RENEE MONTAGNE, HOST:
Open enrollment round two for health insurance on the Affordable Care Act exchanges got underway over the weekend. On the first day alone, more than 100,000 people signed up for plans. With the website now working more smoothly, health officials hope to attract people who did not buy insurance last year, including many Native Americans. Montana Public Radio's Eric Whitney reports on the challenges and opportunities the healthcare law presents to that community.
ERIC WHITNEY, BYLINE: Native Americans are exempt from the health law's requirement to have insurance coverage. They're eligible for healthcare through the Indian Health Service, or IHS, since the federal government promised in treaties to provide healthcare in exchange for tribes giving up their land. How's it doing? Montana Senator Jon Tester, who sits on both the Veterans' and Indian Affairs Committees, puts it this way.
SENATOR JON TESTER: The VA's actually in better shape than Indian Health Service. It is really in tough shape. It basically runs out of money about nine months into the fiscal year. There's a real issue on getting healthcare professionals into Indian country. I mean, it's really in crisis.
WHITNEY: The IHS budget crisis means tribal members can often only get healthcare when they're in immediate danger of losing life or limb, says Lesa Evers, a member of the Turtle Mountain tribe who works for Montana's state health department.
LESA EVERS: If you have an individual who really requires a knee surgery from trying to play basketball with their kids or whatever they tried to do, they may never have that opportunity to have that knee surgery.
WHITNEY: Buying private coverage would give them access to more healthcare providers, and subsidies under the healthcare law are making insurance affordable for many Indians. But efforts to get them to enroll in private coverage aren't bearing much fruit yet. Less than half a percent of people who enrolled last year are Native American. Evers says there needs to be more outreach to tribes.
EVERS: I think people need education first. They need to understand it from people they trust. And that's how, you know, people communicate in Indian country. It's a lot about what your friends say and what your family's saying.
WHITNEY: Evers says that so far only a handful of healthcare navigators have been deployed to reservations, or to the native population that lives off of reservations, to help them understand the healthcare law. It's estimated that about 2 million people are members of federally recognized Native American tribes nationwide. For NPR News, I'm Eric Whitney in Missoula, Montana. Transcript provided by NPR, Copyright NPR.
