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Swinomish Indian Tribal Community Affordable Care Act Considerations  Tribal Health Director has responsibilities to : Present Tribal Specific Cost-Benefit.

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Presentation on theme: "Swinomish Indian Tribal Community Affordable Care Act Considerations  Tribal Health Director has responsibilities to : Present Tribal Specific Cost-Benefit."— Presentation transcript:

1 Swinomish Indian Tribal Community Affordable Care Act Considerations  Tribal Health Director has responsibilities to : Present Tribal Specific Cost-Benefit Analysis Be well informed on State Insurance Exchange Develop alternate premium support options

2 Swinomish Indian Tribal Community Affordable Care Act Considerations  Tribal Health Directors should recognize that Cost-Benefit Analysis is just the start of the technical process  Policy Development process is a dynamic process of Health Policy/Economics/Politics

3 Location of Reservations in the State of Washington

4 Swinomish Indian Tribal Community Affordable Care Act Considerations  An Initial Question is what is the Source of Premium Support costs- Federal dollars or Tribal Hard Dollars The answer affects who the Tribe will politically/legally consider providing support for-ie CHS eligibles or Tribal members only or “creaming” of high cost users Another question is where a Council looks at coverage for Tribal members is : In CHSDA only or all members both inside and outside CHSDA

5 Swinomish Indian Tribal Community Affordable Care Act Considerations  Tribal Provision of Premium Support provides individuals Coverage and Choice ie, with Insurance a member could use it anywhere unless the Tribe institutes some kind of Premium Support limitation This raises the whole question of “Choice” as a Philosophy or Policy Question for the Tribe

6 Swinomish Indian Tribal Community Affordable Care Act Considerations  Individual Patient Choice has implications  Tribal Geography and Proximity to Alternate Services affect Patient Choices  Where Alternate Service Providers exist the Tribe is further “incentivized” to Compete by Improving Quality  Additional questions for Administrators re Tribal Clinic contracting with ACO’s, PPO networks, etc..

7 Swinomish Indian Tribal Community Affordable Care Act Considerations  Medicaid Expansion, CHIP and Insurance Premium Support provide new potential sources of revenue for Clinic and significant reductions in CHS –Both net benefits to the Tribe  Medicaid Expansion will provide the largest net benefit even with relatively small population in poverty-mainly single adult males  Premium Support will provide the largest net benefit for those under 200% of Federal Poverty Level Income

8 Swinomish Indian Tribal Community Affordable Care Act Considerations  Swinomish will likely provide significant Premium Support Return on Investment is likely >$2.00/$1.00 invested  Politics will likely push us to use of Tribal Hard Dollars for Premium Support for Tribal Enrolled Members  Patient Choice has historically been the philosophy at SITC  Continuing with that Choice Philosophy means we must continue our focus on Improving Patient Care and Quality Improvement to “incentivize” use of the Tribal Clinic

9 Swinomish Indian Tribal Community Affordable Care Act Considerations Thanks for Listening! Every Tribe has significant internal work to do to make the most of the Affordable Care Act Contact Information: John Stephens Programs Administrator Swinomish Indian Tribal Community


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