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Confederated Salish and Kootenai Tribes Health Department Director Kevin Howlett.

POLSON – You can look at the potential questions and problems facing many Indian people across the nation when it comes to the Affordable Health Care Act, and quickly check off all the ones that don’t apply on the Flathead Reservation.

The Confederated Salish and Kootenai people are a federally recognized tribe, so no problem there. Members can be enrolled in the tribe at birth, so children’s standing isn’t in question like it is for members of some tribes. There is no reservation residency requirement like ones that are posing problems for others.

When you’re done, Kevin Howlett says, just understand: The Affordable Health Care Act will still present issues locally, for many people of Indian descent.

Howlett, director of the Confederated Salish and Kootenai Tribal Health Department, stresses that everyone currently eligible for tribal health care will continue to be eligible.

But those who aren’t enrolled members may be subject to tax liability if they don’t purchase insurance for coverage they already qualify for.

“I anticipate problems, not for tribal members who are being exempted, but I do think there will be issues for descendants who can and do receive health care from us,” Howlett says.

The law, as written, exempts enrolled tribal members from having to purchase health insurance.

“We have a lot of people who are not enrolled, for whatever reason,” Howlett says. “It’s really unclear” how the new law will affect them.

“We do know they’ll come to the tribes asking for answers,” Howlett says. “But we don’t have them.”

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The 2013 Montana Legislature made things more difficult for Indians and non-Indians alike, Howlett says.

“Montana missed the boat,” he says. “It would have simplified things, but the Legislature failed to pass Medicaid expansion. Seventy-thousand more people would have been covered who now have to figure out how to enroll” for health care coverage.

“Montana also chose not to set up a state exchange, so we’ll be dealing with a federal exchange,” Howlett continues. “There will be a number of plans, but how do you access them? Where will they be? Washington, D.C.? Denver? I have no idea. It will be confusing. It’s confusing right now.”

The new law came with good things, Howlett says. The Indian Health Care Improvement Act was permanently reauthorized with its passage, there will be opportunities to provide expanded levels of care, and it gives tribal health departments the ability to create an additional revenue stream.

But right now, he says, the tribes aren’t getting the information from the U.S. Department of Health and Human Services people will soon be seeking.

“We hear of things,” he says, but nothing concrete has “trickled its way out here yet. We’re just one of 555 tribes, and we’re up against the clock.”

That total doesn’t count more than 100 other tribes that aren’t federally recognized; their members are in no-man’s land when it comes to health care reform. Montana has one, the Little Shell, which has spent decades trying to gain federal recognition, to no avail and apparently due in large part to political in-fighting between rival factions within the tribe.

But the Confederated Salish and Kootenai Tribes are federally recognized. People are not required to live on the reservation to qualify for membership, nor are people banned from enrolling until they turn 18, things that are creating uncertainties for members of other tribes when it comes to the new law.

“If they figure out how to get exchanges available and accessible, it has the potential to do good things,” Howlett says of the health care overhaul. “But if you look at the clock, it’s tight. I’m concerned a lot of people are going to be really confused. It’s not just a Native issue, it’s a national issue.”

Reporter Vince Devlin can be reached at 1-800-366-7186 or by email at vdevlin@missoulian.com.

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