The Indian Health Service Tribal Self-Governance Advisory Committee’s National Indian Health Outreach & Education project is pleased to present the following Self-Governance success stories on the positive impacts of  enrollment of Tribal members in the Marketplace.  These Tribes and Tribal Organizations have successfully used provisions of the Patient Protection and Affordable Care Act (ACA) to maximize health care availability and quality in their communities.

We hope that you will find these stories uplifting and perhaps will discover helpful examples that can be replicated in your own communities.  We encourage you to share these stories by including any of the following press releases and photos in your Tribal newsletters and local newspapers in your area.  To obtain a copy of the press release, please click on the links below for a Word version of the story and black and white photos.  You can also use a color version for any copies that you would like to make.

We extend our sincere thanks to the following Tribes and Tribal organizations for sharing these heartfelt stories with us.

Chickasaw Nation expands health campus thanks to partnership with Indian Health Service

Ada, Oklahoma

The Chickasaw Nation, headquartered in Ada, Oklahoma, is economically strong, culturally vibrant and full of energetic people dedicated to the preservation of family, community and heritage. The Chickasaw Nation was among the first of several Tribes to embark on Tribal Self-Governance beginning in 1994. Being Chickasaw myself, I was particularly excited to sit down with some of the brightest minds the tribe has to offer to better understand the ways in which Tribal Self-Governance combined with the Affordable Care Act/Indian Health Care Improvement Act (ACA/IHCIA) has made a positive impact for the Nation and advanced health care for its’ citizens.

Melissa Gower, Senior Advisor & Policy Analyst, has seen the evolution of the Chickasaw Nation Medical System from its humble beginnings into the complex campus it has become today. “When we compacted (under Self-Governance) in 1994, it was a small, tiny hospital run by the Indian Health Service (IHS). Today, we have a medical center campus. It’s amazing to go from this ‘little bitty building’ under IHS to what the tribe has today, a whole medical campus with a huge new hospital. The majority of our facilities have been built under the joint venture construction program because the tribe put up the money to do it. None of it would have been possible without Self-Governance.”

Read more of CSN’s ACA story here.

Controlling our Destiny: Jamestown S’Klallam Tribe sees exponential growth of health care services for their Tribal citizens and local community.

Sequim, Washington

“The Tribes that are most successful are the ones who went out and just started doing things. Those Tribes have decided they can control their own destiny. We’re not a Tribe that sits around and talks about things. We’re a Tribe that does things. And I think that’s at the core and way of thinking for Self-Governance Tribes. They’re doers. They don’t demand that somebody else do it, they’re saying, ‘Just get out of our way and we’ll do it.’” – Brent Simcosky, Health Director at Jamestown S’Klallam Tribe (JST).

The Jamestown S’Klallam Tribe (JST) is headquartered in a small town called Blyn on the Olympic Peninsula of Washington state. “S’Klallam” is a Salish term for “The Strong People.” The Tribe’s history shows that they have always been self-reliant and determined to forge their own path. JST has long been recognized as a progressive Tribe, now wholeheartedly rooted in the 21st century, but with a deep connection to their traditional resources, history and culture, which inform the present and serve as the foundation of their success.

The work JST has done for their citizens was truly built from scratch. The Tribe’s Chairman/CEO is W. Ron Allen who has been at the helm of the Tribe steering this ship for 47 years. According to Chairman Allen, Tribal Self-Governance and opportunities provided under the Aff ordable Care Act/Indian Health Care Improvement Act (ACA/IHCIA), have been critically important tools allowing them allowed them to expand and elevate both the quantity and quality of healthcare services they can provide to their community. Self-Governance has allowed them to do a great job retaining quality talent and allowed them to become a solution for quality healthcare in their surrounding community. Opening their own Tribal clinic paved the trail for new models of providing healthcare in their community, and thinking outside the box has proven quite successful. Chairman Allen adds that “with our control, we’ve been able to address the true need of not just the Tribe/Tribal citizens, but the extended family and the employees who serve and live around us.” But he notes that “it just doesn’t happen overnight, it takes purpose, persistence, and patience.”

Read more of JST’s ACA story here.

Citizen Potawatomi Nation Insurance Sponsorship Project Gives Hope and Help

Shawnee, OK

“Last Friday I had long curly hair,” a bald William Moore says cheerfully. He sports a crimson and cream t-shirt as his 6’1” long body reclines in a bed in a room at the University of Oklahoma Medical Center in Oklahoma City. He tries to sleep during the day and stay awake at night so that he will be ready to return to the night shift as a nursing assistant at the same hospital the day after he is discharged from this round of chemotherapy.

Mr. Moore’s on-call job does not provide health insurance. He was on his mother’s insurance policy until he turned 26 years old in 2013. He assumed he wouldn’t need health insurance at that time. “I had no clue I would be a Stage 4 cancer patient in six months,” he says.

It all happened so fast.

First, there was the visit to the emergency room, then the diagnosis.  Surgery followed three days later with chemotherapy starting 10 days after that.

During the 10 days between surgery and chemotherapy, Mr. Moore drove the 30 miles from his home in Oklahoma City to the Citizen Potawatomi Nation (CPN) in Shawnee, OK, for assistance in applying for insurance on the Federally-Facilitated Marketplace on   CPN assisted Mr. Moore to enroll in a Blue Cross/Blue Shield (BCBS) plan with $123 monthly premiums. A federal tax credit reduced the premium by $29.  Since he met the criteria for the CPN Insurance Sponsorship Project, the Tribe paid the balance for the health insurance premiums.

Read more of CPN’s ACA story here.

Coeur d’Alene Tribal Members Receive Needed Health Care Through the Affordable Care Act

Plummer, ID

After her brother ran over her foot with a car nine years ago, Margaret Coffey was left with broken bones and a useless toe.  The 50-year-old citizen of the Coeur d’Alene (CDA) Tribe had no insurance and her injury did not meet the priority for Contract Health Services, now called Purchased/Referred Care (PRC).

Nearly six years later, the damaged bones in her foot snapped.  “I dropped to the floor in pain,” she recalls.  Still, her injury was not considered life threatening, and PRC was unable to pay for treatment.  “I lost my temper,” she exclaims.  “I can’t walk!  Isn’t that a priority?”

The Tribe contacted her in March 2014 to offer her health insurance through Your Health Idaho (YHI), the health insurance marketplace established by the State of Idaho under the Patient Protection and Affordable Care Act (ACA).  The CDA Tribal Premium Sponsorship Program paid the portion of the premiums that was not subsidized through federal tax credits.

Read more of CDA’s ACA story here.

Tribal Sponsorship Helps Fond du Lac Band Reach Goal Of Providing Health Insurance for All

Cloquet, MN

When the Fond du Lac Band of Lake Superior Chippewa (FDL) began planning for the Patient Protection and Affordable Care Act (ACA), they already had an effective campaign in place to let Tribal citizens know that enrolling in health insurance benefits everyone in the Tribe.

In 2013, the FDL Band of Lake Superior Chippewa Tribal Council approved a tribal Sponsorship program called FDL Total Coverage mostly for people under 300 percent of the federal poverty level who enrolled in MNsure, the marketplace set up by Minnesota under ACA.  They expected about 80 people to enroll and set aside $134,000 to pay the balance of their premiums after federal tax credits.

A funny thing happened.  In the first year, only 10 people signed up for MNsure plans and their combined premiums cost the Tribe only $9,767.

The unexpected low enrollment was not due to lack of effort.  Seven trained FDL staff assisted 800 people with enrollment during 2014.

“At the end of the first year, we evaluated our experience,” reports Jennifer DuPuis, Associate Director of Fond du Lac Human Services.  The main reason that  enrollment in the MNsure was lower than expected is that most Tribal citizens who did not have insurance provided by their employer qualified for Minnesota programs that covered people below 200 percent of the federal poverty level with no premiums or co-pays.  Minnesota is the only state to have Medicaid, Medicaid Expansion and a Basic Health Plan (called MinnesotaCare).

With approximately 500 new enrollees in Medicaid and careful attention to billing, FDL’s income from Medicaid increased by $1.62 million in 2014, an increase of 11 percent over the previous year.

Read more of FDL’s ACA story here.

Tribal Sponsorship Gives Peace of Mind, Access to Care and Better Health

Anchorage, AK

When the movie crew for “Big Miracle” starring Drew Barrymore came to shoot scenes in Alaska in 2012, Mary Lou Asicksik tried out for one of the parts.  She didn’t get the part she wanted, so she signed on as an “extra” for the movie. The director remembered her tryout and insisted that the script be re-written to give her lines.

“He saw a spark in me,” recalls Ms. Asicksik, who grew up in the small Inupiaq village of Shaktoolik.  “Big Miracle” motivated her to continue acting and also made her a member of the Screen Actors Guild.

After re-locating to Los Angeles to continue her acting career, she worried about what would happen if she got sick or had an accident on the freeways.  There was no Indian Health Service hospital.  She didn’t work enough to qualify for health benefits from the Screen Actors Guild, and she couldn’t afford to buy insurance.

“We sometimes take our health care for granted because it is pre-paid,” she reflects.

After a year in California, Ms. Asicksik returned to Anchorage.  Southcentral Foundation (SCF) helped her to obtain insurance through the Affordable Care Act. The premiums were $396 per month, and the Tribally- Sponsored Health Insurance Program (TSHIP) paid the entire amount since Ms. Asicksik’s income was too low to qualify for tax credits.  If Alaska had Medicaid Expansion, there would be no cost for health coverage for her.   As a shareholder in Bering Straits Native Corporation, Ms. Asicksik has no co-pays or deductibles under the Affordable Care Act.

Read more of SCF’s ACA story here.

To learn more about Tribal Nations’ success with Self-Governance and Sovereignty,
click here to watch the video series, “For Our People”.