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WASHINGTON, DC - NOVEMBER 15:  Senate Budget Committee member Sen. Mark Begich (D-AK) questions Congressional Budget Office Director Doug Elmendorf during a full committee hearing on Capitol Hill November 15, 2011 in Washington, DC. Elmendorf presented the committee with the CBO's fiscal and legislative policy options for increasing economic growth and employment in 2012 and 2013, including increased aid to the unemployed, tax credits to lower and middle income households and reducing employees' payroll taxes.  (Photo by Chip Somodevilla/Getty Images)
Legislation to add new, comprehensive definitions of "Indian" to the Affordable Care Act were introduced Oct. 17 by five Senators, to correct inconsistencies that could prevent health care benefits for thousands of Alaska Natives and American Indians.

The current version of the health care law contains several important provisions for Native Americans, including permanent reauthorization of the Indian Health Care Improvement Act. The law also contains several definitions of "Indian" which led to conflicting interpretations of eligibility for benefits and requirements for coverage. Sponsors of the legislation include Senators Mark Begich, D-Alaska, Max Baucus, D-MT, Tom Udall, D-NM, Brian Schatz, D-HI, and Al Franken, D-MN.

Up to 14,000 Alaska Natives in Alaska are not enrolled in Alaska Native corporations, or in tribal governments. These people have historically been eligible for HIS benefits, and will continue to be. However the issues at stake are the Internal Revenue Service tax penalties for not caring coverage, cost sharing provisions and special enrollment periods.

The proposed legislation would change the definition of Indian within the Affordable Care Act to include all Alaska Natives who are eligible to receive health care under existing law, which would allow those 14,000 Alaska Natives to receive fair treatment under the law, Begich said. - The Cordova Times, 10/18/13

Here's a little more info:

“I have heard from Alaska Tribal Health organizations for months about the urgent need to introduce legislation that will serve as a technical fix within the ACA to broaden the definition of Indian as applied to Alaska Natives,” said Sen. Mark Begich (D-Alaska).

Earlier this year, the Department of Health and Human Services issued a regulation making sure that the discrepancy between different health programs would not force Native Americans to pay a tax penalty for going without health insurance. Tribal health advocates, though, say that legislation is required to cement that exemption. - The Hill, 10/17/13

This is great news because the Affordable Care Act is kind of a hard sell for Native Americans:

Although tribal members are entitled to free health care, most Indian health facilities do not offer a full array of services. When patients need major surgery or cancer treatments, for example, they are referred to specialists outside of Indian lands. At least two-thirds of those referral claims are rejected, Roxane Spruce Bly said. That puts Indians at risk of either paying major medical bills themselves or doing without needed treatments. In addition, about half of Native Americans live in urban areas that are great distances from tribal health facilities.

As a group, the nation's 5.2 million Native Americans have poorer health and less access to health care than the rest of the U.S. population. Their uninsured rate is nearly 30 percent, compared to 15 percent for the country as a whole. And nearly half of all Indians have incomes low enough to qualify for Medicaid in states that have chosen to expand coverage, according to the Center on Budget and Policy Priorities. More than 1 million Native Americans are already enrolled in Medicaid.

Still, Bly and others said the idea of purchasing health insurance, even if deeply discounted, is a foreign concept for most tribal members. Even optimistic advocates for Indian enrollment in the exchanges said convincing tribal leaders and individuals to sign up could take years. Bly's goal is to sign up 10 percent of New Mexico's eligible Native Americans by the end of 2014. - USA Today, 10/15/13

This new legislation helps strengthen the ACA for Native Americans which is beneficial for Native Americans:

With the implementation of the Affordable Care Act (ACA), Native Americans who qualify for service from the IHS are exempt from the ACA regardless of official documentation of native ancestry. Earlier this year, the ACA had mandated a restriction that meant Native Americans had to provide documentation that proves their native ancestry to be recognized by the federal government to get the ACA exemption, which would have further complicated the already tedious system. Considering there are 100 tribes recognized by the state, but not the federal government, this change in the ACA is great news. It means Native Americans who chose not to participate in ACA and stay with the IHS will not have to pay a penalty.

Does the ACA help fund clinics and hospitals in reservations? Absolutely!  The ACA permanently reauthorizes the Indian Health Care Improvement Act, which will strengthen health care for 1.9 million Native Americans. Additionally, Native communities have the option of applying to both services from the ACA and the IHS. Hopefully this will solve the crisis the IHS experienced resulting from extreme budget cuts from the sequester in March, and more people will have access to decent health care.

With the implementation of the act, Americans are scrambling to understand how health care will impact their finances, and this is especially true for folks who already qualify for government insurance programs. Marginalized communities in the United States are often disproportionately impacted by legislation, which is why it is important to take a closer look at how the ACA will impact us. While the act is intended to solve the issue of providing health care to all Americans, Native Americans are having to wade through the limitations and budget cuts that could possibly afford them protection under the IHS and ACA. Clearly, the U.S. government has treaty obligations to provide health care to Native Americans and this is a great start. - PolicyMic, 10/9/13

Valarie Davidson, the Alaska Native Tribal Health Consortium's government affairs director, has been out explaining how the ACA benefits Alaska Natives:

The Affordable Care Act can help in two ways, Davidson said. First, if Gov. Sean Parnell agrees to expand Medicaid, an option allowed for states by the federal law, Alaska’s Medicaid enrollment can be sharply expanded with higher allowable incomes and also extended to people currently ineligible, such as single adult males, she said.

This would financially strengthen the tribal health organizations by increasing their ability to tap Medicaid as a supplementary source of revenue. The federal government would pay the 90 percent of the costs for the Medicaid expansion, too, after fully funding the expansion for the first three years.

Parnell hasn’t yet made the decision to expand Medicaid for Alaskans, and a U.S. Supreme Court decision has left that choice up to the governors of states. The governor now says he will make the decision as he announces his proposed budget for state Fiscal 2014 on Dec. 15.

But whether Parnell expands Medicaid or not, many Alaska Natives may benefit from the Affordable Care Act in a second way, by purchasing their own private insurance through the new health insurance exchange for Alaska established by the federal law.

Alaska Natives registering on the exchange may also qualify for federal tax credits that would reduce the cost of the insurance. Most important, Davidson said, is that they may be able to get coverage for things not covered by the Indian Health Service. - Alaska Journal of Commerce, 10/17/13

I'd like to thank Senator Begich and his colleagues for pushing to help make the ACA more accessible to Native Americans.  If you would like to thank Begich, please consider donating to his 2014 re-election campaign so he can continue to look out for Alaska Natives in the U.S. Senate:

Originally posted to pdc on Fri Oct 18, 2013 at 02:30 PM PDT.

Also republished by The Democratic Wing of the Democratic Party, Invisible People, and Native American Netroots.

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