• Exchanges in States with Indian health programs
  • QHP Enrollment Reports

Kaiser Family Fondation

  • Alabama
  • Alaska
  • Arizona
  • Florida
  • Illinois 
  • Kansas
  • Louisiana
  • Maine
  • Michigan
  • Montana
  • North Dakota
  • Nebraska
  • South Dakota
  • South Carolina
  • Wisconsin
  • Wyoming
  • Texas
  • States with state Exchanges are most likely to expand Medicaid to 139% for all  (under 65 years old).  Conversely, 33 states with federal exchanges are less likely ---Arizona, New Mexico, and North Dakota, three Indian states, did expand Medicaid, but do not have state exchange although New Mexico expects to in 2015.

  • These reports estimate the number of uninsured eligible for tax subsidies and Medicaid based on American Community Survey data.
ASPE reports 48,000 AIANs have selected a marketplace plan in states with FFM.  Another 15,000 likely enrolled in state marketplaces.  

About 480,000 to 500,000 AIANs are eligible for tax credits nationally, 460,000 in states with Tribes.

  • About 460,000 AIANs  are eligible for tax credits in the 33 states with federally recognized tribes, about 500,000 nationwide.
  • 345,000 live in states that use healthcare.gov.
  • Estimated 14% of those eligible have enrolled in QHPs.
  • 71,711 have enrolled in QHPs in FFE perhaps 10,000 in state exchanges (17% of 460,000 estimated eligible).
AIANs are twice as likely income-eligible for health care through health exchanges as general population.
  • Estimate your cost and benefit of a tribal premium sponsorship program with NCAI calculator. (refresh to restart)  See summer 2014 update.
  • 1. Enter Area of IHS 
  • 2. Choose State 
  • 3. Your program 
  • 4. Specific Facility 

April, 2014 Report on Enrollment in Qualified Health Plans.
Which AIANs are most and least likely to enroll?
  • There is no estimate of the number of enrolled Tribal members eligible for no cost sharing (under 300% of FPL) to determine the take up rate of those eligible for tribal member provisions.
  • Understand that enrollment reporting is highly problematic for American Indians and Alaska Natives.
  • This table estimates take up rate for AIANs eligible for Marketplace tax credits in healthcare.gov states.
  • ​There are many factors that explain low enrollment in states, but one is unique to IHS health programs:
  • There is a strong negative correlation between enrollment in Qualified Health Plans and Access to IHS.
  •     This means More Access to IHS = Less QHP enrollment.
Typically, you must be uninsured (unless you buy your own insurance) to be eligible for Marketplace tax credits.  
American Indian and Alaska Native Applicants and Enrollees in the Federally-Facilitated Marketplace
November 2015
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).
  • Private insurance coverage has increased since 2012.
  • 5 year estimates show a 3% increase from 2012 to 2014 with great variation between states.
Private Insurance Increase