In 2013, when the North Dakota Legislature passed the Medicaid expansion bill, it predicted 20,500 North Dakotans would fit the guidelines to sign up for this kind of coverage under the Affordable Care Act.
“As of July, 2015, the Medicaid expansion enrollment was approximately 18,833 individuals,” said Stephanie Waloch, the Medicaid Expansion Administrator for the state Department of Human Services. "Most enrollees are childless adults -- 77 percent -- with over half of them ages 19 to 44."
Waloch told the Legislature’s Tribal and State Relations Committee – the Department has no way to find out how many of those who signed up for the expansion are Native American.
Committee members also asked questions about how many Native Americans have signed up through the health insurance exchange. Brad Hawk of the North Dakota Indian Affairs Commission says he knows the number signing up for health insurance is growing – but it has taken a lot longer than anticipated.
“There's a misconception on the reservation from community members thinking that, since they have access to IHS (Indian Health Service) that they don’t need insurance,” Hawk told the Committee. He says there are educational efforts underway on the reservations – to talk about the advantages of having private insurance. And he offered the Committee a personal example.
“I had a knee injury this summer," said Hawk. "I went to the doctor, and he said you need to have surgery on your knee. I was in surgery within the week. One of my brothers had the same injury. He went to the IHS facility. And he didn't get surgery until six months later.”
Hawk says that’s a case where Indian Health Service is overworked and under-funded.