You probably already knew that a Caucasian in Colorado has a life expectancy of almost 80 years. But did you know that an American Indian’s life expectancy is 45 years? This article from the Colorado Health Foundation, written by Sandy Graham, is a must-read for anyone interested in healthcare for minorities, specifically American Indians. The article focuses on the work that Marguerite Salazar is doing as Region VIII director of HHS, based in Denver (In addition to Colorado, Region VIII encompasses UT, WY, MT, SD and ND). Prior to working with HHS, 
Salazar was President and CEO of Valley-Wide Health Systems, a rural community-based healthcare program that served 40,000 people in Southern Colorado, including many migrant farm workers.
I particularly liked the focus on “culturally competent” healthcare – a concept that can be vital for the health of any minority group that doesn’t have the same heritage and traditions as the majority of healthcare providers in an area. And I liked this description from the article of work that Salazar did at Valley-Wide:
“…she [Salazar] and her staff had to explain to non-Hispanic providers that, yes, this person could not afford care, but had a cell phone – because he had to be able to hear from the field boss when agricultural work was available. And yes, the family drove a new truck – because they needed dependable transportation to get to the next farm job and that was most likely all they owned.”
It’s a perfect anecdote for anyone who has ever been frustrated by the internet meme describing how a patient in the ER has a cell phone (with a fancy ring tone!) and various other bling – and is on Medicaid. It seems to be circulated in an effort to show righteous indignation towards people who would dare to have anything more than a cardboard box and a blanket if they’re using “entitlements” to pay for things like food or healthcare. Salazar’s understanding of the healthcare needs of low-income families and cultural minorities comes through very well in the Colorado Health Foundation article.
Although I have read many sections of the ACA over the last few years, I haven’t read all of it. I wasn’t aware of many of the special provisions in the legislation pertaining to American Indians and Alaska Natives (AI/AN). AI/ANs with household incomes up to 300% of FPL won’t have to pay any cost sharing if they enroll in a qualified health plan through the exchange. There is also a provision to waive cost sharing if an AI/AN (enrolled in a qualified health plan through the exchange) receives healthcare from Indian Health Service, a tribe or tribal organization, or through the Contract Health Service. In addition, AI/ANs are not subject to the penalty for not maintaining health insurance coverage, and they’re exempt from having to wait for the annual open enrollment period for individual health insurance coverage. These are all good provisions that will no doubt help to provide access to critically needed healthcare, but I think that Salazar’s focus on “culturally competent” care is just as important. No minority group should have to face a life expectancy that is just barely over half that of white Americans.
