1. The Affordable Care Act Swinomish Experiences in the First 1 Year of Implementation Northwest Portland Area Indian Health Board

2. Swinomish Indian Trial Community -Health Programs Background The Swinomish Indian Tribal Community is the federally recognized entity comprised of the aboriginal Swinomish, Lower Skagit, Kikialus and Samish tribes. Self Governance Tribe since 1996 4 Health Divisions-Medical/Dental/Behavioral Health/Wellness Supported by a centralized Patient Registration/Business Office (PRBO) All Divisions and PRBO under a consolidated Health, Education, Social Services, Self Governance (HESS) Department with a Single Administrator

3. Location of Swinomish Reservation in the State of Washington

4. Swinomish Medical Clinic and Fitness Center

5. Swinomish Dental Clinic

6. Indian Health Service Revenue Challenges and User Count Indian Health Service provides only 35% of current program funding from funds –balance comes from the Tribal general fund and 3 rd Party billing, mainly Medicaid plus some from other Insurance Program is dependent upon soft money from 3 rd party collections, especially Medicaid reimbursements Indian Health Service is a dramatically underfunded system, both in how it counts Users and how Congress funds its operations. Rule of thumb-Indian Health Service gets 60% of Level of Need Funding, actually a little lower in I.H.S. User Population of 1,288

7. ACA Coverage Improvements at Swinomish -Medicaid coverage increased by 152% -Medicaid to QHP ratio is 24 to 1 /Expected ratio was 10 to 1 -Sample Size still small for Tribal Sponsorship due to much greater than anticipated Medicaid Eligibility 233 NEW MEDICAID 153 RENEWED MEDICAID 12 Sponsorships 4 QHP-Zero Premium

8. ACA Dramatically Improving 3 rd Party Revenues Comparison of 2013 to 2014 Medical-Up 113% Dental-Up 108% Wellness-Up 106% Behavioral Health-Up 135%

9. Swinomish QHP Experience ( Sample Size still small ) * Premiums paid compared to Revenue produced - for each $1.00 spent produced $.69 in revenue *Premiums Paid compared to CHS costs saved -for each $1.00 spent produced $4.63 in savings *Premiums Paid compared to Revenue Produced plus CHS costs saved -for each $1.00 spent produced $5.32 in benefits to Tribal programs

10. Thanks for Listening and Appreciate your Time John Stephens Programs Administrator Swinomish Indian Tribal Community jstephens@swinomish.nsn.us 360-466-7216