A federal court in Casper considered blocking an Internal Revenue Service rule that Northern Arapaho officials say could cause Native Americans to pay more for insurance or lose health care benefits.
Tribal leaders say the proposed IRS interpretation of a mandate for large employers to provide health care coverage would unlawfully exempt tribal members who work for the Northern Arapaho from receiving tax credits and cost-sharing benefits granted Native Americans in the Affordable Care Act.
Kelly Rudd, the Northern Arapaho attorney, said the agency’s interpretation could subject the tribe to more than $1.5 million in tax penalties if its business entities, including Wind River Casino, do not offer employer-sponsored insurance.
“They proposed a one-size-fits-all, large-employer mandate that doesn’t fit Congress’ purpose of bringing health care to working-class Native Americans,” Rudd said.
He said the tribe insures employees with plans from the federal health insurance marketplace and pays 80 percent of the premium costs.
Those policies provide better coverage than the tribe could purchase independently, Rudd said.
Attorneys for the U.S. Department of Health and Human Services say the rule-making is based on Congress’ intent to promote employer-sponsored health coverage under the ACA.
Jacek Pruski, a U.S. Department of Justice attorney, told the court that the IRS rule-making is in compliance with the purpose of the ACA.
He said the court should reject the motion to block enforcement of the rule because the tribe did not establish the strength of its case based on prior case law.
Rudd said the U.S. Department of the Interior is charged with overseeing tribal health care programs. He said the IRS did not communicate with the Interior Department while drafting the rule.
“Basically what we have is a left-hand-right-hand problem in communication among agencies,” Rudd said.
U.S. District Judge Scott W. Skavdahl said he would need more time to deliberate on the suit because of the complicated nature of the Affordable Care Act.
“This is the statute that cast a thousand lawsuits,” he said.
Skavdahl said he would release his decision in the coming weeks.
Once again, the federal government is funding “navigators” in Montana to help the uninsured buy private, subsidized health coverage this fall — with a new emphasis on Native American consumers.
Earlier this month, federal officials awarded $609,000 in navigator grants to three Montana groups: Planned Parenthood of Montana, the Montana Health Network and the Montana Wyoming Tribal Leaders Council.
“We had great, great success with the program last year,” Martha Stahl, CEO of Planned Parenthood of Montana, said Monday. “I think it’s a great way to continue our mission of connecting people with affordable health care, which is what we’re all about.”
Stahl said her group will be working closely with the other two grant recipients and other organizations to sign up more people for health insurance under the Affordable Care Act, as well as target Native Americans. Planned Parenthood and the Health Network had navigator programs last year.
Navigators, who must be certified by the state insurance commissioner, help people buy private health insurance through the online “marketplace,” a key part of the ACA, the federal health-care overhaul also known as “Obamacare.”
Individuals buying policies on the marketplace can get federal subsidies to offset the cost of those policies. Lower-income consumers also can get further discounts on certain marketplace policies.
Most consumers who earn less than 400 percent of the federal poverty level — about $79,000 for a family of three — are eligible for the subsidies, which are paid directly to the insurance company.
The Obama administration launched the marketplaces last October in 34 states, including Montana, initially with disastrous results. Beset with technical problems, the marketplaces barely worked.
However, by the end of March, more than 36,000 Montanans gained coverage through marketplace policies, out of 8 million people nationwide.
The marketplaces will open again this year Nov. 15. Customers can shop for and purchase new policies for 2015. Four companies will be offering policies on Montana’s marketplace.
Cheryl Belcourt, executive director of the Montana-Wyoming Tribal Leaders Council in Billings, said the group will use its $142,000 grant to hire some navigators and coordinate with other groups to encourage Native Americans both on and off reservations to buy marketplace policies.
Many Native Americans think the policies are not for them, because they expect to use the Indian Health Service and don’t face a tax penalty if they’re not insured, Belcourt said.
However, the affordable private policies and their low-cost coverage can expand health care for Native Americans, she said.
“This is an opportunity to address the health disparities of Native American people,” Belcourt said. “We want to be able to really make a difference in terms of the quality of life for Indian people.”
Chris Hopkins of the Montana Health Network, a consortium of smaller hospitals and health-care centers, said its $175,000 grant will be used to add nine new navigators to the 20 it already trained with last year’s grant. Most of them are staffers at hospitals and nursing homes.
“Our focus is to have local people providing services in their own community, rather than having someone come in from the outside, do a presentation, and then leave,” he said.
The Montana Primary Care Association, which represents federally funded health clinics, had a navigator program last year but did not get a grant this year.
Amanda Harrow of the association said clinics will continue to work with various groups to help people sign up for ACA-subsidized policies.
PINE RIDGE, South Dakota — Denise Mesteth signed up for new health insurance through the federal Affordable Care Act, despite concerns that it may not be worth the money for her and other Native Americans who otherwise rely on free government coverage.
Mesteth, who has a heart murmur and requires medication and regular blood work, said she’s cautiously optimistic that the federal insurance will be superior to what she has now. Many other American Indians have been more reluctant to enroll, choosing instead to continue relying on the Indian Health Service for their coverage and taking advantage of a clause in the federal health reform law that allows them to be exempt from the insurance mandate if they meet certain requirements.
“If it’s better services, then I’m OK,” Masteth said of ACA. “But it better be better.”
Mesteth and other American Indians in South Dakota account for 2.5 percent of the people in the state who have signed up for insurance under the federal health care law, according to the latest signup numbers. The state, with nearly 9 percent of its overall population Native American, ranks third for the percentage of enrollees who are American Indian among U.S. states using the federal marketplace.
The Great Plains Tribal Chairmen’s Health Board, which provides support and health care advocacy to tribes, received $264,000 to help Native Americans in South Dakota navigate the new insurance marketplace.
Tinka Duran, program coordinator for the board, said people are primarily concerned about the costs of enrolling. Insurance is a new concept to most because health care has always been free, she said.
“There’s a learning curve for figuring out co-pays and deductibles,” she said.
During a U.S. Senate Indian Affairs Committee hearing in May, tribal leaders chastised IHS as a bloated bureaucracy unable to fulfill its core duty of providing health care for more than 2 million Native Americans and Alaska Natives. IHS acting director Yvette Roubideaux said changes were underway but that more money will be needed than the $4.4 billion the agency receives each year.
She noted that federal health care spending on Native Americans lags far behind spending on other groups such as federal employees, who receive almost twice as much on a per-capita basis. Meanwhile, American Indians suffer from higher rates of substance abuse, assault, diabetes and a slew of other ailments compared to most of the population.
Native Americans and Alaska Natives are exempt from the health insurance mandate if they meet certain requirements. ACA also permanently reauthorized the Indian Health Care Improvement Act and authorized new programs for IHS, which also is starting to get funds from the Veterans Affairs Department to help native veterans.
When American Indians do obtain insurance, it means fewer people are tapping the IHS budget, said Raho Ortiz, director of the IHS Division of Business Office Enhancement.
“If more of our patients have health insurance or are enrolled in Medicaid, this means that more resources are available locally for all of our patients,” Ortiz said in an emailed statement. “This, in turn, allows scarce resources to be stretched further.”
Those who sign up for federal health care can still use IHS facilities but have the option of seeking health care elsewhere, Ortiz said.
State Democratic Sen. Jim Bradford is among the skeptics. The Oglala Sioux member lives on the Pine Ridge reservation, home to two of the poorest counties in the nation.
The U.S. government provides health care to Native Americans as part of its trust responsibility to tribes that gave up their land when the country was being formed. Bradford and others object to the shift in health care providers on the principle that IHS is obligated by treaty to supply that care.
Harriett Jennesse, a member of the Lower Brule Sioux Tribe who lives in Rapid City, said she already has seen the benefits of the new health insurance and doesn’t mind paying a little out of pocket.
Jennesse said she put off treatment for a painful bone chip in her elbow after IHS denied a doctor’s referral to a specialist on grounds that it wasn’t an urgent enough need. She’s now seeing a specialist for dislocation in her other elbow and will also try to get the bone chip fixed when the other arm heals.