What does the Affordable Care Act Mean to You as an AI/AN

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What does the Affordable Care Act Mean to You as
an AI/AN
Donald Warne, MD, MPH Oglala Lakota Senior Policy
Consultant Great Plains Tribal Chairmens Health
Board Director Office of Native American
Health Sanford Health
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Overview

• Brief overview of PPACA
• Brief overview of Indian Health System
• Impact of PPACA on Indian Health System
• What does this mean to you?
• Jennifer CooperKey Components of Insurance
  Reform and Consumer Protections

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Patient Protection Affordable Care Act

• PPACAMarch 23, 2010, includes IHCIA
• Health Insurance ReformPEC, Prev Svs, etc
• Government Takeover of Health Care
• No Single Payer
• Obamacare
• No Public Option
• Individual Mandate
• Employer Mandate
• Impact on AI/ANs?

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Who is Insured?

• Private
• Employed adults and families
• Health Insurers Post Record Profits
• Five largest insurers had 12.2B profit in 2009
• Public
• ElderlyMedicare
• ImpoverishedMedicaid, CHIP
• Military VeteransVA
• AI/ANIs IHS Insurance?

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(No Transcript)
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IHS Areas
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10 CMS Regional Offices
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AAIHS / AATCHB
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INDIAN HEALTH SERVICE

• The Indian Health Service (IHS) is the principal
  federal health care provider and health advocate
  for Indian people
• Its goal is to assure that comprehensive,
  culturally acceptable personal and public health
  services are available and accessible to American
  Indian and Alaska Native people

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CMS Role in Indian Health Care

• Medicare and Medicaid third-party revenue are
  increasing portions of Indian health budgets
• Important to bill at service unit level
• CMS is key component of the trust responsibility
• AI/AN Medicare and Medicaid coverage impacts
  Contract Health Service (CHS) spending
• Any changes in CMS policies and programs can make
  a significant difference in Indian health budgets
  and programs

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AI Health Disparities

• Life Expectancy in Years
• Men Women Total
• U.S. 74.1 79.5 76.9
• AAIHS 63.5 71.0 67.3
• Disparity 10.6 8.5 9.6
• Median age at death in SD (2007)
• 81.0 General Population
• 59.0 AI Population

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AI Health Disparities

• Death rates from preventable diseases among AIs
  are significantly higher than among non-Indians
• Diabetes 208 greater
• Alcoholism 526 greater
• Accidents 150 greater
• Suicide 60 greater

Indian Health Service. Regional Differences in
Indian Health 2002-2003
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Diabetes Death Rates (Rate/Per 100,000
Population)
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Alcohol Related Death Rates (Rate/Per 100,000
Population)
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AI/AN Cancer Disparities
IHS total 184.1
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PPACA Role in Indian Health Care

• Key Provisions No Cost Sharing
• Coverage of Preventive Services
• Expanding Medicaid Coverage
• Expanding FQHCs
• I/T/U Delivery System
• IHS only
• Tribal 638 services
• Urban Indian Health Centers

• Payer Source
• NAR, CHS only
• On Medicaid
• On Medicare
• Privately Insured

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2009 IHS Expenditures Per Capita and Other
Federal Health Care Expenditures Per Capita
Per Capita spending in the year for which data
are published most recently see base of each
bar.
IHSMedical
IHSOther
2009
2009
2007
1999
2008
2007
648
2009
See page 2 notes on reverse for data sources and
extrapolation assumptions.
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IHS Budget 2008
3,782
700
345
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DHHS Budget 2008800 Billion
386
202
28.9
4.1
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Indian Health Payer System
IHS Federal
PL 93-638 Tribal
AI Healthcare Consumer
Medicaid State
Health Sector
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Percent High School Graduation 2000 Census
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Percent At or Below FPL 2000 Census
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Medicaid Considerations

• States determine Medicaid Planeven for services
  covered by 100 FMAP
• (e.g. TCM in ND v SD or BH meds in AZ v NM)
• States control number of All-Inclusive Rates
  billed per day (100 FMAP)
• (e.g. 3/day in AZ1/day in SDchanged!)

IHS or Tribal services
100 FMAP
State
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Thank you! Donald Warne donald.warne_at_sanfordhea
lth.org
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SD Medicaid Next Steps

• Continue Medical Processes
• Expand efforts in BH services coordination
• IHS, Tribal, State, Private Sector, ATR?
• Identify issues in LTC
• Partners in Advocacy
• e.g. Full funding of IHSmore local servicesmore
  access to 100 FMAP payments