Oklahoma has the second highest concentration of American Indians who have selected private health insurance plans through the federally run marketplace since it opened Oct. 1, according to data released Thursday.
In Oklahoma, at least 1,638 American Indian or Alaska Native residents selected private insurance plans through the marketplace from October to the end of March, representing 3.1 percent of the total number of Oklahomans who have signed up for coverage whose race or ethnicity was known.
Federal health officials in a conference call with reporters Thursday pointed out that the racial or ethnic data for 16,477 Oklahoma residents was unavailable, adding that race was an optional category in a person’s marketplace application.
In Oklahoma, an estimated 74,500 American Indian or Alaska Native adults younger than 65 are uninsured, according to the Kaiser Family Foundation.
That’s more than 30 percent of the 232,800 American Indian or Alaska Native adults younger than 65 living in Oklahoma, according to the foundation.
Robyn Sunday-Allen, the CEO of the Oklahoma City Indian Clinic, said her organization and others must do a better job educating American Indians about the Affordable Care Act, especially explaining that the March 31 deadline to enroll in coverage did not apply to American Indians who are members of tribes.
“If you are listening to media outlets, we've all heard ‘March 31, March, 31, March 31,’ and Indian people heard the same thing, so they thought that included them, and we’ve not done a good enough job to educate them that the deadline did not apply to us,” Sunday-Allen said.
Sunday-Allen said benefit coordinators at the clinic have performed 300 consultations with patients about health insurance — but only six patients then enrolled in private health insurance plans through the marketplace.
That’s in part because more than 50 percent of those patients were part of the Medicaid “coverage gap.”
“There's a huge gap because basically you’ve got what I would call working poor — they work, and so they don’t qualify for SoonerCare, but if the state of Oklahoma had expanded the Medicaid program, they would have fallen under those guidelines,” Sunday-Allen said.
Originally under the Affordable Care Act, states were required to expand their Medicaid programs, but after the U.S. Supreme ruled on the health reform law, expansion was an option for states.
In November 2012, Gov. Mary Fallin announced that Oklahoma would not expand its Medicaid program to cover people younger than 65 with incomes below 133 percent of the federal poverty level.
Oklahoma’s Medicaid program only offers coverage for certain adults with incomes at 38 percent of the federal poverty level and below. The majority of Oklahomans enrolled in the program are children.
Currently, an adult younger than 65 who isn’t pregnant, doesn’t have children or does not have disabilities cannot generally qualify for Medicaid.
Meanwhile, adults between 100 percent and 400 percent of the federal poverty level can qualify for income-based subsidies that help pay for their health insurance they buy through the federal marketplace.
Without Medicaid expansion, people who have incomes between 38 percent and 100 percent of the federal poverty level neither qualify for subsides nor do they qualify for Medicaid.
Sunday-Allen said this is a huge obstacle for the population that she sees at the Oklahoma City Indian Clinic.
“Until we are able to cover that population, they’re going to continue to end up in the ER where they’re basically ‘treated and streeted,’ and (they’re) not under a chronic care plan, and a lot of these people have chronic conditions, and it’s going to continue to pull our health indicators down in our state,” Sunday-Allen said.
At a glance
Of the total number of residents where race was known:
•36,960 of the residents who selected plans were white
•4,762 were black
•3,952 were Latino
•3,588 were Asian
•1,793 were multiracial
•1,638 were American Indian/Alaska Native
•51 were Native Hawaiian or Pacific Islander
•16,477 residents who enrolled were included in the “Unknown/Other” category.