American Community Survey Data: 
American Indians and Alaska Natives income and insurance status in 33 states (2012) for ACA estimates.
The following information on insurance status by income is prepared for free and unrestricted use.
PowerPoints should be revised for use by each state's programs. 2012 Raw data from California Rural Indian Health Board dataset 2012 from ACS 2008, 2009, 2010 3 year pooled data.

See:  Census data for 50 states page for 2013 ACS 3 year estimates (in excel format).
  • Presentations (PPTs click on icons) contain:
  • Insurance status 
  • ACA Income Categories
  • Design (and analysis):  Verne Boerner
  • Data Input: Philip Fox
  • 33 states have federally recognized Tribes
  • IHS funds programs in 35 states with Urban Programs in Maryland and Illinois.
  • Pennsylvania and Indiana also have CHSDA counties, but not enough AIAN population to be included in these reports
  • Illinois and Maryland have IHS funded health programs, but are not included in these reports
  • To be precise IHS funds programs in 37 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).
edfox_phd@yahoo.com  
  • State and Tribal estimates of tax credit eligible AIANs
  • 1. Enter Area of IHS 
  • 2. Choose State 
  • 3. Your program 
  • 4. Specific Facility 
  • 5. Adjust estimates to fit your situation-tribes with per capitas will have more eligible for marketplace, but vast majority do not. 


  • About 460,000 AIANs are eligible for tax credits in the 33 states with federally recognized tribes
  • 2014 Updates of 2012 PPTs for 5 of the largest AIAN state

  • Oklahoma, Arizona, Oregon, New Mexico, Washington
  • 2014 Reports with 

  • 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.
  • 138% (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
  • 138% to 400% of FPL is the income range for exchange subsidies to purchase 'exchange' health insurance
  • Has reports and data for all the income categories.
​Income Distribution (all AIAN)
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
  • What information is needed to guide the planning necessary to maximize the benefit of the Affordable Care Act for American Indians and Alaska Natives?  Insurance and Income Status
See this report and 2009 women's report for how insurance relates to poor access to health care services and poor health status
The lack of health insurance is one reason for the poor rank of Indian men in most health indicators
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.  No federal funding expended to create these reports.
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.
  • 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.
  • 2012 XLS (Draft December 2, 2012) of AIAN alone and in combination population, income and insurance 
KFF report  on health coverage by race, March 2013
Enroll America's FAQs for ACS data
  • There are over 1.2 million uninsured AIANs 
2014 Insurance Coverage Estimates for American Indians and Alaska Natives, compiled by Ed Fox, 2014.
Latest Insurance Coverage Estimates for Expansion and Non-Medicaid Expansion States for American Indians and Alaska Natives, compiled by Ed Fox, 2014.
NIHB PPT based on 2012 report
Tracking ACA by using the American Community Survey
Tracking Health Insurance Coverage; Lead Author Carol Korenbrot (see error rate discussion)