• Health Care Reform for American Indians and Alaska Natives 
  • 2011-2017   No longer updated as of January 2018
  • This site organizes the information you will need to understand health care reform by directing you to the best resources and some original analysis.  It should be clear that it is NOT an official,semi-official,tribal or state sanctioned website.  That's a good thing in some ways, bad in others.
  • The target audience is Indian Health Program Staff, elected tribal leaders and staff from other Indian organizations.  
  • In most cases it recommends other sites as the 'best' place for information--not this site. Typically you have better or more current information about your own state, but should find useful the information about progress in other states.
  • Most visits are from Washington State
  • Acknowledgments to Tribes and Organizations who have shared data or provided research contracts to the author, no contracts for this website and responsibility solely that of editor, Ed Fox.  
  • Port Gamble S'Klallam Tribe 
  • Fond du lac Band of Lake Superior Chippewa
  • California Rural Indian Health Board
  • National Indian Health Board
  • National Congress of American Indians
  • Assistance from Emma Medicine White Crow
  • No direct financial support for website from any state or federal agency.  
  • Contact editor: edfox_phd@yahoo.com
  • The American Indian Health Commission is a state level organization of 27 Washington Tribes and the 2 Title V Urban Indian (and other Indian Organizations). 

  • The Northwest Portland Area Indian Health Board members include all tribes of the Portland Area of the Indian Health Service, the part of Indian country that traditionally has the most progressive Indian health policy in the nation thanks to active Tribes and active organizations.
What does an American Indian or Alaska Native need to know?
About enrolling in health insurance coverage using federal or state exchanges.
Kaiser Family Fondation
Suggested Citation: Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2011-2016 Website.

Scenes in pictures are all within 3 hours of the Skokomish Tribe from the Olympic Homelands to Mt. Rainier and North Cascades.
  • ACS 2013 estimates of percentage uninsured in 33 states
  • Ranked by highest uninsured rate
  • 'split' shows rate for respondents indicating they have access to IHS
  • States with more access to IHS have higher rates of 'uninsured.'
  • This website receives no direct funding from any source, but the editor wishes to thank those Tribes, Indian organizations and state agencies for funding the research and reports that appear on this website and helped pay the monthly fee to refine and maintain it and inexpensively store and access very large data files that can be accessed by anyone.
  • I worked for the Port Gamble S'Klallam Tribe from July, 2011 to January, 2016 and the Tribe supports the sharing of success stories in Indian Country.
  • I am currently the Health Director at the Skokomish Tribe on the Olympic Peninsula.
The Mother of all FAQs at Kaiser Family Foundation is constantly updated and searchable.
2015 WA Medicaid report
Suggested Citation: Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2017 Website.
Free and unlimited use granted with citation (suggested citation above).
By 2015, how successful was the ACA in increasing health insurance coverage for AIANs?
1. Medicaid, increase of over 217,000
2. Private Insurance of over 60,000 in Qualified Health Plans.
  • Why are there different reports of changes in insurance coverage?
  • Most are estimates, they can be from different surveys, from different years, 'snapshots of coverage today' or coverage over the past year, and with questions seeking same information, but asked differently.
  • Actual totals, not estimates, lag 2 or more years from national and state government sources. In addition, some private sources are not available.
  • Of all reports the US Census are the worst when it comes to ignoring the need to report AIAN alone and in combination.  It misinforms when it reports 'Alone.'
Reduction in Uninsured
Private Insurance Increase
Very Successful!
Nearly $1,250,000,000 increase in payments for health care services for AIANs since 2013.
Medicaid Expansion:  217,000 2013-2015
Reduction in Uninsured
One year survey better reflects actual change than the 5 year due to pooling methodology of 5 year survey.
Medicaid Expansion and Qualified Health Plan Calculator that gives state and tribal estimates (Note state estimate follows the tribal estimate)
  • By April 2017 Tribes Nationwide were unanimous in their support for the full implementation of the Affordable Care Act
  • The reason for the broad support of Tribes was the measurable success in states that support full implementation.  Conversely, the evidence of failure in those states that resisted full implementation.
  • ​Nevada, Oregon and Washington are good examples of full implementation:  Uninsured dropped, Medicaid coverage increased, revenue and health improved.
  • Oklahoma and South Dakota are examples of the opposite:  Stagnant revenue, Medicaid coverage and rates of uninsured.