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Report: ACA Repeal Would Send Native American Uninsured Rate Soaring

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Funding reductions for the Indian Health Service proposed by President Donald Trump could force the federal agency and tribes across the country to ration care provided at locations including Haskell Indian Health Center in Lawrence.

The number of Native Americans without health insurance would increase sharply if Republicans in Congress succeed in repealing and replacing the Affordable Care Act, according to a new report.

The report, from the left-leaning Center on Budget and Policy Priorities, says that proposed cuts to Medicaid and to the subsidies that reduce out-of-pockets costs for low-income individuals purchasing private insurance in the ACA marketplace would jeopardize the coverage of more than 300,000 Native Americans and Alaska Natives. 

The uninsured rate among Native Americans would climb by 27.4 percent in Kansas and 36.2 percent in Missouri, according to the report. Kansas is home to approximately 60,000 people who identify as either Native Americans or Alaska Natives. Missouri has a Native American population of more than 70,000.

An analysis done by the Urban Institute released earlier this month estimated that Kansas’ overall uninsured rate would be 35 percent higher by 2022 under the Obamacare replacement bill now under consideration in the U.S. Senate. It estimated the uninsured rate in Missouri would increase by 50 percent. 

Nationally, the uninsured rate among Native Americans dropped by nearly 40 percent after enactment of the ACA in 2010. Repealing it, the report says, would jeopardize those gains by “slashing Medicaid and making marketplace coverage unaffordable.”

In addition, reductions in funding for the Indian Health Service proposed by President Donald Trump could force the federal agency and tribes across the country to ration care provided to more than 2 million Native Americans and Alaska Natives through a network of hospitals and clinics, including the Haskell Indian Health Center in Lawrence and several others in Kansas. 

“The Senate Republican health bill would be devastating to American Indians in Kansas,” said David Jordan, executive director of the Alliance for a Healthy Kansas, a group formed by several health foundations to lobby for Medicaid expansion in Kansas.

The proposed phaseout of Medicaid expansion in the 31 states and District of Columbia that adopted it constitutes the biggest threat to coverage among Native Americans, according to the report.

Kansas lawmakers passed legislation this session to expand Medicaid coverage to approximately 150,000 low-income adults earning up to 138 percent of the federal poverty level, but Republican Gov. Sam Brownback vetoed the bill.

Republican leaders continued to struggle Wednesday in their effort to get the necessary votes to pass the U.S. Senate version of the Obamacare replacement bill, according to numerous reports.

U.S. Sen. Jerry Moran of Kansas is one of several Republican holdouts on the bill. At a town hall meeting last week in western Kansas, Moran said he was open to supporting a revised version of the bill if Senate leaders could address his concerns, which include the impact of proposed Medicaid cuts on rural health providers. 

However, Moran also said that using the budget reconciliation process to pass major health reform legislation, as the GOP leaders are attempting to do, is “almost impossible” when there is no consensus on what “the end result ought to be.”

By most accounts, Republican leaders who hope to vote next week on a new version of the bill don’t yet have the votes to pass it. 

Jim McLean is managing director of KMUW's Kansas News Service, a collaboration of KMUW, Kansas Public Radio and KCUR covering health, education and politics in Kansas. Follow him on Twitter @jmcleanks.