• Access to IHS the least valid ‘measure’ of the responses reported in the results of the American Community Survey.  It does appear to be reliable in that the estimates do not vary much from one year to the next(reliability).
  • Validity has to do with knowing what you are measuring. Consider for example, the difference between the answer of a respondent in a remote Alaska Native village compared to a respondent living on a reservation in a tribe that operates its own health program in the lower 48 located near a large metropolitan center. The Alaska Native villager is probably more likely to say they have ‘access to IHS,’ since that is, indeed, the only health care services available to them. On the other hand, the lower 48 respondent may be less likely to say she has access to IHS since she likely has multiple options for care. For example,  even if eligible to use her own tribe’s health program,  she may have private insurance and not use the IHS-funded tribal program that she has a right to use, or it may be easier to use an emergency room and take her chances with charity care.

  • These responses also differ in what they consider ‘coverage’ with the Alaska Native villager highly unlikely to have a doctor, nurse or other mid-level provider, but a community health aide, at times assisted by telemedicine, as their primary care provider. For specialist or hospital care they will be forced to travel, typically by air, with longer time away from home than the respondent from the lower 48. The result is often forgone care, delayed care, or accessing care later than optimal.  
  • 2012 36% of Alaska Natives have no health insurance
  • Only 35% have private insurance one of the lowest rates of any state.
  • 49% are below 139% of the federal poverty level and potentially eligible for Medicaid.
Anchorage, Alaska, center of the Alaska Native Health Care System and the Southcentral Native Health Corporation, a world leader in innovative health care delivery whose Nuka Model predates other coordinated care models.
33 State Report
Estimates for Medicaid Expansion (AK has not yet approved Medicaid Expansion) see lost revenue.
Explanation of these Medicaid expansion estimates (made in 2011) are in the Health Care Reform:  Tracking Tribal, Federal,and State Implementation
Alaska Natives have built the only true health care finance and delivery 'system' in Indian health where no Alaska Native is considered outside the system, where every Alaska Native health program attempts to serve any Alaska Native / American Indian.
81% of all AIANs in Alaska report that they have 'access to IHS' services.
Up to $100 million in new Medicaid Payments for Alaska Natives (3% of AIANs are American Indians who are not Alaska Natives)
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).
  • Alaska expands Medicaid in 2015.
  • 15,500 to 17,500 estimated uninsured AIANs will now be eligible for Medicaid.
  • An estimated 10,000 of newly eligible enrolled by March, 2017.
  • In 2012 35% of all Medicaid Enrollees were Alaska Natives / American Indians.
  • $265 Million paid to Tribal Programs in 2015, 40,000+ with Medicaid prior to expansion.