Medicaid expansion under the Affordable Health Care Act is expected to bring in much-needed dollars to the chronically underfunded Indian Health Service. But tribal health experts say the main game changer in Indian country will be new health insurance exchanges. For the first time ever, the IHS, a system traditionally open only to Native Americans, will be competing for non-Indian patients in order to survive.
There are 27 IHS facilities in New Mexico, and most are located in some very rural areas — so rural, they’re often described as “frontier”. The Pueblo of Jemez’s clinic is one of those where Dave Panana serves as nurse manager, and today, tour guide.
“We have seven rooms, the first two are for triage, and then the other five are for regular doctor visit exam rooms,” Panana said as he walked through the clinic. “This is our lab, so we do basic point-of-care testing to your normal A1C's, your UA's, Hemoglobin’s, etc.”
The clinic handles ambulatory care, dental, standard X-rays. All the services a rural community like Jemez Pueblo needs. But on Jemez, about 55 percent of the patients who come in are currently uninsured, which means IHS and Jemez Pueblo absorb the medical costs of that population.
“Hopefully that number will go down,” Panana said. “Especially with the changes with the health insurance exchanges that are coming down in 2014.”
Health insurance exchanges are marketplaces for people to buy private insurance. In essence, it will be like comparing prices for airline tickets online, and once you purchase an insurance plan, you’re locked into a network.
Here’s how the exchanges could benefit the Indian Health Service: If IHS clinics are contracted with these private insurance plans, suddenly more non-Indian patients will be able to access health care at places like Jemez Pueblo.
“They pass us everyday wondering ‘wow, it would be really neat if I could just go there, it would be such a short drive, be a wonderful convenience’,” said Maria Clark, director of the Pueblo’s Health and Human Services Department. “So we want to be able to promote ourselves in a way that we want their health care dollars spent here and we welcome them. “
“I think that health reform, with the exchanges, are going to forge a new business model mindset within the Indian health system,” said Jim Roberts, a Native American health expert with the Northwest Portland Area Indian Health Board.
Roberts says right now in Oregon, the Indian Health System has already been integrated into the state’s exchange, and he says that the idea is spreading.
“In Washington State we have begun that process where I have no doubt fully that our programs will be able to provide services to non-Indians and Indians, served by qualified health plans,” Roberts said.
Another opportunity the state’s health exchange offers tribes will be the ability to purchase supplemental insurance plans for their members. For tribal citizens with serious medical issues, tribal governments could opt to purchase plans for them through the exchange instead of dipping into limited IHS funds from the federal government.
“So if we can pay a $100 premium a month for somebody that has some significant illnesses, and utilize that insurance to supplement what we would have put out for their health care bill, we’re going to do that,” said April Wilkinson, program specialist for the Pueblo of Jemez.
But that’s only viable if the insurance plan lists Jemez and other IHS clinics in their networks, which is happening, but slowly. Becky Kenny is with Blue Cross Blue Shield.
“Blue Cross and Blue Shield of New Mexico is including IHS clinics in our exchange network as we consider them to be essential community providers here in our state,” Kenny said.
Across the country, heath care exchanges won’t be up and running until October. But already many health insurance providers are seeing opportunities in tribes, reportedly showing up on reservations around New Mexico looking to sign up tribal members for private insurance.
