family Fondation
Health Care Reform
  • The Problem (s) that Health Care Reform attempts to address are:
  • 1.  the high rate of uninsured (50 million, already reduced to 48 million) and 
​ 
  • 3 key income groups for American Indians & Alaska Natives: 
  • 0-138% wlll be eligible for Medicaid in states chosing to expand.
  • 300% of poverty upper threshold for no cost sharing for AIANs
  • 100%-400% will be eligible for subsidies in states NOT expanding Medicaid
  • 139-400% in states that do expand Medicaid.

  • Note: If under 100% of poverty, not eligible for subsidy (UI report)in states that don't expand Medicaid to 138% of poverty.  Millions live in states where eligibility ranges from 17% of poverty to 100% of poverty.

  • State Implementation Resources and Forum with resources contributed by state staff and researchers.  Includes AIAN documents.
  • Area/Regional and State Indian Organizations
Federal Regulatory Agency, CCIIO, has approved an Indian Addendum reccommended for use by Qualfied Health Plans 
 American Indian Health Commission
for updated information and calendar.
  • The Best Source of Health News in general is at Kaiser News
The Mother of all FAQs at Kaiser Family Foundation is constantly updated and searchable.
  • Health Care Reform is back on the agenda in 2017.
  • Repeal
  • Repeal and Replace
  • Repeal and Repair
  • No repeal, fix what's wrong
  • No repeal, ignore fixable issues
  • No repeal, undermine critical elements

Will success in reducing number of  uninsured AIANs be lost?​

The short tragic life of the AHCA.
  • The 2 main components of ACA 

  1. Medicaid Expansion

  This is the easier part of reducing the uninsured and Indian programs and by 2017 had great success in states that expanded Medicaid to 138% of the federal poverty level.

  2. Marketplace​  

  Unfortunately, fewer than 20% of those AIANs eligible for subsidies will purchase qualified health plans.  Texas and Oklahoma had best enrollment of AIANs, but states that expanded Medicaid had dismal enrollment as of February 2017.

   Tribal Sponsorship programs could increase this percentage substantially especially if 2017 reforms make two changes proposed in Urban Institute in "Fix-It":

1.  End the family glitch to extend tax credits to  spouses and dependents of tribal employees.
2.  Medicaid eligibility is reduced from 138% to 100% of the Federal Poverty Level.
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).
edfox_phd@yahoo.com  
  • FAMILY GLITCH 2017
  •   # 1 question (question most commonly asked) is: 
  • "I have insurance, can my spouse get tax credits?" The answer is, NO.

  •   The spouse of an employee 'offered' employer sponsored insurance is typically not eligible for tax credit in the exchange.

  •   They can purchase insurance in the exchange, but no tax credit is available until Congress fixes the "family glitch" ignores affordability of family coverage
  • Urban Institute's reform recommendations includes proposed elimination of family glitch.

Tribal Sponsorship programs could increase this percentage substantially especially if 2017 reforms include  two changes proposed by Urban Institute  "Fix-It" recommendations.

Medicaid Expansion and Qualified Health Plan Calculator that gives state and tribal estimates for uninsured by income in 2012 (Note state estimate follows the tribal estimate)