Health insurance coverage among American Indians and Alaska Natives in the context of the Affordable Care Act

Bibliographic Data

ID12554604
AuthorsLeah Frerichs (0000-0002-2507-3789, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA, corresponding author), Ronny A Bell (0000-0001-8512-2565, East Carolina University), Ronny Bell (Department of Public Health, East Carolina University, Greenville, NC, USA), Kristen Hassmiller Lich (0000-0002-3311-4202, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA), Daniel S Reuland (0000-0002-7839-6581, University of North Carolina at Chapel Hill), Dan Reuland (Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA), Donald K Warne (University of North Dakota), Donald Warne (0000-0002-2977-5286, University of North Dakota)
Year2019
Volume27
Issue1
Pages174-189
Publication date2019-06-10
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueEthnicity and Health (JOURNAL)
Journal identifiersISSN: 1355-7858 • E-ISSN: 1465-3419
PublisherTaylor & Francis (PUBLISHER • GB)
DOI10.1080/13557858.2019.1625873
PMID31181960
OpenAlexW2952580403
LanguageEN
Citations received4
References cited29

Objectives: American Indians and Alaska Natives (AI/AN) have a unique healthcare system uniquely interwoven with the Affordable Care Act (ACA). The aim of this study is to document changes in health insurance among AI/AN adults before and after implementation of the ACA. Design: We used data from the American Community Survey from 2008 to 2016 to examine trends in health insurance. We compared to Non-Hispanic Whites and stratified AI/AN adults with and without Indian Health Service (IHS) coverage. We used multivariate regression to evaluate the probability of health insurance post-ACA and included time period and subgroup interaction terms. Results: Public and private health insurance coverage increased post-ACA by 3.17 and 1.24 percentage points, respectively, but the percent uninsured remained high (37.7% of those with IHS coverage and 19.2% of those without). AI/AN in Medicaid Expansion states had a significantly greater percentage point (pp) increase in public insurance (6.31 pp, 95% CI 5.04-7.59) than AI/AN in non-expansion states ( p p = 0.002). Conclusions: Despite improvements in healthcare insurance coverage for AI/AN, substantial disparities remain. The improvements appeared to be largely driven by Medicaid Expansion. Without specific considerations for AI/AN, future healthcare reforms could intensify health injustices and inequities they face

Actuarial science · American Community Survey · Business · Census · Context (archaeology · Economic growth · Economics · Environmental health · Geography · Health care · Health insurance · Medicaid · Patient Protection and Affordable Care Act · Political science · Population · Sociology · Demography · Food Security and Health in Diverse Populations · Healthcare Policy and Management · Medicine · Primary Care and Health Outcomes