GAO Meeting/Teleconference Call with Portland Area Tribes

TOPIC: Effects of the ACA on AI/ANs and IHS

DATE: Tuesday, December 4

TIME: 10:00AM – 11:30AM PT

Dial-In: 1-877-921-7013

Passcode: 85022438

Congress has requested that GAO review the effects of the Affordable Care Act (ACA) on American Indians and Alaska Natives and IHS. On Tuesday, December 4 at 10:00AM – 11:30AM PT, we have scheduled a meeting with GAO to discuss the effects of the ACA on our member tribes and provide responses to the GAO questions (attached).

The GAO objectives include:

(1) Describing any reported changes in health insurance coverage and third party collections at IHS and tribal facilities since the implementation of the ACA in 2014; and

(2) Review the effects of any changes in health insurance coverage and third party collections on IHS and tribal facilities since 2014, and assess IHS oversight of the use of third party collections.

GAO Interview with Area Indian Health Boards

Effects of PPACA on Health Insurance Coverage for American Indians and IHS

GAO has been asked to review the effect of the Patient Protection and Affordable Care Act (PPACA) on American Indians and Alaska Natives and the Indian Health Service (IHS). Our study has two objectives:

1. Describe any reported changes in health insurance coverage and third party collections at IHS and tribal facilities since the implementation of PPACA in 2014.
2. Review the effects of any changes in health insurance coverage and third party collections on IHS and tribal facilities since 2014, and assess IHS oversight of the use of third party collections.

We are interested in gathering any information you can share on these topics as it relates to your Area, including for IHS and tribal facilities (as possible).

 Discussion Questions

Overview

1. Please provide us with an overview of your organization and its involvement in issues related to PPACA coverage expansions, as well as your knowledge of the use and effects of third party reimbursements at facilities in your area.

Insurance Coverage

2. To what extent have there been changes to the health insurance status (insured vs uninsured) and coverage type among American Indians and Alaska Natives living within this area since 2014?
3. How, if at all, have changes in insurance coverage differed within the area, and why?
   1. To what extent were there differences in coverage changes between populations seeking care at IHS and tribal facilities (as applicable)?
4. What steps have been taken to encourage enrollment in Medicaid and health insurance through the exchanges since 2014? To what extent has this varied throughout the area, including in areas with IHS versus tribal facilities, and what has been its impact?
5. What are some examples of best practices that you have seen in area facilities with respect to enrolling individuals in Medicaid or other insurance?
6. Aside from the coverage expansions included in PPACA, what other factors may have impacted the health insurance coverage of this population since 2014?
7. Please describe the impact of any changes in insurance coverage for this area.

Third Party Collections

8. To what extent are you aware of how third party collections at facilities in this area have changed since 2014?
   1. How have trends in collections differed for tribal facilities as compared to IHS-operated facilities, and why?
   2. What, if any, challenges have facilities faced with respect to enhancing collections since 2014? Please describe.
9. How are decisions about the use of third party collections generally made at tribal and IHS facilities within the area?
10. How, if at all, has the area’s need for and use of PRC changed since 2014? Please explain.
11. To what extent are you aware of how funding from third party collections has been used at facilities within the area since 2014? For example, has it been used to fund or augment funding for:
    1. Purchased and Referred Care (PRC)
    2. Catastrophic Health Emergency Fund (CHEF)
    3. Introduction of new medical specialty/services
    4. Purchase of medical equipment
    5. Increased compensation for medical staff
    6. Construction of new facilities or renovation of existing facilities
    7. Purchase of tribe members’ marketplace premiums/co-payments
    8. Other
12. Overall, how would you describe the impact of any changes in coverage or third party collections since 2014 on facilities in your area?
    1. How, if at all, has the effect of these changes differed between tribal and IHS facilities, and why?
13. What are some examples of best practices that you have seen at facilities in the area with respect to enhancing collections and using these collections to enhance access to care?
14. Are there any particular individuals or groups that you suggest we speak with regarding our study?