Why Federal Health Insurance Policy Matters to Cherokee Nation

Osiyo,

The debate happening at the federal level over the future of health insurance policy demands the attention of each of us.

Decades ago, if a Cherokee family was fortunate enough to have affordable private health insurance, such coverage was key to moving beyond substandard federal Indian health programs and services. Today, strong federal health insurance policies are key to making access to health care for all Cherokees stronger.

For hundreds of thousands of Cherokees and citizens of other federally recognized tribes living inside or within commuting distance of the Cherokee Nation Reservation, our health systemprovides incredible access to excellent health care from first-class staff in state-of-the-art facilities.

For all Native Americans living within the "purchased and referred care" area administered by Cherokee Nation, that includes "contract health" referrals to outside specialists using a pool of federal funds subsidized by Cherokee Nation tribal business revenue.

With equal access for all citizens of every federally recognized tribe across our 12 health facilities, our staff provides over 3 million patient services per year. None of those patients are charged a fee.

So, what does it matter if any of those patients have health insurance. Why should any of these patients concern themselves with the current national debate over the Affordable Care Act?

As it turns out, there are lots of reasons.

First, hundreds of thousands of Cherokees live outside the Cherokee Nation and many are out of reach of any federally or tribally administered health care. For them, health insurance is the only way to access basic health care.

Second, even for those within the reach of a federally or tribally administered system, there are times when health coverage opens access to specialty care that may not be available through those systems.

Third, in many cases, Cherokee households also include non-Indians. Our non-Indian family members deserve access to health care. Our culture teaches us that the health and well-being of our whole family - indeed, our whole community - is our own concern.

Fourth, the most important factor in the expansion of Cherokee Nation health care in the past two decades has been the availability of "third party revenue," generated by billing health insurance coverage of our patients. Laws like ACA and Medicaid Expansion increased that funding source.

Our health system has three funding sources: federal, Cherokee Nation business revenue, and "third party" revenue generated by our health system. Federal funds have always been inadequate and fail to keep pace with the demands of our system. We earmark a portion of profits from Cherokee Nation Businesses for our health system - and that portion grows over time. However, there are lots of other demands on our business revenue, from higher education scholarships to housing, to a baseline of general government revenue to business expansion and job creation.

Third-party revenue - which we dedicate 100% to improving and expanding our health and wellness facilities, workforce, programs and services - is an indispensable revenue source that helps us meet the expectations of our patients and keep us building toward a world-class system of wellness.

Around 75% of our patients have health coverage. Some are on government programs like Medicaid or Medicare. We bill the U.S. Department of Veterans Affairs for patients with VA coverage. Some of our patients have private insurance, including nearly 7,000 with ACA coverage.

All of this is why the debate in Washington, D.C., over the ACA and related issues commands my full attention as Principal Chief.

If you hear proposals for a full repeal of ACA, ask whether that includes terminating the Indian Health Care Improvement Act, which is part of the ACA. IHCIA includes a variety of benefits to all Native Americans and tribal health systems, from enhancement of third-party revenue collection to expansion of behavioral health programs. Would a full ACA repeal also repeal Medicaid expansion? What happens to special benefits for Native Americans under ACA if the law is repealed? Would our elder care funding and home health take a hit?

As Congress debates whether to extend special ACA premium tax creditsfor middle income Americans, consider what impact that may have on those individuals - who may be your family members, friends or neighbors - and on Cherokee Nation's health system. The cost of ACA premiums is expected to increase between 36% to over 200% for individuals in Eastern Oklahoma on January 1, 2026, depending on their age, unless Congress extends the premium tax credit. How many of them will be unable to afford coverage? How much third-party revenue will Cherokee Nation lose?

Whether it is new ideas about health insurance, reforms to decades-old programs like Medicare and Medicaid, or legislative and programmatic changes impacting the Indian Health Service, the debate in Washington, D.C., has the full attention of my administration. I recommend you give it attention, as well, because knowledge is strength. We need to remain in a strong position when it comes to health care.

Wado,

Chuck Hoskin Jr.
Principal Chief