• 1/2 of all uninsured AIANs live in Urban Areas and, with notable exceptions in Arizona and Alaska, few report that they have access to IHS services.
  • How will uninsured Urban Indians obtain health insurance?  
  • It will be very difficult and most will not without a concentrated effort to change the current law, increase IHS appropriations, or develop an alternative funding stream for sponsorship.

  • Can they afford even exchange-subsidized insurance and meet the high cost of urban living  or will they go without insurance and further strain the resources of Urban Indian Programs?
  • Individual Indians and their families should at least review their options for low cost insurance.
  • Urban Indian Programs (and NIAAA) programs have great experience in providing Behavioral Health Services to AIANs, but will  exchange plans include them as essential community providers with payment rates sufficient to cover 'needed' services?

  • A new conferring policy with IHS may increase urban input to health care reform.  Unfortunately, few state health insurance exchanges have not directly conferred with Urban health programs. 


  • 38 Metropolitan Areas with the largest American Indian and Alaska Native Population (ACS 3 year 2011-2012-2013 data) spreadsheet.

  •  2,076,896 Total AIAN population of 38 Metros
  • UNINSURED
  •  22.4% 
  •  392,937; excluding foreign born
  •  420,580; including foreign born 
2008-2010 ACS Estimates of Uninsured AIANs
2009 ACS Estimates of Insurance by income 3 NW Metropolitan Areas
  • Uninsured Urban AIANs 

  • Los Angeles has the lowest rate of uninsured AIANs in the country, but the third largest (29,000) uninsured population the same number as Tulsa Oklahoma.

  • With 36,000 uninsured AIAN, Phoenix has largest number and the 2nd highest rate of uninsured at 32%.

  • The Portland Metro Area contains 1/3 of Oregon's uninsured and almost 50% of Washington's uninsured AIAN live in metropolitan areas.
  • Is Sponsorship Possible for Urban Indians?
  • "Straw Man" Proposal for State-Based Foundations for Exchange-plan 

  • Sponsorship for Urban Indians ---
  • Model 1 Washington's Basic Health Plan foundations.
  • Model 3  Foundations pay for premiums
  • Model 4  An appropriation in IHS for premiums
  • $5-10 Million Urban Indian Sponsorship Proposal in Washington State
  • Cover all uninsured between 139% and 300% of poverty (estimated 7,500 at $2,000 premium each sponsored, but as low as $500 per year to no more than $3,000 per person).
  • It would depend on contributions in an Urban Indian Health Program-lead sponsorship program requiring $5 to $10 million (estimate)in annual funding in Washington State to reach the state's 7,500 subsidy-eligible Urban Indians under 300%.

  • Core Eligibility Group

  • 1. All AIANs (those 'currently' defined as Indian are 'enrolled' in a federally recognized tribe ) under 300% of poverty regardless of age, health 
  • 2. All AIAN elders over 50 and under 400% of poverty 

  • Expanded Eligibility Group
  • 3. All AIANs between 300% and 400% of poverty  ($93,000 family of 4)
Urban Indians
  • Of the 362,000 uninsured subsidy-eligible AIAN adults 18-64 years old, ACS estimates that 239,000 do not have access to IHS programs-most are likely urban Indians.
Poverty Rates for Urban Indians
Portland has twice as many in poverty than Seattle
Pierce (5,000 uninsured) and King County (6,500 uninsured)
Washington:   9,458 uninusured, exchange/marketplace eligible AIANs  are likely Urban Indians with "no access to IHS," this does not mean they are not eligible for IHS only that respondent feels they do not have the ability to access IHS paid services.

Suggested Citation: Website,  Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2015
105 Maple Park Ave SE Olympia,WA 98501
Free and unlimited use granted, citation appreciated
edfox_phd@yahoo.com  360 790 1164
Free and unlimited use granted, citation appreciated
2011 Compared to 2014 ACS Insurance Coverage Estimates for American Indians and Alaska Natives, compiled by Ed Fox, 2014 for 22 States (all with over 65,000 AIANs)
2011 & 2013 Compared to 2014 ACS Insurance Coverage Estimates for American Indians and Alaska Natives, compiled by Ed Fox, 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.

  • 2012 Compared to 2014 ACS Insurance Coverage Estimates for American Indians and Alaska Natives, 
  • 4 Metro areas reduced uninsured by over 20%
  • S0201: SELECTED POPULATION PROFILE IN THE UNITED STATES
  • Downloaded for AIANs alone and in combination, resorted to highlight insurance.
25 Largest Metropolitan Areas by Population of American Indian and Alaska Native Alone: Population and Uninsured Population 2014. 
Excel spreadsheet for 400 Metro and Micro Areas with above data, Downloaded December 19,2015 from US Census.
Excel spreadsheet for 100 Metro and Micro Areas with data below, Downloaded December 19,2015 from US Census.
100 Metro and Micro Areas