Health law has special rules for Native Americans

Native Americans have a different take on health reform than the rest of the country. "Longstanding treaties with the federal government guarantee all Native Americans free health care. As a result, the Affordable Care Act exempts them from paying a penalty if they choose not to purchase insurance," Christine Vestal writes for Stateline. "More than 2 million Native Americans receive free health care at federally supported Indian health facilities. Many others receive care from tribal facilities and urban Indian organizations."

That doesn't mean Native Americans are healthier than the rest of America. In fact, "5.2 million Native Americans have poorer health and less access to health care than the rest of the U.S. population," and 30 percent are uninsured, Vestal writes. And getting Native Americans to enroll hasn't been easy. Roxane Spruce Bly, who is working with New Mexico’s health insurance exchange to provide outreach to Native Americans, told Vestal, “It’s the biggest thing to happen in Indian health in my lifetime. It solves so many problems for Indian people," but she said purchasing health insurance is a foreign concept to most tribal members. (Census Bureau chart)

The Affordable Care Act even favors Native Americans, with no open enrollment deadlines, and "members with incomes below 300 percent of the federal poverty level ($34,470 for an individual) are exempt from paying deductibles and copays, so they can purchase the cheapest plans without worrying about out-of-pocket expenses," Vestal notes. "All tribal members, no matter what income level, are exempt from out-of-pocket payments if they receive services from Indian health facilities. And unlike employers, tribes can pay exchange premiums for their members without paying taxes."

Also, "new provisions make it easier for Indian health facilities to accept payments from other insurers, including Medicaid, Medicare and private insurance," Vestal reports. "The new law also expands the types of services the facilities can offer and requires inclusion of behavioral health and substance abuse treatments. For Indians enrolled in Medicaid, Indian health providers receive a fee-for-service that is much higher than other providers receive. In addition, they can collect fees from private insurers if Native Americans take advantage of the exchanges." (Read more)