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Many Native Americans haven't thought a lot about health insurance because they haven't had to. The government provides free health care through the Indian Health Service. That's been the case for decades. But Native Americans are seeing the benefit of having options since they're also eligible to sign up for insurance under the Affordable Care Act. Anna Gorman reports that this is translating to benefits for the community as a whole.
ANNA GORMAN, BYLINE: Each summer in New Mexico's vast Indian country, you'll find flea markets, traditional feasts and tribal ceremonies like this one in Gallup.
SONNY WEAKHEE: How are you doing?
GORMAN: Sonny Weakhee walks through the crowds and hands out fliers.
WEAKHEE: So we're talking to Native Americans about the Affordable Care Act, or Obamacare.
GORMAN: One by one, Weakhee tried to persuade them to do something many have never done before - sign up for health insurance. He works with New Mexico to get people enrolled.
WEAKHEE: Insurance itself has always been available to other people, you know, for a long time (laughter). It's brand new to us.
GORMAN: The U.S. has a treaty responsibility to provide free health care to Native Americans. It does so primarily through the Indian Health Service. But the IHS has a fixed budget, and many of its hospitals and clinics offer only limited services. Weakhee tells his fellow Native Americans that if they get insured, they can go more places for health care. But he often meets resistance from people like Rochelle Jake. She's 45 and lives in Albuquerque.
ROCHELLE JAKE: I have asthma, allergies and eczema, and all my life, I've gone to the Indian Health Service for my care. And I thought Obamacare didn't apply to me.
GORMAN: She's partially right. Native Americans don't have to sign up under the law. But when Jake got sharp pains in her side, her doctor urged her to buy a private health plan through the New Mexico health exchange.
JAKE: I couldn't wrap my head around it. I thought, what? (Laughter). Why do I have to pay for this?
GORMAN: Jake is Navajo. She needed an MRI and other tests she couldn't get through the Indian Health Service. With insurance, she can go to a private doctor. She signed up for a plan that came to $37 a month with a tax credit. The Indian Health Service is excited about Obamacare too. When their patients get covered, the hospitals can bill insurers and use the extra money to hire staff and add services.
JEAN OTHOLE: This way is our emergency room.
GORMAN: That's what's happening at this hospital on the quiet Zuni reservation about three hours west of Albuquerque.
OTHOLE: My name is Jean Othole. (Speaking Zuni).
GORMAN: What does that mean?
OTHOLE: We are here at the Zuni hospital.
GORMAN: Othole is the CEO. On a recent morning, she shows me around. We walk through a labor-and-delivery unit that only performs low-risk births and an emergency room with just two beds.
OTHOLE: Many of our emergency patients are brought here, stabilized and transferred out.
GORMAN: With more resources from those newly insured, though, Othole hopes more patients will be able to stay. She plans to use the extra revenue to add exam rooms and expand the pharmacy.
Brian Garretson also knows the limits of the Indian Health Service well. He works just outside the Navajo reservation at San Juan Regional Medical Center. The hospital contracts with the government to care for Native Americans.
BRIAN GARRETSON: IHS has a limited amount of dollars, and when they run out of money, they run out of money. So there are times that when we get towards the end of their fiscal year, we're not going to get paid.
GORMAN: Garretson was more than willing to lend space to Weakhee and his team. That's where Margaret Thompson signed up for insurance with the help of Weakhee's colleague Shana Ramone.
SHANA RAMONE: Did you get your health insurance situated?
MARGARET THOMPSON: I sure did, yeah.
RAMONE: So did you get your card, your new card...
GORMAN: It's the first time Thompson's had insurance, and she's at the outreach office with more questions. She's looking for doctors to help manage her diabetes and arthritis.
THOMPSON: It's something that I have never done before. I want to start doing that, but I really don't know where to begin yet.
GORMAN: And that's the next challenge for these outreach workers. Along with continuing to sign Native Americans up for insurance, they're also helping teach them how to use it. For NPR News, I'm Anna Gorman.
SIEGEL: Anna Gorman is with Kaiser Health News, a nonprofit news service.
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