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The Affordable Care Act:
What Does It Mean for Your Community?July 17, 2012
Series 2 of 4
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AcronymsACA Affordable Care Act
AI/AN American Indian/Alaska Native
FPL Federal Poverty LevelIHCIA Indian Health Care Improvement
Act
I/T/U Indian Health Services, Tribal and Urban
Indian organization programs/providersCHIP Childrens Health
Insurance Program
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Basic Health Insurance Terms
Premium: The amount paid to an insurance company, usually ona
monthly basis, for health insurance coverage.
Out-of-pocket costs: Health care costs paid by the patient.
These
include copayments, coinsurance, and deductibles.
Deductible: A specific dollar amount paid by the user each
yearbefore your health insurance plan starts to make payments for
aclaim. Not all health insurance plans require a deductible.
Exclusions: Things not covered by the health insurance
policy.Make sure to check the fine print of the health insurance
policyfor which conditions are excluded.
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Basic Health Insurance Terms cont.
Benefit:Any service or supply (an office visit or a prescription
drug)your health insurance plan will pay for.
Co-payment (copay): The dollar amount paid for a medical
service
or supply according to your insurance plan. ($20 for sick
visit)
Pre-existing condition:A health problem or diagnosis that you
hadbefore applying for health insurance or before the effective
date ofyour new health plan. By 2014, companies will be unable to
deny
you coverage based on pre-existing conditions.
Lifetime maximum: Refers to the amount of money the
healthinsurance policy will pay for the entire life plan.
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The Health Care Law On March 23, 2010, PresidentObama signed
into law the Patient
Protection and Affordable Care Act(ACA)
The ACA protects the right of allAmericans, including
AmericanIndians and Alaska Natives, toaccess affordable health
care
More than 32 million in this countrywho would otherwise not
havehealth insurance will have accessto health coverage
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Recent Supreme Court Decision On June 28, 2012 the Court
upheld minimum coveragerequirement
Precluded Medicaidexpansion requirement
Protected IHCIA and
implementation efforts todate
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The Federal Trust Responsibility
The ACA fulfills the federaltrust relationship andstrengthens
tribal sovereigntythrough:
o Protection of the IHSsystem
o Providing equal accessto quality care
o
Expansion of tribalgovernments role inhealth care decisions
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ACA Benefits Tribal Governments and Citizens
o Permanent reauthorizationof the IHCIAo Strengthens the
Indian
Health Services systemauthorities
o Greater access to healthinsurance coverage
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What Does the ACA Mean for Indian Country
New sources of fundingfor tribal facilities
Quality health care forcitizens
Stronger role for tribalgovernments
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You Can Improve Your Local Facilities
Third-party billing Offer services to
non-IHS eligiblebeneficiaries
Share facilities andservices with VA and
DOD Expand workforce
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You Can Compact or Contract
Community Health AidProgramso Dental Health Aid Therapists
Dialysis Programs
Long Term Care
Alternative Health CareDelivery Models
Mobile Health Services Expanded Behavioral Health
Care Options
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You Can Educate Citizens About
The State Exchanges
No premiums ordeductibles
Monthly enrollment
Group pay premiums
for tribal citizens
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You Can Work to Implement the Law
Policymakers need your help1. State-Based Insurance Exchanges2.
State Medicaid Expansion
3. Federally Facilitated Exchanges
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What You Can Do
1. Improve your local health care
2. Educate tribal citizens
3. Increase access to care
4. Expand your authority thecompacting and contracting
5. Meet tribal needs through the
state and federal consultationprocess
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Learn More Athttp://www.tribalhealthcare.org
http://www.HealthCare.gov
http://www.IHS.gov
http://www.tribalhealthcare.org/http://www.healthcare.gov/http://www.ihs.gov/http://www.ihs.gov/http://www.healthcare.gov/http://www.tribalhealthcare.org/
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National Indian Health Outreach & Education(NIHOE)
Initiative
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NIHOE National Partners
* With generous support from the Indian Health Service
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13 NIHOE Area Coordinators
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National Congress of American Indians
Terra Branson- Legislative [email protected]
mailto:[email protected]:[email protected]
