“Health Insurance Premium Tax Credit” (IRS REG-131491-10)

NIHB Analysis of Proposed Rule: Health InsurancePremium Tax Credit (IRS REG-131491-10)Even without the provision of premium tax credits, the structuring of the Exchangeitself, with the offering of multiple and comparable health plans, is intended to providemore affordable health insurance options than are generally available today. 7In addition to potential eligibility for premium tax credits, individuals enrolled in ahealth plan in the individual market through an Exchange may be eligible for cost-sharingassistance. For those taxpayers and their dependents with household income not greaterthan 400 percent of the Federal poverty line, cost-sharing reductions are providedaccording to a table found in ACA § 1402. Additional cost-sharing protections for AI/ANs areprovided under ACA § 1402(d).Eligibility for premium tax credits and for cost-sharing assistance requires enrollmentin a health plan in the individual market through an Exchange. Eligibility for enrollment in ahealth plan in the individual market through an Exchange is established under ACA § 1312.Eligibility for enrollment in a health plan in the individual market through an Exchange is notdependent on eligibility for either premium tax credits or cost-sharing assistance.Treasury and HHS, along with each Exchange, have responsibility for administeringthe various elements of the interrelated sections pertaining to eligibility determination,assistance calculations, and distribution and potential recapture of the assistance toenrollees and health plans.2. Federal Trust ResponsibilityThe Federal government has a unique responsibility and obligation to American Indians andAlaska Natives. This Federal Trust Responsibility is enshrined in Federal law 8 and guided by thegovernment-to-government relationships between the Federal government and Tribes. 9Historically, the Federal Trust Responsibility to provide health care services to AI/ANs has beencarried out through the Indian Health Care Providers. Facilitated by provisions in the IHCIA,Medicare and Medicaid have become important additional means through which the resources tofulfill the Federal Trust Responsibility have been made available. Now, with the passage of theAffordable Care Act and the assistance to be provided to certain AI/ANs enrolled through anExchange, Congress established an additional mechanism—although not a replacementmechanism—to fulfill the Federal Trust Responsibility and to achieve the national Indian healthpolicy reconfirmed by Congress in § 103 of the Indian Health Care Improvement Act, which wasenacted as part of the ACA. 1078http://www.americanprogress.org/pressroom/releases/2011/06/states_exchanges_release.htmlMost recently in Section 102 of the Indian Health Care Improvement Act (IHCIA), as amended bySection 10221(a) of the ACA, (codified at 25 U.S.C. § 1602) (Congress declares a national Indian healthpolicy ―in fulfillment of its special trust responsibilities and legal obligations to Indians‖.)910See, 25 U.S.C. § 1602(6).25 U.S.C. § 1602.National Indian Health Board Page 3 of 23 October 31, 2011