1. AMERICAN COMMUNITY SURVEY ESTIMATES OF UNINSURED AMERICAN INDIANS AND ALASKA NATIVES Bemidji Area of the Indian Health Service

2. THE AMERICAN COMMUNITY SURVEY’S ESTIMATES OF INSURANCE STATUS 2 American Community Survey: 3-year Pooled Data from 2009-2010-2011 Downloaded using US Census, Dataferret, with recoded variable for age and income. American Indian Alone and In Combination.

3. Income and Insurance Estimates for American Indians and Alaska Natives 1.Approximately 1.2 million American Indians and Alaska Natives are uninsured. About 900,000 of the 2.8 million AIANs between 19 and 65 (inclusive) are uninsured- a rate of 32% uninsured. 2.Nationally, about 38% of uninsured AIAN respondents report they have access to Indian Health Services- funded programs and 62% report that they do not have access to IHS. 3.In the Bemidji Area, with approximately 60,000 uninsured, 40% of the uninsured (24,000) report access to IHS and 60% (36,000) report they do not have access to IHS essentially the same as the national average. 3

4. Uninsured AIANs Two key income categories 0-138% and 139-400% 4 American Indians and Alaska Natives: Estimate of the Number Uninsured in 50 States by ‘Access to IHS’

5. Income Distribution of the Uninsured 5

6. Medicaid and Marketplace income categories: 0-138% and 139-400% Estimates for Medicaid and Marketplace Tax subsidies 1.AIANs, like the general population, have nearly equal numbers uninsured in the two main categories for the affordability programs, Medicaid and Marketplace Qualified Health Plans. 2.526,000 of uninsured AIANs are under 139% of FPL and 511,000 are between 139 and 400% of FPL. 3.26,056 uninsured in the Bemidji Area are from 0-139% of the federal poverty level. 4.23,000 are between 139-400% of FPL 5.18,000 are between 139 and 300% of FPL. 6

7. Bemidji Area Uninsured 1.There are an estimated 60,654 uninsured in the Bemidji Area. 2.Nearly 48,000 are adults and 13,000 children under 19 years old. 3.It appears that children, most of whom are likely Medicaid eligible, are less likely to be enrolled if they have ‘access to IHS’. This is a lost opportunity to secure insurance coverage at no cost to the Tribe or families and a lost opportunity for revenue to health programs. 7

8. 8 Uninsured by Age and Access to IHS

9. Michigan, Minnesota, Wisconsin 1.Michigan has the largest number of uninsured (21, 900), but all three states have similar sized uninsured populations with Minnesota’s 21,300 essentially that same and Wisconsin’s just 4,000 less at 17,500. 2.Minnesota has proportionally more uninsured children than the other two states---almost as many as Michigan and Wisconsin combined (see discussion below). 3.The states do vary by ‘access to IHS’ with Wisconsin have the largest uninsured population reporting access to IHS services followed by Minnesota and then Michigan. 4.Each state has large Urban populations that may not have easy access to an Urban Indian health program as evidence by the fact that 36,000 of the 60,000 uninsured in the area do not have access to IHS paid services and just 24, 000 saying they do have access. 9

10. Wisconsin Wisconsin has 17,500 uninsured, 3,800 children. Wisconsin rejected Medicaid expansion so tax subsidies will start at 100% of the federal poverty level (FPL). 9,200 are between 100% and 400% of FPL. 7,000 are between 100% and 300% of FPL. 10 AGE0-1819-2829-3839-4849-5859-64 Total GEOG-102 1746438054894272027412283875 Between 0 and 99 493890011887411256666109 Between 100 and 200 449912541768383403485206 Between 201 and 300 2410702472591154345110 Between 301 and 399 2279553353438247307372 Between 400 and 500 9061183361112421678 Not Elsewhere Classified (nec.)24322787775565572640 Note: high error rates for small numbers, should not be relied on as firm estimates.

11. Minnesota & the Bemidji Area’s Direct Service Programs 1.The Bemidji Area has 3 Direct Service Programs at Cass Lake, White Earth, and Red Lake; all located in Northern Minnesota.Bemidji Area 2.Most programs, however, are tribal programs (under 638 authority) 3.Four urban programs exist in Chicago, Illinois, Milwaukee, Wisconsin, Minneapolis, Minnesota, and Detroit, Michigan. 11

12. Minnesota Minnesota’s Indian population that indicates they have access to IHS funded programs are poorer than the state average income for all AIANs. This is also reflected in the high percentage who are between 139% and 300% of the federal poverty level and thus eligible for tax subsidies AND the cost sharing exemption (if an enrolled tribal member) in the Marketplace. Another way to look at this: those without access to IHS services are far less likely to have incomes over 300% FPL than those who do have access to IHS (800 who have access to IHS compared to 2,200 who do not). 12

13. 1.In Minnesota, affordability programs (Basic Health Medicaid and Marketplace tax subsidies) reach 80% of Minnesota’s Uninsured AIANs, 86% of those with access to IHS and about 76% of those without access to IHS. 2.12,000 of the 15,000 uninsured adults would have either Medicaid eligibility (43%) or tax subsidy eligibility (37%) in the Marketplace. 3.About 3,000 uninsured AIANs have incomes over 400% of the federal poverty level. 13

14. ADDITIONAL TABLES, INCOME, AGE, AND ACCESS TO IHS 14

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