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Mark Trahant: Healthcare.gov is running but real work lies ahead

Filed Under: Health | Opinion
More on: aca, ihs, internet, mark trahant
   

The healthcare.gov web site is working. I spent some time on it this weekend and it was easy to navigate, pages popped up when they should, and I quickly found answers.

All of this is good news because it will make it easier for folks to fill out the forms and see what’s possible under the Affordable Care Act. If you want insurance to begin on January 1, 2014, then you need to fill these forms out this month. The deadline is December 23.

But for American Indians and Alaska Natives this process is both confusing and damning. It’s confusing because it’s a form that requires financial information, a lot like a tax return, so it means rounding up some documents. The damning part? I’ll get to that shortly. First let’s explore the healthcare.gov process.

For American Indians and Alaska Natives: The most important form is “Appendix B.” This is the paperwork that secures a lifetime exemption from the insurance mandate. Lifetime is a pretty good deal. So paperwork or not, this is worth doing this month (or you can also file this with your tax returns in April).

There is help to fill out these forms. Go to the Indian Health Service or a local urban or tribal clinic. Find someone there who has been trained. You should get answers, because, as IHS acting director Yvette Roubideaux wrote recently, “I don’t know is not an acceptable answer.”

One of the best things I read this weekend was an item in Montana’s Char-Koosta News with a schedule of community meetings on the Affordable Care Act. Yes! This should be happening across Indian Country.

There needs to be information, not just cheerleading, about what this law means and how it might change the Indian health system. (This is the main reason for my five-part video series with Vision Maker Media.) The law will shake up the Indian health system dramatically, opening up new funding sources, as well as presenting new challenges.

The problem is that so much of the discourse has been cast in absolute terms. Democrats need to recognize that this law, like the web site, is not perfect. It’s just one step -- and a complicated one at that. And Republicans would better serve the country if they would stop crying repeal and look for constructive additions or subtractions.

Then it’s the same in Indian Country.

I often hear from people who say that Obamacare should not apply. American Indians and Alaska Natives have a treaty right to health care and therefore insurance is not needed. I agree. But then what? It’s a hard fact that Congress is not going to fund the Indian health system as it should. So the only two options are to use this law to expand resources or to watch the Indian health system decline every year as funding shrinks.

There are real problems with this law -- and that’s what we should focus on.

Indian Country has a huge stake in the expansion of Medicaid. This is money that will directly improve the Indian health system. It’s funding that does not require appropriation from Congress. But states need to make the decision to opt in -- and too many are saying no. Indian Country needs to make sure that the legislators and governors know what this means to their constituents who rely on the Indian health system. (I still think the ultimate solution is to label Indian Country as a 51st state for Medicaid purposes.)

Another concern of mine is that in some cases, individuals will have to purchase the insurance, paying real money, to get a tax credit down the road. On paper that looks like an easy call. But to a family that’s looking at a long list of monthly bills, then one for insurance, even if it’s “free” later is one that might be skipped.

Or, how do tribes pay for insurance as employers for part-time or seasonal employees? It’s a new expense that might not work in a budget environment that is already under pressure because of shrinking federal contracts. Tribes will have do one of three things: Hire fewer people, pay a fine, or come up with the money to buy insurance.

The healthcare.gov web site may work perfect today. But there still is a lot of fine tuning ahead when it comes to the Affordable Care Act. Especially for Indian Country.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of the Shoshone-Bannock Tribes. Join the discussion about austerity. Comment on Facebook at: www.facebook.com/IndianCountryAusterity

More from Mark Trahant:
Mark Trahant: Demise of filibuster is good for Indian Country (11/26)


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