• 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%.
  • One-year American Community Survey estimates survey.
  • December, 2015 Report on impact on uninsured American Indians and Alaska Natives based on new ACS data.
  • By Income
  • By Age
  • By Medicaid
  • By Medicare
  • By Public Insurance
  • By Access to IHS

2013 Insurance Coverage Estimates for American Indians and Alaska Natives, compiled by Ed Fox, 2014.
NIHB PPT based on 2012 Fox-Boerner report.
  • 2013 Compared to 2014 ACS Insurance Coverage Estimates for American Indians and Alaska Natives, 2014, for 19  States (all with over 65,000 AIANs)
  • 2011 & 2013 Compared to 2014 ACS Insurance Coverage Estimates for American Indians and Alaska Natives, 2014, for 24 States (all with over 65,000 AIANs)
  • S0201: SELECTED POPULATION PROFILE IN THE UNITED STATES
  • Downloaded for AIANs alone and in combination, resorted to highlight insurance.
  • "Supporting documentation on code lists, subject definitions, data accuracy, and statistical testing can be found on the American Community Survey website in the Data and Documentation section.

  • Sample size and data quality measures (including coverage rates, allocation rates, and response rates) can be found on the American Community Survey website in the Methodology section.


Latest 3 year estimates (all 50 states and other units of 20,000 AIANs)
Latest 5 year estimates
2012 Compared to 2014 ACS Insurance Coverage Estimates for American Indians and Alaska Natives, Metro Areas (all with over 65,000 AIANs)
2014 Insurance Coverage Estimates for American Indians and Alaska Natives, compiled by Ed Fox, 2014.
Oregon's use of Basic Food eligibility an early success.
Income Matters for ACA Financial Assistance:   Income (and cost of living) varies greatly by state.
14 States have over 40% of AIAN population under 139% of the Federal Poverty Level
7 States have over 25% of AIAN population over 400% of the Federal Poverty Level
42% is the average for all study states in the 139-400% income category and most states have between 40% and 50%.  Variation between states is much great under 139% and over 400%.
  • ACS estimates of uninsured AIANs.
  • 315,000 reduction in uninsured.
  • 300,000+ decrease in number of uninsured AIANs since 2011 
  • How?
  • Increase in Employer sponsored insurance (ESI) and Medicaid are reasons for decrease.
  • Only ACS has data to 'prove' this.
  • 17% decrease in 2014 number of uninsured AIANs compared to 2011 
  • A 3.4% Decline in rate of Uninsured compared to 10% for all races.
Insurance Coverage and Access to IHS Estimates from 3 yr ACS
Medicaid Expansion Estimates 
2013 NIHB report on Medicaid Expansion and AIANs in 33 states, by Ed Fox & Verne Boerner
Comparing 1 yr to 3-yr ACS Insurance Coverage Estimates for American Indians and Alaska Natives in Washington shows greater variability in 1 year estimate.
Estimates are for the 'average day' throughout the  year
Error rates mean there is no difference between states that appear to be ranked, e.g. Washington, Oregon, Michigan are essentially the same rate. 
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).
edfox_phd@yahoo.com  
Estimates of Medicaid coverage and Access to IHS
2015 
2014
2013

It is important to note that due to 65,000 population threshold for release of estimates many states do not have estimates for AIANs.
One year estimates of insurance status of AIANs is superior to 5 year estimate.
My Tribal Area[Source: U.S. Census Bureau]
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