A few years before the Covid-19 pandemic, Dale Rice lost his toe to an infection.
But he was uninsured at the time, and the surgery in Reno, Nevada, led to years of suffering. He said he owes the hospital more than $20,000 for the procedure, but still receives calls from collection agencies.
“It can cause a lot of anxiety,” Rice said. “I can’t give you what I don’t have.”
Rice, 62, was born and spent his life in Nevada. He said he fell through the gaps in the tribe’s health care system because he lives 1,500 miles from the Prairie Band’s Potawatomination home area in eastern Kansas.
Although he receives primary care at the Reno-Sparks Indian Colony Tribal Health Clinic in Nevada, structural barriers in federal Indian health services have left him without coverage for specialized care outside the clinic. Although Rice may be eligible for specialty services referred by his tribal health system in Kansas, he must use tribal delivery services to take advantage of tribal health programs that help pay for services other than IHS. Too far from the area.
“You shouldn’t have to move to Kansas City to get full coverage,” Rice said.
A new tribal sponsorship program rolled out in Nevada last year aims to cover tribal citizens like Rice and protect them from incurring debt for uninsured care. It allows tribes to purchase health insurance through the state’s Affordable Care Act marketplace for people living in their service areas, including Native Americans from other tribes.
Tribal leaders and Nevada officials say the sponsorship model increases coverage and access to care for tribal citizens and their families by allowing them to seek medical care outside of the tribal health care system. That’s what I say.
Dozens of tribes have moved to set up insurance programs since the ACA allowed them more than a decade ago.
“It’s not widespread,” said Yvonne Myers, ACA and Medicaid consultant for Citizen Potawatomi Nation Health Services in Oklahoma.
Native American adults are enrolled in Medicaid at higher rates than whites and experience worse health outcomes, higher rates of chronic disease, and shorter life expectancies. Many rely on IHS, the division within the Department of Health and Human Services responsible for providing care to Native Americans, but the agency is chronically underfunded.
In Nevada, tribes can sponsor health insurance for their community members through aggregate billing, a method of paying premiums for multiple individuals in one monthly payment to an insurance company. Another part of the program will include collaboration between Nevada HealthLink, state health insurance marketplaces, and tribes to certify tribal health clinic staff to enroll community members in health plans. . Program officials also said they are committed to providing further education to tribes about the accommodations available under the ACA.
Health agencies in Washington and Nevada are helping establish tribal sponsorship programs. Separately, tribes in Alaska, Wisconsin, Idaho, Michigan, Montana, and South Dakota also have individual programs.
It’s already making a difference for Native American patients in Nevada, said Angie Wilson, tribal health director for the Reno-Sparks Indian Colony and an enrolled member of the Pit River Tribe in California. Wilson said patients showed up in tears because they could not afford the services they needed outside of the tribal clinic and were not eligible for the care program in which those services were purchased/referred. Said.
Reno-Sparks Indian Colony, which will have more than 1,330 members in 2023, is one of two tribes to participate in Nevada’s Tribal Sponsorship Program and Aggregated Claims. Russell Cook, executive director of Nevada HealthLink, said he expects more tribes to come on board as he works to build community trust in tribes wary of government and corporate entities. Ta.
The Fort McDermitt-Pite and Shoshone tribes, whose reservations span Nevada’s northwestern border, were the first tribes to pilot the program. There are approximately 125 households on the reservation.
According to state officials, 30 tribal members are enrolled in eligible health plans through Nevada HealthLink as part of the Tribal Sponsorship Program, including more than 700 self-reported American Indians through the state marketplace. and/or Alaska Native status within the last year.
Through sponsorship, tribes can use federal health care funds to pay premium costs for each participant. This, combined with the ACA’s cost-sharing protections for American Indians and Alaska Natives enrolled in marketplace health plans, provides very low to N costs for beneficiaries to receive care outside of tribal clinics. means facing. The American Rescue Plan also expanded eligibility for premium tax credits, making purchasing health plans more affordable.
Sponsorships with some tribes can help the entire community because they are not limited to enrolling tribal citizens, and in intergovernmental work with the Alaska Native Tribal Health Consortium and enrolled members of the Hopi Tribe of Arizona. said Jim Roberts, senior executive liaison.
Since Alaska first allowed sponsorship in 2013, Roberts said it has not only increased access to care for Native Americans, but also significantly reduced the cost of care.
In Washington state, where ACA plan sponsorship began in 2014, 12 of the 29 tribes participate.
Cook said the national exchange is seeing interest in part of its sponsorship program to train tribal clinic staff to become certified exchange representatives.
He said the agency is working on a marketing campaign to spread awareness among the state’s Native Americans about the sponsorship program. This includes translating other materials from the agency into the native languages spoken in the state, including Paiute, Washoe, and Western Shoshone, both northern and southern Paiute, and Western Shoshone.
Cook said he’s surprised more states haven’t taken the initiative to work with tribes to create sponsorship programs.
Nevada HealthLink patterned its approach by looking at Washington state’s program, Cook said. Since starting its own program, the Nevada agency has been approached by California officials exploring options.
But leaders like Wilson are concerned that under the Trump administration, tax credit enhancements for enrollees in the ACA marketplaces implemented during the pandemic will end. The credits are set to expire at the end of this year if Congress does not act to expand them. Without credit, nearly everyone enrolled in the marketplace would see their premium payments increase sharply next year.
If tribal citizens or other community members are not eligible for premium tax credits, that could jeopardize the tribe’s financial ability to continue sponsoring the health plan, Roberts said.
“No matter what side of the fence people are on, it does not take away from the federal trust responsibilities of the United States to Indigenous peoples,” Wilson said.
Wilson, who has been a sponsorship advocate since the ACA was approved in 2010 and has led efforts to establish the program in Nevada, is happy with the tribal sponsorship program, but hopes it happens sooner. He said he wanted to.
“We have lost a lot in Indian country over time,” she said. “How many more Indians could have accessed care? How much of a difference could it have made in preserving tribal health care?”
