For most uninsured Americans, the motivation for checking out the health insurance exchanges is simple – they could face stiff penalties if they don’t sign up. For Native Americans, the decision is more complicated.
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. 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.
So why would an American Indian or Alaska Native sign up for reduced-rate insurance on the exchanges?
Indian health advocates said the benefits are many. “It’s an unprecedented opportunity,” said Roxane Spruce Bly, who is working with New Mexico’s health insurance exchange to provide outreach to Native Americans. “It’s the biggest thing to happen in Indian health in my lifetime. It solves so many problems for Indian people.”
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, 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.