Health and Health Care for American Indians and Alaska Natives (AIANs) in the United States Updated May 2019.

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Health and Health Care for American Indians and Alaska Natives (AIANs) in the United States Updated May 2019

AIANs account for 2% of the United States population. As of 2017, over 5 million individuals self-identify as AIAN alone or in combination with another race. Under treaties and laws, the U.S. has a unique responsibility to provide certain rights, protections, and services to AIANs, including health care. Source: Kaiser Family Foundation analysis of 2017 American Community Survey (ACS), 1-Year Estimates.

AIANs live across the United States, but 60% reside in 11 states AIANs live across the United States, but 60% reside in 11 states. The majority of AIANs live outside of tribal areas. SHARE OF AIAN POPULATION BY STATE, 2017 Total: 5.4 Million Note: AIAN includes people of mixed race and of Hispanic origin. Source: Kaiser Family Foundation analysis of 2017 American Community Survey (ACS), 1-Year Estimates.

Nonelderly AIANs are younger, more likely to be poor, and less likely to have a full-time worker in the family compared to Whites. Note: AIANs and Whites are non-Hispanic. Excludes individuals of mixed race. Includes nonelderly individuals 0-64 years of age. All values have a statistically significant difference from the White population at the p<0.05 level. Source: Kaiser Family Foundation analysis of 2017 American Community Survey (ACS), 1-Year Estimates.

AIANs fare worse than Whites across many health measures. * Indicates statistically significant difference from the White population at the p<0.05 level. Note: AIANs and Whites are non-Hispanic. Excludes individuals of mixed race. Includes nonelderly adults 18-64 years of age. Source: Kaiser Family Foundation analysis of 2017 National Health Interview Survey (NHIS), 2017 Behavioral Risk Factor Surveillance System (BRFSS), and 2017 National Survey on Drug Use and Health.

Although the Indian Health Service (IHS) provides services to AIANs, health coverage is important for AIANs. IHS is the primary vehicle through which the federal government provides health services to AIANs. IHS has historically been underfunded to met the health care needs of AIANs. Enrolling AIANs in health coverage, including Medicaid or Marketplace coverage, expands their access to services and increases revenues to IHS and Tribal facilities. Source: Kaiser Family Foundation Program on Medicaid and the Uninsured, Medicaid and American Indians and Alaska Natives, (Washington, DC: Kaiser Family Foundation, September 2017), http://files.kff.org/attachment/issue-brief-medicaid-and-american-indians-and-alaska-natives.

Medicaid and CHIP help fill gaps in private coverage for AIANs, particularly AIAN children, but they remain more likely to be uninsured than Whites. Nonelderly Adults (19-64) Children (0-18) Note: AIANs and Whites are non-Hispanic. Excludes individuals of mixed race. Includes nonelderly adults 19-64 years of age and children 0-18 years of age. Totals may not sum to 100% due to rounding. All values have a statistically significant difference from the White population at the p<0.05 level. Source: Kaiser Family Foundation analysis of 2017 American Community Survey (ACS), 1-Year Estimates.

AIANs have Gained Coverage Under the Affordable Care Act, with Larger Increases in States that Expanded Medicaid. HEALTH INSURANCE COVERAGE FOR NONELDERLY AIANs BY EXPANSION STATUS, 2013 & 2017 2013 2017 2013 2017 Expansion States Non-Expansion States Note: AIANs are non-Hispanic. Excludes individuals of mixed race. Includes nonelderly individuals 0-64 years of age. Source: Kaiser Family Foundation analysis of the 2013 & 2017 American Community Survey (ACS), 1-Year Estimates.