Health care for Alaska Native people must be prioritized and protected

I have proudly dedicated my life to fighting and advocating for Alaska Native people. From civil and voting rights to economic equity, it has been my privilege to work tirelessly on behalf of my fellow First Alaskans.

Now comes a new threat that could further jeopardize Alaska Native people’s access to health care. During this time of fear and anxiety surrounding COVID-19 and its potential impact on rural communities, a dangerous provision has been tucked into a U.S. Senate bill that could make a precarious situation worse.

At face value, the Lower Health Costs Act of 2019, sponsored by Sen. Lamar Alexander, claims it will protect patients from unexpected medical bills, which sounds ideal, but is unfortunately not the case. The bill, along with companion legislation in the U.S. House sponsored by Rep. Frank Pallone, will actually allow insurance companies to refuse to cover essential services and procedures, ostensibly to save money. What does that look like on a practical level? One of the provisions tucked into the bill would limit funds available for medevac services, which are critical in rural Alaska, and even more so during a global pandemic.

Alaska Native people in rural Alaska already struggle with access to health care. According to the National Association of Insurance Commissioners, the average air ambulance ride costs between $12,000 and $25,000, with prices in Alaska often exceeding that average. If the provision in this bill were to go into effect, much of the cost would shift from the insurance company to the patient. This is a price the average Alaskan simply cannot afford. Congress should not allow insurance companies to cover only a small portion of the cost and stick vulnerable Alaskans with the bill.

The problem would then spiral down even further. Once medevac companies realize insurance companies are unwilling to cover most air ambulance costs, providers’ business models are likley to become uneconomic, and they will limit or even cancel air ambulance service in rural areas. In a time when air service to remote areas has already decreased with the exit of Ravn from the marketplace, it makes the potential loss of air-ambulance service that much more serious. Alaska Native people already experience health care access limitations, and an outcome should be unacceptable.

Unfortunately, we in Alaska are hardly alone in this predicament. Our indigenous neighbors throughout the U.S. will also experience delays and barriers to care. A First Nations Development Institute’s report shows that 54% of American Indian and Alaska Native people live in rural and small-town areas, on or near reservations. In other words, medevac services are essential for most indigenous people.

To use a recent Alaska example of how this provision would hurt rural communities, look no further than Haines. The city of Haines sits on the Southeast coast and struggles with health care access like many rural communities. When the Alaska Marine Highway System shut down this winter, residents faced serious additional barriers to care. Patients were ultimately forced to pay for private flights, which insurance does not cover. This is not a sustainable situation, and one that is not addressed in the bill currently sitting in the U.S. Senate. We absolutely need reform in medical billing; no one should go bankrupt because they cannot predict the insurance bill that will arrive in their mailbox months after the fact. The current piece of legislation is not the solution, however, and would make a bad situation worse.

I urge Sens. Dan Sullivan and Lisa Murkowski, as well as Rep. Don Young, to protect the people of Alaska and prevent this bill from advancing. We simply cannot stand by and leave rural Alaskans to fend for themselves when it comes to receiving critical health care.

Vicki Otte is the former CEO of MTNT, an ANCSA Village corporation located in McGrath. She also served as the executive director of the ANCSA Regional Association and the Alaska Native Justice Center.

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