It's been incredibly difficult for the government to persuade Native Americans and Alaska Natives to use ObamaCare. One big sticking point: They're exempt from the tax penalties that other Americans are susceptible to if they fail to purchase health insurance, and thus seem to have little incentive to shell out for insurance upfront. In Alaska alone, there are more than 100,000 people who identify as Native American or Alaska Native, and just 115 of them have used the ObamaCare exchange to buy insurance.
The situation is further complicated by treaties between native tribes and the federal government, which already allocate federal funding to pay for many tribe members' health care. "[T]he perception is, 'Well, what's in it for me? Why would I get additional insurance?'" explains Andrea Thomas of the SouthEast Alaska Regional Health Consortium.
Additional confusion arises because states and the federal government do not agree on the classification of more than 100 tribes, a factor which Rep. Tom Cole (R-Okla.) warned last year could leave some Native Americans in health care limbo under the ACA.