Fact Sheet: The Affordable Care Act and American Indian and Alaska Native People

The Affordable Care Act will help make health insurance coverage more affordable and accessible for millions of Americans.  For American Indians and Alaska Natives, the law will address inequities and increase access to quality, affordable health coverage, invest in prevention and wellness, and give First American individuals and families more control over their care. 

At the Department of Health and Human Services (HHS), tribal consultation is a critical ingredient of a sound and productive Federal-tribal relationship, and crucial to the successful implementation of the Affordable Care Act.  Consultation and outreach efforts provide education and information about the law and how it will impact Indian Country while ensuring policies and programs are responsive to feedback from tribal communities.

The Affordable Care Act will provide 579,000 uninsured American Indians and Alaska Natives an opportunity to get affordable health insurance coverage. The following provides an overview of the coverage and benefits available to American Indians and Alaska Natives today and those made possible beginning in 2014 by the Health Insurance Marketplace.

Happening Now: Improving Health Care for American Indians and Alaska Natives

  • The Affordable Care Act permanently reauthorizes the Indian Health Care Improvement Act (IHCIA) and authorizes new programs to ensure that the Indian Health Service (IHS) is more equipped to meet its mission to raise the health status of American Indians and Alaska Natives to the highest level.
  • Tribes or tribal organizations carrying out a program under the Indian Self-Determination and Education Assistance Act or urban Indian organizations carrying out a program under Title V of IHCIA may now purchase coverage for their employees from the Federal Employees Health Benefits Program (FEHB).  As of July 31, 2013, over 10,000 employees from 53 tribes in 15 states are enrolled in the FEHB.  Ten additional tribes have expressed interest, representing approximately 2,000 additional employees.
  •  IHS and Tribal programs are now starting to receive reimbursement payments from the Department of Veterans Affairs (VA) for direct care services provided to eligible veterans under the IHS VA reimbursement agreement signed as a result of a new authority in the Indian Health Care Improvement Act. 
  • Targeted interventions, such as Community Transformation Grants, promote healthy lifestyles, lower health care costs, and reduce health disparities in tribal communities. Major investments to improve quality of care are improving management of chronic diseases that are more prevalent among American Indians and Alaska Natives.
  • Over the last three years, the IHS has supported the National Indian Health Outreach and Education (NIHOE) project, an effort involving the National Congress of American Indians, the National Indian Health Board, and the National Council of Urban Indian Health and 11 regional entities, primarily Regional Tribal Health Boards, to conduct area specific outreach and education regarding the Affordable Care Act.  As of May 2013, the NIHOE project has completed over 330 trainings with tribes, tribal organizations, and urban Indian health programs.

Coming Soon: Better Access to Coverage for American Indians and Alaska Natives

  • 579,000 uninsured American Indians and Alaska Natives will have new opportunities for coverage through the Health Insurance Marketplace.  As many as nine out of 10 of those may qualify for financial assistance either through tax credits to purchase coverage in the Marketplace, cost-sharing reductions that will reduce or eliminate out of pocket costs, or through Medicaid if their state expands eligibility.   
  • American Indians and Alaska Natives will be eligible to purchase coverage through the new Health Insurance Marketplace.  The Marketplace is a destination where consumers can compare health insurance options in simple, easy-to-understand language. At the Marketplace, consumers will be able to compare insurance options based on price, benefits, quality and other factors with a clear picture of premiums and cost-sharing amounts to help them choose the insurance that best fits their needs. 
  • American Indians and Alaska Natives earning between 100 percent of the federal poverty level (FPL) (or $23,550 for a family of four in 2013, $29,440 in Alaska) and 400 percent of FPL (or $94,200 for a family of four in 2013, $117,760 in Alaska) may be eligible for advance premium tax credits that lower monthly premiums right away.  Others may be eligible for free or low cost coverage from the Health Insurance Marketplace.
  • Certain American Indians and Alaska Natives who purchase health insurance through the Marketplace do not have to pay co-pays or other cost-sharing if their income is under 300 percent of FPL, which is roughly $70,650 for a family of four in 2013 ($88,320 in Alaska).  In addition, certain American Indians and Alaska Natives will have access to special monthly enrollment periods so they may get insurance outside the yearly open enrollment period.
  • Many American Indians and Alaska Natives will be newly eligible for Medicaid under the Affordable Care Act.  States have new opportunities to expand Medicaid coverage to include Americans with family incomes at or below 133 percent of the federal poverty level (generally $31,322 for a family of four in 2013). This expansion includes adults without dependent children living at home, who have not previously been eligible in most states. 
  • All American Indians and Alaska Natives who are eligible to receive services from an Indian health care provider  (as defined in 42 C.F.R. § 447.50) may receive an exemption from the shared responsibility payment if they do not maintain minimum essential coverage under the Affordable Care Act. Prior to HHS’ announcement of the exemption, only a portion of the American Indian and Alaska Native population – members of federally recognized tribes – would have access to such an exemption. The exemption reflects comments and feedback received from Indian Country through rulemaking and the tribal consultation process.
  • With greater numbers of American Indians and Alaska Natives with some form of coverage, including Medicaid, the Children’s Health Insurance Program (CHIP) and private insurance, IHS will be better able to provide needed health services. This coverage will improve reimbursements to IHS and will also benefit Indian health programs. 

To learn more about the Health Insurance Marketplace, please visit: www.HealthCare.gov.  For the most recent information on Affordable Care Act and IHCIA implementation, please visit: www.HealthCare.gov/tribal and www.ihs.gov.

Posted: March 21, 2011

Last Updated: August 22, 2013