Bridging the Healthcare Gap: How Tribes are Empowering Native American Communities
For Dale Rice, a 62-year-old resident of Reno, nevada, a simple toe infection spiraled into a years-long ordeal.Uninsured at the time, even the surgery at a local hospital left him with a substantial medical debt exceeding $20,000. “It can cause a lot of anxiety,” Rice admits, “I can’t give you what I don’t have.” His struggles highlight a persistent issue facing many Native Americans: access to quality,affordable healthcare.
Born and raised in Nevada, Rice is an enrolled member of the Prairie Band Potawatomi Nation, whose homelands lie over 1,500 miles away in eastern Kansas. This geographical disconnect created a barrier as he navigated the often-complex web of healthcare services available to Native Americans.
While he receives primary care at the Reno-Sparks Indian Colony tribal health clinic, the limitations of the federal Indian Health Service (IHS) left him without coverage for the specialized care he needed. “I shouldn’t need to move to Kansas City to be fully covered,” Rice laments, reflecting the frustration many feel when seeking care outside their immediate tribal jurisdiction.
Though, a new program in Nevada offers a glimmer of hope. Launched last year, the tribal sponsorship program allows tribes to purchase health insurance through the state’s Affordable Care Act (ACA) marketplace for their members residing within their service area, irrespective of their tribal affiliation.
This innovative approach, championed by tribal leaders and state officials, aims to bridge the healthcare gap for Native Americans like Rice. By providing access to private insurance, the program offers a wider range of care options and protects members from mounting medical debt.
While dozens of tribes have adopted this model since the ACA’s inception over a decade ago, it’s implementation remains fragmented. Yvonne Myers, an ACA and Medicaid consultant for Citizen Potawatomi Nation Health Services in Oklahoma, notes, “It’s not widespread.” Yet, its potential to transform healthcare access for Native Americans is undeniable.
The need for change is urgent.Native American adults have significantly higher enrollment in Medicaid than their white counterparts and grapple with poorer health outcomes, higher chronic disease rates, and shorter life expectancies. The IHS, burdened by chronic underfunding, struggles to meet the growing demand for care.
Nevada’s program leverages aggregated billing, allowing tribes to pay premiums for multiple individuals in a single monthly payment, simplifying the process and easing financial burdens. Collaborative efforts between Nevada Health Link, the state’s health insurance marketplace, and tribes ensure that tribal clinic staff are trained to enroll community members in health plans.
the impact is already being felt. Angie Wilson, tribal health director for the Reno-Sparks Indian Colony and an enrolled Pit River Tribe member, describes patients arriving at her office in tears, overwhelmed by medical bills they couldn’t afford. “The IHS Purchased/Referred Care program can’t cover everything,” she explains. “This program is a lifeline for our people.”
Across the country, efforts to expand access to healthcare for Native Americans are gaining momentum. Tribes in Washington, Alaska, Idaho, Wisconsin, Michigan, Montana, and South Dakota have taken the initiative to establish their own programs, demonstrating a commitment to improving the health and well-being of their communities.
The tribal sponsorship program,a testament to the resilience and innovation of tribal leaders,offers a beacon of hope.By empowering tribes to take control of their healthcare destinies, this model paves the way for a future where every Native American has access to the care they deserve.
Bridging the Healthcare Divide: Tribal Sponsorship empowers Native Communities
Innovative programs connect federal funding with crucial healthcare coverage.
Since the Affordable Care Act (ACA) passed, tribes across America have sought creative solutions to bolster healthcare access in their communities. One transformative approach, the tribal sponsorship program, allows tribes to leverage their federal healthcare funds to cover healthcare premiums for individuals, creating greater affordability and broadening access to extensive healthcare. “whatever side of the fence people fall on, it does not take away that there’s a federal trust responsibility by the United States of America to its First Nations people,” asserts Shoshone representative, Michelle Wilson, highlighting a basic obligation enshrined in tribal relations.
Initially piloted in nevada, by the Fort McDowell Paiute & Shoshone Tribe, located on the reservation spanning Nevada’s northwestern borders, the tribal sponsorship program expanded rapidly. Initially,30 tribal members enrolled in healthcare plans through Nevada Health Link; by December of 2022,the number increased significantly,showing a surge of interest in embracing affordable healthcare choices. jim Roberts, senior executive liaison for the Alaska Native Tribal Health Consortium explains, “Since Alaska first allowed sponsorship in 2013, we’ve witnessed not only increased access for Native Americans to healthcare, but also a significant lowering in healthcare costs for the communities.”
with the tribal sponsorship program,communities see a real,tangible,positive impact:
Lower Cost Barrier: Funding allocated through these programs reduces a major hurdle individuals face in seeking healthcare,empowering them to prioritize their wellbeing.
Increased Enrollment: Programs offer expanded healthcare opportunities, notably advantageous in areas experiencing healthcare shortages and disparities. Over 700 individuals within Nevada’s marketplace identified themselves as American Indians and/or Alaska Natives throughout 2022.
* Community Strengthening: By enrolling beyond tribal citizenship, tribes help encompass the larger community, benefiting broader populations requiring healthcare access
“we’ve lost so much in Indian Country over time…How many more Indian people could have gotten access to care?” Wilson reflects poignantly. “
While celebrating the victories achieved through this innovative approach, Wilson acknowledges its delayed implementation:
“How much more of a difference could that have made in sustaining healthcare for tribes?”
Nevada’s prosperous model prompted othre states like Washington, a pioneer in healthcare sponsorship, along with 29 participating tribes, to mirror this impactful program. Nevada Health Link anticipates more tribes to join the ranks, emphasizing continued efforts to earn trust, navigating a landscape sometimes wary of collaborations with governmental institutions.
These programs face headwinds.
A crucial element supporting tribal sponsorship program’s accessibility, enhanced premium tax credits put in place through the American Rescue Plan, threaten to expire this year.Congress faces a looming deadline, risking steep premium hikes for individuals. Roberts expresses, “If tribal citizens or other community members become ineligible for those premium tax credits, it jeopardises tribal ability to keep sponsoring plans…”
Thus, congressional extension of these essential credits becomes pivotal for ensuring programs like tribal sponsorship remain enduring lifelines for tribal communities.
Looking forward, Nevada Health Link aims to connect directly with tribal communities through cultural sensitivity.
Their outreach will involve translating essential resources to include Northern and Southern Paiute, washoe, and Western Shoshone languages, reaching individuals in an impactful, authentic manner.
