Indian Country provisions within Affordable Care Act discussed at UINOKT quarterly meeting

The U.S. Congress is set to repeal or amend the Affordable Care Act and tribes are closely watching.

At a Jan. 30 meeting of the United Indian Nations of Oklahoma, Kansas and Texas on the Pawnee Nation campus, Terry Harris, COO of RWI Benefits gave a presentation to tribal leaders on what the impact could be to the Indian Health Service (IHS) if a repeal of ACA is successful.

George Tiger, president of UINOKT and the former principal chief of the Muscogee (Creek) Nation, said an invitation to the IHS Area Director to present to the UINOKT was turned down because of the gag order placed on all federal agencies by President Donald Trump.

The protection of the Indian health care within ACA is Indian Country’s highest priority, said Bruce Pratt, Treasurer of the UINOKT and President of the Pawnee Nation.

“One thing, as tribal nations, we need to advocate, contact, voice out that we need to protect that Indian provision in the Affordable Care Act,” he said. 

Harris said since tribes are faced with a new administration that could bring significant changes, tribes should focus on contract health services, paid preferred programs, Indian health services “what has been gained and how to protect those gains for the benefit of tribal members who depend on contract services for their healthcare.”

He said tribes also have an opportunity to voice to their elected representatives in Congress what they would like to see in the replacement health care bill for Indian Country, or what provisions they would like to see carried over or protected.

“We want to be positive, aggressively interact with this administration to the benefit of Indian Country. U.S. Rep. MarkWayne Mullin (Cherokee) is a big plus and is chair of Trump’s Native American Coalition. He’s right here in Oklahoma, which makes a greater opportunity to interact with him face to face,” Harris said.

Harris gave a power point presentation that emphasized the opportunities, potential changes, health reform, tribal unification to protect Native provisions in ACA, and being legislation-aware.


-       Unification of purchasing power through associations to have an impact on the health insurance dollar to receive a bigger return on the insurance company side. To increase the purchasing power in the state to bring the costs of the claims side down.

-       Sovereign nation self-governance advantages – the ability to negotiate and develop alternatives in healthcare that the rest of the country is not positioned to do. The sovereign nation status gives equal footing, a step above state governments, in negotiating results.

-       Congressman MarkWayne Mullin – a way to develop some ideas for alternatives and ask for his assistance and Congressman Tom Cole (Chickasaw), to communicate those concepts and ideas at the state and national level.

Potential changes 

-       Repeal Medicaid expansion

-       Create high-risk pools – the risk pool is funded through tax subsidies or a premium surcharge on people’s insurance that allows for subsidies to continue for people who cannot afford insurance.

-       Change how health savings accounts (HSAs) are used – there is currently a limit one can set aside to pay for deductibles, items not covered in health policy, etc. People can use their HSA for direct power and give a patient the power to negotiate with your doctor or hospital. It’s supposed to empower consumers to take direct control of their health future. We believe that limit will be taken off on a pre-tax basis when it comes time to healthcare

-       Omission of Essential Health Benefits requirement – continued discussion about competition, more insurance companies, more options, more choices to pick the insurance policy they want and can afford.

-       Allow health insurers to sell plans across state lines

-       Replace guaranteed issue – if someone has a preexisting condition they will still get coverage.

-       Change state requirements – relates to insurance rules and regulations.

-       Repeal of the individual and group mandates – so people aren’t penalized if they don’t buy insurance.

Healthcare Reform and Indian Country 

-       Indian Healthcare Improvement Act (IHCIA) was enacted in 2010 as part of the Patient Protection and Affordable Care Act.

-       Section 2901: Allows IHS clinics to remain the payer of last resort

-       Section 2902: Grants IHS providers’ permanent authority to collect reimbursements for all Medicare Part B services

ACA provisions that help Natives 

-       Open enrollment

-       No co-pays and deductibles

-       Grant programs for tribes to promote abstinence and contraception

Tribes must stay aware of legislation 

-       Employee benefits are likely your second largest expense (behind payroll)

-       Business owners don’t have time to track legislation (or don’t want to)

-       Tribes must seek qualified consultants and advisors to assist them

Pratt said it was the duty of the U.S. government to honor treaties, its trust responsibility to tribes for healthcare, education, and other services.

“One thing you can do is contact your congressional leaders,” Pratt said. “Protect us, you have an obligation to protect us, and if there is one thing I would advocate is voice out and make sure the federal government recognizes and understands they need to protect the Indian provision in the Affordable Care Act, it protects us.”