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Howlett urges folks at the Winter Quarterly to hop aboard Obamacare

By B.L. Azure

Tribal Health Nurse Practitioner Patricia Camel-Kelly urged folks at the Winter Quarterly to access the health care provided by THHS. (B.L. Azure photo) Tribal Health Nurse Practitioner Patricia Camel-Kelly urged folks at the Winter Quarterly to access the health care provided by THHS. (B.L. Azure photo)

ST. IGNATIUS — Tribal Health and Human Services Director Kevin Howlett urged folks at the Confederated Salish and Kootenai Tribes Winter Quarterly gathering to adhere to the mandates of the Patient Protection and Affordable Care Act (ACA). Howlett told the standing room only crowd that the ACA or Obamacare, among other things, is step toward comprehensive health coverage as well as individual choice of health care options in Indian Country.

Howlett said the ACA is a convoluted hard read but it is the law of the land including Indian Country. There are mandate hurdles that tribal people must jump over to qualify for insurance under the ACA or to get exemptions from it.

“I know the affordable care act is confusing to people,” Howlett said. “But when it is fully implemented it will be good for tribal people, there will be more health care options for you, the individual.”

There are two types of tax penalty exemptions available to American Indians and Alaska Natives:
   • Tribal member exemption – A member of a federally recognized tribe and member of an Alaska Native village or regional corporation as defined in the Alaska Natives Claims Settlement Act (ANCSA)
      - It is a statutory exemption
      - Exemption can be applied for through the Health Insurance Marketplace or through the IRS filing process
   • Indian Health Care Provider exemption – Those American Indians eligible for services from Indian Health Care providers such as Indian Health Service, Tribal Health Departments or Urban Indian Health Centers
      - They include 1st and 2nd generation descendants
      - It is also known as a hardship exemption
      - Exemption can only be applied for through the Health Insurance Marketplace

They remain in effect permanently, unless there is a change in membership or eligibility requirements.

Applicants for the exemptions will use a paper form, however the paper form is not yet available from the Health Insurance Marketplace or the Internal Revenue Service.

Due to the lack of the official paper form there is no immediate rush or need or requirement or ability to submit the exemption request.

When the forms become available the claimed exemption(s) will be retroactive.

A web-based application process might be available in 2015.

Howlett told folks that Tribal Health has five staff members trained to assist people with applications and exemptions related to the ACA.

“It is necessary that people do the application for an exemption under the affordable care act,” Howlett said. “Enrolled members only have to apply for exemption once.”

Eldon White queried Howlett about the lack of success he has had trying to get a hernia condition operated on. He said money is being spent on the “pretties,” alluding to the construction of modern clinics to better serve the Tribal Health clientele instead of being allocated for his operation.

“With all due respect, these pretty things are clinics. Modern facilities. Do you remember what the former Polson clinic looked like,” Howlett asked. “Our people deserve to have modern facilities.”

The construction of new health care facilities and/or remodeling and expansion of existing ones is part of the goals of Tribal Health to become the provider of choice for eligible clientele.

Howlett told those gathered that the funds, generated by third-party reimbursements provides capital for such endeavors as clinic construction and expanded health care options with Tribal Health as well as employment opportunities. The projects are paid for up front with third-party reimbursement funds not with tribal funds. The third-party reimbursement funds, by law, must be spent on the provision of health care and cannot be used by tribal government.

Tribal Health collects third-party reimbursements for the health care services it provides to folks covered by Medicare, Medicaid and Healthy Montana Kids, as well as private insurance.

Howlett told White that when Tribal Health receded the compact of Contract Health Services back to IHS October 1, 2005 there was a $17 million budget shortfall in FY 2004. The tribal government and administration eventually ponied up the funds necessary to cover the shortfall. Howlett characterized the situation as a financial disaster, one that is avoidable under the new management scheme of Tribal Health.

“We are not going back to those days,” Howlett said. “Why push money out the door when you have the option of keeping it in house. Health care is a business and if we’re going to compete in that arena we are going to operate as a business.”

The construction of the Polson THHS Clinic was a huge step forward to make the provision of health care for tribal people more accessible. Prior to the new clinic folks in the Polson area had a 1,000 square-foot sardine-can facility with a waiting room that could seat about five or so folks. Now it has the modern three-story clinic kiddy corner from the Lake County Courthouse with a waiting room nearly the size of the old clinic. The new clinic created 40 new jobs within Tribal Health to staff the facility.

“If we don’t have modern facilities we can’t generate funds,” Howlett said of the chicken and egg conundrum. “And without the funds we can’t build modern clinics for the people and create well-paying jobs.”

Tribal Health recently created a position that will help pave the way for third-party reimbursements from the Department of Veterans Affairs for services Tribal Health provides for tribal veterans.

The change to the business model of health care provision also allowed Tribal Health to invest $1 million in the Elderly Program and $500,000 for the Deferred Services Program annually. The latter provides funds to pay for non-life threatening but needed health care not being paid for by the Indian Health Service’s Contract Health Services that is funding only life or limb cases. The Deferred Services Program is for enrolled members of the Salish, Pend d’Oreille and Kootenai tribes who need an operation that isn’t life or limb threatening.

Howlett suggested that White contact Deferred Services about his hernia.

Billings-Area Indian Health Service Director Anna Whiting-Sorrell told folks at the quarterly that under her guidance IHS would work to be more open and communicative with the service units, tribal health programs and urban health programs and the people they serve.

“My pledge to you is to create a single health care delivery system for you,” Whiting-Sorrell told the folks at the quarterly. “It doesn’t matter whether you are Indian Health Service or a tribal health program we need to bring health and wellness to the people.”

For information and assistance related to the ACA:
   • In the St. Ignatius area people can contact ACA certified application counselors: Char Neal at 745-3525, ext. 5001; Linda Ebner at 745-3525, ext. 5005; and Alice Moran at 745-3525, ext. 5087.
   • In the Polson area the ACA certified application counselors are: Gloria Quiver at 883-5541, ext. 7319; or Rhonda Lozeau at 883-5541, ext. 7347.
   • For information about Deferred Services, contact Teri Burke at 745-3525, ext. 5044.

Correction: Eldon White was incorrectly identified as Eldon Smith. This version corrects the print version.

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