By Wendy Biddle, J.D.
Broad efforts needed to promote health equity in the AI/AN populations.
The Assistant Secretary for Planning and Evaluation at the Office of Health Policy for the Department of Health and Human Services has released an Issue Brief that describes changes in the uninsured rate, health coverage, and access to care for American Indians and Alaska Natives population. The American Indian and Alaska Native population is 1.7% of the total population of the United States. According to the report, 20.6% of American Indian and Alaska Native adults are in fair or poor health compared to 12.1% of non AI/AN adults (ASPE Issue Brief, HP-2021-18, July 22, 2021).
Uninsured rate. According to the report, the rate of uninsured American Indians and Alaska Natives (AI/AN) under the age of 65 fell from 44% since the Affordable Care Act was passed to 28% in 2018. But despite that decrease, the AI/AN population still has the highest rate of uninsured people (15.2%) compared to other populations. According to the report, under the American Rescue Plan of 2021, an estimated 26,000 uninsured AI/AN people gained access to zero-premium plans and 25,000 gained access to low-premium plans.
Medicaid expansion. The report also showed that Medicaid expansion dropped the uninsured rate among AI/AN from 24.8% in 2013 to 20.6% in 2014. One of the more recent states to expand Medicaid was Oklahoma. Prior to expanding Medicaid on July 1, 2021, Oklahoma had the largest uninsured AI/AN population of any state - more than 79,000 people. The report noted that if remaining non-expansion states were to adopt Medicaid expansion, approximately 55,000 more uninsured AI/AN non-elderly adults would be eligible for Medicaid coverage.
Access to care. AI/AN people are also disproportionately affected by certain chronic conditions and die at higher rates from those conditions than other populations. Death by suicide and accidental death rates are also higher among the AI/AN community than other populations, the report showed. The report noted many factors that contributed to the health disparities, like poor infrastructure, lack of safe drinking water, historical trauma, and cultural suppression. Access to care can be addressed if efforts continue to enroll AI/AN people in Medicaid and Marketplace coverage. Additionally, adding more doctors, dentists, nurses and pharmacists in tribal communities can strengthen the Indian health care system and those efforts along with broader efforts across the government and private-sector partnerships can promote health equity by addressing issues in housing, education, and employment.
Effect of COVID-19. The report showed that data indicates that AI/AN people experienced a higher rate of COVID-19 infections, hospitalizations, and death compared to white people. ONce vaccines became available, however, AI/AN people had higher vaccination rates compared to other groups. According to the report, 55% of AI/AN adult Indian Health Services patients have received at least one dose of the vaccine as of July 9, 2021.
Although there have been gains in the rate of coverage and outcomes in the AI/AN population, the report stressed that uninsurance rates and health disparities are still quite high in the population. Resources need to be increased for the Indian healthcare system to address the disparities to improve health outcomes for the American Indian and Alaska Native populations.
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