Health Insurance Coverage of American Indians and Alaska Natives in Federal Tribal Areas

Brett O'Hara, U.S. Census Bureau
Robin Anderson, Principal Global Investors
Renuka Bhaskar, U.S. Census Bureau
Trent Alexander, U.S. Census Bureau

Compared to other race groups, American Indian and Alaska Natives (AIAN) have higher uninsured rates and worse health outcomes. Starting in 2014, the Patient Protection and Affordable Care Act (ACA) improves health insurance affordability by expanding public coverage and making private coverage more affordable. This analysis assesses determinants of health coverage for the AIAN population and examines the expected shift in coverage profile. Utilizing American Community Survey data, we evaluate how demographic and socioeconomic factors as well as state-level Medicaid policies are associated with whether AIAN individuals utilize the Indian Health Service (IHS), have public insurance or private insurance, or are uninsured. We find that uninsured AIANs have similar socio-economic characteristics to those that rely on IHS. Our findings suggest that policymakers focus on outreach for uninsured AIANs concerning IHS programs. In addition to policy implications, our estimates will also serve as a useful baseline for post-health insurance reform studies.