Insurance regulators from states with American Indian and Alaska native tribal communities say the communities need help with untangling Patient Protection and Affordable Care Act (PPACA) red tape.
Regulators talked about the tribal communities’ PPACA headaches earlier this week in Chicago, at a session of the American Indian and Alaska Native Liaison Committee. Members of the committee, which is part of the National Association of Insurance Commissioners (NAIC), met at the NAIC’s summer meeting.
Drafters of PPACA refer repeatedly to tribal communities and the need to improve Native Americans’ access to health care and health coverage.
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Native Americans who are members of federally recognized tribes can sign up for coverage through the PPACA public health insurance exchange system at any time of the year, not just during the open enrollment period or through a special enrollment period.
Any tribal member who has household income at or below 300 percent of the federal poverty level gets automatic access to cost-sharing reduction subsidies that reduce out-of-pocket payments for in-network covered services to zero.
A tribal member can use access to Indian Health Service (IHS) coverage to qualify for an exemption from having to have minimum essential coverage, and the public exchange managers have made special efforts to market to tribal members.
In one county in Arizona, plan issuers must make Summaries of Benefits and Coverage (SBCs) available in Navajo.
But regulators say tribes are having huge, little-acknowledged problems with PPACA compliance, and not getting much noticeable help from Washington with untangling knots.
For a look at what regulators are seeing, based on documents in a board meeting packet, read on.
1. The United States has negotiated treaties with the tribes that call for the country to pay members’ medical expenses.
Many tribal leaders are uncomfortable with the idea that they or their members need to make changes because of PPACA, because the United States treats the tribes as separate nations and has declared, in treaties, that it will provide health care and other necessities for the tribes’ members.