Under the Trump administration, the United States Department of Health and Human Services (HHS) has steadily scrubbed its website of information about the Affordable Care Act—usually known as the ACA or Obamacare. This purging of ACA information hits some populations harder than others, including Native Americans.
For example, the HHS Office of Minority Health removed its ACA Guidance for American Indians and Alaska Natives page. Other federal websites offer ACA information for Native Americans, but many pages have fallen out of date. As of the date of this post, pages on the websites of the Indian Health Service (IHS) and the Administration for Children & Families fail to provide current information.
Health Coverage for Native Americans: The ACA and More
Native Americans are subject to persistent disparities in health care. American Indians and Alaska natives face many barriers to obtaining health care and frequently go without health insurance. Here, we focus on the ways that Native Americans (American Indians and Alaska Natives) can get affordable health coverage. These include:
- Free health care from the Indian Health Service (IHS), tribal health programs, or urban Indian programs (known together as I/T/Us)
- Qualifying for health coverage under Medicaid or the Children’s Health Insurance Program (CHIP)
- Purchasing a marketplace plan under the Affordable Care Act (ACA/Obamacare)
These options may work alone or in combination with each other. For example, if you get Medicaid or an ACA plan, you can continue to receive free services from your I/T/U.
Benefits from Indian Health Service (IHS)
American Indians and Alaska Natives can get free, primary care services from the Indian Health Service (IHS), tribal health programs, or urban Indian programs (I/T/Us). But these services often fall short for two reasons:
- Services are usually limited to primary care and referrals to outside specialists are common. Health care from specialists outside the IHS program is not free.
- You may qualify for free tribal care but live far from the facilities where that care is available.
The government has historically failed to sufficiently fund IHS services. Availability of care may vary dramatically from place to place. For these reasons, even if you qualify for free tribal care, it can help to get another plan to supplement your benefits. You may be able to enroll in one of the following programs for free or at a very low cost.
Medicaid or CHIP Coverage for Native Americans
Medicaid and the Children’s Health Insurance Program (CHIP) cover more than one in four American Indian adults (not including the elderly) and about 50% of American Indian children. Eligibility rules for these programs vary from state to state. You can find out if you qualify by visiting the Medicaid & CHIP coverage page at HealthCare.gov.
As an American Indian or Native American, federal law gives you special protections when you qualify for Medicaid or CHIP. For example, if you are eligible for services from an I/T/U, the federal government can’t:
- count certain government benefits toward your income when deciding if you qualify for CHIP or Medicaid, or
- charge you Medicaid or CHIP premiums, enrollment fees, or cost-sharing payments.
To learn more, see Medicaid & CHIP for American Indians and Alaska Natives.
Affordable Care Act (ACA) or Obamacare Plans for Native Americans
If you apply for coverage at your state’s insurance marketplace, you may qualify for a plan with low or no monthly premiums. In addition, if your income is between 100% and 300% of the federal poverty level you won’t owe deductibles, copays, or other cost-sharing payments.
And, as always, if you get care from a provider through your I/T/U, you won’t have any out-of-pocket costs.
Native Americans Can Enroll In ACA Plans or Medicaid at Any Time
If you are a member of a federally recognized tribe, you don’t have to wait for open enrollment to sign up for insurance. You can sign up for benefits at any time, including an ACA plan, IHS benefits, Medicaid or CHIP. And you can change insurance plans as often as once a month.
For information about signing up for insurance plans under the Affordable Care Act in your state, see Legal Consumer’s Obamacare Learning Center.
To find a full list of federally recognized Indian tribes, see the National Conference of State Legislatures website.
For a solid overview of Medicaid and the Affordable Care Act for Native Americans, see the report Medicaid and American Indians and Alaska Natives from the Kaiser Family Foundation.
To learn how the Affordable Care Act has helped to reduce health care disparities, see Changes in Health Coverage by Race and Ethnicity Since Implementation of the ACA.
To contact your elected representatives and encourage them to support accessible and affordable health care, see our democracy tools for your state and zip code.