Native Americans and Alaska Natives Will Disproportionately Suffer Under the GOP Health Care Plan

By Amanda Michelle, ThinkProgress

08 June 17

The progress made over the last few years is at risk.

s Senate Republicans attempt to produce their own health care blueprint this week, beneficiaries of the Affordable Care Act are left wondering: what will happen to me? But one community is especially vulnerable if Congress repeals the ACA: Native Americans and Alaska Natives.

The American Health Care Act, the Republican bill currently making its way through Congress, does not undermine the Indian Health Care Improvement Act, a 1976 legislative promise made by the federal government to Native Americans to care and educate their community. (This act was later attached to the ACA in 2010 for funding purposes.) However, the House version of the health care bill rolls back key ACA cornerstones, like Medicaid expansion and cost-sharing protections, which will affect how the Native community gets comprehensive health care.

According to Kaiser Family Foundation, Medicaid expansion has provided more coverage to the Native community by offering health care options beyond the Indian Health Service (IHS) services. It also helped expand IHS and Tribal facilities by increasing Medicaid revenues, as more patients enroll in Medicaid. In 2016, approximately 13 percent of IHS funds came from Medicaid reimbursements.

The ACA also offered American Indians and Alaska Natives a couple of perks if they’d enroll in state exchanges. Low-income members of federally recognized tribes and Alaska natives qualified for a zero cost-sharing plan, which meant they’d pay nothing out-of-pocket.

The Indian Health Service has long suffered from funding limitations and mismanagement, a struggle that predates the Trump and Obama administrations. But the Republican health care plan threatens to roll back the progress made over the last few years. Eliminating cost-sharing subsidies would make health insurance unaffordable for a host of communities, but many American Indians and Alaska Natives will disproportionately suffer given their community’s high rates of poverty. Compared to the overall population, Native Americans and Alaska natives have significantly higher rates of poverty (16 percent and 26 percent, respectively).

At one point, the House GOP bill was at risk of not complying with Senate procedural rules because of how it affected Native American and Alaska health care. According to Bloomberg, the health care bill was in jeopardy of not complying with the Senate reconciliation process, a special legislative process where bills are not subject to a filibuster. Democrats argued that the GOP House bill influenced Native American health care subsidy eligibility, and this fell under the jurisdiction of the Senate Indian Affairs Committee, a committee intended to safeguard this community’s health care.

However, the Senate Budget Committee officially announced Tuesday that the American Health Care Act did comply with reconciliation. According to one Bloomberg reporter, the House bill will finally be sent to the Senate this week. (Yes, apparently the House bill has not been sent to the Senate yet.)

Sen. Repub aide says House will likely send health bill over Wed. or Thursday, even if Dems dispute reconciliation worthiness is finalized.

— Billy House (@HouseInSession) June 6, 2017

Medicaid expansion and cost-sharing reduction subsidies have been points of contention among Senate Republicans. Among the many communities watching is the National Indian Health Board, a national non-profit that facilitates tribal healthcare. The health board’s congressional relations director Caitrin McCarron Shuy told ThinkProgress that they have been very engaged in the Senate over the last three weeks and had great responses from Senators on both sides of the aisle when discussing tribal priorities. But of course, there have been no commitments yet.