Healthcare coverage improves in Indian country amid COVID-19 toll

Health and Human Services Secretary Xavier Becerra, far left, talks with citizens of the Cherokee Nation during a visit to the tribe’s reservation in Oklahoma on July 1, 2021. Photo: Anadisgoi / Cherokee Nation

Healthcare coverage improves in Indian country amid COVID-19 toll

Thursday, July 22, 2021

By Acee Agoyo


The report was released by the Office of the Assistant Secretary for Planning and Evaluation within the Department of Health and Human Services, not the Centers for Medicare and Medicaid Services, as previously reported. An updated copy of the report is available at

Health insurance coverage has improved dramatically among American Indians and Alaska Natives, the Biden administration says in a new report that highlights remaining disparities in tribal and urban communities . According to Department of Health and Social Services, only 28% of Native Americans were uninsured in 2018. While the rate was still the highest among all racial and ethnic groups, it represents huge progress since the Affordable Care Act (ACA) became law more than ten years ago. Between 2010 and 2018, in fact, the percentage of American Indians and Alaska Natives who ended up without health coverage decreased by 16 points, HHS said in the report Thursday. The Biden administration cites the numbers as it seeks to improve insurance rates even further in the coming years. “CMS is committed to working with our tribal partners to ensure American Indians and Alaska Natives have access to the coverage they need,” Administrator Chiquita Brooks-LaSur from Medicare and Medicaid Service Centers says Indianz.Com. “Although American Indians and Alaska Natives can enroll year-round, the Special Enrollment Period offers the opportunity to get coverage faster and we encourage people who need coverage to register before August 15,” Brooks-LaSur said as she encouraged people in tribal communities to explore their options for Health Insurance.

Malgré les gains, le rapport montre à quel point Indian Country a encore un long chemin à parcourir. En 2019, par exemple, la couverture sanitaire des Amérindiens et des Autochtones de l’Alaska accusait un retard considérable par rapport aux Blancs non hispaniques, aux Asiatiques, aux Afro-Américains et aux Hawaïens autochtones, selon les données. Puis en 2020, le coronavirus a fait des ravages majeurs sur les tribus et leurs citoyens. Les Indiens d’Amérique et les autochtones de l’Alaska ont subi les taux d’infection, d’hospitalisation et de mortalité les plus élevés au monde. Pandémie de covid-19, selon le rapport.

La situation s’est améliorée en 2021, en raison des taux élevés de vaccination contre la COVID-19 chez les Autochtones. Au 9 juillet, plus de 55 % des patients adultes de la Service de santé indien avoir reçu au moins une dose du vaccin, qui a été le plus élevé parmi tous les groupes raciaux et ethniques, a noté le rapport du HHS.

Et selon les données de l’IHS du 15 juillet, qui sont les dernières disponibles, plus de 1,47 million de doses de vaccin COVID-19 ont été administrées dans tout le système. Cela représente 57,3% de la population d’utilisateurs de l’agence.

Office of the Navajo Nation President and Vice President: Public meeting on the response to COVID-19 – July 21, 2021
But with the Delta variant leading to more infections, hospitalizations and deaths In the United States, the tribes are increasingly worried. On the Navajo Nation, which has suffered some of the worst effects of the coronavirus, 90% of people over the age of 75 and 64% of residents over the age of 12 have been fully vaccinated. The same cannot always be said of the outside communities. “It’s like going into battle in a war” Navajo Nation President Jonathan Nez said Wednesday during a town hall on COVID-19. “You gear up. You put on your armor, you put on your face mask and you get vaccinated. “People see Navajo off the Navajo Nation and they know we’re Navajo,” Nez said from a reservation that spans the states of Arizona, New Mexico and Utah. “Do you know why? Because we wear masks. The Affordable Care Act came into effect in 2010, ushering in a new era of healthcare options for tribes and their citizens. The law provided for a permanent reauthorization of the Indian Health Care Improvement Act and enabled states to expand services to more American Indians and Alaska Natives through an expansion of the Medicaid program, which is administered by CMS. According to the HHS report, the increase in the number of Natives with health coverage can be attributed to the expansion of Medicare in dozens of states. “Analysis shows that one year after the ACA Medicaid expansion took effect, the national rate of uninsured among AI/ANs fell nationwide from 24.8% in 2013 to 20.6% in 2014, and the greatest coverage gains occurred among people living on or near reservations in states that expanded Medicaid,” the report reads. not everyone had on board. Oklahoma, for example, did not enact a Medicaid expansion until July 1. The state is home to the second largest population of American Indians and Alaska Natives, behind California. “Oklahoma became the most recent state to expand Medicaid, which is notable because prior to the expansion, it had the largest uninsured AI/AN population (79,200) of any state in the nation,” notes The report.

Status of State Action on Medicaid Expansion Decision

As of July 9, 2021, 39 states, including the District of Columbia, have adopted the Medicaid Expansion Program, while 12 states have not. A 13th state, Missouri, adopted but did not implement the expansion. Source: Kaiser Family Foundation
Among Oklahoma’s insured Native population, about 35,100 would be eligible for coverage as a result of Medicaid expansion, according to an estimate provided in the report. the Cherokee Nation, the largest tribe in the state, is already seeing the benefits, Chief Chuck Hoskin, Jr. noted. “More than 2,000 patients in our health system enrolled in Medicaid in the first few weeks of the expansion alone,” Hoskin said in a press release Monday. “It means more Cherokee families will have peace of mind as they face future health care needs here on the Cherokee Nation reservation and throughout Oklahoma,” said Hoskin, who hosted the Brooks-LaSur CMS administrator and Secretary of Health and Human Services Xavier Becerra July 1, the same day the Medicaid expansion became official. Elsewhere in the country, some 20,000 other American Indians and Alaska Natives would be covered if other reluctant states adopted the same program, HHS data shows.

In addition to providing coverage to eligible Natives, the expansion program financially benefits IHS, which has been chronically underfunded. According to the report, Medicaid dollars now account for the overwhelming majority of third-party reimbursements in the system. “Medicaid collections at IHS-operated facilities increased from $496 million in fiscal year 2013 to $729 million in fiscal year 2018,” the report said. “The proportion of patients insured at federally operated IHS facilities increased from 64% to 78% between fiscal years 2013 and 2018, and IHS facilities in states that expanded Medicaid saw the largest increases,” continues -he. The growth is significant, as federally operated IHS facilities collected $1.1 billion in third-party reimbursements in fiscal year 2019 from health agencies to provide the additional revenue needed to provide care,” says the HHS report.

Health Insurance Coverage and Access to Care for American Indians and Alaska Natives: Current Trends and Key Challenges (July 2021) [PDF]


The Affordable Care Act and Indian Country

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