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Tribal Leaders Worry About Future Of Medicaid

New Mexico has one of the largest Native American populations in the nation with over 200,000 registered tribal members and it’s estimated that nearly 40% lacks health insurance. New Mexico has announced it will build a state-run healthcare exchange under the Affordable Care Act. However, the state has yet to decide on whether to expand Medicaid, which could mean a lot of tribal members would suddenly have access to affordable healthcare.

Take Erik Lujan for example: At the age of 30, Lujan, a Taos Pueblo tribal member, began experiencing medical problems.

"I was working nights at a casino, and my leg was sore for a week," says Lujan. "Then one day I was okay, and the next day my leg was twice the size and I was going to the emergency room."

Several emergency room visits and a number of pulmonary embolisms later, Lujan had to quit his job, causing him to lose his health insurance. He also learned what was causing his health problems: his blood lacks the ability to dissolve clots often causing unbearable pain, which can prevent him from working or even walking. To make matters worse, Lujan isn’t able to use the Indian Health Service.

"I am ineligible to use Indian Health Services facilities here in Albuquerque because I am an enrolled member of Taos Pueblo," says Lujan. "If I wanted to access Indian Health Services, I would have to go back to Taos Pueblo." That’s about 130 miles from his home in Albuquerque.

In 2010 the Social Security Administration approved Lujan for disability payments. But that money left him ineligible for Medicaid. "I don't qualify for Medicaid because my Social Security disability income is $10 over the federal poverty level limit for my circumstances."

"If you're a family of four in New Mexico, the adults will not be eligible for Medicaid unless their earnings are below about 7,500 dollars a year," says Kim Posich, Director of the New Mexico Center on Law and Poverty. "Under expansion, a family of four, you can earn up to about 32,000 a year, and the adults will be covered by Medicaid."

What makes this issue unique to Indian Country is that Native people essentially carry dual citizenship: in terms of healthcare access, that means the Indian Health Service is available to those living on their nations and programs like Medicaid, are available to those living away from their communities – like Erik Lujan.
According to former Cochiti Pueblo Governor Regis Pecos, under Medicaid expansion, Native people would be able to utilize both services.

"One of the things that is a particular threat here is that without the proposed expansion here in the state, without the safety net of this Medicaid program, it would cut out as many as 25,000 Indian people," says Pecos.

That’s 25-thousand Native people that would not be eligible for Medicaid and for Pecos, that makes Medicaid expansion absolutely critical.

New Mexico has announced that it will build a state-run healthcare exchange under the healthcare law. However, there could be costs for Native people wanting to join the exchange – which could be considerably high. That’s according Roxane Spruce Bly: a member of the states American Indian Health Advisory Committee.

"If insurance isn't truly affordable, I don't know how likely that Indian people would acquire coverage through an exchange," says Bly.

In other words, if Native people can’t afford to pay healthcare exchange premiums, and Medicaid doesn’t expand in New Mexico, then many Native people in the state could easily stay in the same tenuous healthcare situation they’ve occupied for centuries – along with over 400-thousand other New Mexicans who currently lack healthcare coverage.

"I think it's less a racial question than it is a question of class," says Erik Lujan. "Yes, minorities are typically are on these kind of programs, yes we access these programs more on a greater level, but since the economy has been worse, I think more and more non-minorities, have been forced to be on Medicaid because health insurance is expensive, and everybody's looking for a way to cut corners these days."

Governor Susana Martinez hasn’t said yet whether she’ll expand the Medicaid program, and no federal deadline has been set for the state to make a decision.