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Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
Affordable Care Act: The Hope of Native American Health
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Affordable Care Act: The Hope of Native American Health

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  • The debate over health care reform in the United States is framed by the question of who has health insurance and who does not, and the primary goal of recent health care reforms has been to increase Americans’ access to health insurance.   Despite having a legal right to health care as part of longstanding treaties and laws, many American Indians and Alaska Natives still lack access to health coverage.
  • Since the Snyder Act of 1921 which later became known as the – indian citizenship act of 1924…
  • Ryan
  • So the simple answer to why this topic is about Beyond protecting the sovereign rights of AIANs, disease prevalence is a key driver for the conversation of access to this population group.
  • RYAN
  • RYAN
  • RYAN
  • Ryan
  • RYAN
  • RYAN
  • Ryan
  • Alan
  • ALAN OTHER: heart disease Cancer unintentional injuries stroke Obesity chronic renal failure mental health issues
  • ALAN
  • ALAN
  • MEAGHAN
  • MEAGHAN
  • TARA The Affordable Care Act benefits American Indians and Alaska Natives because they will have more choices for their healthcare. If they have access to IHS, they can still go to IHS because the law makes IHS permanent. If they want to enroll in Medicaid, more people will qualify based on income. If they want to purchase health insurance, it will be more affordable and prices will be lower because of new Affordable Insurance Exchanges. If they work for a tribe or tribal program, they may have access to the FEHB. Expanded Third Party Funding Updates current law regarding collection of reimbursements Contract Health Services – funds used for direct care (substance abuse treatment, inpatient hospitalization, etc.) outside of IHS and tribal health care facilities or supplementation of alternate resources (Medicare or private insurance). Prior to reauthorization funds ran out quickly. It is used as a payor of last resort and was utilized often by those who lacked insurance. With more AI covered by some form of health insurance, more contract health dollars will be available. Federal Employees Health Benefits Program – Beginning in 2012, Indian tribes and tribal organizations (those carrying out programs under the Indian Self Determination and Education Assistance Act and Title V of IHCIA) had the option to purchase federal health insurance for employees that is used by over 8 million federal civilian employees. This allows for access to insurance with potentially more comprehensive coverage. Exempt From Penalty – exempt from the individual responsibility payment for not complying with the requirement to maintain essential insurance coverage.
  • MEAGHAN IHS reports on the quality of care it provides patients for the Government Performance and Results Act (GPRA), which is the same as the VA, DHHS, etc. In 2012 IHS reported on 21 GPRA and three other clinical performance measures. The report went to the Office of Management and Budget (OMB) and Congress. Title III (a)(3015)  authorizes the Secretary to award grants and contracts to eligible entities to support efforts to collect and aggregate quality and resource measures. IHA and tribal health programs are eligible entities.   Title III (a)(3501)  provides grants to identify, develop, evaluate, disseminate, and provide training for quality improvement practices in the delivery of health care services . Qualifying entities include Federal IHS programs and health programs operated by tribes. There are specific provisions for specific language related to cultural competency issues . Title III (f)(5507)  HHS Secretary and Dept of Labor Secretary are able to award demonstration projects designed to give eligible individuals the opportunity to obtain training and education in high demand health care fields . Secretary must award at least three grants to an eligible entity that is an Indian tribe, tribal organization, college, or university. http://www.ihs.gov/PublicAffairs/DirCorner/docs/Affordable_Care_Act_Provisions_Summary.pdf
  • Ryan
  • The Medicaid expansion is particularly critical for those Native Americans who do not have easy access to an Indian Health Service (IHS) or tribally-run facility. Most IHS facilities are located in reservations, making them inaccessible to those who reside outside reservations. In 2009, an estimated 43 percent of American Indians and Alaska Natives lived outside of areas served by the HIS
  • RYAN
  • TARA U.S. Government – increase budget to $4.42 billion ($116 million increase from 2012 budget)
  • TARA
  • AI/AN ARE A MEDICALLY, SOCIALLY ISOLATED AND VULNERABLE POLUATION WHOSE SPECIFIC MEDICAL CARE WILL BE AFFECTED BY THE ACA, POTENTIALLY IN POSITIVE WAYS: Challenges: Even though the expansion of payer and insurers are increasing, the AI/AN population may not have the economic resources to take advantage of the opportunity to access medical care If certain rural hospitals are unable to meet certain quality or patient metrics, they become in jeopardy of being closed which leaves the population further medically vulnerable Because states are able to opt-in or –out of the ACA Medicaid Expansion, this leaves the 21% of AI/AN Medicaid recipients further vulnerable to limited medical support systems. Opportunities:- -Increase in payers and insurer options allow funds to be more readily available -INCREASED PROGRAMING TO CREATE AND EVALUATE EFFECTIVE CARE TO AI/AN THROUGH THE IHCIA Reauthorization -If hospitals who serve AI/AN are able to meet the quality metrics, they have an opportunity to receive the government incentives to off-set the uncompensated costs -The permanent reauthorization allows for permanent funding in the future
  • Transcript

    • 1. CONTRIBUTORS: ALAN BURKE, MEAGHAN CONLISK, RYAN PARKER, TARA ROBINSON HAD 553 SPRING 2013 The Hope for Native American Health Opportunities and Challenges to Improve Health Outcomes through the Affordable Care Act
    • 2. Snyder Act of 1921
    • 3. 5.2 Million
    • 4. Why is this important? As future healthcare administrators, it’s important…  To examine the U.S. healthcare system's attempt and promise to ensure adequate and quality access to care for all Americans.  To better understand these challenges and opportunities to improve Native American health access, costs, quality, and outcomes.
    • 5. Outline  Overview of American Indian & Alaska Native (AIAN) in U.S.  Basics of Indian Health Services (IHS) & Healthcare Coverage  Basics Cultural & Tribal Implications  Indian Healthcare Improvement Act (IHCIA) of 1976 & Affordable Care Act (ACA) Implications  IHS & ACA programs  Federal Funding Shifts  Impact of the ACA on Costs  Conclusion & Key Conclusions
    • 6. Indian Health Service (IHS)  Established in 1955 by the Public Health Service (Department of DHHS)  Mission: to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.  Goal: to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people.  Foundation: to uphold the Federal Government's obligation to promote healthy American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes. www.ihs.gov/about
    • 7. IHS Operational Overview Budget FY 2012 HHS total budget: $822.7 billion IHS budget appropriation: $4.3 billion http://www.hhs.gov/about/budget/fy2012/gdm_cj_fy2012.pdf Health Coverage Restricted to clinics or hospitals on reservations Restricted to providers who contract with HIS Mostly Primary Care Services—some Ancillary and Specialty Services Population Served: Members of 566 federally recognized Tribes 2 million American Indians and Alaska Natives residing on or near reservations Annual Patient Services (Tribal and IHS facilities): Inpatient Admissions: 48,575 Outpatient visits: 12,772,553 Dental Services: 3,736,054
    • 8. Healthcare Coverage
    • 9. Healthcare Coverage
    • 10. Access to Care Services  Hospitals, Clinics, Ambulatory Care Sites, Dentists, Community Health Centers  IHS Facilities (Reservations or Contracted Facilities)  The Urban Indian Health Programs (UIHP)
    • 11. Today’s American Indians/Alaska Native
    • 12. Health Disparities Among AI/AN AI/AN more likely to die… • 500% higher from tuberculosis • 519% high from alcoholism • 195% higher from diabetes • 79% higher from suicide • 40% higher risk from AIDS • 20% higher from cervical cancer • 30% higher from prostate cancer …than their non-AI/AN counterparts http://www.indian.senate.gov/news/pressreleases/upload/PPACAforIndianHealthCare2.pdf
    • 13. Cultural Considerations for Medical Care Strong links between medicine and religion The clinician patient relationship must be sympathetic in understanding the patients spirituality, if the patient does not feel this is happening they are not likely to return. Use of traditional healers restore balance with simple ceremonies with prayers and chants.
    • 14. Culturally Sensitive Educational Materials Childhood Obesity/Diabetes  Eagle Book  uses animals to promote healthy eating and exercise choices  promote traditional foods by sustainable ecological approach
    • 15. Indian Healthcare Improvement Act of 1976 The Indian Healthcare Improvement Act (IHCIA) is the cornerstone legal authority for the provision of health care to American Indians and Alaska Natives Expired in 2000, but was made permanent as part of the Patient Protection and Affordable Care Act. http://www.hhs.gov/news/press/2010pres/03/20100326a.html
    • 16. How does the ACA relate to the IHCIA? IHCIA 2010 compared to IHCIA 1976  Enhancement of the authority of the IHS Director in DHHS  Reimburses for extended continuum services (SNF, Hospice, HCBS, NH, etc)  Encourages partnership with VA and Dept of Defense  Establishes a Community Health Representative program to train and employ AI/AN to provide health care services  Establishes a comprehensive behavioral health, prevention, and treatment programs for AI/AN http://www.hhs.gov/news/press/2010pres/03/20100326a.html
    • 17. How does the ACA relate to the IHCIA? Continued  Updates current law regarding collection of reimbursements from Medicare, Medicaid, and CHIP  Improvements in Contract Health Services  Access to Federal Employees Health Benefits Program  Exempt from the penalty for not purchasing health insurance http://www.hhs.gov/news/press/2010pres/03/20100326a.html
    • 18. IHS Programs Supported by ACA Title III (a)(3015) : grants support efforts to collect and aggregate quality and resource measures. Title III (a)(3501): provides training for quality improvement practices in the delivery of health care services. There are specific provisions for specific language related to cultural competency issues. Title III (f)(5507): eligible individuals the opportunity to obtain training and education in high demand health care fields. Secretary must award at least three grants to an eligible entity that is an Indian tribe, tribal organization, college, or university. http://www.ihs.gov/PublicAffairs/DirCorner/docs/Affordable_Care_Act_Provisions_Summary.pdf
    • 19. Federal Shifts: IHS Budget Increase $124 Million (2.9%) Increase for FY ’14  $35 million to help purchase health care from the private sector through the Contract Health Services program, which is under proposal to be called the Purchased/Referred Care program  $77.3 million to support staffing and operating costs at new and replacement facilities  $5.8 million to fund contract support costs incurred by tribes in managing their own health programs. http://www.ihs.gov/BudgetFormulation/documents/FY2014BudgetJustification.pdf
    • 20. Federal Shifts: Medicaid Expansion Focus on: Indian Country States with Highest Prevalence of AIAN = Expanding = Not Expanding
    • 21. Federal Shifts: Increased Healthcare Coverage
    • 22. How does the ACA effect costs of care to AI/AN? AI/AN Tribal Consultation Outcomes  Affordable Insurance Exchanges  Tax credits  No Cost-Sharing or Co-Payments
    • 23. Projected Individual Costs Lower premiums will cost less if you have an income up to $89,000 for a family of four or $112,000 in Alaska. No out of pocket costs (copays or deductibles) if AI/AN choose IHS provider in the insurance network No out of pocket costs with any health care provider if your income is under $67,000 for a family of four.  www.healthcare.gov
    • 24. Conclusion Challenges  Even though the expansion of payer and insurers are increasing, the AI/AN population may not have the economic resources to take advantage of the opportunity to access medical care  If certain rural hospitals are unable to meet certain quality or patient metrics, they become in jeopardy of being closed which leaves the population further medically vulnerable  Because states are able to opt-in or –out of the ACA Medicaid Expansion, this leaves the 21% of AI/AN Medicaid recipients further vulnerable to limited medical support systems.  Closing the high prevalence of disease among AIAN will be a major challenge without ability to regulate public health provisions as a result of sovereign autonomy from the U.S. Federal Government Opportunities  Increase in payers and insurer options allow funds to be more readily available  Increased programming to create and evaluate effective care to AIAN through the permanent reauthorization of the IHCIA  If hospitals who serve AI/AN are able to meet the quality metrics, they have an opportunity to receive the government incentives to off-set the uncompensated costs  The permanent reauthorization allows for permanent funding in the future

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