WA Health Benefit Exchange Report of AIANs in QHPs: A First Look at the Data

Ed Fox, Director, Health Services Port Gamble S’Klallam

American Indian and Alaska Native Enrollment in Qualified Health Plans

March 25, 2014 Data

Washington has 5th highest enrollment in Qualified Health Plans; est. 6% of those eligible for tax credits.

Most AIANs enrolled in QHPs are from tribes outside Washington

429 report membership in Washington State Tribes

681 from tribes outside Washington

The majority of Washington AIANs are not members of WA tribes, but the exact number is not know-195,000 AIANs and about 70,000 are members of WA tribes.

151 are Alaska Natives enrolled in qualified health plans (more Alaska Natives enrolled in WA than in Alaska -115-)

½ of all Alaska Natives who live outside WA are Alaska Natives –over 5,000.

65% of AIANs in Washington report that they do not have ‘access to IHS’ and for them health insurance is a good option.

Highest enrollment is for Large Tribes who were in Priority One in 2013; 2014 Tulalip, Colville, Yakama, Cowlitz had highest enrollment in Qualified Health

Plans

Beyond the obvious; the reasons is unclear….

1. All are large tribes (thus more eligible) and

2. Many tribal members and descendants do not live on reservation so insurance is a good option.

3. All these tribes experienced health care rationing in 2013 and were on priority one during the year…. meaning care only for ‘life or limb.’

Some tribal members likely decide buying health insurance is a good option.

4. All these tribes have worked hard to enroll tribal members in Medicaid and in many cases tribal members were tax subsidy eligible, not Medicaid eligible. Medicaid outreach highlighted the insurance option.

5. None of these tribes had tribal premium sponsorship program-a surprise.

QHP enrollees: Older eligibles much more likely to purchase a QHP. 52% are over 45 yrs old; just 27% of all eligibles are over 40 years old.

QHP enrollees: Females, just 41% of eligibles under 300% of FPL much more likely to enroll (54%) than males (46%) who make up 59% of eligibles under 300% of Federal Poverty Level.

Take-up rates in Qualified Health Plans do not follow and easily discernable pattern

It is too early in the process to make any firm conclusions about ultimate success of Qualified Health Plans for AIANs in Washington, some promising and some disappointing results to date.