Although 6.5 percent of Montanans are Native Americans, they constitute only 1.7 percent of health insurance marketplace enrollees, a new report shows.
Released Thursday, the "Breaking Barriers: Improving Health Insurance Enrollment and Access to Health Care in Montana" report also showed that health insurance does not necessarily translate into quality care, with only 27 percent of Native Americans and Alaska Natives surveyed saying that they have a primary care physician and about 50 percent saying that they waited more than two weeks for an appointment.
"Breaking Barriers" was compiled by the Alliance for a Just Society, with help from Indian People’s Action and the Montana Organizing Project. The report encompassed 10 states and surveyed 115 low-income Montanans, as well as took into account interviews with navigators and health care professionals and advocates.
It examined enrollment under the Affordable Care Act and the act’s goal to expand access to quality health care.
“Based on this research, the report finds that the delay in Medicaid expansion has been a very significant barrier to care but is far from the only barrier,” Michaelynn Hawk, executive director of Indian People’s Action, said during a press event to release the report.
“Additional barriers include lack of outreach and assistance in enrollment, particularly considering distance and lack of access in Montana on rural reservations,” she added.
Report findings were not surprising, and while Medicaid expansion will help, it does not solve the health insurance disparity between Native Americans and other groups, said LeAnn Johnson, director of the Missoula Urban Indian Health Center.
The Missoula center is not a health insurance provider or a clinic and because of limited funding must rely on a referral network to connect people with needed care, Johnson said.
Because those services are not through a tribal health facility or IHS – the nearest ones are in Pablo and Browning – Native Americans must pay for them, but many don’t have insurance.
Many end up going to the emergency room or clinics for immediate care as issues arise, Johnson said.
"But then they're stuck with a bill that they're unable to pay for," she said.
Awareness is key to helping more Native Americans sign up for coverage, Hawk said.
Initially, Native entities did not receive navigator grants to provide outreach and help for people to sign up for health insurance coverage under the Affordable Care Act.
Now, though, certified application counselors are available to help, including ones at the Missoula Urban Indian Health Care Center. Employees also can help people review all their options, including an exemption for the penalty for not having insurance, and Native Americans can sign up for coverage at any time throughout the year.
“As the Affordable Care Act was first implemented in Montana, there wasn’t enough investment in reaching out to our communities, outreach and assistance that we need in order to understand what we’re eligible for and how to enroll,” said Kathleen Little Leaf, Indian People’s Action board chairwoman.
Little Leaf called Medicaid expansion a step forward, but said it must be implemented correctly to improve access to care for Native Americans.
“That will mean dedicating resources to make sure that Native people know about their rights to health care. They can sign up for coverage and get quality health care. It is a possibility,” she said.
To help more Native Americans access health insurance, the report recommends several actions, including targeting enrollment of low-income residents already enrolled in other social services and requiring networks to provide one full-time primary care physician for every 2,000 patients.
Other recommendations are to increase payment rates for primary care physicians and require plans to track outcomes by identifying factors such as race and gender.
The report also calls for investment in school-based health centers and for penalties for insurers who do not reduce disparities.
More resources for tribes and Urban Indian Health Centers to provide more certified application counselors and navigators in an effort to improve access also is recommended in the report.
Overall, funding is crucial to making recommendations realities, Hawk said.
IHS entities will be able to bill insurance agencies for some services, which will then create a revenue stream for the centers and help them build services, Johnson said.