• Health Care Reform is intended to reduce the number of the uninsured, but it is largely Health Insurance Reform--- we need data on health insurance status ---Private, Medicare, Medicaid, Uninsured, including 'perceived' access to Indian Health Service-funded health care programs. 

  • 1. Insurance Status.  How many are uninsured?  (note some with insurance are also eligible for Medicaid).

  • 2.  Income Distribution.  0-138%, 139% to 300% and 300 to 400% are the key categories. 0-100% and 100 to 138% key in states that did not expand Medicaid.  Wisconsin expanded 0 to 100%.
ACA income categories for financial support
  • 17% to 100% Medicaid eligibility (varies by state) for those states not expanding Medicaid-not eligible for exchange if under 100% of federal poverty level.
  • 139% (in some cases 100% to 400%) to 400% is range of income for health insurance subsidies.
  • 300% of poverty is the upper limit for cost sharing exemptions for American Indians and Alaska Natives only.

  • 0 to 138% of FPL is the income range for Medicaid coverage nearly all expenses paid by governments
  • 139% to 400% of FPL is the income range for exchange subsidies to purchase 'exchange' health insurance
Income Distribution of Uninsured AIAN
Extreme Poverty of Indian Elders with Medicare
Click on text  for all states for PDF, click on image for PPT PowerPoint.
Read how the American Community Survey can inform Policy Analysis 
  • Presentations (PPTs click on icons) contain:
  • Insurance status 
  • ACA Income Categories
  • Design:  Verne Boerner
  • Data Input: Philip Fox
See this report and 2009 women's report for how insurance relates to poor access to health care services and poor health status
American Indians have far higher percentage than 'all races' under 138% of poverty in most, but not all states 
American Indians have a nearly equal percentage between 138% and 400% of poverty; same as 'all races'  in most, but not all states.
Indian women's health also trails that of nearly all races due to social and economic factors.
The following information is prepared for unrestriced use by tribes and Urban Indian Health programs with simple citation:  Fox-Boerner 33 State AIAN Database, August 2012  Authors:  Edward Fox and Verne' Boerner.  PowerPoints should be revised for use by each state's programs.  Raw data from California Rural Indian Health Board dataset 2012.
Authors of these PowerPoints Edward Fox and Verne Boerner free use with proper citation:
"Fox-Boerner 33 State ACS Database, August 2012"
No government(tribal, state or federal) funds used to prepare these reports.
  •  Those over 400% of FPL and uninsured (and not eligible for employer insurance) are still eligible to purchase health insurance in the exchanges with no pre-existing conditions, no lifetime limits, and no extended waiting periods for services.
  • American Community Survey 
  • 33 States 
  • States with Federally recognized Tribes and Indian Health Service-funded programs
  • Population, Insurance and Income of AIANs 

No longer updated as of January 2018​

  • Report With Essential Planning Information

  • This report describes the insurance and income status of AIANs in 33 states with Tribes and Indian Health Programs.

  • 33 States with Indian Health Services-funded programs 
  • The following information is prepared for unrestriced use by Tribes and Urban Indian Health programs with simple citation: Fox-Boerner 33 State AIAN Database, August 2012. Authors: Edward Fox and Verne' Boerner.
  • There are over 1.2 million uninsured AIANs 
2013 Insurance Coverage Estimates for American Indians and Alaska Natives, compiled by Ed Fox, 2014.
Insurance Coverage Estimates for Expansion and Non-Medicaid Expansion States for American Indians and Alaska Natives, compiled by Ed Fox, 2014.
  • NIHB PowerPoint based on 2012 report
Tracking Health Insurance Coverage; Lead Author Carol Korenbrot (see error rate discussion)
2012 Health Insurance Coverage Estimates
2013 Health Insurance Coverage Estimates
AIANs are typically overrepresented in lower income category compared to 'all races,' however the disparity varies greatly between states.
Suggested Citation: Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2016 Website.
Free and unlimited use granted with citation (suggested citation above).
2017 Update (Calendar Year 2015) of Health Insurance Coverage Estimates