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Another change coming courtesy of the Affordable Care Act: Next year, just over 200,000 Native Americans will become eligible for Medicaid. The change translates to more money for the Indian Health Service. But as KUNM's Tristan Ahtone reports from Albuquerque, expansion will also force Native health providers to deal with something they've never faced before: competition from non-tribal health programs.
TRISTAN AHTONE, BYLINE: New Mexico has one of the largest Native American populations in the nation, and nearly 40 percent of that population currently lacks health insurance. Take John Armijo, for instance. He's an enrolled member of the Pueblo of Jemez. And when he learned he would be eligible for Medicaid in 2014, he says it came as a relief.
JOHN ARMIJO: I was thinking, oh, God, you know, this will be great, you know, for me, one of the baby boomers, and my fellow tribal members. It'll be a great thing. And if that happens, I won't have to wait for the retirement age to have these services.
AHTONE: Armijo works part-time for the U.S. Forest Service, which doesn't provide him with insurance, and currently makes too much money to be eligible for Medicaid. However, next year, when the state expands the program, Armijo will have coverage and choices.
ARMIJO: If my health deteriorates or goes bad, then I'll be looking for other services, you know, like special doctors or special hospitals or whatever.
AHTONE: Like many Native Americans, Armijo has received medical care through the Indian Health Service or IHS for most of his life. The service provides free basic medical to tribal citizens, but more complex issues like knee surgery have to be referred to other facilities if there's enough money to pay for it, and there often isn't.
JAY STEINER: So because of the underfunding of the Indian Health Service, there isn't the capacity to provide a lot of the services that our patients require.
AHTONE: That's Jay Steiner with the National Council on Urban Indian Health. He says IHS has only enough money to pay for a quarter of the procedures patients need, and that small amount of funding is divided among more than 600 Indian Health Service facilities across the country. What Medicaid expansion ultimately means is that more Native Americans will have easier access to a higher level of care. And that means if they show up at an IHS facility, the service can bill Medicaid instead of paying with scarce IHS funds.
LINDA STONE: We realize that as people get insurance, they have more choices.
AHTONE: Linda Stone is the CEO of First Nations Community HealthSource, an urban Indian clinic in Albuquerque.
STONE: And that, for us, could mean that some of our patients will seek care elsewhere. And likewise, some patients will come and seek care here.
AHTONE: In rural areas of the state, the challenge of competition may not be as fierce, as hospitals and health centers are often few and far between. However, in a city like Albuquerque, Stone points out that First Nations clinic has a number of competitors just blocks from its location.
STONE: We don't know what it's really going to look like, but we do know that that is always a possibility that yes, there is going to be competition.
AHTONE: But there's a downside to that competition and to the injection of new Medicaid dollars into IHS, says Jim Roberts with the Northwest Portland Area Indian Health Board in Oregon.
JIM ROBERTS: There could be a mindset that would evolve in Congress that why should we continue to fund the Indian health system when you have access to Medicaid? You should go there to receive your care.
AHTONE: Health workers say that most Native Americans with Medicaid currently opt to use IHS as their medical home, and they suspect that will be the case under expansion as well. In January, John Armijo of Jemez Pueblo will join that population.
ARMIJO: I'd rather come here first than rather go outside. This is my hometown and the reservation I live on. I'm a tribal member, and I'd like to help the health center here first.
AHTONE: With Armijo's Medicaid dollars flowing to IHS, better programs, new hires and expanded services may be on the horizon. For NPR News, I'm Tristan Ahtone in Albuquerque. Transcript provided by NPR, Copyright NPR.