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Forum Home - Go Back > General > Native Life > Health Issues IHS and ObamaCare IHS and ObamaCare

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Old 05-06-2013, 07:43 PM   #1
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IHS and ObamaCare

Char-Koosta News - Affordable Care Act will change the health care landscape in Indian Country

Affordable Care Act will change the health care landscape in Indian Country
The Affordable Care Act (ACA), also known as Obamacare, is the law of the land, including Indian Country.

Beginning October 1, all American citizens including American Indians must enroll in the ACA in order to get health care services. The health care coverage under the ACA takes effect January 1, 2014.

American Indian and Alaska Native individuals can continue to access health care from the Indian Health Service (IHS) or a tribally operated clinic. The ACA offers American Indians and Alaska Natives new choices and opportunities for health care insurance. This insurance coverage will pay for local IHS or tribal facility for health care they provided.

With the permanent re-authorization taking place in 2010, the implementation process has begun.

As the law is implemented, tribal leaders should be preparing for Medicaid expansion, open enrollment for health insurance marketplaces, possible insurance coverage for tribal citizens, and employer responsibilities required by the law.

Tribes also need to work closely with states to ensure that the decisions made at the state level are in the best interest of tribal citizens and employers.

Following are a few goals offered for consideration by the national Tribal Health Care organization to providing greater access to health care for American Indians and Alaskan Natives and maximizing opportunities for tribal communities.

Increase enrollment in federal health insurance programs
• The ACA allows states to expand the eligibility for Medicaid services up to 133 percent of the poverty line for individuals.
• The provision allows for greater health care access for American Indians and Alaska Natives.
• The ACA should encourage the Indian Health Service, tribal, and urban Indian facilities to streamline enrollment, business, and the billing processes to ensure that the health facilities maximize their third party billing reimbursements.

Preparing an insurance purchasing plan
• Tribal governments and enterprises are responsible for purchasing insurance as employers.
• Tribal entities with more than 50 fulltime employees must provide insurance that meets the minimum essential coverage required by the law.
• These entities can either, self-insure, join the Federal Employees Health Benefits (FEHB) program or purchase insurance through an insurance agent.

Adopt streamlined business practices
• There are number of new and expanded revenue streams under the ACA and the Indian Health Care Improvement Act (IHCIA), including additional Medicaid enrollees, third party billing, and the dual eligible veterans.
•Tribal leaders should work with health directors to prepare business processes that will ensure streamlined billing practices and enrollment in federal health insurance programs.
• Under the new law tribal governments can pay insurance premiums for members. Although some tribes do this now there may be greater opportunity as health insurance marketplaces launch.
• Tribal leaders considering this option should conduct a cost benefit analysis, especially in communities where health facilities are tribally operated.
• More citizens with coverage means more revenue flowing to tribal health clinics in your area.

Develop and adopt a plan to assist consumers
• The new law is very confusing. There are exemptions and requirements for individual consumers and even small businesses. Outreach and education about the ACA are very important, as is enrollment in health insurance coverage.
• Open enrollment begins October 1, 2013 and it is important that every individual his or her rights and duties as a citizen.
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Old 05-06-2013, 08:09 PM   #2
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I don't see any immediate negatives...
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Old 05-06-2013, 10:15 PM   #3
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It will force our local tribes to provide medical insurance for their employees, which they currently do not.

My daughter's tribal job is already laying them off 2 extra months in the summer. I hope they don't cut positions to pay for the insurance costs.
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Old 05-06-2013, 10:27 PM   #4
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The ultimate reality will be cost. It always is.
I have insurance from my years with the union. I pay for it myself , now that I'm retired.Over 700 a month....most of one of my pensions. I also qualify for Medicare in June , but I refused it. I checked it out and Medicare part B was 100 bucks a month , then add part c to fill in the gaps and even get close to the coverage I have.....well , about a grand , and then another several hundred to get prescription coverage....sorry , it's way too much. My private plan is way better.
The other issue is this , you can't afford it so you have to pay a penalty tax.....but it's way cheaper to pay the penalty tax than to buy the insurance.....hmmmmm that's really good logic.
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Old 05-06-2013, 10:30 PM   #5
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Originally Posted by wyo_rose View Post
It will force our local tribes to provide medical insurance for their employees, which they currently do not.

My daughter's tribal job is already laying them off 2 extra months in the summer. I hope they don't cut positions to pay for the insurance costs.
See , that's the thing about tribal sovereignty ! We can only be as sovereign as the U.S.Govt. will allow !
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I believe blood quantums are the governments way to breed us out of existance !


They say blood is thicker than water ! Now maple syrup is thicker than blood , so are pancakes more important than family ?

There are "Elders" and there are "Olders". Being the second one doesn't make the first one true !

Somebody is out there somewhere, thinking of you and the impact you made in their life.
It's not me....I think you're an idiot !





There's a chance you might not like me ,

but there's a bigger

chance I won't care
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Old 05-07-2013, 04:28 AM   #6
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In Germany they deduct around 15% of your gross monthly income wages automatically and that goes for health insurance and covers almost everything, it used to cover each and every medical services. Unemployment income beneficinaries also have covered all medical needs. Those who have to live on social security still get everything covered. When I worked I never thought about anything being wrong with having to pay social fees. Everybody benefits from it once in need. I like our german health care system.
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Old 05-07-2013, 06:01 AM   #7
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In Germany they deduct around 15% of your gross monthly income wages automatically and that goes for health insurance and covers almost everything, it used to cover each and every medical services. Unemployment income beneficinaries also have covered all medical needs. Those who have to live on social security still get everything covered. When I worked I never thought about anything being wrong with having to pay social fees. Everybody benefits from it once in need. I like our german health care system.

I'm sure the wannabe plains ndns in Germany are scrambling over there to help out the REAL NDNs they love to copy so much.
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Old 05-07-2013, 09:27 AM   #8
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I don't see any immediate negatives...
Until the below happens...

Quote:
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It will force our local tribes to provide medical insurance for their employees, which they currently do not.

My daughter's tribal job is already laying them off 2 extra months in the summer. I hope they don't cut positions to pay for the insurance costs.
Employers are going to fight back by laying people off, switching people to part time and cutting hours to point where they fall below the requirements for the ACA, -OR- the dreaded switching people from full or part time to FREELANCER. Being a freelancer sucked, I got taxed out the wazoo even more so than the current full time job I have now which pays significantly more.


The way I see it is that healthcare reform was/is something that was desperately needed. Common sense things like preventing people from being denied coverage for preexisting conditions are great.

The fact that you can be fined for not having coverage is appalling. Millions of families in the US are struggling as it is to make ends meet, they barely make enough money to keep food on the table and the power turned on at the same time.

We are beginning to look a lot like Europe. They want to take away our guns, censor the internet, invade your internet privacy, tell you how much soda you can drink, tax you to death, and fine you for not having health care.
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Old 05-07-2013, 09:30 AM   #9
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i work for indian health service,yes it is gonna be the law that everybody has to have insurance coverage if not when you do your yearly taxes you will be fined.i guess they will take out more on your taxes.it also states that american indians cannot be fined for not having insurance coverage.so basically if you go to any ihs or tribally run or urban clinic you will not be fined for not having insurance coverage.beginning in jan. 2014 you can go to any ihs run clinic or hospital,as long as you have a cdib and get a letter called "credible coverage letter" so when you go to do your taxes you cannot be fined
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Old 05-07-2013, 12:41 PM   #10
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I'm sure the wannabe plains ndns in Germany are scrambling over there to help out the REAL NDNs they love to copy so much.
---->>> the wannabe plains ndns in Germany <<<---- maybe I should go where they hang out - to see - how much they'd help me - I bet they won't because I am german like them - can't afford to travel there anyway and I don't want to see those hobbyists either. I'd be rude if I'd start laughing at 'em copycats - they'd scold me.
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Old 05-08-2013, 02:00 AM   #11
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Poland has a similar health system is discharged contributions from salaries to the National Health Fund. It does not work, there is still not enough money and therefore limited access to medical care, especially specialist (cardiologist to wait six months or longer)

*The same is true of the diagnostic test.'re Not satisfied. Let's go for a private visit
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Old 05-08-2013, 01:28 PM   #12
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I know IHS has had major cuts. Even though I have health insurance, I still go there and they collect the fees and it helps fund the whole program. I don't mind and most of the time when they see I have insurance, they offer me "premium care" ... tests and other things that they might not offer regular IHS patients.

BUT I know that LOTS of folks that have private insurance or the Title XIX, will NOT go to IHS...thinking they'll get better care in town. The same with dental...I see our once bustling dental program is empty a lot of the time.

Will ObamaCare help or hurt IHS in the long run?
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Old 05-08-2013, 02:13 PM   #13
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its not going to affect it one way or the other.they have always done third party billing insurance, medicaid and other state insurances. thats how they stay in busn. you think the government gives them enough money to operate? no thats why they have always done third party billing.like i stated before yes everybody has to have insurance or you will be fined when you go to file your taxes, american indians are exempt from this fine becuase of ihs. you will need to get a letter to take with you when you go to file taxes that states you are exempt. i dont know how anything will change. theres more people that use indian health services that have insurance than a lot of people think already.the key to this law is if you have a cdib card and get a "credible coverage letter" from any ihs clinic or hospital then you cannot be fined for not having insurance
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Old 05-08-2013, 03:39 PM   #14
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Yeah, I think you went over that quite well in your first post.

But I guess we have yet to see if it will affect IHS one way or another. 3rd party billing is a relatively new thing...at least at our IHS...only brought on in the last decade or two. When I worked there 25 years ago, we didn't do any 3rd party billing...only threw out contract health bills that could be covered by other means.

And boy, do I know how underfunded they are! One way to cut would be to limit it only to enrolled members...we see an extraordinary amount of descendants taking advantage of the "free" care.
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Old 08-22-2013, 11:48 PM   #15
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Obviously, not everyone agrees with Obamacare. May believe that the decision upholding Obamacare is the worst decision issued by any Supreme Court. The Affordable Care Act, which many took to calling “Obamacare,” mandates any person with preexisting problems cannot be excluded from health insurance plans. However, to get them onto plans means somebody will have to pay to get them insured. Everybody with insurance through companies will foot the bill, to the tune of $63 per year starting in 2014.
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Old 08-24-2013, 02:57 AM   #16
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Originally Posted by wyo_rose View Post
Will ObamaCare help or hurt IHS in the long run?
Why do we care?

Universal insurance implies no need for a separate IHS.
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Old 08-24-2013, 09:34 AM   #17
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Quote:
Originally Posted by Zeke View Post
Why do we care?

Universal insurance implies no need for a separate IHS.
Not quite true Zeke, in Canada where we do have universal care, First Nations come under federal jurisdiction for health care (same level as our armed forces and RCMP). Treaty obligations require that the feds continue to provide health care to FN. Although Indian and Inuit health services is now a sun setting org becasue the goal is to transfer all health services to the control of each First Nation in the next 15 years.

What is happening up here is that the FN in which have settled their self governing agreements or have accepted the transfer of their own health care services to their treaty council (see NAN for an example) have had the services taken over their own health care.

The US if any of this goes through, will in all likelihood model their health care as Canada and the UK did. The feds will maintain the control of transfer dollars to either state or regional health authorities to administer. There will be a fed health agency that will fold in orgs like the FDA, CDC but the actual delivery of the system will lie as I set out above at either the state or minimally a regional health authority. Most universal health care systems depend on per caps funding. Those areas that have dense pops with recive more $ than those areas that don't. Getting coverage will be geographically determined. It might be state or health region driven. The care will be accepted interstate and perhaps even transferable as one moves from one area to another. Up here we get 3 months coverage from our previous province coverage and then the new geo location takes over.

I think how Obamacare may affect the IHS is that there will be a great amount of noise done by the feds for tribal councils to transfer all health services to control of the council or treaty group.
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I can see the wheel turning but the Hamster appears to be dead.
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