Tuba City hospital prepares for Affordable Healthcare Act
Hospital administrators attend conference to discuss implications of legislation for Native Americans

Photo courtesy Tuba City Regional Healthcare Corporation

Photo courtesy Tuba City Regional Healthcare Corporation

TUBA CITY, Ariz. - Officials from Tuba City Regional Healthcare Corporation (TCRHCC), joined other Navajo Nation officials at a conference last week to discuss the implementation and implications of the Affordable Healthcare Act for Native Americans.

The Navajo Nation Department of Health sponsored the conference that took place at Twin Arrows Casino Aug. 22-23.

One of the first things the healthcare center is trying to do is get its staff ready and educate them. The hospital's patient benefits coordinators, who are on the front line, are going through training right now to prepare for Oct. 1 when people can begin signing up for health benefits that will start Jan. 1, 2014.

Lynette Bonar, associate executive officer for TCRHCC, explained there are benefits for Native Americans who, because of treaty obligations from the federal government, already have some of their health benefits covered.

"They can have coverage and they don't have to pay any co-pays, they don't have to pay any out-of-pocket expense through the Medicaid expansion as well as the health insurance exchanges (marketplaces is the new term)," Bonar said.

Bonar said one of the biggest benefits with the expansion of Medicaid, Native Americans will now be able to get rides to appointments, which is a big benefit to those on the reservation who have trouble coming in from long distances for a doctor's appointment. She also pointed out that if someone is off the Navajo Nation and they need care or medication, they can use the insurance to get the care they need or their medication and still not have to pay a co-pay. If someone is over the federal poverty level for any of the family sizes, they still won't have to pay the co-pays for the marketplaces because the government will pay for their premiums. In addition, Native Americans will not get penalized for not buying insurance.

"There are motivators and non-motivators and with Native Americans in general it's really a treaty right that we're supposed to get health benefits. So they are trying to make it so there is no out-of-pocket expense," Bonar said.

But Bonar encourages people to sign up for the insurance.

"If we are able to get the revenue for the hospital it will turn around and make us more able to expand services for them and hiring more doctors, every piece of revenue we get goes to improving healthcare, so that's what we're trying to do," Bonar said.

Violet Skinner, utilization review director for Tuba City Healthcare, said the hospital is looking at how it can reach out to their unique community in a culturally sensitive way. The hospital is also working to educate staff and explain how the marketplace will affect the population it serves. She said this will include the staff who speak Navajo.

"[We will be] educating the population on the differences between Medicare and Medicaid and the exchanges and how that works within the Indian Healthcare, Tribal Healthcare system," Skinner said.

She added, "It is a large numbers equation and what we're looking at is our elderly population who have Medicare and our younger population who may be eligible in January, those single childless adults, to get those people enrolled, to reach out to them and help them understand how to apply and how this means something to them."

Bonar said that Native Americans don't always think of health insurance in the same way as non-natives. Non-natives are required to have health insurance because they don't have a place like Indian Health Services.

"If we can get people thinking about health insurance, it will help them think about health in general," Bonar said. "It's possible this may decrease our disparities with Native Americans, give them a different twist on how they think of life in general."

Specifically, TCRHCC will hire two "navigators" trained to do outreach and to enroll people into the health marketplace. Patient benefit coordinators will be certified counselors and will help verify eligibility in alternate resources like Medicare, Medicaid, SSA-Disability, and the VA to name a few.

Selena Simmons, manager for the patient benefits coordinators at TCRHCC, said the hospital will be shopping online to find people above the income level who are transferred over to the marketplace affordable healthcare with a premium they can afford.

She anticipates a lot more single adults will qualify for Medicaid with the expansion of the income level.

Simmons said one of the benefits she sees making a difference is how premiums are covered for people.

"A lot of the employers now, their premiums are so high to get their family members on, so the employee is the only one on the policy, that is where the marketplace is going to be really good for them," Simmons said.

While on the whole the staff sees the Affordable Health Care Act as a positive, Bonar said with the Medicare expansion there will be a loss of some benefits which are currently covered under a waiver. Those losses include coverage for some emergency dental, some podiatry, physical therapy and prosthetics and orthotics which are paid for now. Because they will join the state of Arizona's Medicaid program, which has already lost those benefits, so will everyone.

"That's not good for the dental program, that's not good for the podiatry program because we have a lot of patients who have diabetes who have a lot of foot issues and that covered their cost," Bonar said. "Now that cost won't be covered for anybody."

Tuba City hospital officials are talking to the Center for Medicare and Medicaid Services to see if they can get their coverage for those services back because technically they get their Medicare funding through the federal government and not through the state of Arizona's Medicare system.

Simmons said that she and her staff will be ready to go by Oct. 1 and the changes are not as overwhelming as some may think.

"To me it's almost like, we work with Medicare Part D, open enrollment, it's almost the same thing, the Affordable Care Act," Simmons said. "It's what we're already working with, but bigger."

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