With citizens of federally recognized tribes able to claim a tax exemption from the Affordable Care Act, why should Native Americans be concerned about the ACA?

Even though federal law exempts Native Americans from the individual mandate and the law will not subject them to any financial penalties for not purchasing health insurance, there are benefits to doing so. First, federal law exempts Native Americans who enroll in private health insurance plans offered through a health insurance exchange from cost-sharing requirements if their income is not more than 300 percent of the federal poverty level (approximately $70,650 for a family of four). This means no deductibles, copayments or co-insurance payments. To the extent that a Native American incurs costs or needs medical care that cannot be acquired through an Indian Health Service (IHS) or tribal provider or facility, this exemption from cost-sharing requirements could result in significant cost savings.

Second, Native Americans can continue to enjoy access to IHS or tribal programs, while gaining access to any providers participating in the exchange plans. Native Americans may not have easy or convenient access to an IHS or tribal facility or clinic. If this is the case, using private insurance to cover medical care is far better economically than paying out of pocket. Third, private insurance plans offered through the exchanges will cover conditions and treatments not otherwise available at some IHS or tribal clinics. Unless a Native American lives close to an acute care hospital operated by IHS or a tribe, having access to private insurance to pay for catastrophic or chronic illnesses or conditions is important. Finally, Native Americans will experience financial benefits due to an amendment to the Medicare Part D program that permits costs paid by IHS for prescription drugs for Medicare Part D beneficiaries to count toward the beneficiaries’ out-of-pocket threshold for catastrophic protection. For a Part D beneficiary to receive catastrophic protection, a certain level of out-of-pocket expenses had to be incurred. Prior to the ACA, expenses incurred by IHS, on behalf of a Part D beneficiary, did not count toward the catastrophic threshold.